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An 80-year-old man presented to the cardiology outpatient clinic due to shortness of breath. His past medical history included alcohol intake, hypertension, inferior wall myocardial infarction (five years ago), an ischemic stroke, and permanent atrial fibrillation (diagnosed three years before the current examination). A physical exam revealed a decreased intensity of S1 and S2, irregular rate and rhythm, and no murmurs nor friction rub. X-rays, Computed Tomography, and echocardiography exhibited pericardial calcification, involving mostly the inferior wall and protruding into the left ventricle. A diagnosis of constrictive pericarditis due to pericardial calcification was established and considered idiopathic. Even when it may be related to ischemic heart disease, post-infarction pericarditis could explain how the calcification extended to adjacent territory perfused by the circumflex coronary artery. Combined imaging studies were crucial not only for identifying calcium deposits in the pericardium but also in assessing a patient inherently prone to co-existing and exacerbating conditions. Even though pericardiectomy allows for removal of the clinical manifestations of congestive pericarditis in the most symptomatic patients with pericardial calcification, among patients like ours, with tolerable symptoms, cardiologists should discuss the therapeutic options considering the patient's choices, potentially including a rehabilitation plan as part of non-pharmacological management.
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Calcinose , Ecocardiografia , Pericardite Constritiva , Pericárdio , Tomografia Computadorizada por Raios X , Humanos , Masculino , Calcinose/diagnóstico por imagem , Calcinose/patologia , Idoso de 80 Anos ou mais , Pericárdio/patologia , Pericárdio/diagnóstico por imagem , Ecocardiografia/métodos , Pericardite Constritiva/diagnóstico por imagem , Pericardite Constritiva/patologia , Tomografia Computadorizada por Raios X/métodos , Ventrículos do Coração/patologia , Ventrículos do Coração/diagnóstico por imagemRESUMO
El blastoma pulmonar es una neoplasia poco común y agresiva que se origina en el pulmón; está compuesto por tejido mesenquimal y epitelial inmaduro que imita la configuración pulmonar en etapas embrionarias. Tiene una baja incidencia y una alta tasa de mortalidad, con aproximadamente un 60 %. Este blastoma tiende a desarrollarse con mayor frecuencia entre la cuarta y quinta década de vida, siendo más prevalente en mujeres y generalmente asociado al tabaquismo. Se presenta el caso de una mujer de 23 años sin factores de riesgo conocidos, a quien se le diagnosticó incidentalmente un blastoma pulmonar primario. La paciente experimentaba dolor en la región costal izquierda, tos productiva, disnea y hemoptisis desde hace 30 días. Los hallazgos en las imágenes de rayos X y tomografías de tórax llevaron a la realización de una biopsia del pulmón izquierdo, que reveló fragmentos de tejido con una notable presencia de necrosis tumoral. Cinco días después, la paciente consultó nuevamente debido a un empeoramiento de los síntomas, incluyendo dolor torácico de tipo pleurítico. Se decidió realizar una lobectomía inferior izquierda, durante la cual se encontró un tumor sólido adherido a la pleura visceral, con masas tumorales en la pleura parietal. El estudio histopatológico final confirmó el diagnóstico de un tumor maligno de alto grado compatible con blastoma pulmonar. En conclusión, el blastoma pulmonar es una neoplasia rara que puede presentarse en diferentes etapas de la vida, aunque tiene mayor incidencia entre los 40 y 50 años. Es importante que los patólogos consideren esta enfermedad en sus diagnósticos diferenciales debido a los desafíos que implica su diagnóstico. Detectar el blastoma pulmonar en etapas tempranas es crucial para el tratamiento adecuado, aunque actualmente no se conocen marcadores predictivos confiables y el pronóstico de esta enfermedad es generalmente desfavorable.
