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OBJECTIVES: To evaluate the association between Colombia's third wave when the Mu variant was predominant epidemiologically (until 75%) in Colombia and COVID-19 all-cause in-hospital mortality. METHODS: In this retrospective cohort, we included hospitalized patients ≥18 years with SARS-CoV-2 infection between March 2020 to September 2021 in ten hospitals from three cities in Colombia. Description analysis, survival, and multivariate Cox regression analyses were performed to evaluate the association between the third epidemic wave and in-hospital mortality. RESULTS: A total of 25,371 patients were included. The age-stratified time-to-mortality curves showed differences according to epidemic waves in patients ≥75 years (log-rank test p = 0.012). In the multivariate Cox analysis, the third wave was not associated with increased mortality relative to the first wave (aHR 0.95; 95%CI 0.84-1.08), but there was an interaction between age ≥75 years and the third wave finding a lower HR for mortality (aHR 0.56, 95%CI 0.36-0.86). CONCLUSIONS: We did not find an increase in in-hospital mortality during the third epidemic wave in which the Mu variant was predominant in Colombia. The reduced hazard in mortality in patients ≥75 years hospitalized in the third wave could be explained by the high coverage of SARS-CoV-2 vaccination in this population and patients with underlying conditions.
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Vacinas contra COVID-19 , COVID-19 , Humanos , Idoso , Colômbia/epidemiologia , Estudos Retrospectivos , SARS-CoV-2RESUMO
Introducción. La enfermedad de Peyronie es una malformación adquirida del pene, originada por la deposición de placas fibróticas en la túnica albugínea. La prevalencia en Estados Unidos oscila entre el 0.39% y 11.8%, en Europa 8.9%, en Latinoamérica no existe un porcentaje puntual de prevalencia actual debido a la escasez de reportes de esta patología. Este análisis bibliométrico busca describir la evolución terapéutica de la Enfermedad de Peyronie en la literatura de los últimos 62 años, así como la distribución geográfica de estas publicaciones. Metodología. Estudio observacional, descriptivo, un análisis bibliométrico desde 1957 hasta 2019, utilizando GoPubMed y FABUMED. Resultados. Se obtuvieron 721 referencias sobre tratamiento quirúrgico en enfermedad de Peyronie, con un aumento de la producción científica a lo largo del periodo de estudio. The Journal of Urology fue la revista con mayor cantidad de publicaciones, el 57.9% dentro de la categoría de artículo científico. El país líder fue Estados Unidos con 191 publicaciones. Discusión. Existe poca literatura sobre los avances terapéuticos para el tratamiento de enfermedad de Peyronie, lo que dificulta la comparación de las investigaciones a lo largo de los años en diferentes zonas del mundo. La investigación en Latinoamérica es escasa. Conclusión. La investigación sobre el tratamiento quirúrgico en enfermedad de Peyronie muestra un patrón ascendente en la productividad científica durante los años estudiados. Los países con mayores ingresos económicos son de mayor desarrollo en el tema y en menor medida regiones con recursos limitados. El análisis evidencia la importancia de aumentar producción científica en Colombia, así como estimular la investigación sobre este tema, ya que existen muy pocas publicaciones sobre la evolución del tratamiento quirúrgico para esta enfermedad. Palabras clave: Induración Peniana; Enfermedades del Pene; Bibliometría; Fibrosis; Erección Peniana
Introduction. Peyronie's disease is an acquired malformation of the penis, caused by the deposition of fibrotic plaques in the tunica albuginea. The prevalence in the United States ranges between 0.39% and 11.8%, in Europe 8.9%, in Latin America there is no specific percentage of current prevalence due to the scarcity of reports of this pathology. This bibliometric analysis seeks to describe the therapeutic evolution of Peyronie's Disease in the literature over the last 62 years, as well as the geographic distribution of these publications. Methodology. This is an observational, descriptive study, with a bibliometric analysis from 1957 to 2019, using GoPubMed and FABUMED. Results. 721 references on surgical treatment in Peyronie's disease were obtained, with an increase in scientific production throughout the study period. The Journal of Urology was the journal with the highest number of publications, 57.9% within the scientific article category. The leading country was the United States with 191 publications. Discussion. There is a limited amount of literature on therapeutic advances for the treatment of Peyronie's disease, which makes it difficult to compare research over the years in different areas of the world. Research in Latin America is scarce. Conclusion. Research on surgical treatment in Peyronie's disease shows an increasing pattern in scientific productivity over the years. Countries with higher economic income have greater development in the subject and to a lesser extent regions with limited resources. The analysis shows the importance of increasing scientific production in Colombia, as well as stimulating research on this topic, since there are few publications on the evolution of surgical treatment for this disease. Keywords: Penile Induration; Penile Diseases; Bibliometrics; Fibrosis; Penile Erection
