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1.
J. bras. pneumol ; 47(4): e20210039, 2021. tab, graf
Article in English | LILACS | ID: biblio-1340141

ABSTRACT

ABSTRACT Objective: Obstructive sleep apnea (OSA) is associated with an increased risk of mortality and cardiometabolic diseases. The STOP-Bang questionnaire is a tool to screen populations at risk of OSA and prioritize complementary studies. Our objective was to evaluate the clinical utility of this questionnaire in identifying patients at an increased risk of mortality after discharge in a cohort of hospitalized patients. Methods: This was a prospective cohort study involving consecutive patients admitted to an internal medicine unit between May and June of 2017 who were reevaluated three years after discharge. At baseline, we collected data on comorbidities (hypertension, obesity, diabetes, and fasting lipid profile) and calculated STOP-Bang scores, defining the risk of OSA (0-2 score, no risk; ≥ 3 score, risk of OSA; and ≥ 5 score, risk of moderate-to-severe OSA), which determined the study groups. We also recorded data regarding all-cause and cardiovascular mortality at the end of the follow-up period. Results: The sample comprised 435 patients. Of those, 352 (80.9%) and 182 (41.8%) had STOP-Bang scores ≥ 3 and ≥ 5, respectively. When compared with the group with STOP-Bang scores of 0-2, the two groups showed higher prevalences of obesity, hypertension, diabetes, and dyslipidemia. Multivariate analysis showed an independent association between cardiovascular mortality and STOP-Bang score ≥ 5 (adjusted hazard ratio = 3.12 [95% CI, 1.39-7.03]; p = 0.01). Additionally, previous coronary heart disease was also associated with cardiovascular mortality. Conclusions: In this cohort of hospitalized patients, STOP-Bang scores ≥ 5 were able to identify patients at an increased risk of cardiovascular mortality three years after discharge.


RESUMO Objetivo: A apneia obstrutiva do sono (AOS) está associada a um risco maior de mortalidade e doenças cardiometabólicas. O questionário STOP-Bang é uma ferramenta para rastrear populações em risco de AOS e assim priorizar estudos complementares. Nosso objetivo foi avaliar a utilidade clínica desse questionário na identificação de pacientes com risco aumentado de mortalidade após a alta em uma coorte de pacientes hospitalizados. Métodos: Estudo de coorte prospectivo com pacientes consecutivos internados em uma unidade de medicina interna entre maio e junho de 2017 que foram reavaliados três anos após a alta. No momento basal, coletamos dados sobre comorbidades (hipertensão, obesidade, diabetes e perfil lipídico em jejum) e calculamos as pontuações no STOP-Bang, definindo o risco de OSA (pontuação 0-2, sem risco; pontuação ≥ 3, risco de AOS; e pontuação ≥ 5, risco de AOS moderada a grave), que determinou os grupos de estudo. Também registramos dados sobre mortalidade por todas as causas e mortalidade cardiovascular ao final do período de acompanhamento. Resultados: Foram incluídos 435 pacientes. Desses, 352 (80,9%) e 182 (41,8%) apresentaram pontuações no STOP-Bang ≥ 3 e ≥ 5, respectivamente. Quando comparados com o grupo com pontuação no STOP-Bang de 0-2, os outros dois grupos apresentaram prevalências mais elevadas de obesidade, hipertensão, diabetes e dislipidemia. A análise multivariada mostrou uma associação independente entre mortalidade cardiovascular e pontuação no STOP-Bang ≥ 5 (razão de risco ajustada = 3,12 [IC95%, 1,39-7,03]; p = 0,01). Além disso, doença coronariana prévia também foi associada à mortalidade cardiovascular. Conclusões: Nesta coorte de pacientes hospitalizados, pontuações no STOP-Bang ≥ 5 foram capazes de identificar pacientes com risco aumentado de mortalidade cardiovascular três anos após a alta.


