Comportamiento del flujo y resistencia vascular ocular en pacientes con síndrome de pseudoexfoliacón y glaucoma

Fil: Gómez Demmel, Eduardo. Hospital Privado Universitario de Córdoba; Argentina.Fil: Marulanda Arrieta, Clara. Hospital Privado Universitario de Córdoba; Argentina.Fil: Ahumada, María Inés. Universidad Nacional de Córdoba. Facultad de Ciencias Económicas. Departamento de Estadística; Argentina.Fil: Coronel, Mariana Silvina. Hospital Privado Universitario de Córdoba; Argentina.Fil: Campana, Vilma. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas; Argentina.Fil: Tartara, Luis Ignacio. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas; Argentina.El síndrome de pseudoexfoliación (PSX) es un trastorno genético-hereditario que consiste en el depósito de una sustancia de aspecto blanco fibrinogranular, en tejidos intraoculares. Una serie de estudios han evaluado la asociación de PSX con el riesgo de enfermedad vascular, sin embargo los resultados han sido inconsistentes. El objetivo es determinar si el PSX es un factor de riesgo en la modificación de la resistencia y velocidad vascular ocular. Materiales y Métodos: estudio clínico prospectivo de casos y controles. Se seleccionaron 23 pacientes (46 ojos) que asistieron al servicio de oftalmología del Hospital Privado de Córdoba, entre 59 y 75 años, entre el periodo de julio 2016 a julio2017. Se dividieron la totalidad de los pacientes en 2 grupos. El grupo control n=13 (26 ojos) sin PSX. El grupo PSX n=10 (20 ojos) presentaban además de la PSX característica, glaucoma en ambos ojos. Se excluyeron en los 2 grupos a los pacientes con otras patologías oculares previas. A todos los pacientes seleccionados se les realizo Ecodoppler de vasos oftálmicos: arteria central de retina, arteria oftálmica y arterias ciliares posteriores. Se analizó velocidad y resistencia vascular de ambos ojos. Para el análisis estadístico se realizó Test t-student (tiempos individuales), considerando un nivel de significación de p<0.05. Cómo resultado no se observaron diferencias significativas entre ambos grupos (p > 0,05), en cuanto a velocidad y resistencia de vasos oftálmicos: arteria central de retina (p=0,45 y p=0,44), arteria oftálmica (p=0,18 y p=0,82) y arterias ciliares posteriores (p=0,63 y p=0,27). En conclusión el síndrome de PSX no mostró ser un factor de riesgo para la modificación de la resistencia vascular y la velocidad de flujo arterial de los vasos oftálmicos: arteria central de retina, arteria oftálmica y arterias ciliares posteriores, en pacientes caucásicos entre 59 y 75 años.info:eu-repo/semantics/publishedVersionFil: Gómez Demmel, Eduardo. Hospital Privado Universitario de Córdoba; Argentina.Fil: Marulanda Arrieta, Clara. Hospital Privado Universitario de Córdoba; Argentina.Fil: Ahumada, María Inés. Universidad Nacional de Córdoba. Facultad de Ciencias Económicas. Departamento de Estadística; Argentina.Fil: Coronel, Mariana Silvina. Hospital Privado Universitario de Córdoba; Argentina.Fil: Campana, Vilma. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas; Argentina.Fil: Tartara, Luis Ignacio. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas; Argentina.Otras Ciencias Médica

