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1.
Arq. gastroenterol ; 58(3): 359-363, July-Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1345304

ABSTRACT

ABSTRACT BACKGROUND: The gold standard test for colorectal cancer screening the colonoscopy. Although this is the test of choice, colonoscopy misses a significant number of lesions, mainly in the proximal colon. With the purpose of reducing the number of lesions missed, new techniques have been studied, amongst them, retroflexed view in the right side of the colon and the second direct forward view. OBJECTIVE: Assessing the safety of the retroview in the proximal colon (cecum and ascending colon), its impact on the detection of lesions in the proximal colon and its advantage over the double right forward view using adenoma detection rate and adenoma miss rate. METHODS: Three hundred and ninety-three patients who came to Hospital Mater Dei to undergo colonoscopy from March to July 2017, prospectively. Out of these, 372 were included in the study based on the following exclusion criteria: being under 18 years of age, inadequate bowel preparations (Boston scale <7), history of colectomy, inflammatory bowel disease or polypoid diseases. First, an endoscopist inserted the colonoscope into the cecum and examine the cecum and the ascending colon with a forward view twice. In the third insertion into the cecum, retroflexed view was performed, cecal mucosa was examined until the hepatic flexure in search of polyps missed on forward view. All lesions found were resected and sent for histological analysis. RESULTS: In 334 (89.8%) patients, retroflexed view was performed successfully, 65.8% of failures were attributed to the loops of the device which prevented the maneuver. The direct view identified 175 polyps in the proximal colon in 102 people. Retroflexed view detected 26 polyps missed by the direct view in 24 (6.5%) people, with a missing rate of 12.9% in the test with only the forward view. Out of the 26 polyps found in retroview, 21 (80.76%) were adenomas, one of them with a high-grade dysplasia. Eleven patients had polyps seen only in retroflexed view. Retroview has increased the polyp detection rate from 27.41% to 31.72% and the adenoma detection rate from 21.77% to 25%. The adenoma miss rate by the double direct view was 12.8%. Without the retroview, one polyp in every 13.91 colonoscopies would be missed (number needed to treat - NNT=13.91). There was no adverse event. CONCLUSION: The retroflexed view technique in the proximal colon was shown to be safe, fast and feasible in most cases. It increased the adenoma detection rate and was shown to be advantageous in this study wit benefit beyond the double direct view.


RESUMO CONTEXTO: O exame padrão ouro para rastreamento de câncer colorretal é a colonoscopia. Apesar de ser o exame de escolha, a colonoscopia perde um número não desprezível de lesões, principalmente no cólon proximal. Com a intenção de reduzir a perda de lesões, novas técnicas são estudadas, dentre elas, a retroflexão em cólon direito e a segunda visão frontal direta. OBJETIVO: Avaliar a segurança da retrovisão no cólon proximal (ceco e cólon ascendente), o seu impacto na detecção de lesões em cólon proximal e sua superioridade sobre a dupla visão frontal direta usando taxa de detecção de adenoma e taxa de adenoma perdido. MÉTODOS: Foram avaliados 393 pacientes de forma prospectiva que procuraram o Hospital Mater Dei para realizar colonoscopia entre março e julho de 2017. Desses, 372 foram incluídos baseados nos critérios de exclusão: menores de 18 anos, preparos intestinais inadequados (escala de Boston <7), com antecedente de colectomia, doença inflamatória intestinal ou síndromes polipoides. Primeiramente um endoscopista realizou a inserção do colonoscópio até o ceco e examinou o ceco e o cólon ascendente em visão frontal por duas vezes. Na terceira reinserção até o ceco era realizada a retroflexão e inspeção da mucosa do ceco até a flexura hepática em busca de pólipos perdidos à visão frontal. Todas lesões encontradas foram ressecadas e enviadas para análise histológica. RESULTADOS: Em 334 (89,8%) pacientes a retroflexão foi realizada com sucesso, 65,8% dos insucessos foram atribuídos a alças no aparelho que impediram a manobra. A visão direta identificou 175 pólipos no cólon proximal em 102 pessoas. A retroflexão detectou 26 pólipos perdidos pela visão direta em 24 (6,5%) pessoas, com uma taxa de perda de 12,9% no exame apenas em visão frontal. Dos 26 pólipos encontrados em retrovisão, 21 (80,76%) eram adenomas, um deles com displasia de alto grau. Onze pacientes tinham pólipos vistos apenas em retroflexão. A realização da retrovisão aumentou a taxa de detecção de pólipo de 27,41% para 31,72% e a taxa de detecção e adenomas de 21,77% para 25%. A taxa de adenoma perdido pela dupla visão direta foi de 12,8%. Se a retrovisão não fosse realizada, um pólipo a cada 13,91 colonoscopias seria perdido (NNT=13,91). Não houve nenhum evento adverso. CONCLUSÃO: A técnica de retroflexão em cólon proximal mostrou-se segura, rápida e factível na maioria dos casos. Ela aumentou a taxa de detecção de adenomas e mostrou-se soberana neste estudo com benfeitorias além da dupla visão direta.


Subject(s)
Humans , Adolescent , Colonic Polyps/diagnostic imaging , Colonic Neoplasms/diagnostic imaging , Colonoscopy , Tertiary Care Centers
2.
Arch. argent. pediatr ; 119(4): 224-229, agosto 2021. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1280889

ABSTRACT

Introducción. La apendicitis constituye la principal causa de abdomen agudo quirúrgico en pediatría. Durante la pandemia por COVID-19, se replantearon las estrategias de manejo ydisminuyeron las consultas en las guardias, lo que podría asociarse a diagnósticos tardíos y complicaciones. El objetivo de este estudio fue analizar el impacto de la pandemia en los niños con apendicitis aguda. Métodos. Estudio analítico retrospectivocomparativo de pacientes pediátricos conapendicitis aguda durante los cinco meses del confinamiento por COVID-19 versus los meses equivalentes del año previo. Se analizaron la incidencia, la clínica, el estadio, el abordajequirúrgico y las complicaciones. Resultados. Los casos totales de apendicitisse redujeron un 25 % (n = 67 versus n = 50 en 2020). El tiempo medio hasta la consulta fue de 24 horas en ambos períodos (p = 0,989). La incidencia de peritonitis fue del 44 % (n = 22) versus el 37 % (n = 22) (p = 0,22) en 2019. No se evidenció diferencia en los estadios deenfermedad de acuerdo con lo informado en los partes quirúrgicos. En 2019, todas las cirugías se realizaron por vía laparoscópica; en 2020, solo un42 % (n = 21). La incidencia de complicaciones fue del 6 %, contra 7,5 % en el período previo (p = 0,75). Un paciente fue COVID-19 positivo. Conclusión. A pesar de la reducción en el númerode casos de apendicitis, no se evidenció una demora en la consulta en nuestra población. El mayor impacto se asoció a la readecuación del manejo, evitando el abordaje laparoscópico para reducir la diseminación del virus.


