RESUMO
INTRODUCTION: Pulmonary aspergilloma is commonly associated with comorbidities that cause immunodeficiency such as diabetes mellitus, tuberculosis, human immunodeficiency virus/acquired immunodeficiency syndrome and/or a pre-existing parenchymal lung disease such as chronic obstructive pulmonary disease. Predisposing factors can further increase the risk of acquiring this mycosis. Our objective was to determine the frequency, clinical and microbiological characteristics of pulmonary aspergilloma in immunocompromised patients. METHODOLOGY: Retrospective case series of patients diagnosed with pulmonary aspergilloma in a respiratory care unit in Mexico City from 2000 to 2019 was studied. Bronchoalveolar lavage cultures on Sabouraud-dextrose agar and serum galactomannan determination were performed on each patient. RESULTS: We identified twenty-four patients with pulmonary aspergilloma (sixteen male and eight female), thirteen had a history of tuberculosis (54%), seven of diabetes mellitus (29%), three of human immunodeficiency virus/acquired immunodeficiency syndrome (13%) and one of chronic obstructive pulmonary disease (4%). The most commonly reported symptoms were hemoptysis in eighteen patients (75%), dyspnea in sixteen patients (67%) and chest pain in thirteen patients (54%). Aspergillus fumigatus was identified in all cultures and galactomannan was positive in 21 serum samples (87%). CONCLUSIONS: Coexistence of diseases that could suppress the immune system predispose to pulmonary aspergilloma; clinical presentation is often confused with other systemic diseases. A high degree of clinical suspicion is important for early detection.
Assuntos
Síndrome da Imunodeficiência Adquirida , Aspergilose Pulmonar , Doença Pulmonar Obstrutiva Crônica , Tuberculose , Feminino , Humanos , Hospedeiro Imunocomprometido , Masculino , Aspergilose Pulmonar/complicações , Aspergilose Pulmonar/diagnóstico , Aspergilose Pulmonar/epidemiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Unidades de Cuidados Respiratórios , Estudos Retrospectivos , Tuberculose/complicaçõesRESUMO
BACKGROUND: Diabetes mellitus is a public health problem in Mexico, and the trend of the disease is increasing. From 2000 to 2017, 7.32 million new cases were diagnosed, with pulmonary mycoses being one of the most serious complications. AIMS: To describe the frequency and the clinical characteristics of patients diagnosed with pulmonary mycoses, and to identify the risk factors associated with this entity. METHODS: Case-control study, paired by gender (1:1-3) and age (± 5 years), that analyzed patients with pulmonary mycosis (mucormycosis, histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis, cryptococcosis, paracoccidioidomycosis) and studied the risk factors present in each patient. RESULTS: From the 162 patients studied, 56 suffered pulmonary mycosis and 106 were controls. The median of the age was 51 and 50 years for the cases and for the controls, respectively. Multiple logistic regression analysis showed that patients with diabetes mellitus had an odds ratio of 8,3 (p < 0.001), and patients with a history of tuberculosis had an odds ratio of 8,8 (p < 0.001). CONCLUSIONS: Our results show that 52% of the patients with pulmonary mycoses had a history of diabetes mellitus. Diabetes mellitus is a relevant risk factor for pulmonary mycoses, which are usually diagnosed in advanced stages and have a high mortality.
Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Pneumopatias Fúngicas/epidemiologia , Adulto , Estudos de Casos e Controles , Comorbidade , Feminino , Infecções por HIV/epidemiologia , Humanos , Pneumopatias Fúngicas/microbiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tuberculose/epidemiologiaRESUMO
BACKGROUND: There is little information of intensive care unit (ICU) performance when it's relocated to a totally new and equipped area. OBJECTIVE: To analyze the clinical performance and use of resources of a new respiratory-ICU (nRICU) in a large third-level care hospital. METHOD: Cross-sectional, comparative study using prospective data of patients admitted from July 17, 2017 to July 17, 2018. The Rapoport adjusted method was used to obtain the standardized clinical performance index (SCPI) and the standardized resource use index (SRUI). RESULTS: Out of 354 patients, those who were readmissions or remained hospitalized and those whose treatment was withheld or withdrawn where excluded from the analysis. In 301 patients, the observed survival at hospital discharge was 63% while the expected survival was 67.7%. Values of SCPI and SRUI were -1.03 and 0.05 respectively, placing results in coordinates within two standard deviations when plotted in the Rapoport chart. There was a statistically significant difference in survival when comparing the study period with outcomes obtained in the RICU before its relocation (63% vs. 55%, p = 0.01). CONCLUSIONS: In its 1st year of operation, the nRICU had better clinical performance compared to the former RICU, with no change in the use of resources.
ANTECEDENTES: Existe poca información acerca del desempeño de una unidad de cuidados intensivos (UCI) cuando es reubicada en un área totalmente nueva y equipada. OBJETIVO: Analizar el rendimiento clínico y el uso de recursos de la nueva UCI respiratoria (UCIR) de un hospital grande de tercer nivel. MÉTODO: Estudio transversal, comparativo, con datos prospectivos de pacientes ingresados del 17 de julio de 2017 al 17 de julio de 2018. Se usa el método ajustado de Rapoport para obtener el índice de rendimiento clínico estandarizado (IRCE) y el índice de uso de recursos estandarizado (IRURE). RESULTADOS: De 354 pacientes fueron excluidos los reingresos, los pacientes aún hospitalizados y aquellos a quienes se limitó o retiró el tratamiento. En 301 pacientes la sobrevida hospitalaria fue del 63%, mientras que la sobrevida esperada fue del 67.7%. El IRCE fue −1.03 y el IRURE fue 0.05, situando el resultado en coordenadas dentro de dos desviaciones estándar en el gráfico de Rapoport. Hubo una diferencia estadísticamente significativa en la sobrevida comparando el periodo de estudio con resultados de la UCIR obtenidos antes de su reubicación (63 vs. 55%, p = 0.01). CONCLUSIONES: En su primer año de funcionamiento, la nueva UCIR tuvo mejor rendimiento clínico que la antigua, sin modificación en el uso de recursos.
Assuntos
Arquitetura Hospitalar , Unidades de Terapia Intensiva/organização & administração , Adulto , Idoso , Cuidados Críticos/organização & administração , Estudos Transversais , Grupos Diagnósticos Relacionados , Equipamentos e Provisões Hospitalares/estatística & dados numéricos , Feminino , Recursos em Saúde/estatística & dados numéricos , Arquitetura Hospitalar/estatística & dados numéricos , Hospitais Gerais/organização & administração , Hospitais Gerais/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , México , Pessoa de Meia-Idade , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos , Resultado do Tratamento , Desempenho Profissional , Adulto JovemRESUMO
It is known that, in ancient Mexico, diseases of the respiratory system were a major cause of death in the population. Severe epidemics in the XVI Century ravaged and killed nine out of ten indigenous persons. Pre-Hispanic physicians served as medical sorcerers and dealt with the physical and spiritual diseases that afflicted the population. Important medical knowledge pertaining to each culture has been identified; this knowledge explained the diseases depending on the religious beliefs of each culture, and it tried to solve the health problems that afflicted the population at that time.
En el México antiguo se tiene conocimiento de enfermedades propias del sistema respiratorio que fueron una causa importante de mortalidad en la población. Severas epidemias en el siglo XVI asolaron y produjeron la muerte a nueve de cada 10 indígenas. Los médicos prehispánicos se desempeñaban como médicos-hechiceros y atendían las enfermedades físicas y espirituales que aquejaban a la población. Se ha identificado un conocimiento médico importante propio de cada cultura, que explicaba las enfermedades dependiendo de las creencias religiosas e intentaba resolver los problemas de salud que aquejaban a la población en esa época.