Influência da síndrome da pseudo-esfoliação capsular na perda auditiva

Introducción: El Síndrome de Pseudoexfoliación (PEX) es un trastorno genético-hereditario, consiste en el depósito de microfibras de elastina en tejido intra y extraocular. El PEX es una de las causas secundarias identificables más comunes del glaucoma. Varios estudios han asociado el PEX con afecciones sistémicas y se ha descripto el hallazgo de material fibrilar en las estructuras del oído interno, similares al de pseudoexfoliación detectado en el ojo.Objetivo: comparar los niveles de audiométricos en pacientes con y sin PEX ocular.Materiales y Métodos: Estudio retrospectivo de casos y controles. Se seleccionaron 48 historias clínicas de pacientes que asistieron al servicio de oftalmología del Hospital Privado de Córdoba, entre enero del 2015 y diciembre de 2017, de entre 59 y 75 años. Se los dividió en grupos: controles (n=22): sin PEX y casos (n=26): con PEX. Se analizaron las historias clínicas de pacientes a los que se les realizaron estudios oftalmológicos y audiométricos. Para el análisis estadístico se utilizó el test T de Student para muestras independientes y apareadas; en todos los casos se consideró un nivel de significación ≤ 0.05.Resultados: El porcentaje de pérdida auditiva fue del 56,8% en el grupo control y un 82,7% en el grupo PEX. La incapacidad porcentual en el grupo con PEX fue mayor en la audición monoaural (p=0,0008) y biaural (p=0,0307) con respecto a los pacientes sin PEX.Conclusión:Los pacientes con PEX ocular mostraron un porcentaje mayor de hipoacusia, en comparación con aquellos pacientes sin evidencia oftalmológica de PEX.Introduction: Pseudoexfoliation Syndrome (PEX) is a genetic-inherited disorder, consisting of the deposition of elastin microfibers in intra and extraocular tissue. PEX is one of the most common identifiable secondary causes of glaucoma. Several studies have associated PEX with systemic conditions and the finding of fibrillar material in the structures of the inner ear, similar to that of pseudoexfoliation detected in the eye, has been described. Objective: to compare audiometric levels in patients with and without ocular PEX. Materials and Methods: Retrospective case-control study. 48 medical records of patients who attended the ophthalmology service of the Private Hospital of Córdoba were selected between January 2015 and December 2017, between 59 and 75 years. They were divided into groups: controls (n = 22): without PEX and cases (n = 26): with PEX. The medical records of patients who underwent ophthalmological and audiometric studies were analyzed. For the statistical analysis, the Student's T test was used for independent and paired samples; in all cases a level of significance ≤ 0.05 was considered. Results: The percentage of hearing loss was 56.8% in the control group and 82.7% in the PEX group. The percentage disability in the group with PEX was greater in monaural (p = 0.0008) and biaural (p = 0.0307) hearing compared to patients without PEX. Conclusion: Patients with ocular PEX showed a higher percentage of hearing loss, compared to those patients without ophthalmic evidence of PEX.Introdução: A Síndrome de Pseudo-Esfoliação (PEX) é umdistúrbio genético herdado, que consiste nadeposição de microfibras de elastina no tecidointra e extra-ocular. O PEX é uma das causas secundáriasidentificáveis maiscomuns de glaucoma. Váriosestudosassociaram a PEX a condiçõessistêmicas e o achado de material fibrilar nasestruturas da orelha interna, semelhanteao da pseudoexfoliação detectada no olho, foi descrito. Objetivo: Comparar os níveisaudiométricosem pacientes com e sem PEX ocular. Materiais e Métodos: Estudo de caso-controle retrospectivo. Foramselecionados 48 prontuários de pacientes que compareceramaoserviço de oftalmologia do Hospital Privado de Córdoba entre janeiro de 2015 e dezembro de 2017, entre 59 e 75 anos. Eles foram divididos em grupos: controles (n = 22): sem PEX e casos (n = 26): com PEX. Foramanalisados os prontuários dos pacientes submetidos a estudos oftalmológicos e audiométricos. Para a análiseestatística, foi utilizado o teste T de Student para amostrasindependentes e emparelhadas; em todos os casos, foi considerado umnível de significância≤ 0,05. Resultados: O percentual de perda auditiva foi de 56,8% no grupo controle e 82,7% no grupo PEX. A porcentagem de incapacidade no grupo com PEX foimaiornaaudição mono (p = 0,0008) e biaural (p = 0,0307) emcomparaçãoaos pacientes sem PEX. Conclusão: Pacientes com PEX ocular apresentarammaiorpercentual de perda auditiva emcomparaçãocomaquelessemevidência oftalmológica de PEX.Fil: Real, Juan Pablo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Unidad de Investigación y Desarrollo en Tecnología Farmacéutica. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Unidad de Investigación y Desarrollo en Tecnología Farmacéutica; ArgentinaFil: Campana, Vilma. Universidad Nacional de Córdoba. Facultad de Medicina; ArgentinaFil: Luna, Consuelo. Hospital Privado Centro Médico de Córdoba; ArgentinaFil: Acosta, Luciana. Hospital Privado Centro Médico de Córdoba; ArgentinaFil: Coronel, Mariana Silvina. Hospital Privado Centro Médico de Córdoba; ArgentinaFil: Gomez Demmel, Eduardo. Hospital Privado Centro Médico de Córdoba; ArgentinaFil: Tartara, Luis Ignacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Unidad de Investigación y Desarrollo en Tecnología Farmacéutica. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Unidad de Investigación y Desarrollo en Tecnología Farmacéutica; Argentin

