RESUMO
Dengue is a viral disease transmitted by the bite of a female arthropod, prevalent primarily in tropical and subtropical regions. Its manifestations include asymptomatic infections, dengue fever, and a severe form called hemorrhagic dengue or dengue shock syndrome. Atypical manifestations can also occur, called expanded dengue syndrome. We describe the case of a 43-year-old man with an unusual presentation of dengue, demonstrating a workup suggestive of myocardial and pericardial damage. Symptoms and markers indicative of cardiac compromise improved after five days on anti-inflammatory treatment. Dengue myocarditis is considered an uncommon complication of dengue, although its reported incidence is likely an underestimation. In general, most cases of dengue myocarditis are self-limited, with only a minority at risk of progressing to heart failure. In order to improve recognition and prevent progression, healthcare providers should maintain a high degree of suspicion regarding potential cardiac complications in patients with dengue.
Assuntos
Dengue , Cardiopatias , Insuficiência Cardíaca , Miocardite , Dengue Grave , Masculino , Humanos , Feminino , Adulto , Miocardite/diagnóstico , Miocardite/etiologia , Dengue/complicações , Dengue/diagnóstico , Dengue Grave/complicações , Dengue Grave/diagnósticoRESUMO
INTRODUCTION: Antiretroviral treatment for HIV generates dyslipidemia, which is associated with cardiovascular risk and atherosclerosis. OBJECTIVE: To compare antiretroviral agents effects on lipids in patients with HIV-AIDS. METHODS: Retrospective cohort. The lipid profiles of patients receiving efavirenz (EFV) vs. atazanavir (ATV) with a zidovudine + lamivudine backbone for 36 months were compared. RESULTS: 212 patients were included in the study. From baseline to month 36, HDL increase in the group of patients treated with ATV was higher in comparison with that of patients on EFV (8.33 vs. 4.26; p < 0.01); a difference in triglycerides was observed between groups, with a decrease of 19.06 mg/dL in patients on ATV and an increase of 40.62 mg/dL in those who received EFV (p < 0.001). Mean difference in total and LDL-cholesterol change between both treatments was not significant (p = 0.32 and p = 0.951, respectively). CONCLUSIONS: ATV-containing regimens were associated with more favorable changes in triglyceride and HDL levels than EFV regimens. This benefit could be associated with a reduction in long-term cardiovascular risk; this relationship requires further study.
INTRODUCCIÓN: El tratamiento antirretroviral para VIH genera dislipidemia asociada a riesgo cardiovascular y aterosclerosis. OBJETIVO: Comparar los efectos lipídicos de los antirretrovirales en pacientes con VIH-sida. MÉTODOS: Cohorte retrospectiva. Se comparó el perfil lipídico de los pacientes que recibieron efavirenz (EFV) versus atazanavir (ATV) con una backbone de zidovudina + lamivudina durante 36 meses. RESULTADOS: Se incluyeron 212 pacientes. Desde el inicio hasta los 36 meses, el aumento del HDL del grupo de pacientes en tratamiento con ATV fue mayor en comparación con el que presentaron los pacientes con EFV (8.33 versus 4.26, respectivamente; p < 0.01); se observó una diferencia de triglicéridos entre los grupos, con disminución de 19.06 mg/dL en los pacientes con ATV y aumento de 40.62 mg/dL en los que recibieron EFV (p < 0.001). La diferencia de medias en el cambio de colesterol total y LDL entre ambos tratamientos no fue significativa (p = 0.32 y p = 0.951, respectivamente). CONCLUSIONES: Los regímenes con ATV se asociaron a cambios más favorables en los niveles de triglicéridos y HDL que los regímenes con EFV, relación que podría asociarse a reducción del riesgo cardiovascular a largo plazo, la cuál requiere estudios adicionales.
Assuntos
Fármacos Anti-HIV , Infecções por HIV , Alcinos , Fármacos Anti-HIV/efeitos adversos , Sulfato de Atazanavir/uso terapêutico , Benzoxazinas , LDL-Colesterol , Estudos de Coortes , Ciclopropanos , Infecções por HIV/tratamento farmacológico , Humanos , Estudos RetrospectivosRESUMO
PURPOSE: To analyze the prognostic role of positive cultures in patients with sepsis. METHODS: A prospective cohort study in a tertiary referral hospital in Medellín, Colombia. Adults older than 18 years of age with a bacterial infection diagnosis according to Centers for Disease Control criteria and sepsis (evidence of organ dysfunction) were included. A logistic regression model was used to determine the association between positive cultures and hospital mortality, and a Cox regression with a competing risk modeling approach was used to determine the association between positive cultures and hospital stay as well as secondary infections. RESULTS: Overall, 408 patients had positive cultures, of which 257 were blood culture, and 153 had negative cultures. Patients with positive cultures had a lower risk of mortality (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.27-0.68), but this association was not maintained after adjusting for confounding factors (OR, 0.56; 95% CI, 0.31-1.01). No association was found with the hospital stay (adjusted subhazard ratio [SHR], 1.06; 95% CI, 0.83-1.35). There was no association between positive cultures and the presence of secondary infections (adjusted SHR, 0.99; 95% CI, 0.58-1.71). CONCLUSION: Positive cultures are not associated with prognosis in patients with sepsis.
