ABSTRACT
Background and Objective: The aim was to evaluate the role of anti-annexin A5 (anti-ANXA5) antibodies as risk factor for recurrent miscarriage (RM) and unexplained fetal loss (UFL). Patients and methods: Retrospective, cohort study. Setting: Vall dHebron University Hospital. Subjects: 122 women, in two groups: Study group: 54 women with RM/UFL and control group: 68 pregnant without RM/UFL. Intervention: Antiphospholipid, mainly anti-ANXA5 antibody analysis. Comparison of all antiphospholipid antibodies between groups. Results: Antiphospholipid antibody (aPL) prevalence in the study group was 10/54 (14.8%) and 5/68 (7.3%) in control group (p=0.09). In the RM subgroup, it was 3/25 and 9/34 in UFL versus 5/68 in controls (p=0.013). Lupus anticoagulant (LA) was present in 4 cases, all belonging to the study group (p=0.011). Four out of 34 women with UFL were positive for anticardiolipin antibodies-IgG (IgG-aCL) versus 1/68 in controls (p=0.041). In RM subgroup, anti-ANXA5 antibodies were positive in 2/25 versus 3/68 in controls, and in UFL subgroup, 3/34 versus 3/68 cases (p=1.000). Conclusion: According to our results, anti-ANXA5 antibodies should not be considered as a risk factor for RM/UFL (AU)
Fundamento y Objetivo: El objetivo principal fue evaluar el papel de los anticuerpos anti-anexina A5 (ac-anti-ANXA5) como factor de riesgo de abortos recurrentes (AR) y de la pérdida fetal inexplicada (PFI). Pacientes y Método: Se trata de un estudio de cohortes retrospectivo. Se desarrolló en el Hospital Universitario Vall dHebron de Barcelona. Se estudiaron un total de 122 mujeres, en dos grupos: grupo de estudio, formado por: 54 mujeres con AR/PFI y grupo control, constituido por 68 gestantes sin historia de AR/PFI. Se estudiaron los anticuerpos antifosfolípido (aFL), con especial interés para los ac-anti-ANXA5. Se compararon los resultados entre ambos grupos, estudio y control. Resultados: La prevalencia de positividad para los aFL fue de 10/54 (14,8%) en el grupo de estudio y de 5/68 (7,3%) en el grupo control (p=0,09). En el subgrupo de mujeres con AR, la prevalencia de los aFL fue de 3/25 y de 9/35 en el subgrupo afecto de PFI, versus 5/68 en el grupo control (p=0,013). El anticoagulante lúpico (AL) fue positivo en 4 casos, todos ellos pertenecientes al grupo de estudio (p=0,011). Cuatro de las 34 mujeres con historia de PFI tenían anticuerpos anti-cardiolipina isotipo IgG versus 1/68 en el grupo control (p=0,041). En el subgrupo de AR, los ac-anti-anexina A5 se detectaron en 2/25 casos versus 3/68 en el grupo control y 3/34 el subgrupo con PFI (p=1,000). Conclusiones: De acuerdo con los resultados de nuestro estudio, los anticuerpos anti-anexina A5 no deberían ser considerados como factores de riesgo de AR y/o de PFI (AU)
Subject(s)
Humans , Female , Pregnancy , Adult , Abortion, Spontaneous/immunology , Annexin A5/immunology , Antibodies, Antiphospholipid/blood , Antiphospholipid Syndrome/immunology , Cohort Studies , Retrospective Studies , Lupus Coagulation InhibitorABSTRACT
Fundamento y objetivo: Existen pocos datos en la bibliografía sobre el tratamiento antibiótico intravenoso de abscesos hepáticos en unidades de hospitalización a domicilio (UHD). Nuestros objetivos fueron analizar las características de los pacientes con abscesos hepáticos ingresados en nuestra UHD, la eficacia y la seguridad del tratamiento antibiótico intravenoso y los factores de riesgo de reingreso hospitalario. Pacientes y método: Se incluyeron en el estudio todos los pacientes ingresados en nuestra UHD para tratamiento antibiótico intravenoso por absceso hepático desde marzo de 2006 hasta junio de 2009. Resultados: Se incluyeron 30 pacientes en el estudio. Cinco pacientes (16,6%) presentaron flebitis durante el tratamiento y no se observó ningún efecto secundario mayor. La reducción media (desviación estándar) del tamaño durante el ingreso en la UHD fue del 49,3% (36,6). El número de reingresos totales fue de 9 (30%), 6 (20%) durante el período de ingreso en la UHD y 3 (10%) el año posterior. Cuatro pacientes (13,3%) fallecieron durante el seguimiento. Los pacientes que reingresaron tuvieron un tamaño medio del absceso al alta de la UHD mayor respecto de los que no lo tuvieron (4,5 frente a 1,5cm; p=0,001), así como un menor porcentaje de disminución de su tamaño durante el ingreso en la UHD (el 19 frente al 64%; p=0,001). Las mujeres reingresaban más que los varones (el 77,8 frente al 28,6%; p=0,02), pero aquéllas presentaron una menor puntuación de Barthel (75 frente a 92; p=0,01). Conclusiones: El tratamiento antibiótico intravenoso domiciliario en el tratamiento del absceso hepático parece una alternativa segura y eficaz en la mayoría de los pacientes. El tamaño y reducción del absceso al alta, el sexo y el grado de dependencia del paciente constituyeron las principales variables de reingreso (AU)