String test : a new tool for tuberculosis diagnosis and drug-resistance detection in children

Background: There is a critical need to improve the diagnostic accuracy of tuberculosis (TB) in children. Several techniques have been developed to improve the quality of sputum samples; however, these procedures are very unpleasant and invasive and require hospitalization and trained personnel. This study aims to explore the potential use of a new and noninvasive tool, "string test," for TB diagnosis in children and in adults not able to render sputum samples and at risk of developing multidrug-resistant TB (MDR-TB). Methods: Children with clinical suspicion of TB attending the pediatric consultation at the Cetrangolo or Cordero Hospitals and adults suspected of MDR-TB and unable to produce sputum attending the Infectious Disease Unit of Cetrangolo Hospital were included in this study. Subjects and Methods: The " string test" is a string that is swallowed by the patients and exposed to gastrointestinal secretions that were late analyzed for TB diagnosis and drug-resistance detection by GenoType MTBDRplus. MedCalc software was used to perform statistical analysis. Results: This technique could be applied on 62.1% of selected children. About 11 (30.6%) children were diagnosed as TB cases, 8 (22.2%) from gastric aspirate and using the "string test." Six out of 19 adults were also diagnosed. Genotype directly on the string specimen detected two MDR-TB in adults and two isoniazid-resistant cases before obtaining the isolate. Conclusion: This test was safe, cheap, and easily implemented without requiring hospitalization. This research could represent a significant step forward to diagnose and rapidly detect drug-resistant TB in children

Relevancia clínica, diversidad y variabilidad genética de distintas especies del género Mycobacterium