Subject(s)
Humans , Hypertension , Prospective Studies , Surveys and Questionnaires , Cohort Studies , Polysomnography
2.
J. bras. pneumol ; 47(4): e20210131, 2021. tab, graf
Article in English | LILACS | ID: biblio-1340140

ABSTRACT

ABSTRACT Objective: To describe baseline characteristics of outpatients with a positive RT-PCR for SARS-CoV-2 and to define whether "red flags" (new-onset fever, dyspnea, and chest pain) can predict clinical worsening during the isolation period. Methods: This was an epidemiological, observational, descriptive study. Between March and September of 2020, all outpatients who tested positive for SARS-CoV-2 at a tertiary medical center located in Santiago de Chile were included. Demographic variables, comorbidities, red flags, and other symptoms were compiled using follow-up surveys at specific time points. The risk of clinical worsening (hospitalization) and adjusted hazard ratios (HRs) were calculated. Results: A total of 7,108 patients were included. The median age was 38 years (range, 0-101), and 52% were men. At baseline, 77% of the patients reported having characteristic symptoms of SARS-CoV-2 infection. The most prevalent onset symptoms were headache (53%), myalgia (47%), and fever (33%). According to the follow-up surveys, the incidence of symptoms decreased during the isolation period; however, 28% of the patients still presented with symptoms on day 14. The risk of hospitalization for patients with new-onset fever and dyspnea during the follow-up period was HR = 7.43 (95% CI, 3.85-14.3, p<0.01) and HR = 5.27 (95% CI, 1.52-18.30; p < 0.01 for both), respectively. New-onset chest pain showed no association with clinical worsening. Conclusions: In this sample of outpatients with a recent diagnosis of SARS-CoV-2 infection, a survey-based monitoring of symptoms was useful to identify those at risk of clinical worsening. New-onset fever and dyspnea during the isolation period were considered as red flags associated with clinical worsening and warrants prompt medical evaluation.


RESUMO Objetivo: Descrever as características basais de pacientes ambulatoriais com RT-PCR positivo para SARS-CoV-2 e definir se os sintomas de alerta para gravidade (febre, dispneia e dor torácica de início recente) podem prever piora clínica durante o período de isolamento. Métodos: Trata-se de um estudo epidemiológico, observacional e descritivo. Entre março e setembro de 2020, foram incluídos todos os pacientes ambulatoriais com teste positivo para SARS-CoV-2 em um centro médico terciário localizado em Santiago do Chile. Variáveis demográficas, comorbidades, sintomas de alerta para gravidade e outros sintomas foram compilados usando pesquisas de seguimento em intervalos específicos. Também foram calculados o risco de piora clínica (hospitalização) e as razões de risco (RR) ajustadas. Resultados: Foi incluído um total de 7.108 pacientes. A mediana de idade foi de 38 anos (variação: 0-101), e 52% eram homens. No início do estudo, 77% dos pacientes relataram sintomas característicos de infecção por SARS-CoV-2. Os sintomas recentes mais prevalentes foram cefaleia (53%), mialgia (47%) e febre (33%). De acordo com as pesquisas de seguimento, a incidência de sintomas diminuiu durante o período de isolamento; no entanto, 28% dos pacientes ainda apresentavam sintomas no dia 14. O risco de hospitalização para pacientes com febre e dispneia de início recente durante o período de seguimento foi RR = 7,43 (IC95%: 3,85-14,3; p < 0,01) e RR = 5,27 (IC95%: 1,52-18,30; p < 0,01 para ambos), respectivamente. A dor torácica de início recente não mostrou associação com a piora clínica. Conclusões: Nesta amostra de pacientes ambulatoriais com um diagnóstico recente de infecção por SARS-CoV-2, um monitoramento dos sintomas baseado em pesquisa foi útil para identificar aqueles com risco de piora clínica. Febre e dispneia de início recente durante o período de isolamento foram consideradas sintomas de alerta associados ao agravamento clínico e justificam avaliação médica imediata.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , SARS-CoV-2 , COVID-19 , Reverse Transcriptase Polymerase Chain Reaction , Pandemics , Hospitalization
3.
Rev. méd. Chile ; 148(5): 689-696, mayo 2020. tab
Article in Spanish | LILACS | ID: biblio-1139354