Introdução. A doença de Peyronie é uma malformação adquirida do pênis, causada pela deposição de placas fibróticas na túnica albugínea. A prevalência nos Estados Unidos varia entre 0.39% e 11.8%, na Europa 8.9%, na América Latina não existe um percentual específico de prevalência atual devido à escassez de relatos desta patologia. Esta análise bibliométrica tem como objetivo descrever a evolução terapêutica da Doença de Peyronie na literatura dos últimos 62 anos, bem como a distribuição geográfica destas publicações. Metodologia. Estudo observacional, descritivo, análise bibliométrica de 1957 a 2019, utilizando GoPubMed e FABUMED. Resultados. Foram obtidas 721 referências sobre tratamento cirúrgico na doença de Peyronie, com aumento da produção científica ao longo do período do estudo. The Journal of Urology foi o periódico com maior número de publicações, 57.9% dentro da categoria artigo científico. O país líder foram os Estados Unidos com 191 publicações. Discussão. Há pouca literatura sobre avanços terapêuticos para o tratamento da doença de Peyronie, o que dificulta a comparação de pesquisas ao longo dos anos em diferentes partes do mundo. As pesquisas na América Latina são escassas. Conclusão. As pesquisas sobre o tratamento cirúrgico da doença de Peyronie mostram um padrão crescente de produtividade científica ao longo dos anos estudados. Os países com maior rendimento económico são mais desenvolvidos no assunto e, em menor medida, regiões com recursos limitados. A análise mostra a importância de aumentar a produção científica na Colômbia, bem como estimular a pesquisa sobre o tema, uma vez que existem poucas publicações sobre a evolução do tratamento cirúrgico desta doença. Palavras-chave: Induração Peniana; Doenças do Pênis; Bibliometria; Fibrose; Ereção Peniana
Assuntos
Doenças do Pênis , Induração Peniana , Fibrose , Ereção Peniana , BibliometriaRESUMO
A case report is presented of a 50-year-old woman who was seen in Accident and Emergency because of pain in the lumbar area. She was subsequently diagnosed with septic arthritis of the left hip due to being Neisseria gonorrhoeae positive for beta-lactamase. She responded to treatment with ceftriaxone, but later required a total hip replacement.
Presentamos el caso de una mujer de 50 arios, sin antecedentes de importancia, a quien se le diagnosticó inicialmente lumbago e infección de vías urinarias. Por persistencia del dolor y limitación de la movilidad en la cadera izquierda se inicia el estudio de artritis séptica, que fue provocada por Neisseria gonorrhoeae betalactamasa positiva, sensible a tratamiento con ceftriaxona, con posterior deterioro articular, el cual requirió reemplazo total de cadera.
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Humanos , Feminino , Pessoa de Meia-Idade , Bactérias , Artrite Infecciosa , Bactérias Gram-Negativas , Infecções , Neisseria gonorrhoeaeRESUMO
Background: In the absence of antiviral alternatives, interventions under research for COVID-19 might be offered following guidelines from WHO for monitored emergency use of unregistered and experimental interventions (MEURI). Ivermectin is among several drugs explored for its role against SARS-CoV-2, with a well-known safety profile but conflicting data regarding clinical utility for COVID-19. The aim of this report is to inform on the results of a MEURI Program of high-dose ivermectin in COVID-19 carried out by the Ministry of Health of the Province of La Pampa, Argentina. Methods: COVID-19 subjects, within 5 days of symptoms onset were invited to participate in the program, which consisted in the administration of ivermectin 0.6 mg/kg/day for 5 days plus standard of care. Active pharmacosurveillance was performed for 21 days, and hepatic laboratory assessments were performed in a subset of patients. Frequency of Intensive Care Unit (ICU) admission and COVID-19-related mortality of subjects in the ivermectin intention to treat group were compared with that observed in inhabitants of the same province during the same period not participating in the program. Results: From 21,232 subjects with COVID-19, 3,266 were offered and agreed to participate in the ivermectin program and 17,966 did not and were considered as controls. A total of 567 participants reported 819 adverse events (AEs); 3.13% discontinued ivermectin due to adverse events. ICU admission was significantly lower in the ivermectin group compared to controls among participants ≥40 year-old (1.2 vs. 2.0%, odds ratio 0.608; p = 0.024). Similarly, mortality was lower in the ivermectin group in the full group analysis (1.5 vs. 2.1%, odds ratio 0.720; p = 0.029), as well as in subjects ≥ 40 year- old (2.7 vs. 4.1%, odds ratio 0.655; p = 0.005). Conclusions: This report highlights the safety and possible efficacy of high dose ivermectin as a potentially useful intervention deserving public health-based consideration for COVID-19 patients.