Introducción: El término micobacterias no tuberculosas (MNT) incluye distintas especies ambientales capaces de enfermar humanosy/o animales incluso mediante una probable transmisión zoonótica Objetivos. Determinar: la importancia clínica de varias especies del género Mycobacterium y la diversidad genética del Complejo M. avium (MAC), la sensibilidad bacteriana in vitro yel éxito del tratamiento especifico. Materiales y Métodos: Recolección de datos clínicos, epidemiológicos y aislamientos en el periodo 2009-2016; identificación molecular de los aislamientos; determinación de la sensibilidad bacteriana in vitro y de la diversidad genética del MAC; evaluación del tratamiento. Resultados: Fueron diagnosticados 225 casos de micobacteriosis, con prevalencia estable ≈ 6% por año, y 22 especies recuperadas: 4 de rápido desarrollo aisladas de 66 pacientes y 18 de lento desarrollo. MAC fue aislado en 95 casos, 40 M. avium hominissuis, 51 M. intracellulare, 3 M. chimaera, 1 M. colombiense. Se observó mayor probabilidad de enfermar por M. intracellulare en pacientes tratados previamente por tuberculosis (TB). Los pacientes HIV+ tuvieron riesgo incrementado de enfermedad causada por M. avium hominissuis. Los aminoglucósidos, fluoroquinolonas y macrólidos fueron las drogas más activas frente a la mayoría de las MNT. Aproximadamente la mitad de los casos curaron. Conclusiones: M. intracellulare, M. aviumhominissuis con una gran variabilidad genética, y M. abscessus fueron los patógenos más frecuentemente hallados. Un hallazgo importante fue el de casos de enfermedad mixta TB+MNT. Estos pacientes requirieron una terapia con agregado de drogas de segunda línea al esquema terapéutico para TB habiendo curado la mayoría de ellos.Fil: Imperiale, Belen. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigación en Ciencias Veterinarias y Agronómicas; ArgentinaFil: Di Giulio, Beatriz. Hospital Petrona V. de Cordero; ArgentinaFil: Moyano, Roberto Damian. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigación en Ciencias Veterinarias y Agronómicas; ArgentinaFil: Santangelo, María de la Paz. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigación en Ciencias Veterinarias y Agronómicas; ArgentinaFil: Tartara, Silvina. Provincia de Buenos Aires. Ministerio de Salud. Hospital "Dr. Antonio A. Cetrángolo"; ArgentinaFil: Alonso, Viviana. Provincia de Buenos Aires. Ministerio de Salud. Hospital "Dr. Antonio A. Cetrángolo"; ArgentinaFil: Sanjurjo, Myrian. Provincia de Buenos Aires. Ministerio de Salud. Hospital "Dr. Antonio A. Cetrángolo"; ArgentinaFil: Garcia, Graciela. Provincia de Buenos Aires. Ministerio de Salud. Hospital "Dr. Antonio A. Cetrángolo"; ArgentinaFil: Castellano, Patricia. Provincia de Buenos Aires. Ministerio de Salud. Hospital "Dr. Antonio A. Cetrángolo"; ArgentinaFil: Romano, Maria Isabel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Provincia de Buenos Aires. Ministerio de Salud. Hospital "Dr. Antonio A. Cetrángolo"; ArgentinaFil: Morcillo, Nora. Provincia de Buenos Aires. Ministerio de Salud. Hospital "Dr. Antonio A. Cetrángolo"; Argentin

Bacterial etiology of community-acquired pneumonia in immunocompetent hospitalized patients and appropriateness of empirical treatment recommendations: an international point-prevalence study

An accurate knowledge of the epidemiology of community-acquired pneumonia (CAP) is key for selecting appropriate antimicrobial treatments. Very few etiological studies assessed the appropriateness of empiric guideline recommendations at a multinational level. This study aims at the following: (i) describing the bacterial etiologic distribution of CAP and (ii) assessing the appropriateness of the empirical treatment recommendations by clinical practice guidelines (CPGs) for CAP in light of the bacterial pathogens diagnosed as causative agents of CAP. Secondary analysis of the GLIMP, a point-prevalence international study which enrolled adults hospitalized with CAP in 2015. The analysis was limited to immunocompetent patients tested for bacterial CAP agents within 24 h of admission. The CAP CPGs evaluated included the following: the 2007 and 2019 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA), the European Respiratory Society (ERS), and selected country-specific CPGs. Among 2564 patients enrolled, 35.3% had an identifiable pathogen. Streptococcus pneumoniae (8.2%) was the most frequently identified pathogen, followed by Pseudomonas aeruginosa (4.1%) and Klebsiella pneumoniae (3.4%). CPGs appropriately recommend covering more than 90% of all the potential pathogens causing CAP, with the exception of patients enrolled from Germany, Pakistan, and Croatia. The 2019 ATS/IDSA CPGs appropriately recommend covering 93.6% of the cases compared with 90.3% of the ERS CPGs (p < 0.01). S. pneumoniae remains the most common pathogen in patients hospitalized with CAP. Multinational CPG recommendations for patients with CAP seem to appropriately cover the most common pathogens and should be strongly encouraged for the management of CAP patients.info:eu-repo/semantics/publishedVersio

Prevalence and risk factors for Enterobacteriaceae in patients hospitalized with community-acquired pneumonia

