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1.
Neurologia (Engl Ed) ; 38(6): 419-426, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37120108

RESUMO

OBJECTIVE: This study provides a series of updated, evidence-based recommendations for the management of acute stroke. We aim to lay a foundation for the development of individual centres' internal protocols, serving as a reference for nursing care. METHODS: We review the available evidence on acute stroke care. The most recent national and international guidelines were consulted. Levels of evidence and degrees of recommendation are based on the Oxford Centre for Evidence-Based Medicine classification. RESULTS: The study describes prehospital acute stroke care, the operation of the code stroke protocol, care provided by the stroke team upon the patient's arrival at hospital, reperfusion treatments and their limitations, admission to the stroke unit, nursing care in the stroke unit, and discharge from hospital. CONCLUSIONS: These guidelines provide general, evidence-based recommendations to guide professionals who care for patients with acute stroke. However, limited data are available on some aspects, showing the need for continued research on acute stroke management.


Assuntos
Cuidados de Enfermagem , Acidente Vascular Cerebral , Humanos , Acidente Vascular Cerebral/terapia , Hospitalização , Hospitais , Encaminhamento e Consulta
2.
Best Pract Res Clin Obstet Gynaecol ; 72: 117-128, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32900599

RESUMO

The purpose of this review is to describe the panorama of placenta accreta spectrum (PAS) disorder management in low- and middle-income countries, providing information that allows for the improvement of maternal and perinatal outcomes in the management of this pathology. This spectrum of disorders is associated with implications of high morbidity and mortality, both maternal and perinatal, which is why clinical practice guidelines based on management are produced in settings where there is a wide range of available resources. This situation often contrasts with what the reality is in low-resource countries. Prenatal diagnosis of placental accreta is essential to carry out adequate surgical planning in centres where multidisciplinary teams are in place, which improve results and reduce complications. These ideal scenarios should be developed in countries with more significant difficulties in the availability of human and technological resources, through teamwork in the different hospital centres and the adequate transfer of patients at higher risk to centres with the best interdisciplinary management skills.


Assuntos
Placenta Acreta , Placenta Prévia , Feminino , Humanos , Placenta , Placenta Acreta/diagnóstico por imagem , Placenta Acreta/terapia , Gravidez , Diagnóstico Pré-Natal
3.
Neurologia (Engl Ed) ; 2020 Nov 02.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33153769

RESUMO

OBJECTIVE: This study provides a series of updated, evidence-based recommendations for the management of acute stroke. We aim to lay a foundation for the development of individual centres' internal protocols, serving as a reference for nursing care. METHODS: We review the available evidence on acute stroke care. The most recent national and international guidelines were consulted. Levels of evidence and degrees of recommendation are based on the Oxford Centre for Evidence-Based Medicine classification. RESULTS: The study describes prehospital acute stroke care, the operation of the code stroke protocol, care provided by the stroke team upon the patient's arrival at hospital, reperfusion treatments and their limitations, admission to the stroke unit, nursing care in the stroke unit, and discharge from hospital. CONCLUSIONS: These guidelines provide general, evidence-based recommendations to guide professionals who care for patients with acute stroke. However, limited data are available on some aspects, showing the need for continued research on acute stroke management.

4.
Clin Nephrol ; 75(4): 328-35, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21426887

RESUMO

BACKGROUND: Hereditary hemochromatosis is an autosomal recessive condition causing excessive intestinal iron absorption related to C282Y hemochromatosis mutation gene. Dialysis patients receive intravenous iron supplements as treatment for anemia. The gene mutation frequency and its influence on iron deposits and intravenous iron response are unknown in these patients. STUDY DESIGN: Prospective observational. SETTING AND PARTICIPANTS: 290 dialysis patients in Gran Canaria, Spain. OUTCOMES AND MEASUREMENTS: The C282Y hemochromatosis mutation gene was studied. Other active players in iron metabolism have not been included in this study. Red cell parameters, serum iron, transferrin and ferritin concentrations were measured every 2 months for 2 years. RESULTS: No differences in allelic and genotypic frequencies between dialysis patients and the general population were detected. Baseline clinical or analytical parameters were similar in C282Y +/- and C282Y -/- patients. Among those who did not need intravenous iron treatment, C282Y+/- patients maintained constant serum ferritin (302.1 ± 216.7 vs. 319.5 ± 300.5 µg/l after 4 months), whereas C282Y-/- patients showed decreased levels during the same period (306.7 ± 212.2 vs. 221.6 ± 167.8 µg/l, p < 0.001). After 4 months of parenteral iron, serum ferritin increased more intensely in C282Y +/- patients than in C282Y -/- patients (934.2 ± 195.8 vs. 658.7 ± 259.9 µg/l, p < 0.001). A multivariance analysis identified the C282Y allele as the most important factor that explains this difference. CONCLUSIONS: Heterozygosity for the C282Y allele of the hemochromatosis mutation gene could be associated with differences in iron parameters in dialysis patients.