Introduction. Appendicitis is the leading cause of surgical acute abdomen in pediatrics. During the COVID-19 pandemic, management strategies were reassessed and the number of visits to the emergency department dropped down, which may be associated with delayed diagnoses and complications. The objective of this study was to analyze the impact of the pandemic on children with acute appendicitis. Methods. Analytical, retrospective, comparative study of pediatric patients with acute appendicitis in the 5 months of COVID-19 lockdown versus the same period in the previous year. Incidence, clinical data, stage, surgical approach, and complications were analyzed. Results. The total number of appendicitis cases went down by 25 % (n = 67 versus n = 50 in 2020). The mean time to consultation was 24 hours in both periods (p = 0.989). The incidence of peritonitis was 44 % (n = 22) versus 37 % (n = 22) (p = 0.22) in 2019. No differences were  observed in terms of appendicitis stage based on surgery reports. In 2019, all surgeries were laparoscopic; while in 2020, only 42 % (n = 21). The incidence of complications was 6 % versus 7.5 % in the previous period (p = 0.75). One patient was COVID-19 positive. Conclusion. Although in our population the number of appendicitis cases dropped down, consultation was not delayed. The greater impact was associated with the reformulation of management strategies, in which the laparoscopic approach is avoided to reduce virus transmission.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Appendectomy/trends , Appendicitis/surgery , Appendicitis/diagnosis , Appendicitis/epidemiology , Practice Patterns, Physicians'/trends , Delayed Diagnosis/trends , COVID-19/prevention & control , Health Services Accessibility/trends , Appendectomy/methods , Argentina/epidemiology , Acute Disease , Incidence , Retrospective Studies , Laparoscopy/trends , Pandemics/prevention & control , Tertiary Care Centers , COVID-19/diagnosis , COVID-19/epidemiology , Hospitals, General
3.
Arq. gastroenterol ; 58(2): 202-209, Apr.-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1285321

ABSTRACT

ABSTRACT BACKGROUND: Non-variceal upper gastrointestinal bleeding (NVUGIB) secondary to peptic ulcer disease is a medical digestive emergency and could be one of the most serious adverse drug reactions. OBJECTIVE: To identify the frequency of diagnosis of NVUGIB secondary to peptic ulcer disease. METHODS: Prospective and epidemiological study conducted in a tertiary referral Brazilian hospital, from July 2016 to December 2019. Upper gastrointestinal endoscopies (UGE) reports were evaluated daily. The diagnosis of NVUGIB secondary to peptic ulcer disease was defined through endoscopic findings of peptic ulcer and erosive gastric lesions, and clinical symptoms. The frequency of diagnosis of NVUGIB secondary to peptic ulcer disease was estimated through the ratio between the number of patients diagnosed and the number of patients underwent UGE in the same period. RESULTS: A total of 2,779 endoscopic reports (2,503 patients) were evaluated, and 178 patients were eligible. The total frequency of diagnosis of NVUGIB secondary to peptic ulcer disease was 7.1%. The annual frequency of diagnosis between 2017 and 2019 ranged from 9.3% to 5.7%. Most patients were men (72.8%); self-declared white (71.8%); older people (56.7%); and, had no familiar or personal history of gastrointestinal diseases (60.1%). 90% of the patients had a peptic ulcer and melena (62.8%). Patients made chronic use of low-dose aspirin (29.3%), other antiplatelet agents (21.9%) and, oral anticoagulants (11.2%); and non-steroidal anti-inflammatories use in the week a prior to the onset of clinical symptoms (25.8%). CONCLUSION: Seven in every 100 patients admitted and underwent UGE in a tertiary hospital were diagnosed with NVUGIB secondary to peptic ulcer disease.


RESUMO CONTEXTO: A hemorragia digestiva alta não varicosa (HDANV) secundária à úlcera péptica é uma emergência médica digestiva e pode ser uma reação adversa a medicamento severa. OBJETIVO: Estimar a frequência de HDANV secundária à doença péptica. MÉTODOS: Estudo prospectivo e epidemiológico realizado em um hospital brasileiro terciário de referência, no período de julho de 2016 a dezembro de 2019. Os laudos de endoscopia gastrointestinal alta foram avaliados diariamente. O diagnóstico de HDANV secundária para úlcera péptica foi definido por achados endoscópicos de úlcera péptica e lesões gástricas erosivas e sintomas clínicos. A frequência de diagnóstico de HDANV secundária à úlcera péptica foi estimada por meio da razão entre o número de pacientes diagnosticados e o número de pacientes submetidos à endoscopia gastrointestinal alta no mesmo período. RESULTADOS: Um total de 2.779 laudos endoscópicos (2.503 pacientes) foram avaliados e 178 pacientes foram elegíveis. A frequência total de diagnóstico de HDANV secundária à úlcera péptica foi de 7,1%. A frequência anual de diagnósticos entre 2017 e 2019 variou de 9,3% a 5,7%. A maioria dos pacientes era do sexo masculino (72,8%); auto-declarado branco (71,8%); idoso (56,7%); e não possuía histórico familiar ou pessoal de doenças gastrointestinais (60,1%). 90% dos pacientes apresentaram úlcera péptica e melena (62,8%). Os pacientes faziam uso crônico de ácido acetilsalicílico como antiagregante plaquetário (29,3%), outros antiplaquetários (21,9%) e anticoagulantes orais (11,2%); e fizeram uso e uso de anti-inflamatórios não esteroidais na semana anterior ao início dos sintomas clínicos de HDANV (25,8%). CONCLUSÃO: Cerca de sete em cada 100 pacientes admitidos em um hospital terciário e submetidos à endoscopia gastrointestinal alta foram diagnosticados com HDANV secundária à úlcera péptica.


