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Systemic lupus erythematosus (SLE) is a disease that affects the immune system, and it can lead to increased morbidity and mortality. The primary causes of mortality for individuals with SLE are disease activity, infections, drug toxicity, and other health conditions. The aim of this study is to estimate the mortality rate of patients with SLE who are hospitalized, describe the causes of death, and identify factors associated with mortality. The study was conducted at a referral hospital from 2009 to 2021, utilizing a nested case-control design. The records of patients with SLE who were hospitalized in the Department of Rheumatology were reviewed. Cases were identified as individuals who died during their hospitalization, while controls were those who were discharged alive during the same period. Elective hospitalizations were not included in the study. The primary causes of death were recorded, and demographic, clinical, laboratory, and immunological variables were analyzed as potential risk factors associated with in-hospital mortality. The study included 105 patients who died while hospitalized and 336 who were discharged alive. The estimated mortality rate was 10.93 deaths per 1000 hospital admissions per year. The leading causes of death were SLE activity (20%), infections (34.2%), or a combination of both (24.8%). Risk factors associated with in-hospital mortality were any infection (OR 2.5, CI 95% 1.2-5.2), nosocomial infections (OR 5.0, CI 95% 1.8-13.7), SLEDAI-2K > 2 (OR 2.0, CI 95% 1.02-3.8), lymphopenia (OR 2.1, CI 95% 1.01-4.6), anemia (OR 2.9, CI 95% 1.4-5.7), and thrombocytopenia (OR 3.3, CI 95% 1.7-6.4). Disease activity and infections, particularly nosocomial infections, are significant causes of mortality in hospitalized patients with SLE. Furthermore, hematological manifestations play a significant role in in-hospital mortality for these patients.
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BACKGROUND: Immune cell counts in blood in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection may be useful prognostic biomarkers of disease severity, mortality, and response to treatment. OBJECTIVES: To analyze sub-populations of lymphocytes at hospital admission in survivors and deceased from severe pneumonia due to coronavirus disease-2019 (COVID-19). METHODS: We conducted a cross-sectional study of healthcare workers confirmed with SARS-CoV-2 in convalescents (control group) and healthy controls (HC) diagnosed with severe COVID-19. Serum samples were taken at hospital admission and after recovery. Serum samples ≥ 25 days after onset of symptoms were analyzed for lymphocyte subpopulations through flow cytometry. Descriptive statistics, Kruskall-Wallis test, receiver operating characteristic curve, calculation of sensitivity, specificity, predictive values, and Kaplan-Meier analysis were performed. RESULTS: We included 337 patients: 120 HC, 127 convalescents, and 90 severe COVID-19 disease patients (50 survivors, 40 deceased). For T cells, total lymphocytes ≥ 800/µL, CD3+ ≥ 400/µL, CD4+ ≥ 180/µL, CD8+ ≥ 150/µL, B cells CD19+ ≥ 80/µL, and NK ≥ 34/µL subsets were associated with survival in severe COVID-19 disease patients. All subtypes of lymphocytes had higher concentrations in survivors than deceased, but similar between HC and convalescents. Leukocytes ≥ 10.150/µL or neutrophils ≥ 10,000/µL were associated with increased mortality. The neutrophil-to-lymphocyte ratio (NLR) ≥ 8.5 increased the probability of death in severe COVID-19 (odds ratio 11.68). CONCLUSIONS: Total lymphocytes; NLR; and levels of CD3+, CD4+, CD8+, and NK cells are useful as biomarkers of survival or mortality in severe COVID-19 disease and commonly reach normal levels in convalescents.
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Linfócitos T CD4-Positivos/patologia , Linfócitos T CD8-Positivos/patologia , COVID-19 , Linfopenia , Neutrófilos/patologia , Biomarcadores/sangue , COVID-19/sangue , COVID-19/diagnóstico , COVID-19/mortalidade , COVID-19/terapia , Correlação de Dados , Estudos Transversais , Feminino , Humanos , Estimativa de Kaplan-Meier , Células Matadoras Naturais/patologia , Contagem de Leucócitos/métodos , Linfopenia/sangue , Linfopenia/diagnóstico , Linfopenia/etiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Mortalidade , Valor Preditivo dos Testes , Avaliação de Sintomas/métodosRESUMO
INTRODUCTION: Health staff self-applied strategies are insufficiently to reduce cardiovascular risk factors. The aim of this article is to investigate the prevalence of overweight, obesity and metabolic syndrome and waist/height index on health staff. METHODS: This is a cross-sectional study from January to April 2014 in 735 workers of the UMAE Specialties La Raza. A diagnosis of overweight and obesity was established according to WHO criteria and metabolic syndrome NCEP ATP-III. In 250 participants lipid profile and blood chemistry were obtained. Descriptive statistics was applied, chi square, Student t test or Kruskal-Wallis to compare groups. RESULTS: We included 496 women and 239 men (physicians, nurses and other workers). 38% were overweight; 22% had obesity. We found fasting hyperglycemia>126 mg/dl in 5.1%, between 100-126 mg/dl in 17.4%, hypertriglyceridemia in 40.4%; HDL cholesterol<40 mg/dl 66% in men and HDL cholesterol<50 mg/dl 51.4% in women. Waist measurement was 93±11 cm in men vs. 88±13 m in women. The waist/height index in the ideal weight group was 0.048±0.04, for overweight 0.55±0.04 and for obesity 0.65±0.064 (p<0.01). Metabolic syndrome prevalence was 30.6%, smoking 21.6% and alcohol consumption 35%. CONCLUSIONS: The prevalence of obesity-overweight was 60% and metabolic syndrome 30%, making it necessary to take immediate actions to modify the lifestyle of health staff.