ABSTRACT

Coronavirus infection (SARS-CoV-2), is a pandemic disease declared by the World Health Organization (WHO). This disease reports a high risk of contagion, especially by the transmission of aerosols in health care workers. In this scenario, aerosol exposure is increased in various procedures related to the airway, lungs, and pleural space. For this reason, it is important to have recommendations that reduce the risk of exposure and infection with COVID-19. In this document, a team of international specialists in interventional pulmonology elaborated a series of recommendations, based on the available evidence to define the risk stratification, diagnostic methods and technical considerations on procedures such as bronchoscopy, tracheostomy, and pleural procedures among others. As well as the precautions to reduce the risk of contagion when carrying out pulmonary interventions.


Subject(s)
Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Coronavirus Infections/prevention & control , Pandemics , Infection Control
4.
Rev. méd. Chile ; 148(1): 46-53, Jan. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1094205

ABSTRACT

Background: Supplementation of vitamin B12 in older adults is a common practice to avoid vitamin B12 insufficiency. However, there is a paucity of information about the effects of cobalamin excess. Aim: To asses any potential effects of high levels vitamin B12 on mortality on adults aged ≥ 65 years admitted to an internal medicine service. Material and Methods: We Prospectively studied patients admitted to an internal medicine service of an academic hospital from September 2017 to September 2018, who were able to give their consent and answer questionnaires. We tabulated age, gender, medical history, comorbidity index (Charlson), frailty score (Fried scale), admission diagnosis and blood tests performed within 48 hours of admission. The primary outcome was death by any cause in less of 30 days or after one of year follow up, determined according to death certificates. Results: We included 93 patients aged 65 to 94 years (53% males). Fifteen patients died during the year of follow up (five within 30 days of admission). Those who died had higher cobalamin levels than survivors (1080.07 ± 788.09 and 656.68 ± 497.33 pg/mL respectively, p = 0.02). Patients who died had also a significantly lower corrected serum calcium, sodium (p = 0.04) and a medical history of chronic liver disease (p = 0.03). In the multivariable analysis, only vitamin B12 preserved the association with mortality (p = 0.009). Conclusions: There was a significant association between high levels of cobalamin and all-cause mortality in this group of patients aged ≥ 65 years-old.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Vitamin B 12 Deficiency , Vitamin B 12 , Surveys and Questionnaires , Hospitalization , Hospitals , Internal Medicine
5.
Rev. méd. Chile ; 148(1): 109-117, Jan. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1094213

ABSTRACT

Systematic reviews evaluating multiple interventions can be useful in different clinical situations. However, some concerns arise when more than two interventions are compared and there is a paucity of good quality randomized clinical trials. A novel statistical method based on indirect comparisons, called network meta-analysis (NMA), can be a useful approach to find a clinical answer when multiple interventions are evaluated for the same outcome or comparator. The aim of this review is to describe the main characteristics and provide a user guide for a critical analysis of NMA focusing on its three main domains, namely homogeneity, transitivity and consistency.


Subject(s)
Network Meta-Analysis
7.
Rev. méd. Chile ; 147(10): 1315-1322, oct. 2019. graf
Article in Spanish | LILACS | ID: biblio-1058599

ABSTRACT

Tridimensional printing is becoming relevant in medicine, specially in surgical and interventional specialties. We review the technical aspects and clinical application of airway tridimensional printing. Using this technique, simulation models for bronchoscopy and models for diagnostic and therapeutic procedures such as stent design, tracheal reconstruction and airway models can be created.


Subject(s)
Humans , Respiratory System , Printing, Three-Dimensional , Models, Anatomic , Prostheses and Implants , Prosthesis Design , Trachea , Stents , Simulation Training
8.
Rev. méd. Chile ; 146(9): 1033-1040, set. 2018. tab
Article in Spanish | LILACS | ID: biblio-978794

ABSTRACT

Bronchoscopy cryoprobes are used for palliative treatment of endobronchial obstructions caused by tumors and removal of granulation tissue or foreign bodies. Currently this technology is also used for diagnosis of diffuse interstitial lung disease (ILD). The multidisciplinary team that establishes the clinical, radiological and histopathological correlation in ILD, decides about performing a surgical lung biopsy when the characteristics of the interstitial disease are not similar to Idiopathic Pulmonary Fibrosis (IPF). Although surgical lung biopsy is the gold standard for diagnosis, treatment, and prognosis, transbronchial cryo-biopsy has a high diagnostic yield, low morbidity and mortality rate, low rate of complications and lower cost. It is the diagnostic method of choice in ILD when it is available. Technological improvements with greater freezing power and tensile strength of the cryo probes, allow their use in cryotherapy and cryo-recanalization for occlusive airway tumors.