Subject(s)
Humans , Male , Peptic Ulcer/complications , Peptic Ulcer/epidemiology , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/epidemiology , Referral and Consultation , Prospective Studies , Tertiary Care Centers
4.
Int. j. med. surg. sci. (Print) ; 8(2): 1-10, jun. 2021. tab
Article in English | LILACS | ID: biblio-1284419

ABSTRACT

Introduction.Thyroid cancer is currently the first most common cancer in women in Ecuador. This study aimed to assess the changes in clinical presentation and diagnosis of differentiated thyroid cancer at a third level hospital in Quito, Ecuador.Methods and Materials.This is a retrospective case series performed in three consecutive periods from 1990 to 2019 at a tertiary level hospital, in Quito, Ecuador. The clinical records of 875 patients who had been diagnosed and surgically treated for differentiated thyroid cancer were reviewed. Demographic, clinical, imaging, and pathological data were collected and analyzed.Results. Significant trends toward older age, higher educational level, less palpable primary tumors, less palpable neck nodes, less distant metastases, more ultrasound, tomography and cytology exams, smaller primary tumors, more stage I patients, and more histological variant description, were found. Introduction.Thyroid cancer is currently the first most common cancer in women in Ecuador. This study aimed to assess the changes in clinical presentation and diagnosis of differentiated thyroid cancer at a third level hospital in Quito, Ecuador.Methods and Materials.This is a retrospective case series performed in three consecutive periods from 1990 to 2019 at a tertiary level hospital, in Quito, Ecuador. The clinical records of 875 patients who had been diagnosed and surgically treated for differentiated thyroid cancer were reviewed. Demographic, clinical, imaging, and pathological data were collected and analyzed.Results. Significant trends toward older age, higher educational level, less palpable primary tumors, less palpable neck nodes, less distant metastases, more ultrasound, tomography and cytology exams, smaller primary tumors, more stage I patients, and more histological variant description, were found.


Introducción. El cáncer de tiroides es actualmente el cáncer más frecuente en la mujer en Ecuador. El presente estudio ha tenido como objetivo evaluar los cambios en la presentación clínica y el diagnóstico del cáncer diferenciado de tiroides en un hospital de tercer nivel de Quito, Ecuador. Material y Métodos. El presente es un estudio retrospectivo de casos realizado en tres períodos consecutivos desde 1990 a 2019 en un hospital del tercer nivel en Quito, Ecuador. Los expedientes clínicos de 875 pacientes tratados quirúrgicamente por un cáncer diferenciado de tiroides fueron revisados. Los datos demográficos, clínicos, de imagen y patología fueron extraídos y analizados. Resultados. Se encontraron tendencias significativas hacia una edad más avanzada, nivel educativo más alto, menos tumores palpables, menos adenopatías regionales palpables, menos metástasis a distancia, más exámenes de ultrasonido y tomografía, más estudios de citología, más tumores pequeños y pacientes con estadío I y más descripciones de las variantes histológicas. Conclusiones. El cáncer de tiroides no sólo que ha aumentado continuamente en su frecuencia en los años recientes, sino que la presentación clínica, el manejo diagnóstico y terapéutico ha cambiado significativamente en las tres últimas décadas.


Subject(s)
Humans , Male , Female , Middle Aged , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/epidemiology , Time Factors , Thyroid Neoplasms/pathology , Clinical Evolution , Demography , Retrospective Studies , Self-Examination , Ecuador/epidemiology , Tertiary Care Centers
5.
Rev. bras. oftalmol ; 80(1): 49-55, jan.-fev. 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1251312

ABSTRACT

RESUMO Objetivos: Traçar o perfil epidemiológico, clínico, evolução e desfechos dos pacientes com ceratocone diagnosticados no serviço de referência oftalmológica do estado de Santa Catarina, Brasil. Métodos: Foram analisados retrospectivamente os prontuários de todos os pacientes com ceratocone do setor de córnea do Hospital Regional de São José, entre Janeiro de 2016 e dezembro de 2018. Os seguintes dados foram extraídos: sexo, idade, estágio da doença, doenças sistêmicas, sintomas oftalmológicos, adaptação de lentes de contato, tratamentos prévios, melhor acuidade visual monocular, medidas ceratométricas, condutas oftalmológicas, desfechos clínicos. Resultados: Os prontuários de 267 pacientes foram avaliados. A média de idade foi de 23 anos (intervalo: 06 - 60 anos), 159 (59,55%) eram do sexo masculino. 12 (4,49%) pacientes já haviam realizado ceratoplastia penetrante; 22 (8,24%) haviam realizado crosslinking; 07 (2,62%) já possuíam implante de anel intraestromal. 81 (30,34%) pacientes já haviam adaptado lentes de contato. 168 (62,92%) possuíam acuidade visual corrigida, do melhor olho, igual ou superior a 20/40. Encontrou-se uma distribuição entre casos leves, moderados e graves de: 03 (1,12%), 78 (29,21%), 157 (58,80%), respectivamente. Ao longo do período, efetivaram-se 51 (73,9%) transplantes de córnea, 09 (90,0%) implantes de anel intraestromal, 35 (32,4%) crosslinking, 22 (23,4%) adaptações de lentes de contato; 205 (76,77%) pacientes perderam seguimento, 12 (4,49%) receberam alta. Conclusão: Os pacientes são em sua maioria jovens, com doença moderada a grave, e boa acuidade visual no melhor olho. Ainda assim, muitos receberam indicação de tratamento cirúrgico. A perda de seguimento clínico constitui um fator importante na qualidade da assistência oftalmológica desta população.


ABSTRACT Objectives: To describe the epidemiological and clinical profile, evolution and outcomes of keratoconus patients diagnosed in the ophthalmologic reference service of the state of Santa Catarina, Brazil. Methods: The medical records of all patients with keratoconus attended at the Cornea service of the Regional Hospital of São José, between January 2016 and December 2018 were retrospectively analyzed. The following data were extracted: sex, age, disease stage, systemic diseases, ophthalmological symptoms, adaptation of contact lenses, previous treatments, best monocular visual acuity, keratometric measurements, ophthalmological procedures, clinical outcomes. Results: The medical records of 267 patients were analyzed. The average age was 23 years (range: 06 - 60 years), 159 (59.55%) were male. 12 (4.49%) patients had already performed penetrating keratoplasty; 22 (8.24%) had performed crosslinking; 07 (2.62%) had already an intrastromal ring implant. 81 (30.34%) patients had already adapted contact lenses. 168 (62.92%) had best corrected visual acuity, of the better eye, equal to or greater than 20/40. A distribution between cases was found light, moderate and severe of: 03 (1.12%), 78 (29.21%), 157 (58.80%), respectively. Throughout the period, a total of 51 (73,9%) corneal transplants, were performed 09 (90,0%) intrastromal ring implants, 35 (32,4%) crosslinking, 22 (23,4%) contact lens adaptations were performed; 205 (76.77%) patients lost follow-up, 12 (4.49%) were discharged. Conclusion: The patients are mostly young, with moderate to severe illness and good visual acuity in the best eye. Even so many received a surgical management. The loss of clinical follow-up is an important factor in the quality of ophthalmic care in this population.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Tertiary Care Centers , Keratoconus/diagnosis , Keratoconus/epidemiology , Retrospective Studies , Cohort Studies , Observational Study
6.
Article in English | AIM | ID: biblio-1293118

