RESUMO
INTRODUCTION: Different COVID-19 vaccines were developed in a short time after the beginning of pandemics, reducing mortality, especially in high risk population. This was demonstrated in several studies, mostly retrospective or based in mathematical models. The objective was to compare mortality in inpatients with COVID-19 related to vaccination. METHODS: Longitudinal, prospective, comparative, observational study. Inpatients with COVID-19 diagnosis were included between 17/12/2021 and 23/02/22, in Hospital Nacional Prof. A Posadas and Hospital Interzonal General de Agudos Eva Perón. RESULTS: Inpatients (245) were analyzed, finding an overall mortality of 25.3%, 16.8% in fully vaccinated patients (two or more doses with less than 150 days since the last dose until the COVID-19 test) and 31.9% in those with incomplete vaccination (unvaccinated, one dose or two or more doses with more than 150 days since the last dose) (p = 0.007), OR 2.31 (IC95; 1.25-4.28) for incomplete vaccination. Mortality was 32.2% in patients who developed pneumonia, 22.2% for fully vaccinated and 38% for incompletely vaccinated (p = 0.048), OR 2.15(IC95; 1.01-4.58). Mortality was associated with older age (70 vs. 59 years; p < 0.001), female sex (54.8% vs. 37.7%; p < 0.02) and oncologic disease (27.4 vs. 14.8%; p = 0.02). PESI score was higher in incompletely vaccinated (102.5 vs. 93, p = 0.05) and SOFA score was lower (2 vs. 3, p = 0.01). The necessary number to treat (NNT) to prevent one death was 7 patients for the overall sample (IC95;4-22) and 6 (IC95;3-106) for pneumonia. DISCUSSION: This study constitutes a starting point for developing other investigations and raising awareness of medical community and people about the beneficial effects of vaccination.
Introducción: Luego del inicio de la pandemia por COVID-19, se desarrollaron diferentes vacunas, disminuyendo la mortalidad según estudios retrospectivos o con modelos de cálculo. El objetivo fue comparar la mortalidad de pacientes internados con diagnóstico de COVID-19 según su vacunación. Métodos: Estudio comparativo observacional longitudinal. Se incluyeron pacientes internados con COVID-19 del 17/12/21 al 23/02/2022 en el Hospital Nacional Prof. A Posadas y en el Hospital Interzonal General de Agudos Eva Perón. Resultados: Se analizaron 245 pacientes hallando una mortalidad total del 25.3%, 16.8% en aquellos con vacunación completa (2 dosis o más y menos de 150 días desde la última) y 31.9% con vacunación incompleta (no vacunados, 1 o 2 dosis y más de 150 días desde la última) (p = 0.007), OR 2.31(IC95; 1.25-4.28). En aquellos con neumonía, la mortalidad fue del 32.2%, 22.2% con vacunación completa y 38% con vacunación incompleta (p = 0.048), OR 2.15(IC95; 1.01-4.58. La mortalidad se asoció a mayor edad (70 vs. 59 años; p < 0.001), sexo femenino (54.8% vs. 37.7%; p < 0.02) y enfermedad oncológica (27.4 vs. 14.8%; p = 0.02). El PESI score fue mayor en aquellos con vacunación incompleta (102.5 vs. 93, p = 0.05) y el SOFA score fue menor (2 vs. 3, p = 0.01). El número necesario a tratar (NNT) para evitar una muerte fue de 7 pacientes para el total de la muestra (IC95; 4-22) y 6 (IC95;3-106) para aquellos con neumonía. Discusión: Este trabajo constituye un punto de partida de nuevas investigaciones, contribuyendo a la concientización acerca de los efectos beneficiosos de la vacunación en profesionales y pacientes.
Assuntos
COVID-19 , Pacientes Internados , Humanos , Feminino , COVID-19/prevenção & controle , Pandemias , Vacinas contra COVID-19 , Teste para COVID-19 , Estudos Prospectivos , Estudos Retrospectivos , VacinaçãoRESUMO
Resumen Introducción: Luego del inicio de la pandemia por COVID-19, se desarrollaron diferentes vacunas, disminuyendo la mortalidad según estudios retrospectivos o con modelos de cálculo. El objetivo fue comparar la mortalidad de pacientes internados con diagnóstico de COVID-19 según su vacunación. Métodos: Es tudio comparativo observacional longitudinal. Se incluyeron pacientes internados con COVID-19 del 17/12/21 al 23/02/2022 en el Hospital Nacional Prof. A Posadas y en el Hospital Interzonal General de Agudos Eva Perón. Resultados: Se analizaron 245 pacientes hallando una mortalidad total del 25.3%, 16.8% en aquellos con vacu nación completa (2 dosis o más y menos de 150 días desde la última) y 31.9% con vacunación incompleta (no vacunados, 1 o 2 dosis y más de 150 días desde la última) (p = 0.007), OR 2.31(IC95; 1.25-4.28). En aquellos con neumonía, la mortalidad fue del 32.2%, 22.2% con vacunación completa y 38% con vacunación incompleta (p = 0.048), OR 2.15(IC95; 1.01-4.58. La mortalidad se asoció a mayor edad (70 vs. 59 años; p < 0.001), sexo femenino (54.8% vs. 37.7%; p < 0.02) y enfermedad oncológica (27.4 vs. 14.8%; p = 0.02). El PESI score fue mayor en aquellos con vacunación incompleta (102.5 vs. 93, p = 0.05) y el SOFA score fue menor (2 vs. 3, p = 0.01). El número necesario a tratar (NNT) para evitar una muerte fue de 7 pacientes para el total de la muestra (IC95; 4-22) y 6 (IC95;3-106) para aquellos con neumonía. Discusión: Este trabajo constituye un punto de partida de nuevas investigaciones, contribuyendo a la concientización acerca de los efectos beneficiosos de la vacunación en profesionales y pacientes.