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Tratamento Farmacológico da COVID-19 , Ivermectina , Adulto , Humanos , Ivermectina/uso terapêutico , SARS-CoV-2RESUMO
The rate of suicide attempts among people with substance abuse disorders in the U.S. is six times higher than in the general population. The prevalence of suicidal ideations and attempts continues to increase in Puerto Rico, with a significant incidence in substance-abusing populations. This retrospective cohort study evaluate the suicide profile of 4,347 opioid dependent participants in ASSMCA's methadone center in San Juan, PR, from 2015 to 2018 using questions related to suicidal ideation and attempts included in the admission questionnaire. Participants reporting suicide ideation increase from 8.5% in 2015 to 17.0% in 2018. In 2015 only 7.0% claimed to have had a history of a suicide attempt, increasing to 12.4% in 2018. Our data support the need for screening for suicide risk among substance abusing populations to identify targeted interventions. The identification of high-risk populations for suicide can help during rehabilitation and finding the adequate resources needed.
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Transtornos Relacionados ao Uso de Substâncias , Ideação Suicida , Analgésicos Opioides , Humanos , Porto Rico/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Tentativa de SuicídioRESUMO
Introducción. El compromiso tumoral metastásico del melanoma al tracto genitourinario es frecuente, pero, la metástasis a vejiga es rara, constituye menos del 2% de los casos. Sin embargo, en autopsias realizadas a pacientes con melanoma se ha encontrado metástasis en la vejiga en entre un 18% y un 37% de los casos, lo que la convierte en la segunda en incidencia posterior al adenocarcinoma gástrico. La media de supervivencia suele ser entre 6 - 7.5 meses. El objetivo de este trabajo es presentar el caso de un melanoma metastásico a vejiga, entidad poco frecuente y poco diagnosticada por ser la mayoría de las veces asintomática. Presentación del caso. Paciente femenina de 62 años, con antecedente de melanoma al nivel del primer artejo del pie, con manejo quirúrgico y farmacológico. Consultó por hematuria. La cistoscopia evidenció una lesión única sólida, eritematosa, con necrosis y fácil sangrado y se indicó realizar resección transuretral (RTU). La patología demostró compromiso por melanoma ulcerado metastásico. Se inició manejo de segunda línea (Pembrolizumab) y presentó progresión a miembros superiores y recaída a nivel vesical. La paciente falleció un año después. Discusión. Las metástasis de melanoma al tracto genitourinario son frecuentes, pero las metástasis vesicales aisladas son raras. El tratamiento suele ser RTU de la lesión, cistectomía, quimioterapia y radioterapia. La RTU es curativa para las lesiones restringidas al epitelio, aunque la cistectomía radical suele ser la terapia de elección ante un paciente con un tumor localizado. El Pembrolizumab ha demostrado aumentar la supervivencia. El pronóstico depende del tamaño y profundidad de la invasión. Conclusiones. El compromiso vesical metastásico es poco frecuente y diagnosticado, puede estar presente en pacientes con melanoma, síntomas irritativos urinarios no específicos y hematuria. Suele ser de mal pronóstico, y requiere de manejo quirúrgico asociado a manejo sistémico.
Introduction. Metastatic tumor compromise of melanoma to the genitourinary tract is frequent, but metastasis to the bladder is rare, representing less than 2% of cases. However, autopsies performed on patients with melanoma have found metastases in the bladder in 18-37% of cases, making it the second incidence after gastric adenocarcinoma. The median survival is usually 6 to 7.5 months. The objective of this work is to present the case of a metastatic melanoma to the bladder, a rare and underdiagnosed condition because most of the time it is asymptomatic. Case Presentation. 62-year-old female patient, with a history of melanoma at the level of the first toe, with surgical and pharmacological management. The reason for consultation was hematuria. Cystoscopy revealed a single solid, erythematous lesion with necrosis and easy bleeding, and a transurethral resection (TUR) was indicated. The pathology found compromise for metastatic ulcerated melanoma. Second-line treatment (Pembrolizumab) was started and presented progression to the upper limbs and relapse at the bladder level. The patient died a year later. Discussion. Melanoma metastases to the genitourinary tract are common, but isolated bladder metastases are rare. Treatment is usually TUR of the lesion, cystectomy, chemotherapy, and radiation therapy. TUR is curative for lesions restricted to the epithelium, although radical cystectomy is usually the therapy of choice in patients with a localized tumor. Pembrolizumab has been shown to increase survival. The prognosis depends on the size and depth of the invasion. Conclusions. Metastatic bladder compromise is rare and underdiagnosed, it may be present in patients with melanoma, non-specific urinary irritative symptoms, and hematuria. It tends to have a poor prognosis, and requires surgical management associated with systemic management.