ABSTRACT

Objectives: While studies on satisfaction following medical procedures are well documented, but this is not so with dental procedures. Therefore, this study aims to determine the level of satisfaction in patient undergoing intraoral examination (IOE). Material and Methods: Consecutive patients attending the oral diagnosis clinic of University of Benin Teaching Hospital from April 2020 to September 2020 were interviewed using a questionnaire modified from the modified Group Health Association of America-9 questionnaire. Results: A total number of 103 consecutive dental patients were recruited as they all agreed to participate in the study. The age range was 18­77 years with a mean age of 35.8 ± 14.3 years. There were more males (51.5%). The overall satisfaction was 82.5%. The maximum satisfactory response was on doctor's manner (93.2%), followed by staff 's manner (89.3%), comfort during IOE (80.6%), adequate explanation (78.6%), and finally by waiting time (60.2%). There was association between occupation (P = 0.04) of the patients, type of dental condition (P = 0.03), waiting time (P = 0.01), doctor's manner (P = 0.00), staff manner (P = 0.00), adequate explanation (P = 0.00), comfort during IOE (P = 0.00), and level of satisfaction. The problem rate was 16%. Conclusion: Although waiting time and adequate explanation ranked the highest in terms of unfavorable responses, the overall satisfaction of patients following IOE was generally good. The factors that influence satisfaction were occupation of the patients, type of dental condition, waiting time, doctor's manner, staff manner, adequate explanation, and comfort during IOE.


Subject(s)
Humans , Global Health , Patient Satisfaction , Diagnosis, Oral , Tertiary Care Centers , Nigeria
7.
Afr. J. Clin. Exp. Microbiol ; 22(4): 465-472, 2021.
Article in English | AIM | ID: biblio-1342117

ABSTRACT

Background: AmpC or class C or group 1 beta lactamases are class C cephalosporinases that hydrolyse a wide variety of beta-lactam antibiotics including alpha methoxy beta-lactams (cefoxitin), narrow and broad spectrum cephalosporins. This study was conducted to characterize plasmid-mediated AmpC producing enteric Gram- negative bacteria from patients with lower respiratory tract infections in Obafemi Awolowo University Teaching Hospital Complex (OAUTHC) Ile Ife, Osun State, Nigeria Methodology: A total of 149 patients with clinical features of lower respiratory tract infections (LRTI) were selected by simple random sampling for the study. All Gram-negative isolates recovered from standard microbiological cultures of respiratory specimens of these patients were tested against cefoxitin, third generation cephalosporins (3GCs), and other antibiotics using the disc diffusion AST method, and also screened for production of AmpC beta-lactamases phenotypically by the CLSI method. Plasmid DNA extraction was carried out on twenty-nine cefoxitin-resistant selected isolates using the Kado and Lin method, while genotypic detection of plasmid-mediated AmpC gene was carried out by the polymerase chain reaction (PCR) assay. Results: The results showed that 204 (43.3%) of 471 isolates recovered from the 149 selected patients were resistant to 3GC in the AST assay, among which 121 (59.3%) were resistant to cefoxitin, and 189 of the 471 isolates (40.1%) were AmpC producers. The AmpC producers concurrently showed multiple resistance pattern to other antibiotics tested in this study. Ninety six percent of the 29 selected isolates for plasmid analysis contained plasmids, 45% of which amplified positive on PCR for CMY, 38% for FOX, and 31% for ACC types of AmpC genes. Conclusion: This study showed a high degree of antibiotic resistance among enteric Gram-negative bacteria recovered from patients with LRTIs, as well as high degree of plasmid-encoded AmpC genes responsible for this high antibiotic resistance among the isolates. Proper antibiotic policy and regulation are required to limit the spread of plasmid mediated AmpC ß-lactamase


Subject(s)
Humans , Plasmids , Respiratory Tract Infections , Polymerase Chain Reaction , Tertiary Care Centers , Nigeria
8.
The Nigerian Health Journal ; 21(2): 99-109, 2021. Tables, figures
Article in English | AIM | ID: biblio-1342132

ABSTRACT

Background:Needlestick injuries (NSIs) are percutaneous injuries sustained during delivery of medical care. They are occupational hazards faced by health workers and are a source of transmission of bloodborne pathogens.This study was aimed at determining the prevalence, utilization of post-exposure prophylaxis(PEP) and assessed the association between the sociodemographic, occupational factors, knowledge and attitude towards NSIs to its occurrence among the residents in a Tertiary hospital in Port Harcourt Nigeria.Methods: Descriptive cross-sectional analytical study design Results: The study found a 53.8% prevalence of NSIs. Annual prevalence was 50.9%. The prevalence was significantly higher among senior residents (65.1%) (p=0.006), residents in Paediatrics (75.6%) (p<0.001), and among residents who had worked three years or more (65.7%) (p<0.001). The most frequently reported factors that predisposed to NSIs were excess workload (77.9%), insufficient consumables (72.6%) and long working hours (70.2%). 77.4% of residents recapped needles, 66.1% did not report NSIs. Only 8.9% of the residents utilized PEP after injury. In 51.8% of cases, the needle had been used on a patient prior to the injury. In 25.9% of these cases, the injury involved a high-risk patient (HIV, Hepatitis B or C infected). This study found a risk of transmission of HIV following a needle stick injury to be 0.48%. Conclusion: Needlestick injuries are common among resident doctors. A large number of these injuries go unreported. The attitude toward preventive measures and use of PEP services is sub-optimal necessitating a need for more attention to be drawn to occupational health and safety in the region


Subject(s)
Humans , Male , Female , Adult , Needlestick Injuries , Health Personnel , Post-Exposure Prophylaxis , Physicians , Tertiary Care Centers , Nigeria
9.
Afr. health sci. ; 21(3): 1093-1099, 2021.
Article in English | AIM | ID: biblio-1342430

