RESUMO
Herein we report the case of a patient with antiphospholipid Syndrome (APS) and an ischemic stroke suffered while he was anticoagulated, and we discuss the usefulness of magnetic resonance angiography in the early diagnosis of such a complication. We also attempt to emphasize the great value of an individual risk evaluation when warfarin therapy is introduced. In fact, our case supports the importance of high-intensity anticoagulation in patients with multiple thrombotic recurrences, and the exceptional value that strict anticoagulation control has in this kind of patients.
Assuntos
Anticorpos Anticardiolipina/sangue , Anticoagulantes/administração & dosagem , Síndrome Antifosfolipídica/complicações , Acidente Vascular Cerebral/etiologia , Varfarina/administração & dosagem , Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/tratamento farmacológico , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/prevenção & controle , Varfarina/uso terapêuticoRESUMO
La medicina presenta cambios clínicos, terapéuticos, y tecnológicos, coincidiendo con variaciones demográficas culturales y epidemiológicas. Este conjunto de factores y la rapidez con la que se suceden las innovaciones en todos los campos, obliga a replantearse la formación de los médicos, no sólo durante su periodo inicial universitario, sino también a lo largo de toda su vida profesional. Los tribunales de selección de los profesionales que llevarán el peso de la formación universitaria, deben de atender a todas estas dimensiones para asegurar que los futuros profesores transmitan estos valores a los estudiantes. A su vez, los candidatos deben de conocer aquellos puntos sobre los que construir su currículum (AU)
Medicine is undergoing clinical, therapeutic and technological changes, and this is coinciding with demographic, cultural and epidemiological variations. These factors, and the speed with which innovations occur in all fields, requires a rethink of doctors' training, not only during their initial university studies but also throughout their professional life. Those responsible for appointing medical school lecturers must take into account all these aspects in order to ensure that the teaching staff of the future will transmit these values to students. In turn, candidates must be aware of the key aspects around which they should develop their curriculu (AU)
Assuntos
Humanos , Educação de Graduação em Medicina/normas , Avaliação Educacional/métodos , Docentes/normas , 34002 , 51706 , Organização e Administração/organização & administraçãoRESUMO
No disponible
Assuntos
Humanos , Pesquisa Biomédica/tendências , Atenção Primária à Saúde/tendências , Garantia da Qualidade dos Cuidados de Saúde/tendências , Projetos de Pesquisa/tendênciasAssuntos
Adenocarcinoma/patologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundário , Derrame Pleural Maligno/etiologia , Neoplasias da Próstata/patologia , Idoso , Humanos , L-Lactato Desidrogenase/metabolismo , Masculino , Antígeno Prostático Específico/sangue , Proteínas/metabolismoRESUMO
Introducción. Los objetivos del estudio son estimar la prevalencia de las coinfecciones por virus de la hepatitis en la población española infectada por el VIH y determinar el porcentaje de pacientes candidatos a tratamiento de la hepatitis C crónica (HCC) y a trasplante hepático dentro de esta población. Métodos. Estudio transversal de dos poblaciones de pacientes infectados por el VIH realizado en el año 2002: 1.260 pacientes de la población de 39 centros de toda la geografía española (P1) y 1.560 pacientes de la de tres hospitales de tercer nivel de Madrid (P2). Resultados. La prevalencia sérica de virus de las hepatitis A (VHA), B (VHB) y HCC encontrada respectivamente en P1 y P2. IgG anti-VHA1: 74% y 78%. HBsAg1: 4,9 y 4,8%. HBsAg, anti-HBc1, anti-HBs1: 39 y 39%. HBsAg, anti-HBc1, anti-HBs: 25 y 31%. HBsAg, anti-HBc, anti-HBs1: 7 y 8%. HBsAg, anti-HBc, anti-HBs: 22 y 16%. Anti-VHC1: 61 y 65%. Entre estos 88,8 y 84,6% tenían una PCR VHC1. Coinfección múltiple por virus de la hepatitis 3,2 y 2,8% y de estos, 70 y 78% con coinfección por el VHB, el VHC y el VHD. Cirrosis hepática el 5,8 y 9,6% de los pacientes coinfectados por el VIH y el VHC, con indicación de considerar trasplante hepático aproximadamente en uno de cada seis. El 43 y 37% de los coinfectados por el VHC eran buenos candidatos a tratamiento de HCC, pero sólo el 14 y el 15% lo habían iniciado. Conclusiones. Un elevado porcentaje de pacientes infectados por el VIH en España están coinfectados por virus de hepatitis, especialmente por el tipo C (VHC). El número de posibles candidatos a trasplante hepático es elevado y puede aumentar en los próximos años. En el futuro será necesario un mayor esfuerzo de tratamiento en los pacientes coinfectados por el VIH y virus de hepatitis (AU)