Background and objective: Few data exists in the literature about intravenous antibiotic treatment of hepatic abscess in hospital based care units. Our objectives were to analyze the efficacy and safety of intravenous antibiotic therapy and the predictors of hospital readmission. Patients and methods: The study included all the patients admitted in our home care unit for intravenous antibiotic treatment of hepatic abscess from March 2006 to June 2009. Results: We included 30 patients in the study. Five patients (16,6%) had phlebitis during treatment and none presented a major secondary effect. Mean size reduction of abscess during admission in our home care unit was 49,3% (36,6%). Nine (30%) patients were readmitted, 6 (20%) during admission at home and 3 (10%) along the year after. Four (13.3%) patients died along follow-up. Patients readmitted had a higher mean size of abscess at discharge from our home care unit as compared to the non readmitted ones (4,5 vs 1,5cms P=0,001), besides a minor percentage of reduction of size (19% vs 64% P=0,001). Female patients were readmitted more frequently than male ones (77,8% vs 28,6% P=0,02), but they had minor scores of Barthel scale (75 vs. 92 P=0,01). Conclusions: Home intravenous antibiotic treatment of hepatic abscess seems to be a safe and effective alternative in most patients. The size and reduction of abscess at patient discharge, the female gender and dependence degree constituted the principal predictors of readmission (AU)
Subject(s)
Humans , Male , Female , Aged , Liver Abscess/drug therapy , Anti-Bacterial Agents/administration & dosage , Injections, Intravenous , Anti-Bacterial Agents/therapeutic use , Patient Readmission/statistics & numerical data , Prospective Studies , Home Care Services , Treatment Outcome , PrognosisABSTRACT
BACKGROUND AND OBJECTIVE: Few data exists in the literature about intravenous antibiotic treatment of hepatic abscess in hospital based care units. Our objectives were to analyze the efficacy and safety of intravenous antibiotic therapy and the predictors of hospital readmission. PATIENTS AND METHODS: The study included all the patients admitted in our home care unit for intravenous antibiotic treatment of hepatic abscess from March 2006 to June 2009. RESULTS: We included 30 patients in the study. Five patients (16,6%) had phlebitis during treatment and none presented a major secondary effect. Mean size reduction of abscess during admission in our home care unit was 49,3% (36,6%). Nine (30%) patients were readmitted, 6 (20%) during admission at home and 3 (10%) along the year after. Four (13.3%) patients died along follow-up. Patients readmitted had a higher mean size of abscess at discharge from our home care unit as compared to the non readmitted ones (4,5 vs 1,5 cms P=0,001), besides a minor percentage of reduction of size (19% vs 64% P=0,001). Female patients were readmitted more frequently than male ones (77,8% vs 28,6% P=0,02), but they had minor scores of Barthel scale (75 vs. 92 P=0,01). CONCLUSIONS: Home intravenous antibiotic treatment of hepatic abscess seems to be a safe and effective alternative in most patients. The size and reduction of abscess at patient discharge, the female gender and dependence degree constituted the principal predictors of readmission.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Home Care Services , Liver Abscess/drug therapy , Patient Readmission/statistics & numerical data , Aged , Female , Humans , Injections, Intravenous , Male , Prospective StudiesABSTRACT
Cerebrovascular accidents (CVAs) and multi-infarct dementia have rarely been reported as presenting symptoms of giant cell arteritis (GCA), although 3%-4% of patients with GCA may present with CVAs during the course of the disease. We describe 7 patients with biopsy-proven GCA who presented with stroke or multi-infarct dementia. Most of them had other symptoms of GCA when the disease began that were misdiagnosed or not noticed. The internal carotid arteries were involved in 4 patients and the vertebrobasilar arteries in 3, with bilateral vertebral artery occlusion in 1. Small cerebral infarction foci on cranial computed tomography (CT) scan and magnetic resonance imaging (MRI) were found in 5 cases, and cerebellar infarction, in 2. MR angiography showed intracranial arteritis in 4 cases. Treatment with glucocorticoids and adjunctive antiplatelet or anticoagulant therapy was given in all cases, with neurologic improvement in 5. Two patients died. Necropsy demonstrated generalized GCA involving the medium and small cerebral vessels in 1 case. Central nervous system involvement is a rare complication in GCA but is important to recognize, as it can be reversible if diagnosed and treated promptly. Suspicion should arise in elderly patients suffering from strokes with a quickly progressing stepwise course and associated headache, fever, or inflammatory syndrome. In these cases, temporal artery biopsy should be performed without delay. Early diagnosis of GCA and immediate initiation of corticosteroid treatment may prevent progressive deterioration and death. Additional antiplatelet or anticoagulant therapy should be evaluated according to the individual risk and benefit to the patient under care.