Abstract Introduction: Different COVID-19 vaccines were developed in a short time after the beginning of pandemics, reducing mortality, especially in high risk population. This was demonstrated in several studies, mostly retrospective or based in mathematical models. The objective was to compare mortality in inpatients with COVID-19 related to vaccination. Methods: Longitudinal, prospective, comparative, observational study. Inpatients with COVID-19 diagnosis were included between 17/12/2021 and 23/02/22, in Hospital Nacional Prof. A Posadas and Hospital Interzonal General de Agudos Eva Perón. Results: Inpatients (245) were analyzed, finding an overall mortality of 25.3%, 16.8% in fully vaccinated patients (two or more doses with less than 150 days since the last dose until the COVID-19 test) and 31.9% in those with incomplete vaccination (unvaccinated, one dose or two or more doses with more than 150 days since the last dose) (p = 0.007), OR 2.31 (IC95; 1.25-4.28) for incomplete vaccination. Mortality was 32.2% in patients who developed pneumonia, 22.2% for fully vaccinated and 38% for incompletely vaccinated (p = 0.048), OR 2.15(IC95; 1.01-4.58). Mortality was associated with older age (70 vs. 59 years; p < 0.001), female sex (54.8% vs. 37.7%; p < 0.02) and oncologic disease (27.4 vs. 14.8%; p = 0.02). PESI score was higher in incompletely vaccinated (102.5 vs. 93, p = 0.05) and SOFA score was lower (2 vs. 3, p = 0.01). The necessary number to treat (NNT) to prevent one death was 7 patients for the overall sample (IC95;4-22) and 6 (IC95;3-106) for pneumonia. Discussion: This study constitutes a starting point for develop ing other investigations and raising awareness of medical community and people about the beneficial effects of vaccination.
RESUMO
The purpose of this study was to investigate whether myofibroblast-related fibrosis (scarring) after microbial keratitis was modulated by the epithelial basement membrane (EBM) injury and regeneration. Rabbits were infected with Pseudomonas aeruginosa after epithelial scrape injury and the resultant severe keratitis was treated with topical tobramycin. Corneas were analyzed from one to four months after keratitis with slit lamp photos, immunohistochemistry for alpha-smooth muscle actin (α-SMA) and monocyte lineage marker CD11b, and transmission electron microscopy. At one month after keratitis, corneas had no detectible EBM lamina lucida or lamina densa, and the central stroma was packed with myofibroblasts that in some eyes extended to the posterior corneal surface with damage to Descemet's membrane and the endothelium. At one month, a nest of stromal cells in the midst of the SMA + myofibroblasts in the stroma that were CD11b+ may be fibrocyte precursors to myofibroblasts. At two to four months after keratitis, the EBM fully-regenerated and myofibroblasts disappeared from the anterior 60-90% of the stroma of all corneas, except for one four-month post-keratitis cornea where anterior myofibroblasts were still present in one localized pocket in the cornea. The organization of the stromal extracellular matrix also became less disorganized from two to four months after keratitis but remained abnormal compared to controls at the last time point. Myofibroblasts persisted in the posterior 10%-20% of posterior stroma even at four months after keratitis in the central cornea where Descemet's membrane and the endothelium were damaged. This study suggests that the EBM has a critical role in modulating myofibroblast development and fibrosis after keratitis-similar to the role of EBM in fibrosis after photorefractive keratectomy. Damage to EBM likely allows epithelium-derived transforming growth factor beta (TGFß) to penetrate the stroma and drive development and persistence of myofibroblasts. Eventual repair of EBM leads to myofibroblast apoptosis when the cells are deprived of requisite TGFß to maintain viability. The endothelium and Descemet's membrane may serve a similar function modulating TGFß penetration into the posterior stroma-with the source of TGFß likely being the aqueous humor.
