94 research outputs found
Disfunción neuroendócrina secundaria a hemorragia subaracnoidea por ruptura de aneurisma. Revisión
La disfunción neuroendócrina es una complicación secundaria a lesión cerebral aguda que cursa con alteración del eje hipotálamo-hipofisario, por daño directo de origen vascular. Se caracteriza por la alteración de uno o varios de los sistemas hormonales regulados por la glándula pituitaria, llegando en casos graves al hipopituitarismo franco. Una de las causas más importantes de esta patología es la hemorragia subaracnoidea. El déficit hormonal aparece poco tiempo después de ocurrido el sangrado y puede persisitir a largo plazo, causando síntomas secundarios al nivel bajo de ciertas hormonas, y trastornos neuropsicológicos alterando en gran medida la calidad de vida de aquellos pacientes cuyo pronóstico funcional ya se encontraba alterado por la hemorragia en sí. El tratamiento con sustitución hormonal está indicado tanto en la fase aguda, como en la deficiencia permanente de cada hormona. A continuación se ofrece una actualización sobre el tema, con el fin de conocer mejor la enfermedad, cómo sospecharla, cuándo identificarla, y brindar el manejo adecuado
Pneumonitis as A Consequence of (Peg)Interferon-Ribavirin Combination Therapy for Hepatitis C: a Review of the Literature
Combination of peginterferon and ribavirin is the current therapy for chronic hepatitis C infection (HCV). Interstitial pneumonitis is a rare side-effect of HCV therapy and is an important cause of dose reduction or discontinuation, impairing success of antiviral therapy. We performed a review of the literature in order to present diagnostic modalities and possible treatments for pneumonitis and to offer guidelines. We searched for cases where pneumonitis as a side-effect of HCV treatment was documented. First we performed a literature search via PubMed and Web of Science interface and second we searched three drug toxicity databases. We systematically analyzed all case reports with respect to clinical manifestations, type of treatment, and outcome. A literature search revealed 19 articles, containing 25 case descriptions, while we traced 33 cases from the drug toxicity databases. Pneumonitis presented with any of the combination of fever, dyspnea, and cough and can arise with any type of (conventional or pegylated) interferon. Mortality secondary to pneumonitis was seen in 7% of cases, exclusively with peginterferon α-2b. In most cases therapy was discontinued and steroids were started. Interferon-induced pneumonitis during HCV treatment is a severe complication and should be recognized in order to prevent further pulmonary damage and/or death
Cervical intramedullary schwannoma: a case report and review of the literature
Intramedullary schwannomas unrelated with neurofibromatosis are uncommon tumors, but if correctly diagnosed and properly treated they may have a good prognosis
HLA-Driven Convergence of HIV-1 Viral Subtypes B and F Toward the Adaptation to Immune Responses in Human Populations
BACKGROUND: Cytotoxic T-Lymphocyte (CTL) response drives the evolution of HIV-1 at a host-level by selecting HLA-restricted escape mutations. Dissecting the dynamics of these escape mutations at a population-level would help to understand how HLA-mediated selection drives the evolution of HIV-1. METHODOLOGY/PRINCIPAL FINDINGS: We undertook a study of the dynamics of HIV-1 CTL-escape mutations by analyzing through statistical approaches and phylogenetic methods the viral gene gag sequenced in plasma samples collected between the years 1987 and 2006 from 302 drug-naive HIV-positive patients. By applying logistic regression models and after performing correction for multiple test, we identified 22 potential CTL-escape mutations (p-value<0.05; q-value<0.2); 10 of these associations were confirmed in samples biologically independent by a Bayesian Markov Chain Monte-Carlo method. Analyzing their prevalence back in time we found that escape mutations that are the consensus residue in samples collected after 2003 have actually significantly increased in time in one of either B or F subtype until becoming the most frequent residue, while dominating the other viral subtype. Their estimated prevalence in the viral subtype they did not dominate was lower than 30% for the majority of samples collected at the end of the 80's. In addition, when screening the entire viral region, we found that the 75% of positions significantly changing in time (p<0.05) were located within known CTL epitopes. CONCLUSIONS: Across HIV Gag protein, the rise of polymorphisms from independent origin during the last twenty years of epidemic in our setting was related to an association with an HLA allele. The fact that these mutations accumulated in one of either B or F subtypes have also dominated the other subtype shows how this selection might be causing a convergence of viral subtypes to variants which are more likely to evade the immune response of the population where they circulate
Persistent left superior vena cava: Review of the literature, clinical implications, and relevance of alterations in thoracic central venous anatomy as pertaining to the general principles of central venous access device placement and venography in cancer patients
Persistent left superior vena cava (PLSVC) represents the most common congenital venous anomaly of the thoracic systemic venous return, occurring in 0.3% to 0.5% of individuals in the general population, and in up to 12% of individuals with other documented congential heart abnormalities. In this regard, there is very little in the literature that specifically addresses the potential importance of the incidental finding of PLSVC to surgeons, interventional radiologists, and other physicians actively involved in central venous access device placement in cancer patients. In the current review, we have attempted to comprehensively evaluate the available literature regarding PLSVC. Additionally, we have discussed the clinical implications and relevance of such congenital aberrancies, as well as of treatment-induced or disease-induced alterations in the anatomy of the thoracic central venous system, as they pertain to the general principles of successful placement of central venous access devices in cancer patients. Specifically regarding PLSVC, it is critical to recognize its presence during attempted central venous access device placement and to fully characterize the pattern of cardiac venous return (i.e., to the right atrium or to the left atrium) in any patient suspected of PLSVC prior to initiation of use of their central venous access device
Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine
[This corrects the article DOI: 10.1186/s13054-016-1208-6.]
Evaluation of the microbiological quality of ricotta cheese commercialized in Santa Catarina, Brazil
Disfunción neuroendócrina secundaria a hemorragia subaracnoidea por ruptura de aneurisma: Revisión
La disfunción neuroendócrina es una complicación secundaria a lesión cerebral aguda que cursa con alteración del eje hipotálamo-hipofisario, por daño directo de origen vascular. Se caracteriza por la alteración de uno o varios de los sistemas hormonales regulados por la glándula pituitaria, llegando en casos graves al hipopituitarismo franco. Una de las causas más importantes de esta patología es la hemorragia subaracnoidea. El déficit hormonal aparece poco tiempo después de ocurrido el sangrado y puede persisitir a largo plazo, causando síntomas secundarios al nivel bajo de ciertas hormonas, y trastornos neuropsicológicos alterando en gran medida la calidad de vida de aquellos pacientes cuyo pronóstico funcional ya se encontraba alterado por la hemorragia en sí. El tratamiento con sustitución hormonal está indicado tanto en la fase aguda, como en la deficiencia permanente de cada hormona. A continuación se ofrece una actualización sobre el tema, con el fin de conocer mejor la enfermedad, cómo sospecharla, cuándo identificarla, y brindar el manejo adecuado
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