Assuntos
Infecções Bacterianas/mortalidade , Técnicas Bacteriológicas/estatística & dados numéricos , Mortalidade Hospitalar , Sepse/mortalidade , Idoso , Infecções Bacterianas/microbiologia , Colômbia , Resultados de Cuidados Críticos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Sepse/microbiologia , Centros de Atenção TerciáriaRESUMO
OBJECTIVE: To assess the true association between appropriate prescription of antibiotics and prognosis in patients with sepsis, a key issue in health care and quality improvement strategies. METHODS: Prospective cohort study in three university hospitals to determine whether the empirical prescription of antibiotics was adequate or inadequate, and to compare hospital death rates and length of stay according to different classifications of antibiotics prescription. Logistic regression models for risk estimation were fitted. RESULTS: A total of 705 patients with severe sepsis were included. No differences were found in positive-culture patients (n = 545) regarding the risk of death with insufficient spectrum antibiotics, compared to patients who received adequate spectrum antibiotics (OR = 0.90; 95% CI = 0.55-1.48). Delay in initiating antibiotics was not associated with the risk of death in patients with adequate spectrum of antibiotics, either with positive (OR = 1.04; 95% CI = 0.99-1.08) or negative cultures (OR = 0.98; 95% CI = 0.92-1.04). There were no differences in the length of hospital stay, according to the antibiotic prescription (median 11 days, IQR = 7-18 days for the whole cohort). CONCLUSIONS: No associations were found between inadequate antibiotic prescription or delay to initiate therapy and mortality or length of stay.
Assuntos
Antibacterianos/uso terapêutico , Mortalidade Hospitalar , Tempo de Internação/estatística & dados numéricos , Sepse/tratamento farmacológico , Choque Séptico/mortalidade , Idoso , Idoso de 80 Anos ou mais , Bactérias/isolamento & purificação , Colômbia/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sepse/microbiologia , Sepse/mortalidade , Índice de Gravidade de Doença , Choque Séptico/tratamento farmacológico , Choque Séptico/microbiologiaRESUMO
OBJECTIVE: This study aims to expand knowledge of Concha bullosa in a prehistoric population. MATERIALS: The skull of an adult female from the Bronze Age archeological site ofCastellón Alto (Granada, Spain), dated between 1900 and 1600 BCE. METHODS: The diagnosis of middle turbinateconcha bullosa was based on macroscopic, radiographic, and computed tomography studies. RESULTS: This is one of the oldest findings ofconcha bullosa in Europe. Despite the possible obstruction of the osteomeatal complex by the concha bullosa in this individual, no signs of sinusitis were observed in maxillary sinuses. CONCLUSIONS: The maxillary sinuses of this female showed no signs of sinusitis related to theconcha bullosa. SIGNIFICANCE: This study provides new evidence on the chronological limits of this condition. The particular funeral rites of these populations have preserved the majority of skeletons at this site in an excellent condition. LIMITATIONS: The identification ofconcha bullosa continues to be rare in ancient populations, in part due to the poor preservation of nasal bones in archeological collections. Suggestions for further research: Detailed study of the nasal cavity of adequately preserved individuals can be expected to identify further cases of concha bullosa in ancient populations.
Assuntos
Septo Nasal/patologia , Sinusite/patologia , Crânio/patologia , Conchas Nasais/patologia , Europa (Continente) , História Antiga , Humanos , Seio Maxilar/fisiologia , Osso Nasal/diagnóstico por imagem , Cavidade Nasal/patologia , Sinusite/diagnóstico , Sinusite/história , Espanha , Tomografia Computadorizada por Raios X/métodosRESUMO
In this study, effects of lead on ultracellular structure and pigment contents of Brassica napus were examined. Pb(II) was added in soluble form to soil prior to sowing. Pb contents were measured in plant organs at the ontogenetic stages of flowering (FL) and physiological maturity (PM). Pigment contents were evaluated through reflectance measurements. Pb content in organs was found to decrease in the order; roots>stems>leaves. Lead content in senescent leaves at FL stage was significantly higher than harvested leaves, strongly suggesting a detoxification mechanism. Leaves and stems harvested at the PM stage showed damage at subcellular level, namely chloroplast disorganization, cell wall damage and presence of osmiophilic bodies. Chlorophyll content increased in the presence of Pb at the FL stage, compared with control; at the PM stage, chlorophyll contents decreased with low Pb concentration but showed no significant differences with control at high Pb soil concentration. The results suggest an increase in antioxidants at low Pb concentration and cell damage at higher lead concentration.