Subject(s)
Humans , Bronchoscopy/methods , Lung Diseases, Interstitial/diagnosis , Cryotherapy/methods , Biopsy/methods , Tomography, X-Ray Computed , Lung Diseases, Interstitial/classification , Lung Diseases, Interstitial/physiopathology
9.
Rev. méd. Chile ; 145(9): 1165-1171, set. 2017. graf
Article in Spanish | LILACS | ID: biblio-902602

ABSTRACT

In the last years, several techniques have been developed to obtain a prompt diagnosis or rule out lung cancer. Endobronchial ultrasound- guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure with a high diagnostic yield for mediastinal and central pulmonary lesions. This procedure is especially useful for lung cancer diagnosis and mediastinal staging. Two different types of EBUS are currently available: Radial EBUS and lineal EBUS. Each one has technical differences together with a range of clinical indications. The aim of this review is to discuss about EBUS-TBNA and its current clinical indications, evidence about the accuracy of the procedure for lung cancer diagnosis and staging, and evaluation of the pathological and molecular studies (EGFR, ALK, and ROS1) obtained through EBUS-TBNA and rapid on-site evaluation (ROSE).


Subject(s)
Humans , Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods , Lung/pathology , Lung Neoplasms/pathology , Reproducibility of Results , Endosonography/instrumentation , Endosonography/methods , Endoscopic Ultrasound-Guided Fine Needle Aspiration/instrumentation , Lung/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Mediastinal Neoplasms/pathology , Mediastinal Neoplasms/diagnostic imaging , Medical Illustration , Neoplasm Staging
10.
Rev. méd. Chile ; 145(5): 667-672, mayo 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-902525

ABSTRACT

Chronic obstructive pulmonary disease (COPD) has no curative treatment, and in moderate to advanced stages, functional parameters and quality of life are affected. Lung volume reduction improves respiratory parameters and quality of life of these patients. Endoscopic lung volume reduction is a minimally invasive procedure that uses endobronchial valves or coils. Valves are unidirectional, blocking the air from entering the target lobe during inspiration, allowing the exit of air and secretions during expiration. Complete fissure and absence of collateral ventilation are needed for an adequate functioning of endobronchial valves. Endobronchial coils cause mechanical retraction of the lung parenchyma. We report two patients who underwent endoscopic lung volume reduction by endobronchial valves. One patient was on continuous positive pressure non-invasive ventilation due to his severe emphysema.


Subject(s)
Humans , Male , Middle Aged , Aged , Pulmonary Emphysema/surgery , Organ Size , Pneumonectomy/methods , Severity of Illness Index , Bronchoscopy/methods , Treatment Outcome
11.
Rev. méd. Chile ; 144(7): 903-909, jul. 2016. ilus, tab
Article in Spanish | LILACS | ID: lil-794004

ABSTRACT

The use of thoracic ultrasound as a diagnostic tool in the emergency department, intensive care unit or in patients with pulmonary diseases is increasing steadily. It is used to guide percutaneous tracheostomies, to assess pleural effusions, to rule out pneumothorax, and to guide the placement of endovascular and pleural catheters. It is also useful in the assessment of patients with dyspnea. The aim of this review is to provide the practical and technical basics for the use of this diagnostic tool among internists and specialists in pulmonary diseases.


