ABSTRACT
La enfermedad inflamatoria intestinal es una entidad compleja que incluye la enfermedad de Crohn y la colitis ulcerosa, y se caracteriza por un estado proinflamatorio crónico con un curso oscilante y que en muchas ocasiones conlleva una gran morbilidad a estos pacientes. En la última década se han identificado distintas dianas terapéuticas que permiten el uso de fármacos biológicos, en particular los anticuerpos dirigidos contra el factor de necrosis tumoral alfa, que se asocian en un 5% de los casos con reacciones paradójicas psoriasiformes, que requieren una estrecha colaboración entre el dermatólogo y el gastroenterólogo en la toma de decisiones. La enfermedad inflamatoria intestinal se asocia, asimismo, a otras diversas manifestaciones dermatológicas y reumatológicas, y presenta una asociación genética y patogénica con la psoriasis, que justifica tanto el abordaje interdisciplinario de estos pacientes como la presente revisión
Inflammatory bowel disease (IBD) is a complex entity that includes Crohn disease and ulcerative colitis. It is characterized by a chronic proinflammatory state of varying intensity that often leads to considerable morbidity. In the last decade, several therapeutic targets have been identified that are susceptible to the use of biological agents, including anti-tumor necrosis factor alpha antibodies, which are associated with paradoxical psoriasiform reactions in 5% of patients. Decision-making in the management of these cases requires close collaboration between the dermatologist and gastroenterologist. Inflammatory bowel disease is also associated with various other dermatologic and rheumatologic manifestations, and presents a genetic and pathogenic association with psoriasis that justifies both the interdisciplinary approach to these patients and the present review
Subject(s)
Humans , Male , Female , Inflammatory Bowel Diseases/diagnosis , Inflammatory Bowel Diseases/etiology , Inflammatory Bowel Diseases/pathology , Receptors, Tumor Necrosis Factor/analysis , Crohn Disease/complications , Colitis, Ulcerative/complications , Comorbidity , Psoriasis/complications , Spondylarthropathies/complicationsABSTRACT
OBJECTIVE: To evaluate the interobserver reliability of the Short Physical Performance Battery (SPPB) and hand dynamometry when measuring isometric muscle strength in people with chronic obstructive pulmonary disease (COPD). DESIGN: Reliability study. Each patient was assessed by a pulmonology physician and a physical therapist in 2 separate sessions 7 to 14 days apart (mean, 9.8±0.8d). Each rater was blinded to the other's results. SETTING: Pneumology unit of a public hospital. PARTICIPANTS: Random sample of outpatients with stable COPD (N=30). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: SPPB and muscle strength (kg) using electronic handgrip and handheld dynamometers. Reliability was assessed with intraclass correlation coefficients (ICCs), standard error of measurement values, and Bland-Altman plots. ICCs were calculated for the SPPB summary score and for its 3 subscales. RESULTS: The ICCs for the overall reliability of the SPPB summary score and for grip and quadriceps strength were .82 (95% confidence interval [CI], .62-.91), .97 (95% CI, .93-.98), and .76 (95% CI, .49-.88), respectively. The standard error of measurement values were .55 points, 1.30kg, and 1.22kg, respectively. The mean differences between the rater's scores were near zero for grip strength and SPPB summary score measures. The ICCs for the SPPB subscales were .84 (95% CI, .66-.92) for the chair subscale, .75 (95% CI, .48-.88) for gait, and .33 (95% CI, -.42 to .68) for balance. CONCLUSIONS: Interobserver reliability was good for quadriceps and handgrip dynamometry and for the SPPB summary score and its chair stand and gait speed subscales. Both pulmonary physicians and physical therapists can obtain and exchange the scores. Because the reliability of the balance subscale was questionable, it is better to use the SPPB summary score.
Subject(s)
Exercise Test/methods , Hand Strength/physiology , Muscle Strength/physiology , Pulmonary Disease, Chronic Obstructive/physiopathology , Aged , Comorbidity , Female , Gait , Health Behavior , Humans , Male , Middle Aged , Muscle Strength Dynamometer , Observer Variation , Prospective Studies , Quadriceps Muscle/physiology , Reproducibility of Results , Single-Blind MethodSubject(s)
Breast Neoplasms , Pregnancy Complications, Neoplastic , Anthracyclines/therapeutic use , Antineoplastic Agents/therapeutic use , Breast Feeding , Breast Neoplasms/diagnosis , Breast Neoplasms/drug therapy , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Female , Genes, BRCA1 , Genes, BRCA2 , Humans , Postpartum Period , Pregnancy , Pregnancy Complications, Neoplastic/diagnosis , Pregnancy Complications, Neoplastic/drug therapy , Pregnancy Complications, Neoplastic/radiotherapy , Pregnancy Complications, Neoplastic/surgery , Pregnancy Outcome , Prognosis , Taxoids/therapeutic use , Vinblastine/analogs & derivatives , Vinblastine/therapeutic use , VinorelbineABSTRACT
En ocho pacientes pediátricos con carcinoma nasofaríngeo se hizo una análisis histológico, inmunohistoquímico y con cxitometría de flujo. Fueron seis niños y dos niñas con edades entre 1 y 15 años. La evolución de los síntomas hasta el momento del diadnóstico fue de 5 meses o menos en siete de ellos y uno mas tenía tres años de evolución. El diagnóstico se hizo en ganglios linfáticos cervicales en 5 casos y en el tumor primario en tres. Se hallaron tres carcinomas epidermoides no queratinizantes y cinco carcinomas indiferenciados. De los cinco casos estudiados con inmunohistoquímica, todos resultaron positivos para antígeno de membrana epitelial y queratina policlonal, cuatro para queratina de alto peso molecular y tres para queratina de bajo peso molecular. La citometría de flujo para determinar el contenido de ADN mostró picos hipodiploides en tres de cinco casos estudiados. Tres de los pacientes se presentaron con cefalea y lesiones de pares craneales, los otros siete tenían extensa infiltración neoplásica local y de huesos del craneo. Tres fallecieron con actividad tumoral, uno está en remisión total y tres tenían actividad tumoral caundo se examinaron por ultima vez. El carcinoma nasofaríngeo es una neoplasia rara que tiene mal pronóstico por el diagnóstico tardío y la extensa infiltración local.