Subject(s)
Dementia, Multi-Infarct/etiology , Giant Cell Arteritis/diagnosis , Stroke/etiology , Aged , Aged, 80 and over , Female , Giant Cell Arteritis/complications , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
BACKGROUND AND OBJECTIVE: Intravenous antibiotic therapy at home has showed its efficacy as an alternative to hospitalization care in many infectious pathologies. The objectives of this study are: a) to expose our experience, as hospital at home unit (HHU) integrated within a service of internal medicine, in the antibiotic treatment, and b) to define those parameters that can predict hospital readmissions. PATIENTS AND METHOD: This study included all patients with infectious pathology and intravenous antibiotic therapy who were admitted in our HHU from March 2006 to March 2007. RESULTS: 145 patients were included in this study. Successful treatment was observed in 92% of patients. Eleven patients were re-admitted at hospital during the episode by infectious disease, and only 2 of them showed adverse effects to treatment. Twenty-two patients were re-admitted at hospital 3 months after due to chronic pathology. CONCLUSIONS: Intravenous antibiotic therapy at home is a good alternative in many infectious pathologies. Infectious pathology and baseline state can be predictors of hospital readmissions.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Home Care Services, Hospital-Based , Patient Readmission , Aged , Aged, 80 and over , Bacterial Infections/drug therapy , Catheterization, Central Venous , Data Interpretation, Statistical , Female , Humans , Infections/drug therapy , Infusions, Intravenous , Injections, Intravenous , Male , Middle Aged , Prognosis , Time Factors , Treatment OutcomeABSTRACT
FUNDAMENTO Y OBJETIVO: La antibioterapia domiciliariaes una modalidad asistencial alternativa a lahospitalización a domicilio que ha demostrado suseguridad en un gran número de enfermedades infecciosas.Los objetivos principales de este artículoson: a) exponer nuestra experiencia, como unidadde hospitalización a domicilio (UHD)integrada dentro del servicio de medicina interna,en el tratamiento antibiótico intravenoso, y b) definirlos parámetros que pueden predecir un reingresohospitalario.PACIENTES Y MÉTODO: Se incluyó en el estudio a todoslos pacientes ingresados en nuestra UHD porenfermedad infecciosa subsidiaria de antibioterapiaintravenosa desde marzo de 2006 hasta marzode 2007.RESULTADOS: Se incluyó en el estudio a 145 pacientes.El 92% de los casos recibió el alta porbuena evolución clínica. Once pacientes ingresaronen el hospital durante el episodio clínico comoconsecuencia de la propia infección, y sólo 2 presentaronalgún tipo de reacción adversa a causadel tratamiento. Veintidós pacientes ingresaron enel hospital 3 meses después del alta de la UHD,fundamentalmente por enfermedad crónica.CONCLUSIONES: La antibioterapia intravenosa domiciliariaes una buena opción asistencial en unagran variedad de enfermedades infecciosas. A pesarde ello, la propia infección y el estado basaldel paciente influyen activamente en la probabilidadde reingresos hospitalarios
BACKGROUND AND OBJECTIVE: Intravenous antibiotictherapy at home has showed its efficacy as an alternativeto hospitalization care in many infectiouspathologies. The objectives of this study are: a) toexpose our experience, as hospital at home unit(HHU) integrated within a service of internal medicine,in the antibiotic treatment, and b) to definethose parameters that can predict hospital readmissions.PATIENTS AND METHOD: This study included all patientswith infectious pathology and intravenousantibiotic therapy who were admitted in our HHUfrom March 2006 to March 2007.RESULTS: 145 patients were included in this study.Successful treatment was observed in 92% of patients.Eleven patients were re-admitted at hospitalduring the episode by infectious disease, andonly 2 of them showed adverse effects to treatment.Twenty-two patients were re-admitted athospital 3 months after due to chronic pathology.CONCLUSIONS: Intravenous antibiotic therapy athome is a good alternative in many infectious pathologies.Infectious pathology and baseline statecan be predictors of hospital readmissions