Introdução. O comprometimento do tumor metastático do melanoma no trato geniturinário é comum, mas a metástase na bexiga é rara, constituindo menos de 2% dos casos. Entretanto, em autópsias realizadas em pacientes com melanoma, foi encontrada metástase na bexiga entre 18% e 37% dos casos, o que a torna a segunda em incidência após o adenocarcinoma gástrico. A média de sobrevivência é geralmente entre 6 - 7,5 meses. O objetivo deste trabalho é apresentar o caso de um melanoma metastático na bexiga, uma entidade pouco frequente e subdiagnosticada, pois na maioria das vezes é assintomática. Apresentação do caso. Paciente do sexo feminino, 62 anos, com antecedentes de melanoma no nível do hálux, com manejo cirúrgico e farmacológico. Ela consultou por hematúria. A cistoscopia revelou uma única lesão sólida, eritematosa com necrose e sangramento fácil, e foi indicada uma ressecção transuretral (RTU). A patologia mostrou comprometimento de melanoma ulceroso metastático. O tratamento de segunda linha (Pembrolizumab) foi iniciado e a patologia avançou para os membros superiores e uma recaída no nível da bexiga. A paciente morreu um ano depois. Discussão. As metástases de melanoma para o trato geniturinário são frequentes, mas as metástases vesicais isoladas são raras. O tratamento é geralmente RTU da lesão, cistectomia, quimioterapia e radioterapia. A RTU é curativa para lesões restritas ao epitélio, embora a cistectomia radical seja geralmente a terapia de escolha para um paciente com um tumor localizado. O Pembrolizumab demonstrou aumentar a sobrevivência. O prognóstico depende do tamanho e da profundidade da invasão. Conclusões. O comprometimento vesical metastático é raro e subdiagnosticado, pode estar presente em pacientes com melanoma, sintomas irritantes urinários não específicos e hematúria. Geralmente tem um prognóstico negativo e requer manejo cirúrgico em associação com manejo sistêmico.
Assuntos
Neoplasias da Bexiga Urinária , Urologia , Hematúria , Melanoma , Metástase NeoplásicaRESUMO
Abstract Carbapenemase-producing Enterobacterales (CPE) infections have increased in recent years. Colombia has become an endemic country for this group of microorganisms, and the infections they cause have a serious impact in terms of morbidity and mortality. The early identification of CPE carriers who are admitted to health care centers as patients is necessary to implement adequate isolation and infection control measures to limit the spread of this type of microorganisms in hospitals. Furthermore, treating these infections is a challenging task due to the limited therapeutic alternatives available and the fact that there are only a few studies proving their effectiveness in this setting. Therefore, the objective of the present work is to develop a clinical practice guideline (CPG) for the screening of patients at risk of CPE colonization and the treatment of inpatients with suspected or confirmed infections caused by this type of bacteria through a CPG adaptation process based on the ADAPTE methodology. With this purpose in mind, evidence-informed recommendations for the screening and timely identification of CPE carriers admitted to hospitals are made, as well as for the adequate pharmacological treatment of CPE infections in this context.
Resumen Las infecciones por Enterobacterales productores de carbapenemasas (EPC) han aumentado en los últimos años. Colombia se ha convertido en un país endémico para este grupo de microorganismos y las infecciones que causan tienen un impacto importante en términos de morbimortalidad. La identificación temprana de los portadores de EPC que ingresan como pacientes a las instituciones de salud es necesaria para implementar medidas de aislamiento y control de infecciones adecuadas que limiten la diseminación de este tipo de microorganismos en los hospitales. Además, el tratamiento de estas infecciones es difícil debido a las limitadas alternativas terapéuticas disponibles y la escasez de estudios que demuestren su efectividad en este escenario. Por lo anterior, el objetivo del presente trabajo es desarrollar una guía de práctica clínica (GPC) para la tamización de pacientes con riesgo de colonización por EPC y para el manejo de pacientes con infecciones, ya sea sospechadas o confirmadas, causadas por este tipo de bacterias, mediante un proceso de adaptación de GPC basado en la metodología ADAPTE. Con este propósito en mente, se hacen recomendaciones informadas en evidencia para realizar la tamización y oportuna identificación de portadores de EPC admitidos en instituciones hospitalarias, así como para el adecuado manejo farmacológico de las infecciones por CPE en este escenario.