Subject(s)
Humans , Pleural Effusion/diagnostic imaging , Pneumothorax/diagnostic imaging , Pulmonary Edema/diagnostic imaging , Ultrasonography/methods , Thoracostomy/methods , Tracheostomy/methods , Acute Disease
12.
Rev. méd. Chile ; 144(3): 341-346, mar. 2016. tab
Article in Spanish | LILACS | ID: lil-784903

ABSTRACT

Background: Endobronchial ultrasound-guided trans-bronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure with a high diagnostic yield for lesions adjacent to the central airway. Aim: To describe the diagnostic yield of EBUS-TBNA for lesions suspicious of Non-Small Cell Lung Cancer (NSCLC). Material and Methods: Prospective study of 128 patients aged 25 to 87 years (56% males) undergoing EBUS-TBNA. Radiological features of the lesions were recorded by chest CT scan such as morphology, margins of the lesion, lesion size and location based on the International Association for the Study of Lung Cancer (IASLC) map. Definitive pathological results were evaluated. Results: The average size of lesions was 18.5 millimeter and; 68 cases were of less than 20 millimeters. Sensitivity was 96.7%, specificity 100%, and negative predictive value 93.3%. The most common histological diagnosis was adenocarcinoma. Conclusions: EBUS-TBNA is a useful diagnostic tool for NSCLC suspicious lesions adjacent to the central airway.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Bronchoscopy/methods , Carcinoma, Non-Small-Cell Lung/pathology , Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods , Lung Neoplasms/pathology , Bronchoscopy/adverse effects , Prospective Studies , Reproducibility of Results , Risk Factors , Sensitivity and Specificity , Tumor Burden , Endoscopic Ultrasound-Guided Fine Needle Aspiration/adverse effects
13.
Rev. méd. Chile ; 144(2): 262-266, feb. 2016. ilus, tab
Article in Spanish | LILACS | ID: lil-779495

ABSTRACT

Chronic eosinophilic pneumonia (CEP) is uncommon and predominantly seen in women. More than 6% of eosinophils in peripheral blood and more than 25% in bronchoalveolar lavage are diagnostic criteria. Secondary causes of hypereosinophilic pneumonia must be ruled out. We report a 72-year-old non-smoker man presenting in the emergency room with a history of cough, fever, and moderate dyspnea. He was not taking any medication. A chest-X ray showed a left lower lobe (LLL) consolidation, and was started on broad-spectrum antibiotics with a presumptive diagnosis of pneumonia. There was no improvement after therapy. A chest CT scan showed increased LLL consolidation and new left upper lobe ground glass opacities as well as a moderate left pleural effusion. Flexible bronchoscopy was performed and bronchoalveolar lavage showed 95% eosinophils, and had negative cultures. No parasites were identified. Transbronchial biopsies demonstrated eosinophil accumulation in alveoli and interstitium and pleural fluid was composed by 85% eosinophils. With the diagnosis of CEP, systemic corticosteroids were used with favorable clinical and radiological response.


Subject(s)
Humans , Male , Aged , Pulmonary Eosinophilia/diagnosis , Biopsy , Tomography, X-Ray Computed , Chronic Disease
14.
J. bras. pneumol ; 41(3): 219-224, May-Jun/2015. tab
Article in English | LILACS | ID: lil-751961

ABSTRACT

OBJECTIVE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive diagnostic test with a high diagnostic yield for suspicious central pulmonary lesions and for mediastinal lymph node staging. The main objective of this study was to describe the diagnostic yield of EBUS-TBNA for mediastinal lymph node staging in patients with suspected lung cancer. METHODS: Prospective study of patients undergoing EBUS-TBNA for diagnosis. Patients ≥ 18 years of age were recruited between July of 2010 and August of 2013. We recorded demographic variables, radiological characteristics provided by axial CT of the chest, location of the lesion in the mediastinum as per the International Association for the Study of Lung Cancer classification, and definitive diagnostic result (EBUS with a diagnostic biopsy or a definitive diagnostic method). RESULTS: Our analysis included 354 biopsies, from 145 patients. Of those 145 patients, 54.48% were male. The mean age was 63.75 years. The mean lymph node size was 15.03 mm, and 90 lymph nodes were smaller than 10.0 mm. The EBUS-TBNA method showed a sensitivity of 91.17%, a specificity of 100.0%, and a negative predictive value of 92.9%. The most common histological diagnosis was adenocarcinoma. CONCLUSIONS: EBUS-TBNA is a diagnostic tool that yields satisfactory results in the staging of neoplastic mediastinal lesions. .


