Assuntos
Humanos , Atenção , Patologia , Doenças Transmissíveis , Unidades de Terapia Intensiva , Pacientes , EspanhaRESUMO
The objective of this study was to evaluate the efficacy and safety of fidaxomicin in the real-life clinical setting. This was a retrospective cohort of patients with Clostridium difficile infection (CDI) treated with fidaxomicin in 20 Spanish hospitals between July 2013 and July 2014. Clinical cure, 30-day recurrence, 30-day mortality, sustained cure, and factors associated with the failure to achieve sustained cure were analyzed. Of the 72 patients in the cohort 41 (56.9 %) had a fatal underlying disease. There were 44 (61.1 %) recurrent episodes and 26 cases (36.1 %) with a history of multiple recurrences. Most episodes were severe (26, 36 %) or severe-complicated (14, 19.4 %). Clinical cure rate was 90.3 %, recurrence rate was 16.7 % and three patients (4.2 %) died during the follow-up period. Sustained cure was achieved in 52 cases (72.2 %). Adverse events were reported in five cases (6.9 %). Factors associated with the lack of sustained cure were cardiovascular comorbidity (OR 11.4; 95 %CI 1.9-67.8), acute kidney failure (OR 7.4; 95 %CI 1.3-43.1), concomitant systemic antibiotic treatment (OR 6.2; 95 %CI 1.1-36.8), and C-reactive protein value at diagnosis (OR 1.2 for each 1 mg/dl increase; 95 %CI 1.03-1.3). Fidaxomicin is an effective and well tolerable treatment for severe CDI and for cases with elevated recurrence risk.
Assuntos
Aminoglicosídeos/uso terapêutico , Antibacterianos/uso terapêutico , Clostridioides difficile/isolamento & purificação , Infecções por Clostridium/tratamento farmacológico , Diarreia/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aminoglicosídeos/efeitos adversos , Antibacterianos/efeitos adversos , Clostridioides difficile/efeitos dos fármacos , Infecções por Clostridium/microbiologia , Diarreia/microbiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Fidaxomicina , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha , Análise de Sobrevida , Resultado do Tratamento , Adulto JovemRESUMO
La incidencia de fallo renal agudo durante el embarazo ha descendido en los países desarrollados. Este cambio se debe a la legalización del aborto, la amplia cobertura de cuidados prenatales y la disminución de la incidencia del aborto séptico. Sin embargo existen patologías obstétricas que se asocian a fallo renal agudo con una morbi-mortalidad asociada suponiendo un importante reto para el clínico. Este artículo revisa la literatura disponible sobre esta patología considerando la ausencia de ensayos clínicos randomizados que permitan recomendar terapias específicas para su manejo con un nivel de evidencia adecuado (AU)
The incidence of acute renal failure during pregnancy has declined in developed countries. This change is due to the legalization of abortion, prenatal care coverage and decreasing the incidence of septic abortion. However, there are obstetric pathologies that are associated with acute renal failure associated morbidity and mortality is an important challenge for the clinician. This article reviews the available literature on this condition considering the absence of randomized clinical trials to recommend specific therapies that allow for management with an appropriate level of evidence (AU)
Assuntos
Humanos , Feminino , Gravidez , Injúria Renal Aguda/epidemiologia , Complicações na Gravidez/diagnóstico , Testes de Função Renal , Aborto Séptico/epidemiologiaRESUMO
Endotracheal intubation and mechanical ventilation have traditionally been employed in patients with acute respiratory insufficiency. However, this form of management can have serious adverse effects, mainly infections and barotrauma. Noninvasive ventilation (NIV) has been shown to be an effective alternative, as it reduces both the frequency of complications and cost of care. In fact, NIV is currently the first choice treatment for acute respiratory insufficiency in patients who have chronic obstructive pulmonary disease or who are immunocompromised. It is also commonly applied in patients with asthma, pneumonia, and acute cardiogenic pulmonary edema. Correct indication and training in use of NIV equipment is necessary to ensure success and facilitate patient tolerance.
Assuntos
Respiração Artificial/instrumentação , Respiração Artificial/métodos , Doença Aguda , Desenho de Equipamento , Humanos , Máscaras , Seleção de Pacientes , Respiração Artificial/efeitos adversos , Insuficiência Respiratória/terapiaRESUMO
La intubación endotraqueal con ventilación mecánica convencional es el tratamiento habitual de la insuficiencia respiratoria. Sin embargo, a veces se pueden producir efectos secundarios importantes, fundamentalmente de tipo infeccioso y por barotrauma. La ventilación mecánica no invasiva (VMNI),ha demostrado ser una alternativa eficaz, ya que disminuye la incidencia de complicaciones y reduce costes. De hecho, en el momento actual se considera de primera elección en pacientes con insuficiencia respiratoria secundaria a Enfermedad Pulmonar Obstructiva Crónica (EPOC) reagudizada y en inmunocomprometidos, además se utiliza habitualmente en pacientes con asma, neumonía y edema agudo de pulmón. Una correcta motivación y entrenamiento de todo el equipo que utiliza estas técnicas, es imprescindible para asegurar su éxito y favorecer la tolerancia por el paciente
Endotracheal intubation and mechanical ventilation have traditionally been employed in patients with acute respiratory insufficiency. However, this form of management can have serious adverse effects, mainly infections and barotrauma. Noninvasive ventilation (NIV)has been shown to be an effective alternative, as it reduces both the frequency of complications and cost of care. In fact, NIV is currently the first choice treatment for acute respiratory insufficiency in patients who have chronic obstructive pulmonary disease or who are immunocompromised. It is also commonly applied in patients with asthma, pneumonia, and acute cardiogenic pulmonary edema. Correct indication and training in use of NIV equipment is necessary to ensure success and facilitate patient tolerance
Assuntos
Humanos , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Doença Aguda , Desenho de Equipamento , Máscaras , Seleção de Pacientes , Respiração Artificial/efeitos adversos , Insuficiência Respiratória/terapiaRESUMO
AIDS concerns anaesthetic practice for various reasons. First, this syndrome can affect different organs that have anaesthetic implications. Second, drugs usually taken by the patient can interact with anaesthetic agents. And last, the risk of infection for health workers must be taken into account, as well as the procedure to follow after accidental injures.
Assuntos
Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Anestesia , Anestésicos , Fármacos Anti-HIV/uso terapêutico , Síndrome da Imunodeficiência Adquirida/diagnóstico , Síndrome da Imunodeficiência Adquirida/fisiopatologia , Síndrome da Imunodeficiência Adquirida/transmissão , Interações Medicamentosas , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional , Transmissão de Doença Infecciosa do Profissional para o Paciente , Cuidados Pré-Operatórios , Inquéritos e QuestionáriosRESUMO
El síndrome de inmunodeficiencia adquirida (sida) preocupa al anestesiólogo por diferentes motivos. En primer lugar, puede alterar la función de distintos órganos condicionando la práctica anestésica. En segundo lugar, la medicación que precisan estos enfermos puede desencadenar interacciones con los anestésicos. Por último, se debe conocer el riesgo que supone para el trabajador sanitario y la conducta a seguir en caso de lesión accidental (AU)
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