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Ocular allergic diseases are frequently seen in ophthalmological clinical practice. Immunological damage is mediated by a local Th2 inflammatory microenvironment, accompanied by changes in circulating cell subsets, with more effector cells and fewer T regulatory cells (Tregs). This study aimed to evaluate the involvement of toll-like receptor 4 (TLR4) and α-melanocyte stimulating hormone (α-MSH) in the immune regulation associated with perennial allergic conjunctivitis (PAC). We performed an Ag-specific stimulation during 72 h of culturing with or without lipopolysaccharide (LPS) or α-MSH in peripheral blood mononuclear cells (PBMC), analyzing the cell subsets and cytokines induced by the stimuli. We also determined α-MSH in tear samples from healthy donors (HD) or PAC patients. Our findings demonstrate an immunological dysregulation characterized by an increased frequency of CD4+TLR4+ in the PBMC of patients with PAC, compared to HD. Most of these CD4+TLR4+ cells were also CD25+, and when α-MSH was added to the culture, the percentage of CD4+CD25+FoxP3+ increased significantly, while the percentage of CD69+ cells and cytokines IL-4 and IL-6 were significantly decreased. In tears, we found an increased concentration of α-MSH in PAC patients, compared with HD. These findings indicate a novel mechanism involved in controlling ocular allergic diseases, in which α-MSH diminishes the concentration of IL-6 and IL-4, restoring the frequency of Tregs and down-regulating CD4 activation. Moreover, we demonstrated the involvement of CD4+TLR4+ cells as an effector cell subset in ocular allergy.
Assuntos
Linfócitos T CD4-Positivos/imunologia , Conjuntivite Alérgica/imunologia , Células Th2/citologia , Receptor 4 Toll-Like/metabolismo , Regulação para Cima , alfa-MSH/metabolismo , Adolescente , Estudos de Casos e Controles , Células Cultivadas , Criança , Feminino , Humanos , Interleucina-4/metabolismo , Interleucina-6/metabolismo , Lipopolissacarídeos/efeitos adversos , Masculino , Células Th2/efeitos dos fármacos , Células Th2/imunologia , alfa-MSH/farmacologiaRESUMO
Urban yellow dust deposition is a common phenomenon in many parts of the world, which is sometimes called "sulfur shower," "sulfur rain," or "pollen storm." Most people, especially those living in the vicinity of industrial facilities, wrongly perceive the yellow dust as sulfur when in fact it is pollen. The misunderstanding increases risk perception as people believe the "yellow powder" is a serious threat to their health. Based on simple observations, it is virtually impossible to differentiate sulfur from pollen, so risk communication should consider the chemical, biological, and toxicological aspects of these agents. In this review, we clarify that industrial emissions of sulfur are under the form of sulfides, oxides, and other volatile compounds which are gaseous and noncolored, and we explain that it is chemically impossible for gaseous sulfur to become solid yellow sulfur under normal environmental conditions. We also describe pollen and its release from trees, shrubs, and herbs a process influenced by atmospheric conditions. We suggest take-home messages that risk communicators may use when explaining the phenomenon to their communities.
Assuntos
Poluentes Atmosféricos/toxicidade , Poeira/análise , Pólen/química , Enxofre/toxicidade , Poluentes Atmosféricos/análise , Comunicação , Humanos , Pólen/efeitos adversos , Chuva , Enxofre/análiseRESUMO
La bacteriemia por Clostridium sordellii es infrecuente y usualmente se origina a partir de infecciones de etiología generalmente ginecológica y puerperal, con una mortalidad de aproximadamente el 70%. Existen pocas herramientas para el diagnóstico rápido y oportuno, siendo así la experiencia de tratamiento para este germen muy limitada en otros escenarios, lo que probablemente sea la causa de su alta mortalidad. Presentamos una paciente con antecedente de masa abdominal expansiva de larga data, con diagnóstico por histopatología e inmunohistoquimica compatibles con tumor del estroma gastrointestinal (GIST por sus siglas en inglés) y estudios de extensión que confirman compromiso metastásico hepático, en quien se documenta bacteriemia por Clostridium sordellii.
Clostridium sordellii bacteriemia is infrequent and usually comes from infections of gynecological and puerperal etiology, with mortality near 70%. There are few tools for rapid and timely diagnosis. Thus, treatment experience for this pathogen is very limited in other scenarios, which is probably the cause of high mortality rates. We describe a patient with a history of expansive abdominal mass, diagnosed with metastasic Gastrointestinal Stromal Tumor (GIST), with Clostridium sordellii bacteremia.
Assuntos
Humanos , Feminino , Idoso , Bacteriemia , Clostridium sordellii , Tumores do Estroma Gastrointestinal , Bacilos Gram-Positivos , Sepse , NeoplasiasRESUMO
Purpose: The objective of this study was to describe the short-term results of allogenic transplantation of limbal stem cells expanded on amniotic membrane for the ocular surface reconstruction. Methods: Prospective nonrandomized, nonmasked study in a single ophthalmological center. Ten patients with bilateral total limbal stem cell deficiency (LSCD) were included. Expression and presence of ABCB5 and Δp63α in amniotic membrane-cultured limbal epithelial stem cells were analyzed, in relationship with clinical changes after allogenic transplantation. An objective evaluation was performed to determine corneal transparency and superficial vascularization. Results: In a median follow-up time of 11.6 months, 7 patients (70%) were considered as failure compared with the preoperative status. ABCB5 and Δp63α are expressed in similar amount in the limbal epithelial cells expanded in vitro and transplanted in patients with bilateral LSCD. Conclusions: Transplantation of allogenic epithelial limbal cells expanded in amniotic membrane could be considered in patients with LSCD due to burns or congenital etiologies such as aniridia, but its benefit is limited for patients with immunologic diseases.