Pulmonary blastoma is a rare and aggressive neoplasm that originates in the lung. It is composed of immature mesenchymal and epithelial tissue that mimics the embryonic configuration of the lung. It has a low incidence and a high mortality rate, of approximately 60%. Pulmonary blastoma tends to occur more frequently between the fourth and fifth decades of life, being more prevalent in women and generally associated with smoking. The case of a 23-year-old woman with no known risk factors is presented, who incidentally was diagnosed with a primary pulmonary blastoma. The patient experienced pain in the left costal region, productive cough, dyspnea, and hemoptysis for 30 days. Findings on X-ray and chest tomography led to a biopsy of the left lung, which revealed tissue fragments with significant tumor necrosis. Five days later, the patient consulted again due to worsened symptoms, including pleuritic chest pain. It was decided to perform a left lower lobectomy, during which a solid tumor attached to the visceral pleura with tumor masses in the parietal pleura was found. The final histopathological study confirmed the diagnosis of a high-grade malignant tumor compatible with pulmonary blastoma. In conclusion, pulmonary blastoma is a rare neoplasm that can occur at different stages of life, although it has a higher incidence between the ages of 40 and 50. Pathologists need to consider this disease in their differential diagnoses due to the challenges involved in its diagnosis. Detecting pulmonary blastoma at early stages is crucial for appropriate treatment, although currently there are no reliable predictive markers, and the prognosis of this disease is generally unfavorable.
Assuntos
HumanosRESUMO
Accessory mitral valve tissue is a rare congenital cardiac anomaly that is typically discovered incidentally during echocardiographic evaluation prompted by an asymptomatic murmur. This pathology has characteristic echocardiographic elements and is usually associated with other CHD. The decision to perform surgical resection depends on factors such as the degree of obstruction, presence of symptoms, presence of other CHDs, and risk of thrombosis. The researchers hereby present a case of an asymptomatic paediatric patient with accessory mitral valve tissue that produced left ventricular outflow tract obstruction.
Assuntos
Insuficiência da Valva Mitral , Obstrução do Fluxo Ventricular Externo , Humanos , Criança , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Valva Mitral/anormalidades , Diagnóstico Diferencial , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/complicações , Ecocardiografia , Insuficiência da Valva Mitral/cirurgiaRESUMO
BACKGROUND: Despite a large burden of influenza in middle income countries, pediatric vaccination coverage remains low. The aims of this study were to (1) describe mothers' knowledge and attitudes about influenza illnesses and vaccination, and (2) identify characteristics associated with mothers' intent to vaccinate their child. METHODS: From 2015 to 2017, infants 0-11 months old in Nicaragua, Philippines, Jordan, and Albania were enrolled from community settings and hospitals. Interviewers administered a questionnaire to their mothers. Mothers of infants aged 6-11 months rated their intention (small-to-moderate vs. large chance) to accept pediatric vaccination if it was offered at no-cost. The importance of knowledge, attitudes, and sociodemographic characteristics in predicting influenza vaccination intention was measured as the mean decrease in Gini index when that factor was excluded from 1000 decision trees in a random forest analysis. RESULTS: In total, 1,308 mothers were enrolled from the community setting and 3,286 from the hospital setting. Prevalence of at least some knowledge of influenza illness ranged from 34% in Philippines to 88% in Albania (in the community sample), and between 23% in Philippines to 88% in Jordan (in the hospital sample). In the community sample, most mothers in Albania (69%) and Philippines (58%) would accept the influenza vaccine, and these proportions were higher in the hospital sample for all countries except Albania (48%) (P < 0.0001). Perceived vaccine safety (mean decrease in Gini index = 61) and effectiveness (55), and perceived knowledge of influenza vaccine (45) were the most important predictors of influenza vaccination intention in models that also included country and community versus hospital sample. CONCLUSION: Intent to vaccinate infants aged 6-11 months in four middle income countries was tied primarily to knowledge of the vaccine and perceptions of vaccine safety and effectiveness. These findings were noted among mothers interviewed in the community and mothers of recently hospitalized infants.