ABSTRACT

Since the advent of 2019-Corona virus Disease (COVID-19) in Nigeria in February 2020, the number of confirmed cases has risen astronomically to over 61,307 cases within 8 months with more than 812 healthcare workers infected and some recorded deaths within their ranks. Infection prevention and control is a key component in ensuring safety of healthcare workers in the hospital as healthcare- associated infection is one of the most common complications of healthcare management. Unbridled transmission of infection can lead to shortage of healthcare personnel, reduced system efficiency, increased morbidity and mortality among patients and in some instances, total collapse of healthcare delivery services. The Infection Prevention and Control Committee is a recognised group by the Centre for Disease Control and Prevention with their core programmes including drawing up activities, procedures and policies designed to achieve above-stated objectives before, during and after any disease outbreak, especially emerging and re-emerging ones such as the 2019 Coronavirus Disease. In this report, we highlight the roles played by the Infection Prevention and Control Committee of the University of Medical Sciences Teaching Hospital to prevent the spread of COVID-19 within and outside the hospital community and the lessons learned to date


Subject(s)
Humans , Infection Control , Pandemics , COVID-19 , Tertiary Care Centers , Nigeria
10.
S. Afr. med. j. (Online) ; 111(11): 1092-1097, 2021. Tables, figures
Article in English | AIM | ID: biblio-1344165

ABSTRACT

Background. The availability of well and functional healthcare workers (HCWs) and support staff is pivotal to a country's ability to manage the COVID-19 pandemic effectively. While HCWs have been identified as being at increased risk for acquisition of SARS-CoV-2 infection, there is a paucity of data pertaining to South African (SA) HCW-related infection rates. Global and provincial disparities in these numbers necessitate local data in order to mitigate risks. Objectives. To ascertain the overall SARS-CoV-2 infection rates and outcomes among all hospital staff at three hospitals in the Tshwane district of Gauteng Province, SA, and further determine associations with the development of severe COVID-19 disease. Methods. This retrospective audit was conducted across three academic hospitals in the Tshwane district for the period 1 June - 31 August 2020. Deidentified data from occupational health and safety departments at each hospital were used to calculate infection rates. A more detailed analysis at one of the three hospitals included evaluation of demographics, work description, possible source of SARS-CoV-2 exposure (community or hospital), comorbidities and outcomes. Results. The period prevalence of SARS-CoV-2 infections ranged from 6.1% to 15.4% between the three hospitals, with the average period prevalence being 11.1%. The highest incidence of SARS-CoV-2 infections was observed among administrative staff (2.8 cases per 1 000 staff days), followed by nursing staff (2.7 cases per 1 000 staff days). Medical doctors had the lowest incidence of 1.1 cases per 1 000 staff days. SARS-CoV-2 infections were categorised as either possibly community or possibly healthcare facility acquired for 26.6% and 73.4% of the infections, respectively. The administrative group had the highest proportion of possible community-acquired infections (41.8%), while doctors had the lowest (6.1%). The mean age of individuals with mild and severe disease was 41 years and 46.1 years, respectively (p=0.004). The presence of comorbidities was significantly associated with severity of disease (p=0.002). Conclusions. This study highlights that hospital staff, including administrative staff, are clearly at high risk for acquisition of SARS-CoV-2 infection during a surge.


Subject(s)
Administrative Personnel , Health Personnel , Coinfection , SARS-CoV-2 , COVID-19 , South Africa , Tertiary Care Centers
11.
Rev. Soc. Bras. Med. Trop ; 54: e0375-2020, 2021. tab
Article in English | LILACS | ID: biblio-1155553

ABSTRACT

Abstract INTRODUCTION: Leprosy recurrence is the reappearance of the disease after treatment with current schemes and discharged for cure and may have variable incubation periods. METHODS: This is a descriptive observational study of leprosy recurrence in Espírito Santo diagnosed between January 2018 and January 2020. RESULTS: One hundred and ninety-two cases were available, of which 30 were diagnosed with leprosy recurrence. CONCLUSIONS: In 25 cases, the incubation period was 5-15 years after the first treatment, favoring bacillary persistence. In the remaining 5 cases, the disease had recurred after 15 years, pointing to reinfection as none of them exhibited drug resistance.


Subject(s)
Humans , Leprosy/drug therapy , Recurrence , Brazil , Drug Resistance , Tertiary Care Centers
13.
Chinese Medical Journal ; (24): 1317-1323, 2021.
Article in English | WPRIM | ID: wpr-878102

ABSTRACT

BACKGROUND@#Recent cardiovascular outcome trials (CVOTs) changed the therapeutic strategy of guidelines for type 2 diabetes. We compared the characteristics of patients from real-world hospital settings with those of participants in recent pragmatic randomized trials.@*METHODS@#This electronic medical record (EMR)-based retrospective observational study investigated the data of patients with diabetes from inpatient and outpatient settings in West China Hospital of Sichuan University from January 1, 2011, to June 30, 2019. We identified patients meeting the inclusion criteria of a pragmatic randomized trial (EMPA-REG OUTCOME) based on EMRs and compared their baseline characteristics with those of the trial participants. The cutoff for the clinical significance of each characteristic was set as its minimal clinically important difference based on expert consultation.@*RESULTS@#We included 48,257 inpatients and 36,857 outpatients with diabetes and found that 8389 (17.4%) inpatients and 2646 (7.2%) outpatients met the inclusion criteria for the EMPA-REG OUTCOME trial. Compared with the trial population, the real-world inpatients meeting the eligibility criteria of the EMPA-REG OUTCOME had similar age, blood pressure, and lipid profiles but comprised of fewer males, metformin users, anti-hypertensive drug users, and aspirin users, and had a lower body mass index. The group of outpatients meeting the eligibility criteria had fewer males, similar age, fewer metformin users, fewer insulin users, fewer anti-hypertensive drug users, and fewer aspirin users compared with the trial population.@*CONCLUSIONS@#The trial population in EMPA-REG OUTCOME represents only a small portion of patients with diabetes from the inpatient and outpatient departments of a Chinese tertiary medical center. Evidence localization in different clinical settings and validation are essential to enabling extrapolation of the results from CVOTs in patients with diabetes to Chinese clinical practice.