Assuntos
Âmnio/transplante , Doenças da Córnea/etiologia , Epitélio Corneano/transplante , Limbo da Córnea/patologia , Células-Tronco/citologia , Transplante Homólogo/métodos , Subfamília B de Transportador de Cassetes de Ligação de ATP/metabolismo , Adolescente , Adulto , Âmnio/citologia , Âmnio/metabolismo , Aniridia/complicações , Estudos de Casos e Controles , Córnea/irrigação sanguínea , Córnea/metabolismo , Doenças da Córnea/diagnóstico , Doenças da Córnea/metabolismo , Doenças da Córnea/cirurgia , Lesões da Córnea/complicações , Epitélio Corneano/anormalidades , Epitélio Corneano/citologia , Epitélio Corneano/metabolismo , Feminino , Seguimentos , Humanos , Limbo da Córnea/citologia , Limbo da Córnea/metabolismo , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto/métodos , Estudos Prospectivos , Transplante de Células-Tronco/efeitos adversos , Células-Tronco/metabolismo , Células-Tronco/patologia , Fatores de Transcrição/metabolismo , Resultado do Tratamento , Proteínas Supressoras de Tumor/metabolismo , Adulto JovemRESUMO
Bilateral limbal stem cell deficiency (LSCD) treatment requires the need to obtain allogenic limbal tissue for transplantation. Outcomes of different surgical techniques depend on multiple factors, including the underlying etiology, ocular surface, eyelid status and used surgical intervention. Some of the management options for bilateral LSCD include cadaveric, living related or living non-related conjunctival limbal allograft (CLAL), keratolimbal allograft (KLAL), allogenic cultured limbal epithelial transplantation (CLET) and allogenic simple limbal epithelial transplantation (SLET). Systemic immunosuppressive therapy plays a pivotal role in survival of transplanted tissue. The present review focuses on different systemic immunosuppression protocols for limbal allograft and allogenic limbal epithelial cell transplantation, with specific emphasis on different surgical techniques and their outcomes. We included all reports with details of different systemic immunosuppression protocols for limbal allograft and allogenic limbal epithelial cell transplantation. Oral cyclosporine A at different doses is the most commonly used immunosuppressive agent in limbal allograft and allogenic limbal epithelial cell transplantation. However, different studies using oral mycophenolate mofetil and tacrolimus also reported good results. In conclusion, systemic immunosuppression protocols for limbal allograft and allogenic limbal epithelial cell transplantation are not standardized. Further studies regarding different surgical techniques should assess outcomes and adverse effects of such protocols.
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Background: In the diagnostic process of pleural tuberculosis, the findings from video-assisted thoracoscopy (VATS) can be highly suggestive for the diagnosis of infection. Methods: We reviewed VATS records between the years 2012 to 2016 of patients over 16 years of age with pleural effusion and suspected pleural tuberculosis. Symptoms, macroscopic and chemical characteristics of the fluid, surgical descriptions and visual diagnosis of the surgeon were recorded and were compared with the histopathology. Results: 106 patients were selected, most of them men (71.7%), of whom approximately half were active military (51.3%). The predominant symptoms were dyspnea, pleuritic pain, fever and evolution time greater than 15 days (94.3%, 80.2%, 50% and 46,2%, respectively). These symptoms, in turn, were present more frequently in pleural tuberculosis patients than in non-tuberculosis patients. The fluid was mostly turbid yellow (44%) and lymphocytic cellularity exudate (77.4%). The VATS findings in patients with confirmed TBC included nodules (96.9%), adhesions (87.5%) and thickening (78.1%). The diagnosis made by the surgeon in relation to the histopathological diagnosis showed a sensitivity of 88.6% and a specificity of 98.4%. Conclusion: There are highly suggestive characteristics of the macroscopic report of VATS that would allow a quicker diagnosis of pleural tuberculosis.