Assuntos
Vacinas contra Influenza , Influenza Humana , Albânia , Criança , Países em Desenvolvimento , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Recém-Nascido , Influenza Humana/prevenção & controle , Intenção , Jordânia , Mães , Nicarágua/epidemiologia , Filipinas/epidemiologia , VacinaçãoRESUMO
Introduction: Biological products, including infliximab (INF), are a therapeutic option for various medical conditions. In the Peruvian Social Security (EsSalud), infliximab is approved for the treatment of rheumatoid arthritis, psoriasis, psoriatic arthropathy, ankylosing spondylitis, ulcerative colitis and Crohn's disease (in cases refractory to conventional treatment). Biosimilars are a safe and effective alternative approved for these diseases in patients who start treatment with infliximab. Nevertheless, there are people in treatment with the biological reference product (BRP), in whom the continuing therapy with a biosimilar biological product (BBP) must be evaluated. Objectives: To synthesize the best available evidence, calculate a preliminary financial impact and conduct technical discussions about the interchangeability into biosimilar in patients receiving treatment with original infliximab for medical conditions approved in EsSalud. Methodology: We carried out a systematic review of controlled clinical trials. Primary search was performed in Pubmed- MEDLINE, SCOPUS, WOS, EMBASE, TRIPDATABASE, DARE, Cochrane Library, NICE, AHRQ, SMC, McMaster-PLUS, CADTH, and HSE until June-2018. We used the Cochrane Collaboration tool to assess the risk of bias. Also, we implemented a preliminary financial analysis about the impact of biosimilar introduction on institutional purchasing budget. Moreover, technical meetings with medical doctors specialized in rheumatology, gastroenterology and dermatology were held for discussing findings. Results: In primary search, 1136 records were identified, and 357 duplicates were removed. From 799 records, we excluded 765 after title and abstract evaluation. From 14 full-text appraised documents, we included five clinical trials in the risk of bias assessment: four studies evaluated CTP-13 and one tested SB2. Two double-blind clinical trials reported no differences in efficacy and safety profiles between maintenance group (INF/INF) and interchangeability group in all diseases included (INF/CTP-13) and rheumatoid arthritis (CTP13 and SB2). In the other three studies, open-label extension of primary clinical trials, no differences were founded in efficacy and safety profiles between CTP-13/CTP-13 and INF/CTP-13 groups. In financial analysis, the inclusion of biosimilars implied savings around S/7´642,780.00 (1USD=S/3.30) on purchasing budget of EsSalud. In technical meetings, beyond certain concerns, specialists agreed with the findings. Conclusions: Evidence from clinical trials support that there are no differences in efficacy or safety of continuing the treatment with Infliximab BRP or exchanging into its biosimilar in patients with medical conditions approved in EsSalud. Financial analysis shows that the biosimilar introduction produce savings in purchasing institutional budget. Therefore, based on cost-opportunity principle, exchanging into biosimilar in patients receiving the original Infliximab, is a valid therapeutic alternative in the Peruvian Social Security.