Background and objective Enterobacteriaceae (EB) spp. family is known to include potentially multidrug-resistant (MDR) microorganisms, and remains as an important cause of community-acquired pneumonia (CAP) associated with high mortality. The aim of this study was to determine the prevalence and specific risk factors associated with EB and MDR-EB in a cohort of hospitalized adults with CAP. Methods We performed a multinational, point-prevalence study of adult patients hospitalized with CAP. MDR-EB was defined when >= 3 antimicrobial classes were identified as non-susceptible. Risk factors assessment was also performed for patients with EB and MDR-EB infection. Results Of the 3193 patients enrolled with CAP, 197 (6%) had a positive culture with EB. Fifty-one percent (n = 100) of EB were resistant to at least one antibiotic and 19% (n = 38) had MDR-EB. The most commonly EB identified were Klebsiella pneumoniae (n = 111, 56%) and Escherichia coli (n = 56, 28%). The risk factors that were independently associated with EB CAP were male gender, severe CAP, underweight (body mass index (BMI) < 18.5) and prior extended-spectrum beta-lactamase (ESBL) infection. Additionally, prior ESBL infection, being underweight, cardiovascular diseases and hospitalization in the last 12 months were independently associated with MDR-EB CAP. Conclusion This study of adults hospitalized with CAP found a prevalence of EB of 6% and MDR-EB of 1.2%, respectively. The presence of specific risk factors, such as prior ESBL infection and being underweight, should raise the clinical suspicion for EB and MDR-EB in patients hospitalized with CAP

Microbiological testing of adults hospitalised with community-acquired pneumonia: an international study

This study aimed to describe real-life microbiological testing of adults hospitalised with community-acquired pneumonia (CAP) and to assess concordance with the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) and 2011 European Respiratory Society (ERS) CAP guidelines. This was a cohort study based on the Global Initiative for Methicillin-resistant Staphylococcus aureus Pneumonia (GLIMP) database, which contains point-prevalence data on adults hospitalised with CAP across 54 countries during 2015. In total, 3702 patients were included. Testing was performed in 3217 patients, and included blood culture (71.1%), sputum culture (61.8%), Legionella urinary antigen test (30.1%), pneumococcal urinary antigen test (30.0%), viral testing (14.9%), acute-phase serology (8.8%), bronchoalveolar lavage culture (8.4%) and pleural fluid culture (3.2%). A pathogen was detected in 1173 (36.5%) patients. Testing attitudes varied significantly according to geography and disease severity. Testing was concordant with IDSA/ATS and ERS guidelines in 16.7% and 23.9% of patients, respectively. IDSA/ATS concordance was higher in Europe than in North America (21.5% versus 9.8%; p<0.01), while ERS concordance was higher in North America than in Europe (33.5% versus 19.5%; p<0.01). Testing practices of adults hospitalised with CAP varied significantly by geography and disease severity. There was a wide discordance between real-life testing practices and IDSA/ATS/ERS guideline recommendations

Prevalence and Etiology of Community-acquired Pneumonia in Immunocompromised Patients

BACKGROUND: The correct management of immunocompromised patients with pneumonia is debated. We evaluated the prevalence, risk factors, and characteristics of immunocompromised patients coming from the community with pneumonia. METHODS: We conducted a secondary analysis of an international, multicenter study enrolling adult patients coming from the community with pneumonia and hospitalized in 222 hospitals in 54 countries worldwide. Risk factors for immunocompromise included AIDS, aplastic anemia, asplenia, hematological cancer, chemotherapy, neutropenia, biological drug use, lung transplantation, chronic steroid use, and solid tumor. RESULTS: At least 1 risk factor for immunocompromise was recorded in 18% of the 3702 patients enrolled. The prevalences of risk factors significantly differed across continents and countries, with chronic steroid use (45%), hematological cancer (25%), and chemotherapy (22%) the most common. Among immunocompromised patients, community-acquired pneumonia (CAP) pathogens were the most frequently identified, and prevalences did not differ from those in immunocompetent patients. Risk factors for immunocompromise were independently associated with neither Pseudomonas aeruginosa nor non-community-acquired bacteria. Specific risk factors were independently associated with fungal infections (odds ratio for AIDS and hematological cancer, 15.10 and 4.65, respectively; both P = .001), mycobacterial infections (AIDS; P = .006), and viral infections other than influenza (hematological cancer, 5.49; P &lt; .001). CONCLUSIONS: Our findings could be considered by clinicians in prescribing empiric antibiotic therapy for CAP in immunocompromised patients. Patients with AIDS and hematological cancer admitted with CAP may have higher prevalences of fungi, mycobacteria, and noninfluenza viruses