Assuntos
Hemocromatose/genética , Antígenos de Histocompatibilidade Classe I/genética , Ferro/sangue , Proteínas de Membrana/genética , Mutação de Sentido Incorreto , Diálise Renal , Alelos , Análise de Variância , Antígenos de Superfície/genética , Distribuição de Qui-Quadrado , Feminino , Genótipo , Hemocromatose/sangue , Hemocromatose/tratamento farmacológico , Proteína da Hemocromatose , Humanos , Ferro/uso terapêutico , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Estatísticas não Paramétricas
7.
J Pediatr Gastroenterol Nutr ; 37(5): 604-8, 2003 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-14581805

RESUMO

BACKGROUND: Celiac disease is a multifactorial disorder of the proximal small intestine associated with a permanent intolerance to gluten. The HLA-DQ(alpha1*0501, beta1*02) heterodimer is strongly associated with this disease. MATERIALS AND METHODS: The authors studied a sample of 354 unrelated Caucasoid individuals: 118 patients with celiac disease and 236 control subjects. All patients and controls subjects were born in Gran Canaria (Canary Islands) at least two generations ago. The authors typed the HLA-DQA1 and DQB1 genes by DNA methods. The positive and negative predictive values of the test were studied. RESULTS: The mean age at diagnosis was 25.4 months, with a statistically significant proportion of females (64.4%, P < 0.002). For DQB1 gene, the susceptibility allele found was DQB1*02 (relative risk [RR] = 7.60, confidence interval [CI]: 5.35-10.78), whereas for the DQA1 gene, the susceptibility alleles found were DQA1*0501 (RR = 2.99, CI: 2.16-4.14) and DQA1*0201 (RR = 1.88, CI: 1.25-2.82). The presence of the DQ(alpha1*0501, beta1*02) heterodimer was strongly associated with the disease (92.4% in the patients group vs. 21.6% in control subjects). HLA-DQ8 heterodimer was absent in the authors' patients. DQB1*02 homozygous subjects presented a higher relative risk for celiac disease. There was no correlation of DQB1*02 dosage with age at onset below 12 years of age or with gender distribution. Sensitivity, specificity, and the positive and negative predictive values of the test were 92.4%, 78.4%, 68.1%, and 95.4%, respectively. CONCLUSIONS: The presence of the DQ2 (DQA1*0501/DQB1*02) heterodimer is strongly associated with celiac disease in the population studied by the authors. The value of this test derives from its ability to exclude disease when a negative result occurs.


Assuntos
Doença Celíaca/diagnóstico , Doença Celíaca/genética , Predisposição Genética para Doença , Antígenos HLA-DQ/genética , Alelos , Criança , Pré-Escolar , Dimerização , Feminino , Dosagem de Genes , Genótipo , Cadeias alfa de HLA-DQ , Cadeias beta de HLA-DQ , Humanos , Lactente , Masculino , Sensibilidade e Especificidade , Espanha
8.
Neuroradiology ; 45(10): 725-6, 2003 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-12955367

RESUMO

I report a young man with hemichorea in whom fluid-attenuated inversion-recovery images alone showed signal change.


Assuntos
Coreia/diagnóstico , Imageamento por Ressonância Magnética , Adulto , Corpo Estriado/patologia , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino
9.
Thorax ; 58(7): 618-22, 2003 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12832681

RESUMO

BACKGROUND: In recent years several population based studies using restriction fragment length polymorphism (RFLP) analysis have shown a higher rate of recent transmission of tuberculosis than previously thought. This study was undertaken to determine the transmission patterns of tuberculosis and the potential causes of recent transmission on the island of Gran Canaria (Spain). METHODS: The strains of all patients diagnosed with tuberculosis confirmed by culture between 1 January 1993 and 31 December 1996 were typed by RFLP using the insertion sequence IS6110. A cluster was defined as two or more isolates with an identical RFLP pattern. Epidemiological linkage through contact tracing was investigated. RESULTS: Of the total of 719 patients, 153 (21.3%) were excluded because there was inadequate bacterial DNA for genotyping (n=129) or the isolates of Mycobacterium tuberculosis had less than five copies of IS6110 (n=24). The isolates from 409 patients (72.3%) were grouped into 78 different clusters with an estimated 58.5% of the cases being due to recent transmission. Young age was the only significant predictor of clustering. Only in 147 (35.9%) of the 409 patients belonging to a cluster could an epidemiological link be found. 111 patients (19.6%) were identified as having had previous contact with a tuberculosis patient and 81 of them (72.9%) belonged to a cluster. The three largest clusters included 75, 49 and 20 patients, respectively. CONCLUSION: Recent transmission is frequent among patients with tuberculosis on Gran Canaria and could be associated with certain aspects of control measures. Some of the clusters described in the study could be due to the prevalence of particular strains of M tuberculosis on the island.