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BACKGROUND: Since influenza often presents non-specifically in infancy, we aimed to assess the extent to which existing respiratory surveillance platforms might underestimate the frequency of severe influenza disease among infants. METHODS: The Influenza and Respiratory Syncytial Virus in Infants (IRIS) study was a prospective observational study done at four hospitals in Albania, Jordan, Nicaragua, and the Philippines. We included acutely ill infants aged younger than 1 year admitted to hospital within 10 days or less of illness onset during two influenza seasons (2015-16 and 2016-17) in Albania, Jordan, and Nicaragua, and over a continuous 34 week period (2015-16) in the Philippines. We assessed the frequency of influenza virus infections by real-time RT-PCR (rRT-PCR) and serology. The main study outcome was seroconversion, defined as convalescent antibody titres more than or equal to four-fold higher than acute sera antibody titres, and convalescent antibody titres of 40 or higher. Seroconverison was confirmed by haemagglutination inhibition assay for influenza A viruses, and by hemagglutination inhibition assay and microneutralisation for influenza B viruses. FINDINGS: Between June 27, 2015, and April 21, 2017, 3634 acutely ill infants were enrolled, of whom 1943 were enrolled during influenza seasons and had complete acute-convalescent pairs and thus were included in the final analytical sample. Of the 1943 infants, 94 (5%) were influenza-positive by both rRT-PCR and serology, 58 (3%) were positive by rRT-PCR-only, and 102 (5%) were positive by serology only. Seroconversion to at least one of the influenza A or B viruses was observed among 196 (77%) of 254 influenza-positive infants. Of the 254 infants with influenza virus, 84 (33%) only had non-respiratory clinical discharge diagnoses (eg, sepsis, febrile seizures, dehydration, or other non-respiratory viral illness). A focus on respiratory diagnoses and rRT-PCR-confirmed influenza underdetects influenza-associated hospital admissions among infants by a factor of 2·6 (95% CI 2·0-3·6). Findings were unchanged when syndromic severe acute respiratory infection criteria were applied instead of clinical diagnosis. INTERPRETATION: If the true incidence of laboratory-confirmed influenza-associated hospital admissions among infants is at least twice that of previous estimates, this substantially increases the global burden of severe influenza and expands our estimates of the preventive value of maternal and infant influenza vaccination programmes. FUNDING: US Centers for Disease Control and Prevention.
Assuntos
Anticorpos Antivirais/sangue , DNA Viral/análise , Vírus da Influenza B/genética , Vírus da Influenza B/imunologia , Influenza Humana/diagnóstico , Admissão do Paciente/estatística & dados numéricos , Reação em Cadeia da Polimerase em Tempo Real/métodos , Albânia/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Lactente , Recém-Nascido , Influenza Humana/epidemiologia , Influenza Humana/virologia , Jordânia/epidemiologia , Masculino , Nicarágua/epidemiologia , Vigilância da População , Prevalência , Estudos Prospectivos , Estações do Ano , Fatores de TempoRESUMO
Introducción: la bibliometría se utiliza para evaluar áreas científicas, y resulta un método confiable y universal para medir la productividad de un sector. De la misma manera, determina que los estudios bibliométricos sean cada vez más requeridos y utilizados, hecho que se generaliza en los países científicamente con mayor desarrollo. Objetivo: evaluar la actividad científica y la producción de información de la Revista Información Científica durante el año 2011. Método: se realizó un estudio bibliométrico y descriptivo, de los artículos publicados en la RIC de la universidad médica de Guantánamo durante el año 2011, a través de la red, entre el 15 de enero y el 5 de febrero de 2012. Se revisaron desde la red los 149 artículos publicados en el período mencionado. Las variables estudiadas fueron: tipo de documentos, sexo, número de autores por artículos, municipios e instituciones donde se realizaron las investigaciones, cantidad de referencias bibliográficas utilizadas y grado de actualización. Resultados: los artículos originales fueron los más publicados, con predominio de autores del sexo femenino y autoría grupal de cuatro y cinco investigadores por artículo. Guantánamo es el municipio que más contribuyó con trabajos; la Universidad Médica y el Hospital General Docente provincial son las instituciones de mayor aporte. Hubo predominio en el uso de las referencias bibliográficas actualizadas, lo que refuerza la credibilidad, validez y rigor científico de esta revista guantanamera. Conclusiones: la RIC en sus 18 años de existencia ha sabido consolidarse. Los elementos novedosos aportados por este estudio, y que no habían sido investigados hasta ahora, constituyen datos valiosos para la política de información de la institución y lograr que el órgano oficial de los profesionales de la salud en Guantánamo gane en prestigio y calidad(AU)