Assuntos
Hispânico ou Latino , Humanos , México/epidemiologiaRESUMO
INTRODUCTION: New hospitals are replacing old facilities. There is little information on the performance of an intensive care unit (ICU) when it is relocated in a new and equipped area. OBJECTIVE: To analyze the impact of the change of ICU facilities from a shared environment to individual beds on the occurrence of adverse events. METHOD: Cross-sectional, comparative study, with prospectively collected data from patients admitted from March 01, 2014 to February 28, 2017 to the former ICU (f-ICU) and from July 17, 2017 to January 17, 2019 to the new ICU (n-ICU) of a public teaching hospital. The rate of adverse events was measured in events per 1,000 patient-days. RESULTS: Among 1,188 patients (f-ICU, n = 681 vs. n-ICU, n = 507), a reduction in the rate of unforeseen cardiac arrest (rate ratio: 0.31; 95% confidence interval [CI] = 0.12-0.80) and an increase in the rate of unplanned extubation (rate ratio: 2.49; 95% CI = 1.24-5.01) were observed, with both being statistically significant. The other nine monitored adverse events showed no changes. CONCLUSIONS: In comparison with the f-ICU, most of the monitored adverse events did not significantly change within the first 18 months of activities at the n-ICU.
INTRODUCCIÓN: Nuevos hospitales están reemplazando a instalaciones antiguas. Existe poca información del desempeño de una unidad de cuidados intensivos (UCI) cuando es reubicada en un área nueva y equipada. OBJETIVO: Analizar el impacto del cambio de instalaciones de un ambiente compartido a camas individuales en la ocurrencia de eventos adversos en la UCI. MÉTODO: Estudio transversal, comparativo, con datos prospectivos de pacientes ingresados del 1 de marzo de 2014 al 28 de febrero de 2017 a la antigua UCI (aUCI) y del 17 de julio de 2017 al 17 de enero de 2019 a la nueva UCI (nUCI) de un hospital-escuela público. La tasa de eventos adversos se midió en eventos por 1000 días-paciente. RESULTADOS: En 1188 pacientes (aUCI, n = 681 versus nUCI, n = 507) se observó reducción en la tasa de paro cardiaco no previsto (razón de tasas 0.31, IC 95 % = 0.12-0.80) e incremento en la tasa de extubación no planeada (razón de tasas 2.49, IC 95 % = 1.24-5.01), estadísticamente significativos; los otros nueve eventos adversos monitoreados no mostraron cambios. CONCLUSIONES: Comparada con la aUCI, la mayor parte de eventos adversos monitoreados no se modificaron significativamente en los 18 meses de inicio de actividades de la nUCI.
Assuntos
Extubação/estatística & dados numéricos , Parada Cardíaca/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
INTRODUCTION: In Mexico, there is an alarming increase in the number of cases of Mycobacterium bovis infection on pulmonary and extrapulmonary presentations. The lack of timely identification triggers complications and increases mortality. OBJECTIVE: To know the frequency of M. bovis infections in clinical samples of patients with tuberculosis in the mycobacteria laboratory of a reference hospital in Mexico City. METHOD: Prospective, descriptive study. Strains isolated from biological material were studied in Löwestein-Jensen and MGITI960 cultures. M. bovis was identified by amplifying the RD9 fragment with end-point polymerase chain reaction (PCR). RESULTS: Eight-hundred and fifty tuberculosis-diagnosed patients were included; in 441 cases, Mycobacterium tuberculosis was confirmed by positive culture (250 pulmonary, 65 ganglionic, 39 renal, 34 meningeal, 25 miliary, 14 pleural, 8 peritoneal, 4 bone and 2 pericardial cases). Forty-eight strains (10.8%) were typified as M. bovis by amplification of the RD9 fragment with end-point PCR. CONCLUSIONS: M. bovis is not currently thought of a causative agent of tuberculosis, which could be the cause of pharmacological treatment failure. In this study, the main extrapulmonary form was observed to be cervical lymphadenopathy.