OBJETIVO: La ultrasonografía endobronquial con aspiración transbronquial por aguja fina (EBUS-TBNA, por sus siglas en inglés) es una alternativa mínimamente invasiva con un alto rendimiento diagnóstico para lesiones pulmonares centrales sospechosas de cáncer o para etapificación de linfonodos mediastínicos. El objetivo principal de este trabajo es describir el rendimiento de EBUS-TBNA como método de etapificación de linfonodos mediastínicos en pacientes con sospecha de cáncer pulmonar. MÉTODOS: Estudio prospectivo de pacientes sometidos a EBUS-TBNA como método diagnóstico. Se seleccionaron pacientes mayores de 18 años entre julio del 2010 y agosto del 2013. Se registraron variables demográficas, características radiológicas mediante TC axial de tórax, localización mediastínica según clasificación de la International Association for the Study of Lung Cancer y resultado diagnóstico definitivo (EBUS con biopsia diagnóstica o método diagnóstico definitivo). RESULTADOS: Se incluyeron 145 pacientes con un total de 354 biopsias. El 54,48% de los pacientes eran hombres, con edad promedio de 63,75 años. El tamaño promedio de los linfonodos fue de 15,03 mm, y 90 fueron menores de 10,0 mm. El rendimiento diagnóstico fue: sensibilidad, 91,17%; especificidad, 100,0%; y valor predictivo negativo, 92,9%. El diagnóstico histológico más frecuente fue adenocarcinoma. CONCLUSIONES: EBUS-TBNA es una herramienta diagnóstica con buenos resultados en el estudio de etapificación de lesiones neoplásicas en mediastino. .


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Carcinoma, Non-Small-Cell Lung/pathology , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Lung Neoplasms/pathology , Lymphatic Metastasis/pathology , Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Lymphatic Metastasis , Mediastinum , Neoplasm Staging , Predictive Value of Tests , Prospective Studies , Sensitivity and Specificity
15.
Rev. méd. Chile ; 143(4): 433-438, abr. 2015. ilus, tab
Article in Spanish | LILACS | ID: lil-747548

ABSTRACT

Background: Bronchoscopy is a minimally invasive procedure used for the diagnosis of lung cancer. Aim: To report our experience with bronchoscopy and transbronchial biopsies for the diagnosis of potentially malignant pulmonary lesions. Material and Methods: Revision of electronic records from patients who underwent transbronchial biopsies seeking for lung cancer. The diagnostic yield of the procedure was evaluated using pathology reports or a 24 months follow up. Results: 261 patients were included. Bronchoscopy was diagnostic in 65% of cases. Lesions mean diameter was 51 mm (range 9-120 mm). Diagnostic yield for lesions less than 30 mm was 59%, for lesions less than 35 mm was 61%, and for lesions over 40 mm was 69%. The presence of malignant lesions and their location in the superior or middle lobe were associated with a better predictive value of the procedure. TNM staging was IIIB/IV in 80% of the patient at the time of diagnosis. Conclusions: The diagnostic yield of bronchoscopy is influenced by the etiology and location of lung lesions.


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Adenocarcinoma/pathology , Bronchoscopy/methods , Carcinoma, Squamous Cell/pathology , Lung Neoplasms/pathology , Lung/pathology , Anesthesia, Local , Adenocarcinoma/secondary , Biopsy, Needle , Biopsy/methods , Cohort Studies , Carcinoma, Squamous Cell/secondary , Follow-Up Studies , Fluoroscopy/methods , Lung Neoplasms/secondary , Neoplasm Staging , Predictive Value of Tests , Smoking/pathology
16.
Rev. méd. Chile ; 142(6): 748-757, jun. 2014. ilus, tab
Article in Spanish | LILACS | ID: lil-722925