Subject(s)
Benzhydryl Compounds , Canagliflozin , Cardiovascular Diseases , China , Diabetes Mellitus, Type 2/drug therapy , Glucosides , Humans , Male , Sodium-Glucose Transporter 2 Inhibitors , Tertiary Care Centers
15.
Arq. bras. cardiol ; 115(5): 862-870, nov. 2020. graf
Article in Portuguese | LILACS, SES-SP | ID: biblio-1142247

ABSTRACT

Resumo Fundamento Ainda não temos informações acerca do impacto da pandemia da COVID-19 sobre a atividade médica assistencial no Brasil. Objetivo Descrever as repercussões da pandemia da COVID-19 na rotina de atendimentos em um hospital terciário, referência regional em cardiologia e oncologia. Métodos Estudo de corte transversal. Foi realizado levantamento dos atendimentos no período de 23/03/2020 (fechamento do comércio local) até 23/04/2020 (P20) e comparado com o mesmo período em 2019 (P19).Resultados: Detectamos redução no número de consultas cardiológicas, teste ergométrico, Holter, monitorização ambulatorial da pressão arterial, eletrocardiograma e ecocardiograma (90%, 84%, 94%, 92%, 94% e 81%, respectivamente). Em relação à cirurgia cardíaca e cateterismo cardíaco, houve redução de 48% e 60%, respectivamente. Aumento no número de angioplastia transluminal coronária (33%) e de implante de marca-passo definitivo (29%). Houve 97 internamentos na UTI em P19, contra 78 em P20, redução de 20%. Diminuição dos atendimentos no pronto-socorro cardiológico (45%) e nos internamentos na enfermaria de cardiologia (36%). Houve diminuição nas consultas oncológicas de 30%. Sessões de quimioterapia reduziram de 1.944 para 1.066 (45%). Sessões de radioterapia diminuíram 19%. Conclusão A COVID-19 provocou redução considerável no número de consultas nos ambulatórios de cardiologia, oncologia e demais especialidades. Houve uma preocupante diminuição no número de cirurgias cardíacas e nas sessões de quimioterapia e radioterapia nas semanas iniciais da pandemia. A procura por atendimento no pronto-socorro cardiológico, assim como as internações na UTI e enfermaria cardiológicas, também reduziram, gerando preocupação acerca da evolução e prognóstico destes pacientes portadores de outras patologias, que não a COVID-19, nestes tempos de pandemia. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)


Abstract Background We still do not have information regarding the impact of the COVID-19 pandemic on medical care activity in Brazil. Objective To describe the repercussions of the COVID-19 pandemic on the care routine of a tertiary hospital, which is a regional reference in cardiology and oncology. Methods Cross-sectional cohort study. We conducted a survey of medical visits from March 23, 2020 (when local commerce was closed) to April 23, 2020 (P20), in comparison with the same period in 2019 (P19). Results We found decreases in the number of cardiology consultations, exercise tests, Holter, ambulatory blood pressure monitoring, electrocardiogram, and echocardiogram (90%, 84%, 94%, 92%, 94%, and 81%, respectively). In relation to cardiac surgery and cardiac catheterization, there were 48% and 60% decreases, respectively. There was an increase in the number of percutaneous transluminal coronary angioplasties (33%) and definitive pacemaker implantations (29%). There were 97 admissions to the ICU during P19, in contrast with 78 during P20, a 20% decrease. Visits to the cardiac emergency room (45%) and admissions to the cardiology ward (36%) also decreased. The decrease in oncology consultations was 30%. Chemotherapy sessions decreased from 1,944 to 1,066 (45%), and radiotherapy sessions decreased by 19%. Conclusion COVID-19 has led to a considerable decrease in the number of consultations in outpatient clinics for cardiology, oncology, and other specialties. There was a concerning decrease in the number of cardiac surgeries, chemotherapy sessions, and radiotherapy sessions during the initial weeks of the pandemic. The number of people seeking care in the cardiac emergency room and the number of admissions to the cardiology ward and ICU also decreased, generating concern regarding the evolution and prognosis of these patients with pathologies other than COVID-19 during this pandemic time. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)


Subject(s)
Humans , Pneumonia, Viral/epidemiology , Coronavirus Infections , Coronavirus Infections/epidemiology , Betacoronavirus , Brazil , Cross-Sectional Studies , Blood Pressure Monitoring, Ambulatory , Pandemics , Tertiary Care Centers
16.
Rev. Assoc. Med. Bras. (1992) ; 66(11): 1521-1525, Nov. 2020. graf
Article in English | LILACS, SES-SP | ID: biblio-1143633

ABSTRACT

SUMMARY INTRODUCTION: EUS-guided gastroenterostomy (EUS-GE) is a novel procedure for palliation of malignant gastric outlet obstruction (GOO). Our aim was to evaluate the outcomes of this technique in our initial experience. METHODS: Patients with GOO from our institute were included. Technical success was defined as the successful creation of a gastroenterostomy. Clinical success was defined as the ability to tolerate a soft diet after the procedure. We assessed adverse events and diet tolerance 1 month after the procedure. RESULTS: Three patients were included. Technical and clinical success was achieved in all cases. There were no adverse events and good diet tolerance was observed 1 month after the procedure in the included patients. CONCLUSION: EUS-GE is a promising treatment for patients with GOO.


RESUMO INTRODUÇÃO: A gastroenterostomia ecoguiada é um novo procedimento para paliação da obstrução maligna gastroduodenal. Nosso objetivo foi avaliar os resultados dessa técnica em nossa experiência inicial. MÉTODOS: Foram incluídos pacientes com obstrução maligna gastroduodenal de nossa instituição. O sucesso técnico foi definido como a realização adequada de uma gastroenterostomia. O sucesso clínico foi definido como boa aceitação de dieta pastosa durante a internação. Os eventos adversos e a aceitação alimentar foram avaliados um mês após o procedimento. RESULTADOS: Três pacientes foram incluídos. Os sucessos técnico e clínico foram alcançados em todos os casos. Não houve eventos adversos e a aceitação alimentar permaneceu adequada um mês após o procedimento nos pacientes incluídos. CONCLUSÃO: O EUS-GE é um tratamento promissor para pacientes com obstrução maligna gastroduodenal.