Antecedentes: Los hallazgos de toracoscopia asistida por video (VATS) durante el diagnostico de tuberculosis pleural, que son altamente sugestivos de la infección han sido poco descritos. Metodos: Se revisaron los registros de VATS entre los años 2012 a 2016 of de pacientes mayores de 16 años con efusión pleural y sospechosos de etiología tuberculosa. Se analizaron los síntomas, las características macroscópicas y bioquímicas del líquido, la descripción quirúrgica y el diagnostico visual y se compararon con los resultados de la histopatologia. Resultados: Se estudiaron los registros de 106 pacientes, la mayoría fueron sexo masculino (71.7%), y aproximadamente la mitad en servicio militar activo (51.3%). Los síntomas predominantes fueron disnea, dolor pleuritico, fiebre y tiempo de evolución mayor a 15 días (94.3%, 80.2%, 50% y 46,2%, respectivamente). Estos sintomas a su vez fueron más frecuentes en tuberculosis pleural que en no tuberculosis. El liquido fue más amarillo turbio (44%) y con exudado de tipo linfocitario (77.4%). Los hallazgos de VATS en pacientes con tuberculosis confirmada incluyeron nodulos (96.9%), adhesiones (87.5%) y engrosamiento (78.1%). El diagnóstico hecho por el cirujano con relación al histopatológico, tuvo una sensibilidad de 88.6% y una especificidad de 98.4%. Conclusion: Existen características en el VATS altamente sugestivas de tuberculosis pleural.
Assuntos
Humanos , Masculino , Adolescente , Adulto , Derrame Pleural , Toracoscopia , Tuberculose , Biópsia , Tuberculose Pleural , Sepse , Técnicas e Procedimentos Diagnósticos , InfecçõesRESUMO
PURPOSE: To characterize cornea specialists' current practice preferences in the management of primary pterygium. METHODS: A 25-item survey regarding indications for surgery, surgical technique, use of adjuvant therapy, type and duration of postoperative therapy, and treatment of early recurrences was designed and sent to members of the Cornea Society through the kera-net listserv. RESULTS: In total, 199 cornea specialists completed the questionnaire. More than 90% considered that surgery should be performed when there is proximity of the pterygium to the visual axis, pain or redness, eye movement restriction, or induction of astigmatism. Cosmesis was considered as an indication by 41.7% of the participants. The most frequent technique for pterygium excision was complete resection including the base and a moderate quantity of Tenon capsule followed by autologous conjunctival or limbal-conjunctival graft. The preferred graft fixation method in this survey was fibrin glue (61.2%). Most respondents reported a recurrence rate of less than 5% and no use of adjuvant agents to prevent recurrence. When early recurrence did occur, the preferred agents were corticosteroids. CONCLUSIONS: This study reflects the preferences of cornea experts regarding primary pterygium treatment and may serve as a guide for the management of this pathology.
Assuntos
Córnea/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/normas , Oftalmologistas/normas , Padrões de Prática Médica , Pterígio/cirurgia , Inquéritos e Questionários , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pterígio/diagnóstico , Recidiva , Estudos RetrospectivosRESUMO
Purpose: To compare management of postoperative pain after corneal collagen crosslinking (CXL) with oral gabapentin or ketorolac. Methods: Prospective interventional comparative case series in a single center. Patients undergoing epithelium-off (epi-off) or epithelium-on (epi-on) techniques performed by a single surgeon for progressive keratoconus were enrolled and randomly assigned to the ketorolac (10-mg tablets every 8 h) or the gabapentin (300-mg capsules every 8 h) group and instructed to take the medication for the first 3 postoperative days. Using a numeric scale of pain, scores were assessed for current pain (at the time of applying the questionnaire), and average pain over the preceding 24 h. Eye symptoms and systemic adverse events related to oral medication were also assessed. Results: Thirty-seven patients were included, with 22 (10 epi-on and 12 epi-off) assigned to the ketorolac group and 15 (7 epi-on and 8 epi-off) to the gabapentin group. No statistically significant differences were noted on the pain scale between groups at any point of the study, in the median pain scores of patients at the time of applying the questionnaire, nor in the severity of pain during the 24-h period before the assessment. Also, no differences were found among groups for the eye symptoms and the systemic adverse events. The median regression analysis showed no effect of the type of surgery or gender in the severity of pain. Conclusions: Both oral ketorolac and oral gabapentin can be used with similar results for pain and symptomatic control after epi-on or epi-off CXL procedures.
Assuntos
Córnea/metabolismo , Gabapentina/administração & dosagem , Ceratocone/cirurgia , Cetorolaco/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Administração Oral , Adolescente , Adulto , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Colágeno/metabolismo , Reagentes de Ligações Cruzadas/administração & dosagem , Feminino , Gabapentina/efeitos adversos , Humanos , Cetorolaco/efeitos adversos , Masculino , Medição da Dor , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento , Adulto JovemRESUMO
Pin-site myiasis is an underreported complication of surgical interventions. We present a case of myiasis caused by the New World screwworm fly (Cochliomyia hominivorax) in a pin site of a chronic nonhealed wound 12 years after the intervention. This infection apparently was the result of poor perfusion of the leg.