ABSTRACT

Obstructive Sleep Apnea (OSA) is characterized by repetitive upper airway collapse with apnea/hypopnea and recurrent hypoxia during sleep, which results in fragmented sleep and intermittent drops in arterial blood oxygen saturation (hypoxemia). Several dysfunctions of neurocognitive, endocrine, cardiovascular, and metabolic systems are recognized in patients with OSA. The most commonly reported associations are with obesity, increased cardiovascular risk, dyslipidemia, diabetes mellitus 2 and liver damage. However, there is a proven relationship between OSA and other diseases, such as polycystic ovary syndrome, gastroesophageal reflux, and chronic kidney disease. The aim of this review is to analyze clinical and experimental evidence linking OSA with other diseases.


Subject(s)
Humans , Sleep Apnea, Obstructive/complications , Sleep Apnea, Obstructive/physiopathology
17.
Rev. méd. Chile ; 142(3): 299-304, mar. 2014. tab
Article in Spanish | LILACS | ID: lil-714353

ABSTRACT

Background: Flexible bronchoscopy is a useful diagnostic tool with a relative low rate of complications. Aim: To analyze post procedure risk of complications after flexible bronchoscopy with transbronchial or bronchial biopsy. Material and Methods: The electronic database of a bronchoscopy unit at a general Hospital was analyzed. All procedures performed between 2009 and 2011 were reviewed and complications recorded. The primary outcome measure was the risk for complications de fined as the percentage of procedures complicated by hemorrhage, pneumothorax, desaturation < 80% and other complications. We used a logistic regression model to explore the association between each procedure characteristic and complication. Results: One thousand seventy nine procedures were included in the analysis. Eight percent had complications. Among these, the frequency of hemorrhage was 5.9% and pneumothorax was 0.3%. Factors associated with complications were exclusive use of topical anesthesia with an odds ratio (OR) of 1.72 (confidence intervals (CI): 1.04-2.86), regular or bad intolerance to the procedure with an OR 4.70 (CI: 3.00-7.38) and performing biopsies of the upper lobes with an OR of 1.76 (CI: 1.04-2.97). Conclusions: Exclusive use of topical anesthesia, performing biopsies of the upper lobes and procedure tolerance were risk factors associated with complications following bronchoscopic biopsies.


Subject(s)
Female , Humans , Male , Middle Aged , Bronchoscopy/adverse effects , Bronchoscopy/statistics & numerical data , Retrospective Studies , Risk Factors
18.
Rev. chil. infectol ; 30(6): 669-672, dic. 2013. ilus
Article in Spanish | LILACS | ID: lil-701717

ABSTRACT

Treatment failure in community-acquired pneumonia is defined as a clinical condition with inadequate response to antimicrobial therapy. Resistant and unusual microorganisms and noninfectious causes are responsible for treatment failure. Coccidioides immitis is a fungus that causes pneumonia in the northern hemisphere, especially in the United States and northern Mexico. We report a case of pulmonary coccidioidomycosis imported from Mexico to Chile. After a comprehensive study, histopathology was able to establish Coccidiodes immitis as the causative agent, achieving clinical and radiological improvement with antifungal therapy.


La neumonía de evolución tórpida son aquellas en que no se logra una respuesta clínica adecuada con el uso de terapia antimicrobiana. Existen múltiples causas a esta falta de respuesta: resistencia antimicrobiana, microorganismos no cubiertos o infecciones por microorganismos atípicos. Coccidioides immitis es un hongo causante de neumonía en el hemisferio norte, especialmente en E.U.A y norte de México. No existen reportes de casos pulmonares importados en Chile. Presentamos el caso de una mujer adulta con una neumonía que no respondió al tratamiento antimicrobiano habitual. Una vez realizado un estudio exhaustivo, se logró establecer mediante el estudio histopatológico la existencia de una coccidiodomicosis como entidad causal, logrando una respuesta clínica y radiológica favorable al tratamiento antifúngico.