Subject(s)
Humans , Gastroenterostomy , Endosonography , Brazil , Stents , Gastric Outlet Obstruction/surgery , Gastric Outlet Obstruction/etiology , Gastric Outlet Obstruction/diagnostic imaging , Tertiary Care Centers
17.
Medwave ; 20(10)30-11-2020.
Article in English, Spanish | LILACS | ID: biblio-1145803

ABSTRACT

Introducción Desde el comienzo de la pandemia de COVID-19, se han desarrollado diversas investigaciones sobre el pronóstico de pacientes con SARS-CoV-2 asociado a factores como edad, condiciones biodemográficas, comorbilidades, factores sociales, parámetros clínicos, hematológicos, marcadores inflamatorios, de coagulación, bioquímicos y gasométricos, entre otros. Hasta ahora, existen escasos estudios que hayan abordado el tema en América Latina, por lo que es de interés conocer el comportamiento de la enfermedad en la región. Objetivo Evaluar el curso del COVID-19 en pacientes ingresados en un centro terciario en Chile y analizar factores predictores, medidos en el período cercano a la admisión, que se asocien al pronóstico vital y al uso de ventilación mecánica invasiva. Métodos Estudio de cohorte retrospectivo realizado en Clínica Indisa de Santiago, Chile. Participaron todos los pacientes de 15 años o más hospitalizados entre el 11 de marzo y el 25 de julio de 2020. Se analizó la letalidad hospitalaria, la complejidad de los casos y se aplicaron modelos de regresión logística para identificar predictores de las variables de resultado definidas. Resultados La muestra estuvo constituida por 785 sujetos. La edad media fue 59 años, 59% fueron hombres y 61,3% tenía comorbilidades. El 45% requirió cuidados intensivos y 24% ventilación mecánica invasiva. La letalidad hospitalaria global fue de 18,7%. En pacientes de unidad de cuidados intensivos fue 32,1% y en quienes recibieron ventilación mecánica invasiva 59,4%. Los factores de riesgo independientes de morir incluyeron la edad (Odds ratio 1,09; intervalo de confianza 95%: 1,07 a 1,12), diabetes (1,68; 1,06 a 2,67), enfermedad pulmonar crónica (2,80; 1,48 a 5,28) y mayores niveles de proteína C reactiva, creatinina y ferritina. No se demostró asociación con el sexo, pertenencia al seguro público de salud, antecedente de cardiopatía, obesidad, ni dímero D. Similares factores fueron predictores de ventilación mecánica invasiva. Conclusiones El pronóstico y factores predictores en esta cohorte de pacientes hospitalizados en Chile por COVID-19 fueron comparables en su mayoría a los reportados en estudios similares de países de mayores ingresos. El sexo masculino no fue un factor de mal pronóstico en este grupo de pacientes.


Introduction Since the beginning of the COVID-19 pandemic, extensive research has been done on the prognosis of patients with SARS-CoV-2 associated with age, biodemographic conditions, comorbidities, social factors, clinical parameters, inflammatory blood markers, coagulation, biochemical and blood gas parameters, among others. Few studies have addressed this problem in Latin America, so it is of interest to know how the disease plays out in this region. Objective The purpose of our study is to evaluate the course of COVID-19 in patients admitted to a tertiary center in Chile and to assess factors measured close to hospital admission that may be associated with death and the need for invasive mechanical ventilation. Methods We did a retrospective cohort study at Indisa Clinic in Santiago, Chile. We included all patients aged 15 years and older hospitalized between March 11 and July 25, 2020. Hospital mortality and severity of the cases were analyzed, and logistic regression models were applied to identify predictors of outcome variables. Results The sample included 785 subjects. The mean age was 59 years, 59% were men, and 61.3% had comorbidities. Forty five per cent required intensive care, and 24% invasive mechanical ventilation. The overall hospital fatality rate was 18.7%. In intensive care patients, the case fatality was 32.1%, and in those who received invasive mechanical ventilation, it was 59.4%. Independent risk factors for death included age (odds ratio 1.09; 95% confidence interval: 1.07 to 1.12), diabetes (1.68; 1.06 to 2.67), chronic lung disease (2.80; 1.48 to 5.28), increased C-reactive protein, creatinine, and ferritin. No association with sex, public health insurance, history of heart disease, oxygen saturation upon admission, or D-dimer was found. Similar factors were predictors of invasive mechanical ventilation. Discussion The prognosis and predictive factors in this cohort of patients hospitalized in Chile for COVID-19 were comparable to those reported in similar studies from higher-income countries. Male sex was not associated with a poor prognosis in this group of patients.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Pneumonia, Viral/physiopathology , Respiration, Artificial/statistics & numerical data , Coronavirus Infections/physiopathology , Critical Care/statistics & numerical data , Hospitalization , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Prognosis , Chile , Sex Factors , Retrospective Studies , Risk Factors , Cohort Studies , Hospital Mortality , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Tertiary Care Centers
18.
Rev. bras. ortop ; 55(5): 620-624, Sept.-Oct. 2020. tab
Article in English | LILACS | ID: biblio-1144222

ABSTRACT

Abstract Objective To verify the applicability and agreement of the Ottawa ankle rules applied by medical students and orthopedic residents in a tertiary trauma service thus validating the Ottawa protocol for use on Brazilian soil. Prospective This was a prospective study, conducted in a tertiary hospital, including all patients with acute torsial trauma of the tibiotarsal joint. The patients underwent ankle and/or foot radiographs, and the questionnaire with the Ottawa ankle rules was applied by academics and, subsequently, by residents. The radiographs were evaluated by on-call orthopedists and specialist in foot and ankle, and the expert opinion was considered the gold standard for analysis. Results Two hundred and sixty-three patients were evaluated, and, after application of the established inclusion criteria, 226 cases remained for evaluation. The sensitivity to detect lesions and negative predictive value (NPV) was 100%. The most sensitive test with higher NPV for both academics and residents was palpation of the lateral malleolus. The study presented potential for a reduction of 30% in the total number of tests requested. Conclusion The data showed applicability and agreement between academics and residents, which allows for the validation of the Ottawa protocol in emergency care in Brazil.


Resumo Objetivo Verificar a aplicabilidade e a concordância das regras do tornozelo de Ottawa aplicadas por estudantes de medicina e residentes de ortopedia em um serviço de trauma terciário, validando assim as regras de Ottawa para utilização em solo brasileiro. Método Estudo prospectivo, realizado em um hospital terciário, incluindo todos os pacientes com trauma torcional agudo da articulação tibiotársica. Os pacientes realizaram radiografias de tornozelo e/ou pé, tendo sido aplicado o questionário com as regras do tornozelo de Ottawa por acadêmicos e, na sequência, por residentes. As radiografias foram avaliadas por ortopedistas plantonistas e especialista em pé e tornozelo, sendo a opinião do especialista considerada padrão-ouro da análise. Resultados Foram avaliados 263 pacientes e, após aplicados os critérios de inclusão estabelecidos, restaram para a avaliação 226 casos. A sensibilidade para detectar lesões e o valor preditivo negativo (VPN) foi de 100%. O teste mais sensível e com maior VPN para ambos, acadêmicos e residentes, foi a palpação do maléolo lateral. O estudo apresentou potencial de redução de 30% no total de exames solicitados. Conclusão Os dados demostraram aplicabilidade e concordância entre acadêmicos e residentes, o que permite a validação do protocolo de Ottawa nos atendimentos de urgência e emergência no Brasil.


