Esteatosis hepática no alcohólica: relación con la circunferencia de cintura / Non-alcoholic hepatic steatosis: related to waist circumference

Introducción: La esteatosis hepática no alcohólica ocurre cuando la grasa se deposita en el hígado y la obesidad es considerada uno de los factores relacionados en la aparición de esta patología, debido a que se ha observado que es una condición esteato inflamatoria que ocurre sólo en el 2,5% de la población no obesa. La circunferencia de cintura es una medición antropométrica relacionada con adiposidad visceral, y es muy utilizada por su capacidad de identificar el riesgo de padecer algunas enfermedades metabólicas y cardiovasculares. El Objetivo es relacionar la circunferencia de cintura con la presencia de esteatosis hepática no alcohólica determinado por ultrasonido abdominal. Materiales y Métodos: Se determinó la circunferencia de cintura mediante la medición según la técnica de Lohman, Roche y Martorell, y se comparó con los resultados de un ultrasonido abdominal en tiempo real para la determinación de EHNA. Resultados: en todos los pacientes, a medida que existe mayor severidad en el diagnóstico de esteatosis hepática no alcohólica, la circunferencia de cintura es mayor. Conclusiones: la elevación de la circunferencia de cintura se relaciona directa y significativamente con la aparición de esteatosis hepática no alcohólica.

Introduction: The Non-alcoholic fatty liver disease or non-alcoholic hepatic steatosis occurs when the fat is stored in the liver, and Obesity is considered one of the factors related to the onset of this pathology, since it has been observed that it is a steatoinflammatory condition occurring only in 2,5% of the non-obese population. Waist circumference is an anthropometric measure related to visceral adiposity, and is widely used for its ability to identify the risk of metabolic and cardiovascular diseases. The Objective is to relate waist circumference with the presence of non-alcoholic hepatic steatosis detected by abdominal ultrasound. Materials and methods: we determined the measurements of waist circumference according to Lohman, Roche and Matorell’s technique, and we compared that measurements with the results of the abdominal ultrasound in real time, to determinate the presence of non-alcoholic hepatic steatosis. Results: in all patients, when the severity of the hepatic steatosis increased, the value of the waist circumference was higher. Conclusions: the increase of the waist circumference is directly and significantly related to the presence of non-alcoholic hepatic steatosis.

Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis: case series.

OBJECTIVE: In the antibiotic era, purulent pericarditis is a rare entity. However, there are still reports of cases of the disease, which is associated with high mortality, and most such cases are attributed to delayed diagnosis. Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular. METHODS: We report four cases of pneumococcal pneumonia complicated by pericarditis, with different clinical features and levels of severity. RESULTS: In three of the four cases, the main complication was cardiac tamponade. Microbiological screening (urinary antigen testing and pleural fluid culture) confirmed the diagnosis of severe pneumococcal pneumonia complicated by purulent pericarditis. CONCLUSIONS: In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of paramount importance to avoid severe hemodynamic compromise. The complications of acute pericarditis appear early in the clinical course of the infection. The most serious complications are cardiac tamponade and its consequences. Antibiotic therapy combined with pericardiocentesis drastically reduces the mortality associated with purulent pericarditis.

Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis: case series / Pneumonia por Streptococcus pneumoniae complicada por pericardite purulenta: uma série de casos

AbstractObjective: In the antibiotic era, purulent pericarditis is a rare entity. However, there are still reports of cases of the disease, which is associated with high mortality, and most such cases are attributed to delayed diagnosis. Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular.Methods: We report four cases of pneumococcal pneumonia complicated by pericarditis, with different clinical features and levels of severity.Results: In three of the four cases, the main complication was cardiac tamponade. Microbiological screening (urinary antigen testing and pleural fluid culture) confirmed the diagnosis of severe pneumococcal pneumonia complicated by purulent pericarditis.Conclusions: In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of paramount importance to avoid severe hemodynamic compromise. The complications of acute pericarditis appear early in the clinical course of the infection. The most serious complications are cardiac tamponade and its consequences. Antibiotic therapy combined with pericardiocentesis drastically reduces the mortality associated with purulent pericarditis.

ResumoObjetivo:Na era dos antibióticos, a pericardite purulenta é uma entidade rara. Entretanto, ainda há relatos de casos da doença, associados a alta mortalidade, muitos deles atribuídos ao diagnóstico tardio. Aproximadamente 40-50% de todos os casos de pericardite purulenta são causados por bactérias gram-positivas, particularmente Streptococcus pneumoniae.Métodos:Relatamos quatro casos de pneumonia pneumocócica complicada por pericardite, com diferentes características clínicas e níveis de gravidade.Resultados:Em três dos quatro casos, a principal complicação foi tamponamento cardíaco. A pesquisa microbiológica (teste de antígeno urinário e cultura de líquido pleural) confirmou o diagnóstico de pneumonia pneumocócica grave complicada por pericardite purulenta.Conclusões:Em casos de pneumonia pneumocócica complicada por pericardite, o pronto diagnóstico é de extrema importância para evitar comprometimento hemodinâmico grave. As complicações da pericardite aguda aparecem no início do curso clínico da infecção. As complicações mais graves são tamponamento cardíaco e suas consequências. A antibioticoterapia com pericardiocentese reduz sobremaneira a mortalidade associada à pericardite purulenta.

The Effect of Macrolide Resistance on the Presentation and Outcome of Patients Hospitalized for Streptococcus pneumoniae Pneumonia.

RATIONALE: There are conflicting reports describing the effect of macrolide resistance on the presentation and outcomes of patients with Streptococcus pneumoniae pneumonia. OBJECTIVES: We aimed to determine the effect of macrolide resistance on the presentation and outcomes of patients with pneumococcal pneumonia. METHODS: We conducted a retrospective, observational study in the Hospital Clinic of Barcelona of all adult patients hospitalized with pneumonia who had positive cultures for S. pneumoniae from January 1, 2000 to December 31, 2013. Outcomes examined included bacteremia, pulmonary complications, acute renal failure, shock, intensive care unit admission, need for mechanical ventilation, length of hospital stay, and 30-day mortality. MEASUREMENTS AND MAIN RESULTS: Of 643 patients hospitalized for S. pneumoniae pneumonia, 139 (22%) were macrolide resistant. Patients with macrolide-resistant organisms were less likely to have bacteremia, pulmonary complications, and shock, and were less likely to require noninvasive mechanical ventilation. We found no increase in the incidence of acute renal failure, the frequency of intensive care unit admission, the need for invasive ventilatory support, the length of hospital stay, or the 30-day mortality in patients with (invasive or noninvasive) macrolide-resistant S. pneumoniae pneumonia, and no effect on outcomes as a function of whether treatment regimens did or did not comply with current guidelines. CONCLUSIONS: We found no evidence suggesting that patients hospitalized for macrolide-resistant S. pneumoniae pneumonia were more severely ill on presentation or had worse clinical outcomes if they were treated with guideline-compliant versus noncompliant regimens.