RESUMO
BACKGROUND: Blood transfusion reactions may have a negative impact on organ function. It is unknown whether this association holds true for acute kidney injury (AKI). Therefore, we conducted a cohort study to assess the association between transfusion reactions and the incidence of AKI and major adverse kidney events. METHODS: In this retrospective cohort study, we included patients who received transfusion of blood products during hospitalization at the Hospital Civil of Guadalajara. We analyzed them according to the development of transfusion reactions, and the aim was to assess the association between transfusion reactions and AKI during long-term follow-up. RESULTS: From 2017 to 2021, 81,635 patients received a blood product transfusion, and 516 were included in our study. The most common transfusion was red blood cell packaging (50.4%), fresh frozen plasma (28.7%) and platelets (20.9%); of the 516 patients, 129 (25%) had transfusion reactions. Patients who had transfusion reactions were older and had more comorbidities. The most common type of transfusion reaction was allergic reaction (70.5%), followed by febrile nonhemolytic reaction (11.6%) and anaphylactoid reaction (8.5%). Most cases were considered mild. Acute kidney injury was more prevalent among those who had transfusion reactions (14.7%) than among those who did not (7.8%), p = < 0.01; those with AKI had a higher frequency of diabetes, vasopressors, and insulin use. Transfusion reactions were independently associated with the development of AKI (RR 2.1, p = < 0.02). Major adverse kidney events were more common in those with transfusion reactions. The mortality rate was similar between subgroups. CONCLUSION: In our retrospective cohort of patients who received blood product transfusions, 25% experienced transfusion reactions, and this event was associated with a twofold increase in the probability of developing AKI and some of the major adverse kidney events during long follow-up.
Assuntos
Injúria Renal Aguda , Reação Transfusional , Humanos , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/terapia , Injúria Renal Aguda/etiologia , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Reação Transfusional/epidemiologia , Idoso , Incidência , Fatores de Risco , Adulto , Medição de RiscoRESUMO
BACKGROUND: Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine that plays an important role in the pathogenesis of type 2 diabetes mellitus (T2DM). Although the effect of high glucose on liver function has been described, the role of MIF in hepatic mitochondrial function during T2DM has not been studied. OBJECTIVE: We examine the influence of MIF to hepatic mitochondrial function in T2DM mouse model. METHODS: WT and Mif-/- BALB/c mice were treated with a single dose of streptozotocin (STZ). After an 8-week follow-up, serum glucose, proinflammatory cytokines, C-reactive protein (CRP), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) enzyme quantification, and liver histological analyses were performed. Liver mitochondria were extracted, and mitochondrial function was evaluated by oximetry, swelling and peroxide production. RESULTS: Following treatment with STZ, WT mice (WT/STZ) developed significant hyperglycemia and high serum levels of MIF, tumor necrosis factor (TNF)-α, interleukin-ß (IL-ß), and CRP. Liver damage enzymes ALT and AST were found at high levels. In contrast, Mif-/-STZ lacked serum MIF levels and showed smaller increases in blood glucose, less TNF-α, IL-1ß, CPR, ALT and AST, and failure to develop clinical signs of disease compared to the WT/STZ group. Mitochondria extracted from the Mif-/-STZ liver showed similar respiratory control (RC) to WT/STZ or healthy mice with glutamate/malate or succinate as substrates. The four respiratory chain complexes also had comparable activities. WT/STZ-isolated mitochondria showed low swelling with calcium compared to mitochondria from Mif-/-STZ or healthy mice. Peroxide production was comparable in all groups. CONCLUSION: These results show although high systemic levels of MIF contribute to the development of T2DM pathology, the liver mitochondria remain unaltered. Importantly, the absence of MIF reduced the pathology of T2DM, also without altering liver mitochondrial function. These support MIF as a therapeutic target for the treatment of this disease in humans.