Assuntos
Substância Própria/patologia , Úlcera da Córnea/patologia , Lâmina Limitante Posterior/fisiologia , Epitélio Corneano/fisiologia , Infecções Oculares Bacterianas/patologia , Infecções por Pseudomonas/patologia , Regeneração/fisiologia , Actinas/metabolismo , Animais , Biomarcadores/metabolismo , Antígeno CD11b/metabolismo , Lesões da Córnea/metabolismo , Lesões da Córnea/fisiopatologia , Substância Própria/metabolismo , Úlcera da Córnea/metabolismo , Modelos Animais de Doenças , Infecções Oculares Bacterianas/metabolismo , Feminino , Fibrose/patologia , Imuno-Histoquímica , Miofibroblastos/patologia , Infecções por Pseudomonas/metabolismo , CoelhosRESUMO
The epithelial basement membrane (BM) is a specialized extracellular matrix that has been shown to have a critical role in corneal development, wound healing, and disease. Although the epithelial BM contributes to corneal homeostasis, relatively little is know about non-epithelial production of its components that may be important in defective regeneration of the epithelial basement membrane associated with opacity after photorefractive keratectomy. The purpose of the current study was to investigate stromal production of corneal epithelial BM proteins in wounded human corneas using immunohistochemistry. A total of five unwounded control eyes and five 30-min epithelial-wounded corneas were obtained from fresh corneoscleral buttons removed from human eyes enucleated due to choroidal melanoma with normal anterior segments. In the wounded corneas, an eight mm patch of central corneal epithelium and epithelial BM was removed with a Beaver blade when the patient was under general anesthesia. Immunohistochemical analyses were performed to detect perlecan and nidogen-2 proteins-important components of the epithelial BM lamina lucida and lamina densa zones. Perlecan and nidogen-2 proteins were detected in the BM itself and at low levels in keratocytes in all unwounded corneas. After epithelial injury, both perlecan and nidogen-2 were expressed at high levels in stromal keratocytes, including superficial keratocytes in the early phases of apoptosis. Thus, after epithelial and epithelial BM injury, stromal keratocytes contribute important perlecan and nidogen-2 components to the regenerating epithelial BM.
Assuntos
Membrana Basal/metabolismo , Moléculas de Adesão Celular/metabolismo , Ceratócitos da Córnea/metabolismo , Epitélio Corneano/lesões , Traumatismos Oculares/metabolismo , Proteoglicanas de Heparan Sulfato/metabolismo , Proteínas de Membrana/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteínas de Ligação ao Cálcio , Substância Própria/citologia , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Pessoa de Meia-Idade , Doadores de Tecidos , Regulação para Cima/fisiologia , CicatrizaçãoRESUMO
Los síndromes de desmielinización osmótica abarcan a la mielinólisis pontina (MP) y extrapontina (MEP). Se los ha asociado mayormente a correcciones rápidas o desmedidas de disbalances electrolíticos. Presentamos un paciente con cuadro clínico y neuroimágenes característicos de mielinólisis pontina
Osmotic demyelination syndromes include pontine and extrapontine myelinolysis. Both are mostly associated with fast or excessive corrections of electrolytes disorders. Classic clinical presentation and neuroimages due to pontine myelinolysis in a patient recently seen are discussed
As síndromes de desmielinização osmótica abrangem a mielinólise pontina (MP) e extrapontina (MEP). São associados mormente a correções rápidas ou desmedidas de disbalances eletrolíticos. Apresentamos um paciente com quadro clínico e neuroimagens característicos de MP
Assuntos
Humanos , Masculino , Idoso , Doenças Desmielinizantes , Mielinólise Central da Ponte , HidrataçãoRESUMO
En el presente artículo se analiza la vegetación del área delimitada por los ríos Saladillos de la Provincia de Santa Fe, Argentina. La región se ubica al sur del Chaco santafesino entre Arroyo el Toba y los ríos Saladillo al oeste del valle del río Panamá. El clima es cálido a templado, húmedo a subhúmedo. Haytres tipos de bosques, los "espinillares" de Acacia caven, los "algarrabales" de Prosopis spp. y los "quebrachales" de Schinopsis balansae, distribuidos siguiendo un gradiente geográfico. El aumento de espacies leñosas aumenta hacia el norte, y la estructura y estratisficación se hacen más complejas en esa dirección. Las comunidades herbáceas más importantes son los pajonales o sabanas de Spartina argentinesis y Panucum prionitis, junto con los otros pastos menos importantes. En las proximidades de las áreas inundadas por largos períodos o durante todo el año se encuentran juncales de Schoenoplectus californicus, totorales de Thypha domingesis, canutillares y vegas de distintas especies hidrófilas. Las comunidades se distribuyen siguente un gradiente edáfico de salinidad y humedad. El área puede ser considerada un Chaco empobrecido con una fuerte influencia del río Panamá