Assuntos
Brassica napus/efeitos dos fármacos , Chumbo/toxicidade , Fotossíntese/efeitos dos fármacos , Poluentes do Solo/toxicidade , Antioxidantes/metabolismo , Argentina , Biomassa , Brassica napus/metabolismo , Brassica napus/ultraestrutura , Clorofila/metabolismo , Cloroplastos/metabolismo , Monitoramento Ambiental , Chumbo/análise , Folhas de Planta/efeitos dos fármacos , Folhas de Planta/metabolismo , Folhas de Planta/ultraestrutura , Raízes de Plantas/efeitos dos fármacos , Raízes de Plantas/metabolismo , Raízes de Plantas/ultraestrutura , Caules de Planta/efeitos dos fármacos , Caules de Planta/metabolismo , Caules de Planta/ultraestrutura , Solo/química , Poluentes do Solo/análiseRESUMO
Resumen Revascularización del vaso culpable versus completa en enfermedad de múltiples vasos en infarto agudo de miocardio con elevación del segmento ST: metaanálisis de ensayos clínicos. Introducción: se ha recomendado que en los pacientes con infarto agudo de miocardio con elevación del segmento ST se realice revascularización percutánea sólo del vaso culpable. Objetivos: evaluar el efecto de la revascularización percutánea sólo del vaso culpable en comparación a la completa, en pacientes con infarto agudo de miocardio con elevación del segmento ST de menos de 12 horas de evolución para disminuir desenlaces críticos. Material y métodos: se realizó una búsqueda sistemática en las bases de datos bibliográficas, resúmenes de congresos de cardiología y búsqueda manual de los estudios primarios incluidos en otros metaanálisis, de ensayos clínicos con asignación aleatoria de pacientes con infarto agudo de miocardio con elevación del segmento ST de menos de 12 horas de evolución. Resultados: la estrategia de revascularización percutánea completa no aumenta la mortalidad de cualquier causa RR 0.78 (IC 95% 0.44-1.39); ni la de origen cardiovascular RR 0,62 (IC 95% 0.27-1.44), y reduce la frecuencia de reinfartos RR 0.39 (IC 95% 0.2-0.76) y la frecuencia de reintervenciones RR 0.45 (IC 95% 0.31-0.65) en los pacientes con infarto agudo de miocardio con elevación del segmento ST, que se presentan durante las primeras 12 horas de evolución Conclusiones: en pacientes con infarto agudo de miocardio con elevación del segmento ST, quienes se presentan en las primeras 12 horas, la revascularización competa en enfermedad multi-vaso es segura y disminuye la frecuencia de eventos como reinfarto y necesidad de reintervención. (Acta Med Colomb 2016; 41: 116-124).
Abstract Culprit vessel revascularization versus complete revascularization in multivessel disease in acute myocardial infarction with ST segment elevation: meta-analysis of clinical trials. Introduction: it has been recommended to perform only culprit vessel revascularization in patients with acute myocardial infarction with ST-segment elevation. Objectives: to evaluate the effect of percutaneous revascularization of only the culprit vessel compared to the complete in patients with acute myocardial infarction with ST-segment elevation of less than 12 hours of evolution to reduce critical outcomes. Materials and Methods: a systematic search of the literature databases, abstracts of cardiology congress and manual search of primary studies included in other meta-analyzes of clinical randomized trials of patients with acute myocardial infarction with ST-segment elevation of less than 12 hours of evolution, was performed. Results: complete percutaneous revascularization strategy does not increase mortality from any cause RR 0.78 (95% CI 0.44-1.39); nor that of cardiovascular origin RR 0.62 (95% CI 0.27-1.44), and reduces the frequency of reinfarction RR 0.39 (95% CI 0.2-0.76), and the frequency of reoperations RR 0.45 (95% CI 0.31 -0.65) in patients with acute myocardial infarction with ST segment elevation, occurring during the first 12 hours of evolution. Conclusions: in patients with acute myocardial infarction with ST segment elevation who consult in the first 12 hours, complete revascularization in multivessel disease is safe and decreases the frequency of events such as reinfarction and need for reoperation. (Acta Med Colomb 2016; 41: 116-124).