Introducción: el personal de salud se autoaplica insuficientes estrategias para reducir sus propios factores de riesgo cardiovascular. El objetivo fue investigar la prevalencia de sobrepeso, obesidad y síndrome metabólico en personal de salud.Métodos: diseño transversal de enero a abril de 2014, en 735 trabajadores de la UMAE Especialidades La Raza. El diagnóstico de sobrepeso y obesidad se estableció acorde a criterios de la OMS y síndrome metabólico NCEP ATP-III. En 250 participantes se realizó perfil de lípidos y química sanguínea. Se aplicó estadística descriptiva, chi cuadrada, t de Student o Kruskal-Wallis al comparar los grupos, el valor de significancia fue p < 0.05.Resultados: incluimos 496 mujeres y 239 hombres (entre médicos, enfermeras y otros). Tuvieron sobrepeso 38 %, y obesidad 22 %. Encontramos hiperglucemia de ayuno > 126 mg/dl 5.1 %, entre 100-126 mg/dl 17.4 %, hipertrigliceridemia 40.4 %; colesterol-HDL < 40 mg/dl en 66 % de hombres y colesterol-HDL < 50 mg/dl en 51.4 % de mujeres. La cintura 93 ± 11cm en hombres frente a 88 ± 13 cm en mujeres. El índice cintura/talla en el grupo de peso ideal fue 0.048 ± 0.04, en el de sobrepeso 0.55 ± 0.04 y en el de obesidad 0.65 ± 0.064. Tuvieron síndrome metabólico 30.6 %, tabaquismo 21.6 % y consumo de alcohol 35 %. Solo 2 % presentaron presión arterial > 135/85.Conclusiones: la prevalencia de obesidad y sobrepeso del personal de salud es de 60 % y de síndrome metabólico 30 %, por lo que es necesario tomar acciones inmediatas que modifiquen el estilo de vida del personal de salud.
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Síndrome Metabólica/epidemiologia , Sobrepeso/epidemiologia , Recursos Humanos em Hospital/estatística & dados numéricos , Razão Cintura-Estatura , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Síndrome Metabólica/complicações , Síndrome Metabólica/diagnóstico , México/epidemiologia , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/diagnóstico , Obesidade/epidemiologia , Sobrepeso/complicações , Sobrepeso/diagnóstico , PrevalênciaRESUMO
OBJECTIVE: To evaluate comparatively the carotid intima media thickness index (IMT) and brachial index with Doppler ultrasound, and pulmonary artery pressure with echocardiography in allelic variation of G894T and T-789C eNOS (endothelial nitric oxide synthase) in patients with systemic sclerosis. METHODS: This is a cross-sectional study in patients with scleroderma. The inclusion criteria were: age 18-70 years, scleroderma diagnosed patients with a prior informed consent. Polymorphism G894T and T-789C of eNOS was measured in blood, and IMT by carotid and brachial Doppler. We analyzed with descriptive statistics, Student's t test or chi square for association of variables and Spearman to correlate Doppler parameters. RESULTS: We found abnormally high IMT in carotid and brachial arteries. We also observed low correlation between both brachial arteries, good correlation between carotids and no correlation between carotid and brachial arteries. The left IMT>0.65 mm in brachial artery corresponds to pulmonary pressure>30 mmHg by echocardiography. G894T gene polymorphism was associated with increased IMT in right carotid. CONCLUSION: The G894T eNOS polymorphism was associated with increased IMT in right carotid. The one side carotid IMT is consistent with its contralateral. The left brachial IMT above to 0.65 mm, suggests the possibility of pulmonary arterial hypertension.