Assuntos
Tuberculose Pulmonar/epidemiologia , Adulto , Idoso , Análise de Variância , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Polimorfismo de Fragmento de Restrição , Prevalência , Fatores de Risco , Espanha/epidemiologia , Tuberculose/epidemiologia , Tuberculose/microbiologia , Tuberculose/transmissão , Tuberculose Pulmonar/microbiologia , Tuberculose Pulmonar/transmissão
10.
Rev Esp Cardiol ; 54(10): 1230-2, 2001 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-11591306

RESUMO

Hemorrhage of variable severity is the main complication of thrombolytic treatment. We present the case of a rare hemorrhagic location after the use of this treatment for acute myocardial infarction, as ankle hemarthrosis. In the first twelve hours the patient had a joint hemorrhagic effusion with refractory pain and arthrocentesis was required. Recurrence occurred while receiving heparin and after discontinuation of heparin perfusion stopped the patient developed occlusion of the coronary artery related to the infarct requiring emergency angioplasty. We discuss the severity and possible treatment of this situation.


Assuntos
Fibrinolíticos/efeitos adversos , Hemartrose/etiologia , Infarto do Miocárdio/tratamento farmacológico , Terapia Trombolítica/efeitos adversos , Ativador de Plasminogênio Tecidual/efeitos adversos , Adulto , Articulação do Tornozelo , Humanos , Masculino
14.
J Am Soc Echocardiogr ; 11(4): 397-8, 1998 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-9571592

RESUMO

Transesophageal echocardiography is a semi-invasive diagnostic technique with a very low incidence of significant complications. Only two deaths related to the procedure have been reported in the literature. We present the case of a 46-year-old man with a right atrial mass, presumably a cardiac myxoma. During attempts at esophageal intubation for a transesophageal echocardiography procedure, the mass fragmented and dislodged, causing massive pulmonary embolism and death. We believe that to avoid this potential complication, great care must be taken in the evaluation of patients with a right intracardiac mass by means of transesophageal echocardiography.


Assuntos
Ecocardiografia Transesofagiana/efeitos adversos , Embolia Pulmonar/etiologia , Evolução Fatal , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Mixoma/complicações , Mixoma/diagnóstico por imagem
15.
Chest ; 113(4): 1034-6, 1998 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-9554643

RESUMO

STUDY OBJECTIVES: Differences between the number and areas of pleural plaques in every hemithorax could not be expected a priori. However, previous studies based on chest radiographs reported an unexplained left-sided predominance. In this paper, a comparison of summed surfaces and location of plaques calculated from CT studies was performed. PATIENTS AND METHODS: Thoracic CT scans from 40 adults with asbestos exposure and pleural plaques were analyzed. The surface area of every plaque was calculated, and summed areas were recorded separately for every hemithorax. The statistical analysis was performed with t-tests for paired samples. Emphasis was placed on measurement differences. MEASUREMENTS AND RESULTS: The results show lack of significant predominance for any hemithorax. A total of 668 plaques (352 right and 316 left) were measured, with an average area (+/-SD) of 47.81+/-47.72 cm2 for the right plaques and 45.34+/-67.32 cm2 for the left. The mean of differences (left minus right areas) was -2.56+/-53.68 and slightly statistically different from zero (p=0.652). CONCLUSIONS: Left-sided predominance of asbestos-related pleural plaques is not supported by this study.


Assuntos
Amianto/efeitos adversos , Pleura/patologia , Tomografia Computadorizada por Raios X , Adulto , Fibrose , Humanos , Masculino , Pleura/diagnóstico por imagem , Estudos Retrospectivos
19.
Acta Radiol ; 36(3): 273-5, 1995 May.
Artigo em Inglês | MEDLINE | ID: mdl-7742121

RESUMO

We report ultrasound, CT and MR findings in a patient with multiple bile duct hamartomas (BDH) which were associated with disseminated peritoneal leiomyomatosis, a coincidence not previously reported. At MR imaging, the multiple hepatic nodules of BDH were hypointense in T1-weighted images and moderately hyperintense in T2-weighted images, which is in agreement with the findings in the 2 previously reported cases examined with this modality.


Assuntos
Ductos Biliares Intra-Hepáticos/patologia , Diagnóstico por Imagem , Hamartoma/diagnóstico , Doenças dos Ductos Biliares/diagnóstico , Doenças dos Ductos Biliares/diagnóstico por imagem , Feminino , Hamartoma/diagnóstico por imagem , Humanos , Leiomiomatose/patologia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias Peritoneais/patologia , Tomografia Computadorizada por Raios X , Ultrassonografia , Neoplasias Uterinas/patologia
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