Introduction: bibliometrics is used to evaluate scientific areas, and is a reliable and universal method to measure the productivity of a sector. In the same way, it determines that bibliometric studies are increasingly required and used, a fact that is generalized in scientifically developed countries. Objective: to evaluate the scientific activity and the information production of the Scientific Information Magazine during the year 2011. Method: a bibliometric and descriptive study was carried out of the articles published in the RIC of the medical university of Guantánamo during the year 2011, through the network, between January 15 and February 5, 2012. The 149 articles published in the aforementioned period were reviewed from the network. The variables studied were: type of documents, sex, number of authors per article, municipalities and institutions where the research was carried out, number of bibliographic references used and degree of update. Results: the original articles were the most published, with a predominance of female authors and group authorship of four and five researchers per article. Guantanamo is the municipality that contributed most with jobs; the Medical University and the Provincial Teaching General Hospital are the institutions with the greatest contribution. There was a predominance in the use of updated bibliographical references, which reinforces the credibility, validity and scientific rigor of this Guantanamera magazine. Conclusions: the RIC in its 18 years of existence has been able to consolidate. The novel elements contributed by this study, which had not been investigated until now, are valuable data for the information policy of the institution and ensure that the official organ of health professionals in Guantanamo gain in prestige and quality(AU)
Introdução: a bibliometria é usada para avaliar áreas científicas e é um método confiável e universal para medir a produtividade de um setor. Da mesma forma, determina que os estudos bibliométricos sejam cada vez mais necessários e utilizados, fato generalizado nos países cientificamente desenvolvidos. Objetivo: avaliar a atividade científica e a produção de informação da revista Scientific Information durante o ano de 2011. Método: foi realizado um estudo bibliométrico e descritivo dos artigos publicados na RIC da universidade médica de Guantánamo durante o ano de 2011, através da rede, entre 15 de janeiro e 5 de fevereiro de 2012. Os 149 artigos publicados no período supracitado foram revisados da rede. As variáveis estudadas foram: tipo de documentos, sexo, número de autores por artigo, municípios e instituições onde a pesquisa foi realizada, número de referências bibliográficas utilizadas e grau de atualização. Resultados: os artigos originais foram os mais publicados, com predominância de autores femininos e autoria de grupo de quatro e cinco pesquisadores por artigo. Guantánamo é o município que mais contribuiu com empregos; a Universidade Médica e o Hospital Geral Provincial de Ensino são as instituições com maior contribuição. Houve predomínio no uso de referências bibliográficas atualizadas, o que reforça a credibilidade, validade e rigor científico desta revista Guantanamera. Conclusões: o RIC em seus 18 anos de existência conseguiu consolidar. Os elementos novos contribuídos por este estudo, que não haviam sido investigados até agora, são dados valiosos para a política de informação da instituição e garantem que o órgão oficial dos profissionais de saúde em Guantánamo ganhe em prestígio e qualidade(AU)
Assuntos
Bibliometria , Publicação PeriódicaRESUMO
BACKGROUND: This multi-country prospective study of infants aged <1 year aims to assess the frequency of influenza virus and respiratory syncytial virus (RSV) infections associated with hospitalizations, to describe clinical features and antibody response to infection, and to examine predictors of very severe disease requiring intensive care. METHODS/DESIGN: We are enrolling a hospital-based cohort and a sample of non-ill infants in four countries (Albania, Jordan, Nicaragua, and the Philippines) using a common protocol. We are currently starting year 2 of a 2- to 3-year study and will enroll approximately 3,000 infants hospitalized for any acute illness (respiratory or non-respiratory) during periods of local influenza and/or RSV circulation. After informed consent and within 24 h of admission, we collect blood and respiratory specimens and conduct an interview to assess socio-demographic characteristics, medical history, and symptoms of acute illness (onset ≤10 days). Vital signs, interventions, and medications are documented daily through medical record abstraction. A follow-up health assessment and collection of convalescent blood occurs 3-5 weeks after enrollment. Influenza and RSV infection is confirmed by singleplex real time reverse transcriptase polymerase chain reaction (rRT-PCR) assays. Serologic conversion will be assessed comparing acute and convalescent sera using hemagglutination inhibition assay for influenza antibodies and enzyme-linked immunosorbent assay (ELISA) for RSV. Concurrent with hospital-based enrollment, respiratory specimens are also being collected (and tested by rRT-PCR) from approximately 1,400 non-ill infants aged <1 year during routine medical or preventive care. DISCUSSION: The Influenza and RSV in Infants Study (IRIS) promises to expand our knowledge of the frequency, clinical features, and antibody profiles of serious influenza and RSV disease among infants aged <1 year, quantify the proportion of infections that may be missed by traditional surveillance, and inform decisions about the potential value of existing and new vaccines and other prevention and treatment strategies.