Introducción: el objetivo de este estudio es evaluar comparativamente el grosor íntima-media (IMT) carotídeo y braquial con ultrasonido Doppler, la presión arterial pulmonar ecocardiográfica y la variación alélica de los genes G894T y T-789C de la eNOS en pacientes con esclerodermia. Métodos: estudio transversal en pacientes con esclerodermia. Criterios de inclusión: edad 18-70 años, diagnosticado con esclerodermia, previo consentimiento informado. Se evaluó IMT, índice de resistencia (IR) e índice de pulsatilidad (IP) mediante Doppler carotídeo y braquial, perfil de lípidos, proteína C reactiva, polimorfismo G894T y T-789C de óxido nítrico sin tasa endotelial (eNOS). Analizamos con estadística descriptiva, prueba t de Student o chi cuadrada para asociación de variables y Spearman para correlacionar las variables cuantitativas. Resultados: encontramos IMT anormalmente alto en arterias carotídeas y braquiales. Observamos baja correlación entre ambas braquiales, buena correlación entre carótidas y ninguna correlación entre carótidas y braquiales. El IMT braquial izquierdo > 0.65 corresponde con presión arteria pulmonar > 30 mmHg ecocardiográfica. El polimorfismo del gen G894T se asoció con mayor IMT en carótida derecha.Conclusión: El polimorfismo G894T de eNOS se asocia a mayor IMT en carótida derecha. El IMT carotídeo concuerda con su IMT contralateral. El IMT braquial izquierdo mayor a 0.65 sugiere la posibilidad de hipertensión arterial pulmonar.
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Aterosclerose/genética , Artéria Braquial/fisiopatologia , Espessura Intima-Media Carotídea , Óxido Nítrico Sintase Tipo III/genética , Polimorfismo de Nucleotídeo Único , Escleroderma Sistêmico/fisiopatologia , Adolescente , Adulto , Idoso , Aterosclerose/diagnóstico por imagem , Aterosclerose/etiologia , Artéria Braquial/diagnóstico por imagem , Estudos Transversais , Ecocardiografia , Feminino , Marcadores Genéticos , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/genética , Masculino , Pessoa de Meia-Idade , Escleroderma Sistêmico/genética , Ultrassonografia Doppler , Adulto JovemRESUMO
INTRODUCTION: Systemic sclerosis (SSc) is a systemic autoimmune disease characterized by fibrosis, immunological and vascular abnormalities. Cerebral hypoperfusion can be caused by cerebral ischemia. Cognitive impairment (CI) are a major cause of morbidity in SSc The aim of this study is to estimate the frequency of alterations in cerebral perfusion (CP) in SSc patients with CI. METHODS: We studied 88 patients with SSc. The Montreal Test (MT) was given to all patients to evaluate CI. To 15 patients with CI and without systemic hypertension, diabetes mellitus, cerebrovascular disease, vasculitis, hypothyroidism, depression, and drugs that interfere with the cognitive assessment, the PC was measured by cerebral gammagram (CG). RESULTS: Of the 88 patients with ES, 58 had CI by MT. A decrease in CP was observed in following lobes: frontal in 9 of 15 patients, temporal in 7 of 15, and parietal in 3 of 15. Concordance between MT and CG was 60% for the frontal, 46% for the temporal and parietal 13%. CONCLUSIONS: The CI is common in SSc. A decrease in CP was more frequent in the frontal lobe, predominating in older patients and with longer duration of SSc.
Introducción: la esclerosis sistémica (ES) es una enfermedad autoinmune, sistémica, caracterizada por fibrosis, alteraciones inmunológicas y vasculares. La hipoperfusión cerebral puede ser causada por isquemia. Los trastornos cognitivos son causa importante de morbilidad. El objetivo de este estudio fue determinar la frecuencia de alteraciones en la perfusión cerebral (PC) en pacientes con ES y deterioro cognitivo (DC). Métodos: se estudiaron 88 pacientes con ES. A todos se les aplicó el Test de Montreal (TM) para evaluar el DC. A 15 pacientes con DC que cumplieron con los criterios (sin hipertensión arterial sistémica, diabetes mellitus, evento vascular cerebral, vasculitis, hipotiroidismo, depresión, sin ingesta de fármacos que interfieran con la evaluación cognitiva), se les midió la PC mediante Gamagrama Cerebral Perfusorio (GCP).Resultados: de los 88 pacientes con ES, 58 tuvieron DC con el TM. La PC se encontró disminuida en 12/15. La disminución de la PC se observó en los siguientes lóbulos (frontal en 9/15; temporal en 7/15, y parietal en 3/15. La concordancia entre el TM y GC fue 60 % para el lóbulo frontal, 46 % para el lóbulo temporal y 13 % parietal.Conclusiones: el DC es frecuente en la ES, la disminución de la PC fue más común en el lóbulo frontal, predominado en los pacientes de mayor edad y tiempo de evolución de la ES.