INTRODUCCIÓN: En México existe un incremento alarmante de casos de infección pulmonar y extrapulmonar por Mycobacterium bovis. La falta de identificación oportuna deriva en complicaciones y eleva la mortalidad. OBJETIVO: Conocer la frecuencia de infecciones por Mycobacterium bovis en muestras clínicas de pacientes con tuberculosis, identificadas en el laboratorio de micobacterias en un hospital de concentración de la Ciudad de México. MÉTODO: Estudio prospectivo, descriptivo. Se estudiaron cepas aisladas de material biológico en cultivos Löwestein-Jensen y MGITI960. La identificación de Mycobacterium bovis se realizó mediante la amplificación del fragmento RD9 por PCR punto final. RESULTADOS: Se incluyeron 850 pacientes con diagnóstico de tuberculosis, en 441 casos se confirmó Mycobacterium tuberculosis por cultivo positivo (250 casos pulmonares, 65 ganglionares, 39 renales, 34 meníngeos, 25 miliares, 14 pleurales, ocho peritoneales, cuatro óseos y dos pericárdicos). Se tipificaron 48 cepas (10.8 %) como Mycobacterium bovis por amplificación del fragmento RD9 por PCR punto final. CONCLUSIONES: Actualmente no se piensa en Mycobacterium bovis como agente causal de tuberculosis, lo que pudiera ser la causa del fracaso del tratamiento farmacológico. En este estudio se observó que la principal forma extrapulmonar es la linfadenopatía cervical.
Assuntos
Mycobacterium bovis/isolamento & purificação , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Pulmonar/epidemiologia , Tuberculose/epidemiologia , Adulto , Feminino , Humanos , Masculino , México/epidemiologia , Reação em Cadeia da Polimerase , Estudos Prospectivos , Tuberculose/diagnóstico , Tuberculose/microbiologia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/microbiologiaRESUMO
Background: Tuberculosis is a global public health problem, especially in emerging countries. Mycobacterium tuberculosis is the main cause of cervical lymphadenopathy; nontuberculous mycobacteria are relatively common in children and rare in adults. Objective: To identify and establish the frequency of infectious etiology by nontuberculous mycobacteria in Mexican adult patients with cervical lymphadenopathy. Methods: The study included 85 patients over 18 years with cervical lymphadenopathy; 45 were HIV-positive, 40 were HIV-negative; they had no history of tuberculosis treatment and were selected from a third-level hospital. It was carried out a biopsy of the lymph node for the histopathological study, a search for acid-fast bacilli, a tube culture to indicate growth of Mycobacterium BACTEC (MGIT-960) and identification of mycobacterial strain by PCR-RFLP (restriction fragment length polymorfism) of hsp65. Results: In 42 HIV-positive patients (93%), strains corresponded to Mycobacterium tuberculosis complex, two (4.4%) to M. intracellulare and one (2.2%) to M. gordonae. Among HIV-negative patients, 39 of strains (97.5%) corresponded to patients with M. tuberculosis complex and one strain (2.5%) to M. fortuitum. Conclusion: The presence of nontuberculous mycobacteria was found in 4.7% of all cases. Despite this low frequency, it must be taken into account as a possible cause of lymphadenopathy, since its prompt identification enables introducing specific treatment.