Assuntos
Diabetes Mellitus Tipo 2/metabolismo , Mediadores da Inflamação/metabolismo , Oxirredutases Intramoleculares/metabolismo , Fígado/metabolismo , Fatores Inibidores da Migração de Macrófagos/metabolismo , Mitocôndrias/metabolismo , Animais , Proteína C-Reativa/metabolismo , Respiração Celular , Citocromos/metabolismo , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/patologia , Eletrodos , Hiperglicemia/complicações , Hiperglicemia/patologia , Interleucina-1beta/sangue , Oxirredutases Intramoleculares/deficiência , Ilhotas Pancreáticas/metabolismo , Ilhotas Pancreáticas/patologia , Fígado/patologia , Fatores Inibidores da Migração de Macrófagos/deficiência , Masculino , Camundongos Endogâmicos BALB C , Dilatação Mitocondrial , Oxigênio/metabolismo , Peróxidos/metabolismo , Estreptozocina , Transaminases/metabolismo , Fator de Necrose Tumoral alfa/sangueRESUMO
BACKGROUND: Excess of alcohol consumption is a public health problem and has documented effects on the immune system of humans and animals. Animal and in vitro studies suggest that alcohol abuse changes CD8 T cell (CD8) characteristics, however it remains unknown if the CD8 profile of binge drinkers is different in terms of activation, trafficking and cytotoxic capacity. AIM: To analyze the peripheral CD8 cytotoxic capacity, activation and trafficking phenotypic profile of Mexican young adults with regard to alcohol consumption pattern. METHODS: 55 Mexican young adults were stratified as Light (20), Intermediate (18) or Binge drinkers (17) according to their reported alcohol consumption pattern. Blood samples were obtained and hematic biometry and liver enzyme analysis were performed. Peripheral CD8 profile was established by expression of Granzyme B (GB), CD137, CD127, CD69, TLR4, PD1, CCR2, CCR4, CCR5 and CXCR4 by FACS. Data was analyzed by ANOVA, posthoc DMS and Tamhane, and principal component analysis (PCA) with varimax rotation, p<0.05. RESULTS: The Binge drinking group showed increased γGT together with increased expression of CD69 and reduced expression of TLR4, PD1, CCR2 and CXCR4 in peripheral CD8 cells. Other parameters were also specific to Binge drinkers. PCA established 3 factors associated with alcohol consumption: "Early Activation" represented by CD69 and TLR4 expression in the CD8 population; "Effector Activation" by CD69 expression in CD8 CD127(+)CD137(+) and CD8 CD25(+) CD137(+); and Trafficking by CXCR4 expression on total CD8 and CD8 GB(+)CXCR4(+), and CCR2 expression on total CD8. Binge drinking pattern showed low expression of Early Activation and Trafficking factors while Light drinking pattern exhibited high expression of Effector Activation factor. CONCLUSIONS: Alcohol consumption affects the immune phenotype of CD8 cells since binge drinking pattern was found to be associated with high CD69 and low TLR4, CXCR4 and CCR2 expression, which suggest recent activation, decreased sensitivity to LPS and lower migration capacity in response to chemokines SDF-1 and MCP-1. These results indicate that a binge-drinking pattern of alcohol consumption may induce an altered immune profile that could be related with liver damage and the increased susceptibility to infection reported to this behavior.
Assuntos
Consumo Excessivo de Bebidas Alcoólicas/imunologia , Linfócitos T CD8-Positivos/citologia , Linfócitos T CD8-Positivos/imunologia , Movimento Celular , Citotoxicidade Imunológica , Ativação Linfocitária/imunologia , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/imunologia , Antígenos CD/metabolismo , Antígenos de Diferenciação de Linfócitos T/metabolismo , Demografia , Análise Fatorial , Feminino , Humanos , Imunofenotipagem , Lectinas Tipo C/metabolismo , Masculino , Análise de Componente Principal , Receptor 4 Toll-Like/metabolismo , Adulto JovemRESUMO
BACKGROUND: the perinatal mortality (PM) represents a partial expression of a developing country and its health programs. The aim was to determine the rate of PM in a second level hospital that lacks the support of a perinatal care unit, and to help with some epidemiological elements to plan strategies to give a better care in the perinatal stage. METHODS: we collected all records of deaths within the parameters of perinatal death. DATA INCLUDED: maternal age, prenatal history, cause of the perinatal death and birth control information. RESULTS: out of 117 deaths, 59.8 % were in the late fetal death stage, and the rest in the first week of life. The PM rate calculated for each year from 2004 to 2007 was the following: 11.3, 12.8, 12.53, and 15.46: The birth control was good in 73 % of the cases, the most frequent cause of death was the interruption of maternal-fetal circulation in 80 % of the cases, and the early neonatal death was due to perinatal asphyxia in 20 %. The incidence of major malformations was 26.5 %. CONCLUSIONS: the undeniable increase in the PM rate forced us to encourage our staff to improve the availability of adequate material for the neonatal care.
