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1.
Circ Arrhythm Electrophysiol ; 17(1): e01238, 2024 01.
Article in English | MEDLINE | ID: mdl-38126206

ABSTRACT

BACKGROUND: Inflammation may promote atrial fibrillation (AF) recurrence after catheter ablation. This study aimed to evaluate a short-term anti-inflammatory treatment with colchicine following ablation of AF. METHODS: Patients scheduled for ablation were randomized to receive colchicine 0.6 mg twice daily or placebo for 10 days. The first dose of the study drug was administered within 4 hours before ablation. Atrial arrhythmia recurrence was defined as AF, atrial flutter, or atrial tachycardia >30 s on two 14-day Holters performed immediately and at 3 months following ablation. RESULTS: The modified intention-to-treat population included 199 patients (median age, 61 years; 22% female; 70% first procedure) who underwent radiofrequency (79%) or cryoballoon ablation (21%) of AF. Antiarrhythmic drugs were prescribed at discharge in 149 (75%) patients. Colchicine did not prevent atrial arrhythmia recurrence at 2 weeks (31% versus 32%; hazard ratio [HR], 0.98 [95% CI, 0.59-1.61]; P=0.92) or at 3 months following ablation (14% versus 15%; HR, 0.95 [95% CI, 0.45-2.02]; P=0.89). Postablation chest pain consistent with pericarditis was reduced with colchicine (4% versus 15%; HR, 0.26 [95% CI, 0.09-0.77]; P=0.02) and colchicine increased diarrhea (26% versus 7%; HR, 4.74 [95% CI, 1.95-11.53]; P<0.001). During a median follow-up of 1.3 years, colchicine did not reduce a composite of emergency department visit, cardiovascular hospitalization, cardioversion, or repeat ablation (29 versus 25 per 100 patient-years; HR, 1.18 [95% CI, 0.69-1.99]; P=0.55). CONCLUSIONS: Colchicine administered for 10 days following catheter ablation did not reduce atrial arrhythmia recurrence or AF-associated clinical events, but did reduce postablation chest pain and increase diarrhea.


Subject(s)
Atrial Fibrillation , Catheter Ablation , Colchicine , Female , Humans , Male , Middle Aged , Atrial Fibrillation/diagnosis , Atrial Fibrillation/prevention & control , Catheter Ablation/adverse effects , Catheter Ablation/methods , Chest Pain/prevention & control , Colchicine/adverse effects , Colchicine/therapeutic use , Diarrhea/etiology , Recurrence , Treatment Outcome
2.
Salud UNINORTE ; 24(2): 273-293, dic. 2008. tab
Article in Spanish | LILACS | ID: lil-562509

ABSTRACT

La Diabetes Mellitus (DM) es una enfermedad de alta prevalencia, reconocida como un problema de salud pública, debido a sus altas tasas de morbilidad y mortalidad asociadas. Diferentes estudios han documentado que la falta de adherencia al tratamiento, constituye uno de los principales factores desencadenantes para las descompensaciones agudas en el paciente diabético. Dentro del espectro de dichas alteraciones se encuentran las crisis hiperglicémicas agudas, las cuales se han dicotomizado en dos entidades clínicas: la Cetoacidosis Diabética (CAD) y el Estado Hiperglicémico Hiperosmolar (EHH), que constituyen complicaciones metabólicas potencialmente fatales en el corto plazo y de las cuales pueden encontrarse cuadros superpuestos. Se han establecido criterios diagnósticos específicos buscando realizar un diagnóstico diferencial acertado, que permita un tratamiento idóneo; sin embargo, las tasas de morbilidad y mortalidad siguen siendo considerables. Por su parte, la Hipoglicemia también constituye una emergencia médica que, de no ser tratada oportunamente, puede ocasionar daño neurológico permanente e incluso la muerte. De lo anterior se deduce la importancia de que existan guías claras de manejo de estas alteraciones en todos los centros y servicios donde se preste atención médica de urgencias. Se siguen realizando investigaciones en busca de nuevas estrategias diagnósticas y terapéuticas que permitan un manejo más integral de la DM y sus complicaciones, en aras de mejorar la calidad de vida de los pacientes...


