RESUMO
INTRODUCTION: Information about seasonal distribution of Neuromyelitis optica spectrum disorders (NMOSD) attacks, particularly in tropical countries, has rarely been described and the reported data are diverse. OBJECTIVE: To evaluate influence of seasonal variation in NMOSD relapses in an equatorial country. PATIENTS AND METHODS: Exploratory observational, retrospective ecological study in a cohort of patients with NMOSD followed from January 2008 to December 2019. Data of demographic, clinical information, characteristics of relapses and seasonal temporal variation were recorded. Also, the annual, monthly and intra-annual seasonal variation of relapses was quantified. A negative binomial regression was used to estimate the associations between the number of relapses and climatic and temporal variables. RESULTS: One hundred thirteen patients were included, most of them were female (89.38%), with a mean age at NMOSD diagnosis was 44.97 (±13.98) and the median of relapses per patient were 2 relapses (IQR 1-3). The patients presented 237 relapses, most of these in AQP4 seropositive patients (87.76%) and longitudinal extensive myelitis was the most frequent type of relapse (53.59%). According to the temporal variation, relapses were more common in the second rainy season (28.69%) during November and December. However, there weren't significant differences in the number of relapses between seasons and climatic variables in the multivariable model. CONCLUSION: The number of NMOSD relapses in this equatorial country cohort did not exhibit any significant associations with climatic variations, including changes in rainy or dry seasons.
TITLE: Recaídas del trastorno de espectro de la neuromielitis óptica e influencia estacional en una cohorte de un país ecuatorial.Introducción. La evidencia sobre la distribución estacional de las recaídas del trastorno del espectro de la neuromielitis óptica (NMOSD), especialmente en países tropicales, es limitada y diversa. Objetivo. Evaluar la influencia de las variaciones estacionales en las recaídas del NMOSD en un país localizado sobre la línea ecuatorial. Pacientes y métodos. Se llevó a cabo un estudio ecológico, con información retrospectiva de una cohorte de pacientes con NMOSD atendida entre enero de 2003 y diciembre de 2020 en Medellín, Colombia. Se recolectaron datos demográficos y clínicos de los pacientes, así como información sobre variables estacionales y climáticas. Se calculó la frecuencia de recaídas por estación, mes y año, y se realizó una regresión binomial negativa para evaluar la asociación entre el número de recaídas, y las variables estacionales y climáticas. Resultados. Se incluyó a 113 pacientes, de los cuales el 89,38% eran mujeres, con una edad media en el momento del diagnóstico de NMOSD de 44,97 (±13,98) años y una mediana de tres recaídas (rango intercuartílico: 1-2). Se registraron 237 recaídas, la mayoría en pacientes seropositivos para anticuerpos antiacuaporina 4 (87,76%) y con mielitis longitudinal extensa como la presentación clínica más común (53,59%). Las recaídas se presentaron con mayor frecuencia durante la segunda temporada lluviosa (28,69%; n = 68), y en los meses de noviembre y diciembre. Sin embargo, en la regresión binomial negativa no se observó una asociación significativa entre el número de recaídas y las variables climáticas y estacionales, los meses y los años. Conclusión. Las variables climáticas y los patrones estacionales no muestran una asociación significativa con cambios en el número de recaídas del NMOSD en pacientes residentes en un país localizado sobre la línea ecuatorial.
Assuntos
Neuromielite Óptica , Humanos , Feminino , Masculino , Neuromielite Óptica/epidemiologia , Estações do Ano , Estudos Retrospectivos , Doença Crônica , Projetos de PesquisaRESUMO
OBJECTIVE: Primary outcome was to evaluate complete improvement at six months after acute treatment in NMOSD relapses. METHODS: Retrospective observational cohort study of patients with diagnosis of NMOSD admitted for acute attacks. We performed an explanatory analysis using the univariate, bivariate and multivariate logistic regression approach. We compared survival curves using the Kaplan Meier analysis and estimated the median time for the main outcome. RESULTS: In the univariate analysis, basal EDSS score, AQP4-IgG positivity, PLEX as a first-line treatment (IVMP + PLEX), less systemic complications related to acute treatment and total attack history were independently associated with complete improvement at six months. After adjusting for confounding variables and using multivariate analysis by Cox Regression, positive AQ4-IgG (HR 0.04, 95% CI: 0.02-0.66) and IVMP + PLEX (HR 5.1, 95% CI: 3.9-66.4), were kept as independent factors associated to time to complete improvement. Time from admission to PLEX initiation and complete improvement at six months had a median of seven days (95% CI: 5.2-8.8). In secondary effects, there were no statistical differences between the groups. CONCLUSIONS: PLEX + IVMP is the treatment of choice for NMOSD relapses and should be initiated as early as possible.
RESUMO
PURPOSE OF INVESTIGATION: The aim of this study was to evaluate the effect of LEEP and cold-knife conization on the outcome of subsequent pregnancy in a tertiary public hospital. METHODS: One hundred and ninety-nine patients met the inclusion criteria (age between 18 and 45 years old). Cold-knife conization, LEEP, and both (conization and LEEP) were performed in 102 (51.3%), 95 (47.7%) and two (1%) women, respectively. Average ages were respectively, 33 +/- 7.3; 25 +/- 6.73 and 30 +/- 2.8. RESULTS: Pregnancies occurred 2.6 and 4.8 years after LEEP and conization, respectively. Miscarriages and preterm pregnancies were more frequent in conization cases versus LEEP, 26% and 5.2%, 23% and 5.5%, respectively. CONCLUSION: If patients express a desire for pregnancy, LEEP should be the procedure of choice.
Assuntos
Aborto Espontâneo/etiologia , Conização/efeitos adversos , Eletrocirurgia/efeitos adversos , Nascimento a Termo , Adolescente , Adulto , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Neoplasias do Colo do Útero/cirurgia , Adulto Jovem , Displasia do Colo do Útero/cirurgiaAssuntos
Tomografia Computadorizada por Raios X , Traqueobroncomegalia/diagnóstico por imagem , Adulto , Bronquiectasia/diagnóstico por imagem , Broncoscopia , Dilatação Patológica , Divertículo/diagnóstico por imagem , Humanos , Masculino , Traqueia/diagnóstico por imagem , Traqueia/patologia , Doenças da Traqueia/diagnóstico por imagemRESUMO
É apresentado um caso de tuberculose endobrônquica exuberante em paciente do sexo masculino, 29 anos, HIV negativo, sob os aspectos endoscópicos, após a instituiçäo de terapêutica específica. Tendo em vista a alta prevalência da tuberculose infecçäo/doença em nosso meio e as seqüelas em potencial desta forma de tuberculose, os autores enfatizam a importância do exame endoscópico do aparelho respiratório no diagnóstico, tratamento e acompanhamento das lesöes endobrônquicas