Assuntos
Hospitalização/estatística & dados numéricos , Influenza Humana/epidemiologia , Infecções por Vírus Respiratório Sincicial/epidemiologia , Vírus Sincicial Respiratório Humano/isolamento & purificação , Albânia/epidemiologia , Anticorpos Antivirais , Feminino , Humanos , Lactente , Influenza Humana/diagnóstico , Jordânia/epidemiologia , Masculino , Nicarágua/epidemiologia , Filipinas/epidemiologia , Prevalência , Estudos Prospectivos , Reação em Cadeia da Polimerase em Tempo Real , Infecções por Vírus Respiratório Sincicial/diagnóstico , Vírus Sinciciais Respiratórios , Fatores de RiscoRESUMO
Introducción: Desde el inicio de la pandemia del VIH, las infecciones oportunistas (IO) han marcado su pronóstico. El acceso a la terapia antirretroviral de gran actividad (TARGA) supone cambios significativos en la historia natural de la enfermedad. Objetivo: Describir las características de la IO en los pacientes con VIH internados en el Hospital Universitario de Neiva (HUHMP). Materiales y métodos: Estudio observacional, descriptivo, retrospectivo. Se incluyeron pacientes adultos hospitalizados con diagnóstico de VIH/SIDA e IO durante 2007 a 2012; se excluyeron gestantes. Un total de 286 pacientes cumplieron los criterios de selección. Los datos se procesaron en Epi info7. Resultados: El promedio de edad fue de 38,6 años; el 72,7% fueron hombres; el 76,5% tenían diagnóstico de VIH previo al ingreso y el 45,6% no recibían TARGA. Al ingreso, el 39% de los pacientes presentaban leucopenia, el 15%, falla renal, el 70%, conteos de linfocitos TCD4+ < 200 cel/mm ³ , y el 64%, viremia > 100.000 copias/mm ³ . Los diagnósticos de egreso más frecuentes fueron toxoplasmosis cerebral (52%), candidiasis mucocutánea (35%) y tuberculosis (31%). La mortalidad hospitalaria fue del 13%. Conclusión: A pesar de los avances en el manejo del VIH/SIDA, en la región surcolombiana la mayoría de pacientes se hospitalizan en estadios avanzados por IO y no reciben TARGA. La IO más frecuente fue toxoplasmosis cerebral.
Introduction: Since the beginning of the HIV pandemic, opportunistic infections (OI) have determined the prognosis. Access to antiretroviral therapy (HAART) led to significant changes in the natural history of the disease. Objective: To describe the clinical characteristics of patients with HIV and OIs admitted to the Universitary Hospital of Neiva (HUHMP). Materials and methods: An observational, descriptive, retrospective study of hospitalized adults with HIV/AIDS admitted due to OIs during 2007-2012; pregnant women were excluded. The data were processed using Epi info7. Results: A total of 286 patients met the selection criteria. The mean age was 38.6 years and 72.7% were men. 76.5% were diagnosed with HIV prior to entry, 45.6% were not receiving HAART.On admission 39% of patients had leukopenia, 15% renal failure, 70% CD4 + lymphocyte counts< 200 cells/mm ³ and 64% viremia > 100,000 copies/mm ³ . The most common discharge diagnoseswere cerebral toxoplasmosis (52%), mucocutaneous candidiasis (35%) and tuberculosis (31%). Hospital mortality was 13%. Conclusion: Despite improvement in the management of HIV/AIDS in the southwestern region of Colombia, most HIV patients are hospitalized at advanced HIV-stages due to OIs, and are not receiving HAART. The most common OI was cerebral toxoplasmosis.