Assuntos
Dípteros , Miíase/diagnóstico , Miíase/etiologia , Infecção dos Ferimentos , Idoso , Animais , Anti-Infecciosos/uso terapêutico , Coinfecção , Colômbia , Humanos , Larva , Masculino , Miíase/tratamento farmacológico , Resultado do TratamentoRESUMO
Introducción: La desnutrición en pacientes con Parálisis cerebral infantil (PC) aumenta la morbimortalidad, generando alta demanda económica al estado y la familia. Objetivo: Describir estado nutricional de niños con PC. Materiales y Métodos: Estudio observacional, descriptivo con componente analítico, prospectivo. Fueron incluidos niños de 0-18 años con PC que acudieron al Departamento de Neurología en setiembre y octubre del 2017. Variables: edad, sexo, antecedentes perinatales de Riesgo, antecedentes de infección del sistema nervioso central, estado nutricional, talla, perímetro cefálico, grado de discapacidad motora, vía de alimentación, trastornos relacionados a la alimentación, síntomas asociados a reflujo gastroesofágico. Los datos fueron analizados en SPSSv21, utilizando estadística descriptiva e inferencial. Protocolo aprobado por el Comité de Investigación y Ética institucional, con consentimiento informado. Resultados: se incluyeron 42 pacientes. La mediana de edad fue 5 años. Predominio de sexo femenino: 52,4% (22/42). El 83,3%(35/42) tenía antecedentes perinatales de riesgo (80% encefalopatía hipóxico-isquémica); antecedentes de infección del sistema nervioso central 9.5%(4/42); se encontró desnutrición en 35,7% (15/42); alteración de talla 76,2%; todos los lactantes tenían alterado el perímetro cefálico; discapacidad motora Grado 4 en 61,9%(26/42); se alimentaban por vía oral: 78,6%(36/42); tenían trastornos de alimentación, 36/42; síntomas asociados a reflujo gastroesofágico 69%; se relacionó desnutrición con grado de discapacidad y se encontró diferencia significativa, sobretodo con Grado 4 (p<0,005); en relación al grado de discapacidad, trastornos de alimentación y síntomas de reflujo gastroesofágico, se encontró diferencia significativa con mayores grados de discapacidad. Conclusiones: La frecuencia de desnutrición fue 35,7%. El estado nutricional se relacionó con el grado de discapacidad motora.
Introduction: Malnutrition in patients with infantile cerebral palsy (CP) increases morbidity and mortality, generating a high economic burden on he state and the family. Objective: To describe the nutritional status of children with CP. Materials and Methods: This was an observational, descriptive study with analytical and prospective components. Children aged 0-18 years with CP, who consulted at the Department of Neurology in September and October 2017, were included. Variables: age, sex, perinatal risk history, history of central nervous system infection, nutritional status, height, head circumference, degree of motor disability, food intake route, eating-related disorders, and symptoms associated with gastroesophageal reflux. The data were analyzed in SPSSv21, using descriptive and inferential statistics. The protocol was approved by the Institutional Research and Ethics Committee, and we obtained informed consent. Results: 42 patients were included. The median age was 5 years, the subjects were predominantly female: 52.4% (22/42). 83.3% (35/42) had a perinatal risk history, (80% hypoxic-ischemic encephalopathy); a history of central nervous system infection was noted in 9.5% (4/42); malnutrition was found in 35.7% (15/42); height alteration was found in 76.2%; all infants had alterations in their head circumference measurements; motor impairment Grade 4 was noted in 61.9% (26/42); oral feeding was noted in 78.6% (36/42); 36/42 had eating-related disorders; 69% had symptoms associated with gastroesophageal reflux; malnutrition was related to degree of disability and a significant difference was found, especially with Grade 4 (p <0.005); regarding degree of disability, eating-related disorders and gastroesophageal reflux symptoms, we found significant associations with higher degrees of disability. Conclusions: The frequency of malnutrition was 35.7%. The nutritional status was related to the degree of motor disability.
RESUMO
OBJECTIVE: To determine the prevalence of dry eye symptoms (DES) and associated risk factors among adults in Tlaxcala, Mexico. MATERIALS AND METHODS: A cross-sectional population-based study that included 1 508 individuals aged ≥50 years who answered the Dry Eye Questionnaire (DEQ5), with a score ranging between 0 and 22; the following categories were defined: no DES (<6); mild-moderate DES (6 to 11) and severe DES (≥12). RESULTS: The prevalence of DES was 41.1% (95%CI 38.6-43.6), and was higher in women (OR=2.26, 95%IC 1.70-3.00), in individuals with smoking index of <10 (OR=1.40, 95%CI 1.05-1.87) and ≥10 pack-years (OR=2.29, 95%CI 1.44-3.63), compared to never-smokers, subjects with history of ever consuming alcohol (OR=1.31, 95%CI 1.02-1.70), and those receiving antihypertensive treatment (OR=1.29, 95%CI 1.00-1.65). CONCLUSIONS: Dry eye symptoms were highly prevalent in the study population and were associated with sex, smoking, alcohol consumption, and antihypertensive medications.