Subject(s)
Female , Humans , Middle Aged , Coccidioidomycosis , Lung Diseases, Fungal , Antifungal Agents/therapeutic use , Chile , Coccidioidomycosis/diagnosis , Coccidioidomycosis/drug therapy , Community-Acquired Infections/diagnosis , Community-Acquired Infections/drug therapy , Community-Acquired Infections/microbiology , Diagnosis, Differential , Lung Diseases, Fungal/diagnosis , Lung Diseases, Fungal/drug therapy , Lung Diseases, Fungal/microbiology , Mexico , Pneumonia/diagnosis , Travel , Treatment Failure
19.
Artrosc. (B. Aires) ; 19(4): 168-172, dic. 2012.
Article in Spanish | LILACS | ID: lil-674973

ABSTRACT

Introducción: Existe una amplia variedad de factores técnicos que pueden repercutir en los resultados de la reparación artroscópica del manguito rotador. Objetivo: Evaluar biomecánicamente el comportamiento de distintas alternativas técnicas para reparar el manguito rotador en un modelo animal. Material y Método: 96 tendones infraespinosos de cordero se dividieron en 8 grupos de estudio. Para pasar la sutura se usaron combinaciones de pasadores artroscópicos de distinto diámetro (1 mm, 2 mm y 3 mm de diámetro), punto de sutura a 5 y 10 mm del borde libre del tendón roto y reparación con punto simple o mattress. Se aplicó una fuerza axial progresiva, hasta el fallo de la reparación. Resultados: Menor resistencia: punto simple con pasador de 1 mm, a 5 mm del borde del tendón (100,2 N). Mayor resistencia: punto mattress con pasador de 2 mm, a 10 mm del borde del tendón (275,5N). La diferencia entre grupos fue significativa (p< 0,05). Conclusiones: Los distintos parámetros técnicos evaluados inciden significativamente en la resistencia de la reparación del manguito rotador en este modelo animal. Relevancia Clínica: El utilizar técnicas más resistentes para reparar el manguito rotador en humanos podría asociarse a una menor re-rotura del tendón y por consiguiente a un resultado funcional superior. Tipo de Estudio: Estudio Biomecánico.


Subject(s)
Humans , Shoulder Joint/surgery , Arthroscopy/methods , Rotator Cuff/surgery , Suture Techniques , Biomechanical Phenomena , Models, Animal
20.
Rev. méd. Chile ; 140(7): 841-846, jul. 2012. ilus
Article in Spanish | LILACS | ID: lil-656353

ABSTRACT

Background:Although in most patients the diagnosis of cystic fibrosis (CF) is made during their first years of life, a proportion of patients is diagnosed during adulthood. Aim: To describe the features of adult patients diagnosed with CF. Materials and Methods: Analysis of medical records of patients diagnosed with CF in a public hospital devoted to respiratory diseases. Demographic, clinical, laboratory and microbiological data were recorded. Results: Fifty eight patients aged 25.4 ± 6.5 years were included. In 40% of them, CF was diagnosed after 15 years of age. The most common mutation found was AF508. Among clinical characteristics, lung involvement, mainly bronchiectasis, was found in 93%. The mean forced expiratory volume in the first second (FEV,) was 65,7 ± 27,1%. Fifteen patients were colonized with Pseudomonas aeruginosa. The main complication seen was hemoptysis, in 12% of patients. Five patients died, mostly due to respiratory distress associated with sepsis, while three were subjected to bilateral lung transplantation. Patients in whom the diagnosis of CF was made after 15 years of age, had lower frequency of AF508 mutation, were most commonly women and had a lower rate of pancreatic involvement. Conclusions: CF is a disease that is increasingly reaching adult population. CF must be suspected in adolescents and young adults who suffer chronic lung diseases such as bronchiectasis, particularly when they are colonized by Pseudomonas aeruginosa, or in patients who develop infections by uncommon organisms.


Subject(s)
Adolescent , Adult , Female , Humans , Male , Young Adult , Cystic Fibrosis/diagnosis , Respiratory Tract Diseases , Age Factors , Chile , Cystic Fibrosis Transmembrane Conductance Regulator/genetics , Cystic Fibrosis/genetics , Cystic Fibrosis/microbiology , Mutation , Retrospective Studies , Respiratory Tract Diseases/complications
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