Introduction. The aims of this study were to estimate the prevalence of HIV and hepatitis virus coinfection in the Spanish population and to determine the percentage of patients who are candidates for chronic hepatitis C virus (HCV) treatment and liver transplantation within this population. Methods. A cross-sectional study was performed in 2002 in two Spanish populations of HIV-infected patients: 1,260 patients from 39 centers throughout Spain (P1) and 1,560 patients from three tertiary teaching hospitals in Madrid (P2).Results. The following hepatitis A virus (HAV), hepatitis B virus (HBV) and HCV serological prevalence were found in the P1 and P2 groups, respectively: HAV-IgG antibodies: 74% and 78%; HBsAg1: 4.9% and 4.8%; HBsAg, anti-HBc1, anti-HBs1: 39% and 39%; HBsAg, anti-HBc1, anti-HBs: 25% and 31%; HBsAg, anti-HBc, anti-HBs1: 7% and 8%; HBsAg, anti-HBc, anti-HBs: 22% and 16%. Anti-HCV1: 61% and 65%, respectively. Of the patients with positive HCV serology, 88.8% and 84.6% of each group were positive for HCV-RNA by polymerase chain reaction. Multiple coinfections with hepatitis viruses were found in 3.2% and 2.8%, respectively; of these, 70% and 78% had coinfection with HBV, HCV and HDV. Liver cirrhosis was found in 5.8% and 9.6% of the patients coinfected with HIV and HCV, respectively. Liver transplant was indicated in approximately one out of every six coinfected patients with liver cirrhosis. The 43 and 37% of the HCV coinfected patients were good candidates for anti-HCV treatment, but only 14% and 15% of patients had initiated it. Conclusions. A high percentage of HIV-infected patients in Spain were coinfected with hepatitis viruses, especially HCV. The number of possible candidates for liver transplantation is rising and could increase in the next few years. In the future, greater efforts to treat HIV-and hepatitis virus-coinfected patients will be required (AU)
Assuntos
Adulto , Humanos , Hepatite/complicações , Hepatite/imunologia , Hepatite Crônica/prevenção & controle , Cirrose Hepática/etiologia , Cirrose Hepática/fisiopatologia , Transplante de Fígado/efeitos adversos , Transplante de Fígado/imunologia , Hepatite/metabolismo , Cirrose Hepática/patologia , HIV/fisiologia , Antirretrovirais/uso terapêuticoRESUMO
INTRODUCTION: The aims of this study were to estimate the prevalence of HIV and hepatitis virus coinfection in the Spanish population and to determine the percentage of patients who are candidates for chronic hepatitis C virus (HCV) treatment and liver transplantation within this population. METHODS: A cross-sectional study was performed in 2002 in two Spanish populations of HIV-infected patients: 1,260 patients from 39 centers throughout Spain (P1) and 1,560 patients from three tertiary teaching hospitals in Madrid (P2). RESULTS: The following hepatitis A virus (HAV), hepatitis B virus (HBV) and HCV serological prevalence were found in the P1 and P2 groups, respectively: HAV-IgG antibodies: 74% and 78%; HBsAg1: 4.9% and 4.8%; HBsAg-, anti-HBc1, anti-HBs1: 39% and 39%; HBsAg-, anti-HBc1, anti-HBs-: 25% and 31%; HBsAg-, anti-HBc-, anti-HBs1: 7% and 8%; HBsAg-, anti-HBc-, anti-HBs-: 22% and 16%. Anti-HCV1: 61% and 65%, respectively. Of the patients with positive HCV serology, 88.8% and 84.6% of each group were positive for HCV-RNA by polymerase chain reaction. Multiple coinfections with hepatitis viruses were found in 3.2% and 2.8%, respectively; of these, 70% and 78% had coinfection with HBV, HCV and HDV. Liver cirrhosis was found in 5.8% and 9.6% of the patients coinfected with HIV and HCV, respectively. Liver transplant was indicated in approximately one out of every six coinfected patients with liver cirrhosis. The 43 and 37% of the HCV coinfected patients were good candidates for anti-HCV treatment, but only 14% and 15% of patients had initiated it. CONCLUSIONS: A high percentage of HIV-infected patients in Spain were coinfected with hepatitis viruses, especially HCV. The number of possible candidates for liver transplantation is rising and could increase in the next few years. In the future, greater efforts to treat HIV-and hepatitis virus-coinfected patients will be required.