Introducción: la tuberculosis es un problema de salud pública mundial, sobre todo en países emergentes. El Mycobacterium tuberculosis es el principal causante de las adenopatías cervicales; las micobacterias no tuberculosas son relativamente frecuentes en el niño y raras en adultos. Objetivo: identificar y establecer la frecuencia de la etiología infecciosa por micobacterias no tuberculosas (MNT) en pacientes adultos mexicanos con linfadenopatias cervicales. Métodos: se estudiaron 85 pacientes mayores de 18 años, con linfadenopatía cervical, 45 con positividad al virus de la inmunodeficiencia humana (VIH) y 40 VIH negativos, sin antecedentes de tratamiento antituberculoso, seleccionados en un hospital de concentración de especialidad de tercer nivel. Se realizó biopsia de nodo linfático para su estudio histopatológico, búsqueda de bacilos ácido-alcohol resistentes, cultivo en el tubo indicador del crecimiento de Mycobacterium BACTEC (MGIT-960) y la identificación de cepa micobacteriana por PCR-RFLP (restriction fragment lenght polymorfism) de hsp65. Resultados: las cepas correspondieron al complejo Mycobacterium tuberculosis en 42 pacientes VIH positivos (93%), dos (4.4%) a M. intracellulare y una (2.2%) a M. gordonae. Las cepas correspondieron al complejo M. tuberculosis en 39 pacientes VIH negativos (97.5%) y una a M. fortuitum (2.5%). Conclusión: la presencia de MNT se encontró en 4.7% de todos los casos. A pesar de su baja frecuencia, deben ser tomadas en cuenta como posible causa de linfadenopatías, porque su identificación oportuna permite instaurar un tratamiento específico.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Linfadenopatia/epidemiologia , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Tuberculose dos Linfonodos/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Linfadenopatia/diagnóstico , Linfadenopatia/virologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/virologia , Estudos Prospectivos , Tuberculose dos Linfonodos/diagnóstico , Tuberculose dos Linfonodos/virologia , Adulto JovemRESUMO
Non-tuberculous mycobacterial infection has increased significantly in recent years, especially in emerging countries. We present the case of a 25-year-old male patient, immunocompetent, with cervical lymphadenopathy, identifying Mycobacterium kumamotonense, a rare species in extrapulmonary forms and with a high drug resistance index.
Assuntos
Infecções por Mycobacterium não Tuberculosas/microbiologia , Micobactérias não Tuberculosas/classificação , Adulto , Antibióticos Antituberculose/uso terapêutico , Proteínas de Bactérias/genética , Chaperonina 60/genética , Genes Bacterianos , Humanos , Imunocompetência , Linfadenopatia/microbiologia , Masculino , México , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/imunologia , Pescoço , Micobactérias não Tuberculosas/genética , Micobactérias não Tuberculosas/patogenicidade , FilogeniaRESUMO
OBJECTIVE: To evaluate the occurrence of adverse events during a multifaceted program implementation. DESIGN: Cross-sectional secondary analysis. SETTING: The respiratory-ICU of a large tertiary care center. PARTICIPANTS: Retrospectively collected data of patients admitted from 1 March 2010 to 28 February 2014 (usual care period) and from 1 March 2014 to 1 March 2017 (multifaceted program period) were used. INTERVENTIONS: The program integrated three components: (1) strategic planning and organizational culture imprint; (2) training and practice and (3) implementation of care bundles. Strategic planning redefined the respiratory-ICU Mission and Vision, its SWOT matrix (strengths, weaknesses, opportunities, threats) as well as its medium to long-term aims and planned actions. A 'Wear the Institution's T-shirt' monthly conference was given in order to foster organizational culture in healthcare personnel. Training was conducted on hand hygiene and projects 'Pneumonia Zero' and 'Bacteremia Zero'. Finally, actions of both projects were implemented. MAIN OUTCOME MEASURES: Rates of adverse events (episodes per 1000 patient/days). RESULTS: Out of 1662 patients (usual care, n = 981; multifaceted program, n = 681) there was a statistically significant reduction during the multifaceted program in episodes of accidental extubation ([Rate ratio, 95% CI] 0.31, 0.17-0.55), pneumothorax (0.48, 0.26-0.87), change of endotracheal tube (0.17, 0.07-0.44), atelectasis (0.37, 0.20-0.68) and death in the ICU (0.82, 0.69-0.97). CONCLUSIONS: A multifaceted program including strategic planning, organizational culture imprint and care protocols was associated with a significant reduction of adverse events in the respiratory-ICU.