Assuntos
Mortalidade Perinatal/tendências , Adolescente , Adulto , Criança , Hospitais Gerais , Humanos , Recém-Nascido , Estudos Longitudinais , México , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: Chest x-ray (Rx) is the standard test to assess correct placement of a central venous catheter (CVC). Our objective was to validate the use of four clinical measures (CMs) to assess the proper placement of the line. METHODS: During a period of eight month, at the Intensive Care Unit a prospective study was done. A chest Rx was always obtained to assess the position of the catheter. The CMs were: venous return; waveform of the central venous pressure (CVP); arrhythmias while advancing the guide wire and the difference between planned length in cm to be introduced and the length of the catheter introduced. RESULTS: For each parameter alone the sensitivity and specificity found were: for venous return 97% and 22%, for CVP waveform changes 86% and 40%, for arrhythmias 97% and 60%, for difference between planned and real length introduced into the patient 97% and 50% respectively. According to chest x-ray, 78% of the catheters were located at a central position. Using the four CMs, we obtained 86% sensitivity and 90% specificity of the placement of the CVC. CONCLUSIONS: The use of each parameter alone is highly sensitive but poorly specific.
Assuntos
Cateterismo Venoso Central/métodos , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
OBJECTIVE: to evaluate the validity (sensitivity, specificity, and accuracy) of three screening methods used in the early detection of the cervical carcinoma versus the histopathology diagnosis. METHODS: a selected sample of 107 women attended in the Opportune Detection of Cervicouterine Cancer Program in the Hospital de Zona 46, Instituto Mexicano del Seguro Social in Durango, during the 2003 was included. The application of Papa-nicolaou, acetic acid test, and molecular detection of human papillomavirus, and histopatholgy diagnosis were performed in all the patients at the time of the gynecological exam. The detection and tipification of the human papillomavirus was performed by polymerase chain reaction (PCR) and analysis of polymorphisms of length of restriction fragments (RFLP). Histopathology diagnosis was considered the gold standard. The evaluation of the validity was carried out by the Bayesian method for diagnosis test. RESULTS: the positive cases for acetic acid test, Papanicolaou, and PCR were 47, 22, and 19. The accuracy values were 0.70, 0.80 and 0.99, respectively. CONCLUSION: since the molecular method showed a greater validity in the early detection of the cervical carcinoma we considered of vital importance its implementation in suitable programs of Opportune Detection of Cervicouterino Cancer Program in Mexico. However, in order to validate this conclusion, cross-sectional studies in different region of country must be carried out.
Assuntos
Neoplasias do Colo do Útero/diagnóstico , Adulto , Detecção Precoce de Câncer , Feminino , Humanos , Pessoa de Meia-Idade , Adulto JovemAssuntos
Cardiomiopatia Hipertrófica Familiar/genética , Síndrome de Wolff-Parkinson-White/genética , Cardiomiopatia Hipertrófica Familiar/diagnóstico , DNA Mitocondrial/genética , Evolução Fatal , Testes de Função Cardíaca , Humanos , Lactente , Recém-Nascido , Masculino , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico , Taquicardia por Reentrada no Nó Atrioventricular/genética , Síndrome de Wolff-Parkinson-White/complicações , Síndrome de Wolff-Parkinson-White/diagnósticoRESUMO
Atualmente, diversas doenças cardíacas são reconhecidas como de origem genética. As mutações em genes, que codificam várias proteínas do sarcômero com desarranjo miofibrilar e dos miócitos, e a mutação associada à síndrome de Wolff-Parkinson-White, identificada no cromossomo 7q3 como resultado de uma mutação pontual no gene, que codifica uma subunidade reguladora de AMP - proteína quinase ativada, expressa em hipertrofia ventricular, pré-excitação ventricular ou ambas, são dois exemplos de cardiomiopatia hipertrófica familiar 1-3. Outras doenças cardíacas congênitas, nas quais a cardiomiopatia hipertrófica ou dilatada e distúrbios elétricos, podem estar presentes em cerca de 20 a 30 por cento de pacientes, incluem algumas doenças mitocondriais4-6. Apresentamos um caso de uma recém nascida com taquicardia persistente secundaria à síndrome de Wolf-Parkinson-White, na qual hipertrofia importante e outras anormalidades sistêmicas foram atribuídas à doença mitocondrial.