International prevalence and risk factors evaluation for drug-resistant Streptococcus pneumoniae pneumonia

Objective: Streptococcus pneumoniae is the most frequent bacterial pathogen isolated in subjects with Community-acquired pneumonia (CAP) worldwide. Limited data are available regarding the current global burden and risk factors associated with drug-resistant Streptococcus pneumoniae (DRSP) in CAP subjects. We assessed the multinational prevalence and risk factors for DRSP-CAP in a multinational point-prevalence study. Design: The prevalence of DRSP-CAP was assessed by identification of DRSP in blood or respiratory samples among adults hospitalized with CAP in 54 countries. Prevalence and risk factors were compared among subjects that had microbiological testing and antibiotic susceptibility data. Multivariate logistic regressions were used to identify risk factors independently associated with DRSP-CAP. Results: 3,193 subjects were included in the study. The global prevalence of DRSP-CAP was 1.3% and continental prevalence rates were 7.0% in Africa, 1.2% in Asia, and 1.0% in South America, Europe, and North America, respectively. Macrolide resistance was most frequently identified in subjects with DRSP-CAP (0.6%) followed by penicillin resistance (0.5%). Subjects in Africa were more likely to have DRSP-CAP (OR: 7.6; 95% CI: 3.34-15.35, p < 0.001) when compared to centres representing other continents. Conclusions: This multinational point-prevalence study found a low global prevalence of DRSP-CAP that may impact guideline development and antimicrobial policies. Published by Elsevier Ltd on behalf of The British Infection Association

Aspiration risk factors, microbiology, and empiric antibiotics for patients hospitalized with community-acquired pneumonia

Background: Aspiration community-acquired pneumonia (ACAP) and community-acquired pneumonia (CAP) in patients with aspiration risk factors (AspRFs) are infections associated with anaerobes, but limited evidence suggests their pathogenic role. Research question: What are the aspiration risk factors, microbiology patterns, and empiric anti-anaerobic use in patients hospitalized with CAP? Study design and methods: This is a secondary analysis of GLIMP, an international, multicenter, point-prevalence study of adults hospitalized with CAP. Patients were stratified into three groups: (1) ACAP, (2) CAP/AspRF+ (CAP with AspRF), and (3) CAP/AspRF- (CAP without AspRF). Data on demographics, comorbidities, microbiological results, and anti-anaerobic antibiotics were analyzed in all groups. Patients were further stratified in severe and nonsevere CAP groups. Results: We enrolled 2,606 patients with CAP, of which 193 (7.4%) had ACAP. Risk factors independently associated with ACAP were male, bedridden, underweight, a nursing home resident, and having a history of stroke, dementia, mental illness, and enteral tube feeding. Among non-ACAP patients, 1,709 (70.8%) had CAP/AspRF+ and 704 (29.2%) had CAP/AspRF-. Microbiology patterns including anaerobes were similar between CAP/AspRF-, CAP/AspRF+ and ACAP (0.0% vs 1.03% vs 1.64%). Patients with severe ACAP had higher rates of total gram-negative bacteria (64.3% vs 44.3% vs 33.3%, P = .021) and lower rates of total gram-positive bacteria (7.1% vs 38.1% vs 50.0%, P 50% in all groups) independent of AspRFs or ACAP received specific or broad-spectrum anti-anaerobic coverage antibiotics. Interpretation: Hospitalized patients with ACAP or CAP/AspRF+ had similar anaerobic flora compared with patients without aspiration risk factors. Gram-negative bacteria were more prevalent in patients with severe ACAP. Despite having similar microbiological flora between groups, a large proportion of CAP patients received anti-anaerobic antibiotic coverage