Subject(s)
Humans , Male , Female , Wounds and Injuries , Prospective Studies , Surveys and Questionnaires , Ankle Injuries , Emergency Medical Services , Tertiary Care Centers , Fractures, Avulsion , Foot , Orthopedic Surgeons , Ankle
19.
Säo Paulo med. j ; 138(4): 305-309, July-Aug. 2020. tab
Article in English | LILACS, SES-SP | ID: biblio-1139697

ABSTRACT

ABSTRACT BACKGROUND: The COVID-19 pandemic is threatening healthcare systems and hospital operations on a global scale. Treatment algorithms have changed in general surgery clinics, as in other medical disciplines providing emergency services, with greater changes seen especially in pandemic hospitals. OBJECTIVES: To evaluate the follow-up of patients undergoing emergency surgery in our hospital during the COVID-19 pandemic. DESIGN AND SETTING: Cross-sectional study conducted in a tertiary-level public hospital. METHODS: The emergency surgeries carried out between March 11 and April 2, 2020, in the general surgery clinic of a tertiary-care hospital that has also taken on the functions of a pandemic hospital, were retrospectively examined. RESULTS: A total of 25 patients were included, among whom 20 were discharged without event, one remained in the surgical intensive care unit, two are under follow-up by the surgery service and two died. Upon developing postoperative fever and shortness of breath, two patients underwent thoracic computed tomography (CT), although no characteristics indicating COVID-19 were found. The discharged patients had no COVID-19 positivity at follow-up. CONCLUSION: The data that we obtained were not surgical results from patients with COVID-19 infection. They were the results from emergency surgeries on patients who were not infected with COVID-19 but were in a hospital largely dealing with the pandemic. Analysis on the cases in this study showed that both the patients with emergency surgery and the patients with COVİD infection were successfully treated, without influencing each other, through appropriate isolation measures, although managed in the same hospital. In addition, these successful results were supported by 14-day follow-up after discharge.


Subject(s)
Humans , Pneumonia, Viral , Surgical Procedures, Operative , Coronavirus Infections , Emergency Medical Services , Pandemics , Turkey , Cross-Sectional Studies , Retrospective Studies , Tertiary Care Centers , Betacoronavirus , SARS-CoV-2 , COVID-19 , Hospitals, Public
20.
Rev. chil. pediatr ; 91(4): 545-552, ago. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1138669

ABSTRACT

INTRODUCCIÓN: Los síndromes de falla medular (SFM) son trastornos infrecuentes, con una incidencia anual de 2-4 casos por millón. Las opciones de tratamiento incluyen terapia de inmunosupresión (TIS) y restaura ción de la hematopoyesis con trasplante de progenitores hematopoyéticas (TPH). OBJETIVO: Analizar los desenlaces de pacientes pediátricos diagnosticados con SFM tratados en una institución de alta complejidad. PACIENTES Y MÉTODO: Estudio retrospectivo de pacientes pediátricos con diagnóstico de SFM que consultaron a la Fundación Valle del Lili, Cali. Se realizo análisis estadístico descriptivo según SFM adquirida (SFMA) y SFM congénita (SFMC). Los desenlaces incluyeron: tratamiento, complicaciones, supervivencia global (SG) en los trasplantados, calculada con el método Kaplan Meier. RESULTADOS: Se incluyeron 24 pacientes con SFM, edad 6,5 ± 4 años, 50% mujeres. El 58% fue ron SFMC, 9 con anemia de Fanconi, 2 disqueratosis congénita, 2 trombocitopenia amegacariocítica congénita, uno anemia Diamond-Blackfan. Doce pacientes con TPH tuvieron SG a 5 años de 83%. SFMA correspondió al 42%, 6 recibieron TIS-TPH, 3 TIS y 1 TPH, la SG del grupo con TIS-TPH fue 86%. Seis pacientes fallecieron, 4/6 relacionadas con infección. CONCLUSIONES: En esta serie fue mayor el número de casos con SFMC. La SG de los pacientes llevados a TPH es comparable con la reportada en estudios recientes. La causa de muerte predominante fue infecciosa que también se ha reportado previamente. El tratamiento instaurado en los pacientes de esta serie mostró resultados favorables en un centro de alta complejidad en un país latinoamericano.


INTRODUCTION: Bone marrow failure (BMF) syndromes are rare disorders with an annual incidence of 2-4 cases per million. Treatment options include immunosuppressive therapy (IST) and hematopoietic stem cell transplantation (HSCT). OBJECTIVE: To analyze the outcomes of pediatric patients diagnosed with BMF treated in a tertiary care center. PATIENTS AND METHODP: Retrospective study of pediatric patients diagnosed with BMF who consulted at Fundación Valle de Lili, Cali. Descriptive statistical analysis was performed according to Acquired BMF (ABMF) and Inherited BMF (IBMF). The outcomes include treatment, complications, overall survival (OS) in transplant patients, calculated using the Kaplan Meier method. RESULTS: We included 24 patients with BMF, average age 6.5 ± 4 years, and 50% were women. 58% presented IBMF, 9 with Fanconi anemia (FA), 2 dyskeratosis congenita, 2 congenital amegakaryocytic thrombocytopenia, and 1 presented Diamond-Blackfan anemia. 12 patients treated with HSCT had a 5-year OS of 83%. ABMF represented 42%. 6 patients received IST-HSCT, 3 received IST, and 1 received HSCT. The OS of the IST-HSCT group was 86%. Six patients died, four of them related to infection. CONCLUSIONS: In this series, there was a higher number of cases with IBMF. The OS of patients treated with HSCT is similar to that reported in recent studies. The most frequent cause of death was of infectious origin which has also been previously reported. The treatment esta blished in the patients showed favorable results in a Latin American tertiary care center.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Hematopoietic Stem Cell Transplantation , Bone Marrow Failure Disorders/therapy , Immunosuppressive Agents/therapeutic use , Survival Rate , Retrospective Studies , Treatment Outcome , Colombia , Combined Modality Therapy , Kaplan-Meier Estimate , Tertiary Care Centers , Bone Marrow Failure Disorders/complications , Bone Marrow Failure Disorders/diagnosis , Bone Marrow Failure Disorders/mortality
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