Assuntos
Humanos , Masculino , Recém-Nascido , Lactente , Cardiomiopatia Hipertrófica Familiar/genética , Síndrome de Wolff-Parkinson-White/genética , Cardiomiopatia Hipertrófica Familiar/diagnóstico , DNA Mitocondrial/genética , Evolução Fatal , Testes de Função Cardíaca , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico , Taquicardia por Reentrada no Nó Atrioventricular/genética , Síndrome de Wolff-Parkinson-White/complicações , Síndrome de Wolff-Parkinson-White/diagnósticoRESUMO
In Mexico, more of 36% of malignant tumors in the women are cervical cancer, representing an important public health problem. Although cytologic screening for cervical cancer was introduced in 1974, the mortality rate for this disease has been increasing. The state of Durango represents the second national place in mortality by CaCu (3.4/100,000). Since there are few the studies of DOC program evaluation in Mexico were considered important to evaluated the cervical screening program (coverage, assiduity, diagnoses and pursuit) in the state of Durango. Of 40,000 active sexually women attended in the IMSS; we received 11,185 slides during May of 1999 to April of 2000 for cytologic screening. The coverage in this population was 27.96% (11,185/40,000), 8,187 women (73.2%) had cytologic control at least previous two years, 652 (5.83%) had more of four years without control and 2,346 (21%) assisted for first time. The cytological diagnostic showed 189 abnormal Pap (1.68%), and only 40 of them (21.16%) had cytohistopatholgic pursuit and clinic treatment. According to these results we concluded that DOC program in Gomez Palacio, Durango has a deficiency of coverage (72.04%) and pursuit (78.84%). These results indicated the need for development institutional activities of prevention for increase efficiency of preventive services.
Assuntos
Carcinoma in Situ/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Feminino , Humanos , México , Proteínas Associadas a Pancreatite , Avaliação de Programas e Projetos de Saúde , Fatores de TempoRESUMO
In Mexico, more of 36 of malignant tumors in the women are cervical cancer, representing an important public health problem. Although cytologic screening for cervical cancer was introduced in 1974, the mortality rate for this disease has been increasing. The state of Durango represents the second national place in mortality by CaCu (3.4/100,000). Since there are few the studies of DOC program evaluation in Mexico were considered important to evaluated the cervical screening program (coverage, assiduity, diagnoses and pursuit) in the state of Durango. Of 40,000 active sexually women attended in the IMSS; we received 11,185 slides during May of 1999 to April of 2000 for cytologic screening. The coverage in this population was 27.96 (11,185/40,000), 8,187 women (73.2) had cytologic control at least previous two years, 652 (5.83) had more of four years without control and 2,346 (21) assisted for first time. The cytological diagnostic showed 189 abnormal Pap (1.68), and only 40 of them (21.16) had cytohistopatholgic pursuit and clinic treatment. According to these results we concluded that DOC program in Gomez Palacio, Durango has a deficiency of coverage (72.04) and pursuit (78.84). These results indicated the need for development institutional activities of prevention for increase efficiency of preventive services.