Diabetes Mellitus (DM) is a high prevalence disease, recognized as a public health problem because of its high morbidity and mortality rates. Some studies have expose that the lack of adherence to treatment is one of the main triggers for acute complications in diabetic patients. Those complications are the acute hyperglycemic crises, which are two clinical entities: Diabetic Ketoacidosis (DKA) and the Hyperglycemic Hyperosmolar State (HHS), which are potentially fatal metabolic complications in the short term and which can be found overlapping. They have established some specific diagnostic criteria in order to perform a correct differential diagnosis, which allows proper treatment, however, morbidity and mortality remain significantly high. Hypoglycemia is also a medical emergency, which if not treated on time, can cause permanent neurological damage and even death. That’s why it is important to create clear guidelines to treat these complications, in all services, in order to provide emergency medical care. New researchs have been developed to find new diagnostic and therapeutic’s strategies would allow a more integrated management of the DM and its complications, for the sake of improving patients’ life quality...


Subject(s)
Diabetes Mellitus , Blood Glucose
3.
J Clin Rheumatol ; 14(3): 153-5, 2008 Jun.
Article in English | MEDLINE | ID: mdl-18525434

ABSTRACT

OBJECTIVES: To examine current practices for the diagnosis and therapy for glucocorticoid-induced osteoporosis (GIOP) in patients under treatment with corticosteroids at outpatient clinics of rheumatologists in a Colombian Caribbean city. METHODS: All patients noted to be using of glucocorticoids (GC) on an index consult from February to May 2004 were included in a descriptive cross sectional study. Criteria for inclusion of patients were to have had, at least, one previous visit to the service. We evaluated the study population for osteoporosis diagnosis, procedures, and treatment. RESULTS: Of the 121 patients included, 103 (85.1%) were female and 18 (14.9%) were male; 76 patients (62.8%) were under 50 years, and 45 (37.2%) were over 50 years. Main reasons for corticosteroid use were rheumatoid arthritis in 68 patients (56.2%) and systemic lupus erythematous (SLE) in 31 patients (25.6%). Diagnostic testing for osteoporosis was reported on 50.1% of patients. Peripheral dual energy x-ray absorptiometry was the most frequently used method (52.6%). Therapeutic agents for GIOP were used in 96 patients (79.3%), with Calcium plus Vitamin D (55.2%) the principal treatments prescribed. CONCLUSIONS: We found similar rates of diagnosis and treatment for GIOP to those reported in North America and Europe, although in this study treatment was mainly with calcium and vitamin D. There was a statistically significant relationship between being studied with any diagnostic method and being treated for GIOP. There may be undertreatment for GIOP in Latin America. Local interventions to improve care for patients in chronic use of steroids are needed.


Subject(s)
Glucocorticoids/adverse effects , Osteoporosis/chemically induced , Rheumatic Diseases/drug therapy , Absorptiometry, Photon , Bone Density Conservation Agents/therapeutic use , Colombia , Cross-Sectional Studies , Female , Humans , Male , Medical Audit , Middle Aged , Osteoporosis/diagnosis , Osteoporosis/prevention & control
4.
Salud UNINORTE ; 23(1): 96-111, jul. 2007. ilus, tab
Article in Spanish | LILACS | ID: lil-477953

ABSTRACT

Snake bites are prevalent and related to different activities in the area of tropical regions.Since October 2004, The “Ministerio de Protección Social” from Colombia has declared itas an event of mandatory notification.Recent data has facilitated the understanding of the mechanism of action of different venoms.The local toxicity, hemorrhage, renal damage and hipotensive effects of the Botrhopic venomhas been described. As well as the Lachesis’s vagal neurotoxicity, the Chrotalis’ muscularneuraltoxicity, and the Elapidae’s palsy effect. These snakes genders are responsible of 99 percentof snake bites in Colombia, with Bathrops causing 90-95 percent of cases. The better understandingof the toxicity and the body’s response have lead to the publication of management guidesincluding the classification of the bites, according to clinical presentation and laboratoryworkup (specially coagulation studies). This has also leaded the development of protocolsregarding the administration of the neutralizing serum, depending on different presentations,being this the only effective treatment in the case of a systemic envenomation. For these reasonsthe national availability of the serum must be warranted, as well as its administration, inspite of the early allergic reactions. The Whole Blood Clotting Test, which has been certifiednationally in the “Dirección Seccional de Salud de Antioquia” guidelines is also described.This test is a good alternative to guide the management in rural areas. Some recent dataabout the role of the mastocites in the immune response against the venom is also described,opening new ways to treatment investigations.


Subject(s)
Humans , Animals , Poisoning , Snake Bites , Snake Venoms , Crotalus , Elapidae , Enzymes , Necrosis
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