Assuntos
ArgentinaRESUMO
La prevalencia del Helicobacter pylori es alta en nuestro medio, hay informes del 90 por ciento en algunas series de personas sanas. Existen controversia con respecto a la vía de transmisión. Hay algunas evidencias que sugieren que la bacteria ingresa por vía oral. Este trabajo trata de identificar las posibles variables ambientales y/o de la dieta que aumentan el riesgo o protegen de esta infección. Se estudiaron 146 pacientes, 65 con Helicobacter positivos y 81 sin la presencia de la bacteria documentadas por histología. A estas pacientes se les aplicó una encuesta de las condiciones ambientales y dietarias del individuo. En los resultados se encontró como factor protector el hervir el agua, mientras el consumo de pescado y alimentos callejeros se constituyeron como un riesgo para adquirir la infección. Este trabajo sugiere que el hervir el agua puede constituir una medida sanitaria para disminuir el riesgo de infección
Assuntos
Humanos , Infecções por Helicobacter/etiologia , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/prevenção & controle , Infecções por Helicobacter/transmissão , Fatores R , Fatores de RiscoRESUMO
La colonoscopia es un método útil en el diagnóstico y tratamiento de los pólipos del colon. Se revisaron 1354 colonoscopias practicadas durante 1995 y 1996, encontrando que en 342 se había realizado polipectomía. La mayoría de los pólipos eran adenomatosos, localizados especialmente en el hemicolon izquierdo. Se insiste en la necesidad de tener un registro adecuado de esta patología en nuestro medio
Assuntos
Humanos , Pólipos do Colo/epidemiologia , Colômbia/epidemiologia , Colonoscopia/estatística & dados numéricosRESUMO
Los hemangiomas cavernosos de colon y recto son malformaciones excepcionales. El objetivo de la presente revisión es describir las características clínicas, endoscópicas, radiológicas y terapéuticas de esta entidad y familiarizar al clínico con esta infrecuente patología suceptible de terapia específica y de la cual se reportan 2 casos
Assuntos
Feminino , Adulto , Masculino , Neoplasias Colorretais , Hemangioma Cavernoso , Hemangioma Cavernoso/diagnóstico , Hemangioma Cavernoso/terapiaRESUMO
During pregnancy, biochemical evaluation of the liver is affected in many significan ways. Alkaline phosphatase increases in the third trimester and rapidly returns to the normal limits after delivery. This increase is clearly secondary to the placental isoenzyme. AST and ALT are usually normal and GGTP doens't changes significantly. Hepatic flow remains unchanged and estrogen levels increase leading to several metabolic and cutaneous changes, such as hepatic palms and systemic vasodilatation. Liver diseases that occur during pregnancy can be classified as follows: a) Entities exclusive of pregnancy, b) Pregnancy associated diseases, and c) Previous liver diseases. The first group included: 1. Cholestasis of pregnancy, described mainly in Scandinavian and Chilean women and characterized by pruritus in the third trimester, biochemical evidence of cholestasis, increased frequency of cholelitiasis and fetal problems. The entity usually recurs in other pregnancies or during exposure to estrogens. Prognosis is good and the patient improves rapidly after delivery. Several reports have shown that s-Adenosyl-Methionine can be effective. 2) Hyperemesis gravidarum, characterized by protacted vomiting associated to significant malnutrition. Liver function tests are usually abnormal and the liver biopsy shows no specific changes. Prognosis is usually good and most of the patients improved spontaneously. 3) Acute fatty liver, is one of the causes of liver failure during the third trimester and is associated with a very high maternal mortality. Clinically the patient presents with encephalopathy, biochemical evidence of liver failure and microvesicular fat in the liver...
Assuntos
Humanos , Feminino , Gravidez , Colestase/etiologia , Hepatite/etiologia , Fígado Gorduroso/etiologia , Hiperêmese Gravídica/etiologia , Hiperêmese Gravídica/fisiopatologia , Complicações na Gravidez/classificação , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/mortalidade , Complicações na Gravidez/fisiopatologia , Complicações na Gravidez/terapia , Síndrome HELLP/diagnóstico , Síndrome HELLP/etiologiaRESUMO
Las infecciones cervico-vaginales se presentan frecuentemente, con una incidencia que varia entre 7 y 20% de las mujeres por ano. Su significado e importancia clinica tienen que ver con implicaciones de orden social: incomodidad y molestias, potencial de diseminacion, riesgo de contagio al companero sexual, y en el caso de la embarazada, riesgos para el feto y el recien nacido. En este articulo se revisa de manera exhaustiva la etiologia, presentacion clinica y tratamiento medico de este frecuente motivo e consulta