Assuntos
Humanos , Feminino , Carcinoma in Situ , Neoplasias do Colo do Útero , Avaliação de Programas e Projetos de Saúde , México , Fatores de TempoRESUMO
Introducción. La literatura mundial consigna que aproximadamente 50 por ciento de los casos de hipoacusia neurosensorial son atribuidos a factores genéticos; el resto son adquiridos en un alto porcentaje en la etapa perinatal. En población mexicana las características etiológicas de la sordera prelingüística no genética no han sido establecidas. Material y métodos. Se realizó una búsqueda de factores de riesgo para sordera consignados en la literatura mundial, tomando como base el Registro de Alto Riesgo para Sordera del Comité para la Audición Infatil de Estados Unidos de América. El grupo en estudio lo constituyeron 49 lactantes con sordera prelingüística de etiología no genética. El análisis se realizó a través de cálculo de frecuencias y proporciones. Resultados. La presencia de algún factor adverso perinatal (FAP) se documentó en 22 casos (0.45), la sordera fue adquirida durante la etapa de lactancia en 7 casos (0.14), en los 20 casos (0.41) restantes la etiología no fue determinada. De los 22 casos con algún FAP, 7 (0.32) tuvieron un solo factor y resultaron ser en su mayoría recién nacidos de término autróficos que presentaron infección viral congénita, principalmente rubéola; los 15 restantes (0.68) presentaron 2 o más factores y fueron predominantemente pretérminos. Los antecedentes de septicemia, uso de aminoglucósidos e hiperbilirrubinemia se presentaron en alrededor de 75 por ciento de los casos perinatales. La edad de sospecha y el tiempo transcurrido entre la sospecha y el diagnóstico de pérdida auditiva fue menor en los pacientes con FAP. Conclusiones. En alrededor de la mitad de la población se pudo documentar el antecedente de por lo menos un FAP, destacando por su frecuencia los antecedentes de: septicemia, tratamiento con aminoglucósidos, hiperbilirrubinemia e infección congénita por rubéola. El comportamiento de la asociación de factores de riesgo fue diferente de acuerdo a la madurez de los sujetos al nacimiento, pues mientras en la población de término predominó un solo factor de riesgo, en la pretémino en su mayoría se documentó asociación de dos o más factores. La menor edad de sospecha de sordera y el menor tiempo transcurrido entre la sospecha y diagnóstico de deficiencia auditiva en pacientes con FAP...
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Surdez , Surdez/etiologia , Recém-Nascido Prematuro , Pediatria , Prontuários Médicos/estatística & dados numéricos , Fatores de Risco , Inquéritos e Questionários/estatística & dados numéricosRESUMO
Se revisaron los expedientes clínicos de 100 pacientes hospitalizados en el Instituto Nacional de Pediatría entre enero de 1985 y diciembre de 1987, con el diagnóstico de artritis séptica. El 36% de los casos correspondió a menores de 1 año de edad. Las articulaciones más afectadas fueron la cadera, la rodilla y el hombro. El estafilococo fue el agente causal más frecuente en todas las edades, aunque en recién nacidos los gramnegativos juegan un papel muy importante. Se encontró H. influenzae en el grupo de 4 meses a 5 años. La mortalidad por complicaciones fué del 5%; el 30% de los egresados quedaron con secuelas. Los resultados globales no difieren notablemente de lo revisado en la literatura.
Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Masculino , Feminino , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/mortalidade , Artrite Infecciosa/terapia , Doenças Ósseas Infecciosas/complicações , Doenças Ósseas Infecciosas/terapia , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/terapiaRESUMO
Se revisaron 80 casos de sífilis congénita diagnosticados en el Instituto Nacional de Pediatría durante el periodo 1971-1985; 53 (66%) eran del sexo masculino y 27 (34%) del sexo femenino; 33 casos eran niños pretérmino y 39 de término, desconociéndose edad gestacional en ocho casos. Hubo antecedente epidemiológico positivo en los padres en 50 casos (62%), dudoso en 15 y se desconoce en 15; fueron frecuentes las madres solteras (50%) y el abandono paterno (70%). Las madres con antecedente epidemiológico positivo generalmente presentaban poca sintomatología y el 90% de los padres manifestaciones evidentes de sífilis secundaria. Las manifestaciones clínicas que más orientaron al diagnóstico de sífilis congénita fueron las lesiones mucocutáneas presentes en más del 50% de los casos y hepatoesplenomegalia (48%). Se encontró alteración del líquido cefalorraquídeo en 8/36 casos siguiendo un patrón sugestivo de neuroinfección viral más que bacteriana. Los exámenes de laboratorio y gabinete más útiles fueron radiografías de huesos largos. Hubo alteraciones óseas en el 74% de los casos; predominaron la osteocondritis y periostitis de huesos largos. La biometría hemática no fue orientadora. El examen de laboratorio de mayor utilidad fue la serología seriada en los padres y los pacientes; fue positiva en el 98% de los casos. El tratamiento fue a base de penicilina benzatínica 50,000 U/kg/IM dosis única en los casos con LCR normal y PSC 50,000 U/kg/día por 10 días. La evolución una vez establecido el tratamiento fue satisfactoria. La mortalidad fue del 12% debido a proceso septicémico bacteriano agregado y hubo un caso de perforación de colon con peritonitis y septicemia secundaria
Assuntos
Humanos , Masculino , Feminino , Sífilis Congênita/epidemiologia , México , Sífilis Congênita/diagnósticoRESUMO
La tuberculosis laríngea fue una enfermedad común en el pasado asociada a la presencia de tuberculosis pulmonar activa. En la actualidad, con el advenimiento de la quimioterapia antituberculosa, su presentación es rara y se observa principalmente en adultos, siendo en la edad pediátrica un diagnóstico difícil de establecer en ausencia de lesión pulmonar radiológica. El síntoma principal es la disfonía de evolución progresiva; la radiografia de tórax muestra en la mayoría de los casos evidencia de tuberculosis pulmonar. El diagnóstico se confirma por laringoscopia, biopsia e identificación del Mycobacterium tuberculosis en el esputo. Se presenta el caso de una paciente que ingresó por disfonía de evolución progresiva; en la laringoscopia se observaron papilomas laríngeos siendo la biopsia compatible con tuberculosis. El estudio de Combe y la radiografia de tórax fueron positivos; el PPD y el cultivo para M. tuberculosis fueron negativos. Se describe el cuadro clínico y radiológico así como los hallazgos patológicos, similares a los descritos en la literatura
Assuntos
Criança , Humanos , Feminino , Doenças da Laringe/etiologia , Laringe/patologia , Papiloma/etiologia , Tuberculose Pulmonar/complicaçõesRESUMO
Se estudiaron retrospectivamente 25 casos de tétanos atendidos en el Instituto Nacional de Pediatría (INP) comprendidos de Enero/80 a Enero/85, y se compararon los resultados con los publicados por países latinoamericanos, principalmente con los datos obtenidos en el Hospital de Niños Benjamín Bloom (HNBB) de la República de El Salvador, Centro América. Fue más frecuente el tétanos neonatal en un 60% (15/25) principalmente de los estados de Morelos 9/25 y Guerrero 8/25. Las complicaciones más importantes fueron: Sepsis 8/25 y alteraciones respiratorias 8/25. La mortalidad en el INP fue de 28%. Se revisó la tasa de mortalidad a nivel latinoamericano, osciló desde 0.1 x 100,00 hab. en Cuba, hasta 2.4 x 100,00 hab. en Surinam. El HNBB señala una mortalidad del 7.6% en los tétanos neonatal. El número reducido de casos encontrados, no es representativo de la realidad nacional, y se requiere un estudio que comprenda las áreas geográficas, en donde las características socioeconómicas y culturales de la comunidad, aumentan la tasa de frecuencia de esta enfermedad
Assuntos
Recém-Nascido , Lactente , Humanos , Masculino , Feminino , Tétano/epidemiologiaRESUMO
La tuberculosis genital en la infancia es rara. Se presenta con más frecuencia en la puberdad. Se describe el caso de un paciente masculino de 2 años 7 meses de edad con tuberculosis miliar y tumoración de etiología fímica, comprobada por estudio histopatológico y respuesta al tratamiento antifímico