Assuntos
Infecções por HIV/complicações , Soroprevalência de HIV , Hepatite Viral Humana/epidemiologia , Transplante de Fígado , Seleção de Pacientes , Adulto , Antivirais/uso terapêutico , Comorbidade , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Inquéritos Epidemiológicos , Anticorpos Anti-Hepatite/sangue , Hepatite C Crônica/complicações , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/epidemiologia , Hepatite Viral Humana/complicações , Humanos , Cirrose Hepática/epidemiologia , Cirrose Hepática/cirurgia , Masculino , Pessoa de Meia-Idade , RNA Viral/sangue , Espanha/epidemiologiaRESUMO
No disponible
Assuntos
Humanos , Vasculite/diagnóstico , Diagnóstico por Imagem/métodos , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Granulomatose com Poliangiite/diagnóstico , Poliarterite Nodosa/diagnóstico , Arterite de Takayasu/diagnóstico , Arterite de Células Gigantes/diagnósticoRESUMO
No disponible
Assuntos
Humanos , Feminino , Masculino , Terapias Complementares , Linfoma , FasciolíaseRESUMO
No disponible
Assuntos
Humanos , Admissão do Paciente , Determinação da Pressão Arterial , Hospitais Psiquiátricos , Testes Diagnósticos de Rotina , Redação , Infecções por HIV , Mercúrio , Hepatite Viral Humana , Testes SorológicosAssuntos
Arterite de Células Gigantes/diagnóstico , Poliarterite Nodosa/diagnóstico , Vasculite/classificação , Adulto , Idoso , Hiperplasia Angiolinfoide com Eosinofilia/diagnóstico , Autopsia , Diagnóstico Diferencial , Arterite de Células Gigantes/patologia , Humanos , Masculino , Poliarterite Nodosa/patologiaRESUMO
No disponible
Assuntos
Adulto , Idoso , Masculino , Feminino , Humanos , Hemorragia Subaracnóidea , Vasculite , Arterite de Células Gigantes , Tomografia Computadorizada por Raios X , Ticlopidina , Monócitos , Inibidores da Agregação Plaquetária , Poliarterite Nodosa , Acidente Vascular Cerebral , Hiperplasia Angiolinfoide com Eosinofilia , Autopsia , Angiografia Cerebral , Diagnóstico Diferencial , Contagem de Leucócitos , Fibrinogênio , Isquemia EncefálicaRESUMO
Se comunica un caso que cumplía los criterios clásicos de PS, de tal manera que con radiología simple mostraba una sóla lesión ósea, no se advirtió infiltración mielomatosa en la médula ósea, carecía de signos de enfermedad diseminada, y la biopsia de la masa costovertebral izquierda (única lesión ósea demostrada en la radiología convencional) proporcionó la confirmación histológica de plasmocitoma. No obstante, la tuilización de otras técnicas complementarias, como TAC, gammagrafía ósea con SPECT y el análisis citométrico de la médula ósea (CD38+, EMA+, CD56+ y CD138+), permitieron demostrar que se trataba de un mieloma generalizado. De este modo el paciente fue tratado con quimioterapia y no con rardioterapia local que es el proceder recomendado en el PS
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Laminectomia , Neoplasias Pélvicas , Neoplasias Cranianas , Neoplasias Torácicas , Mieloma Múltiplo , Diagnóstico , Tomografia Computadorizada por Raios X , Câmaras gama , Medicina InternaRESUMO
Se comunica un caso que cumplía los criterios clásicos de PS, de tal manera que con radiología simple mostraba una sóla lesión ósea, no se advirtió infiltración mielomatosa en la médula ósea, carecía de signos de enfermedad diseminada, y la biopsia de la masa costovertebral izquierda (única lesión ósea demostrada en la radiología convencional) proporcionó la confirmación histológica de plasmocitoma. No obstante, la tuilización de otras técnicas complementarias, como TAC, gammagrafía ósea con SPECT y el análisis citométrico de la médula ósea (CD38+, EMA+, CD56+ y CD138+), permitieron demostrar que se trataba de un mieloma generalizado. De este modo el paciente fue tratado con quimioterapia y no con rardioterapia local que es el proceder recomendado en el PS
