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Tonya Azevedo Duarte Joilda Silva Nery Neio Boechat Susan Martins Pereira Vera Simonsen Martha Oliveira Maria Gabriela Miranda Gomes Carlos Penha-Gonçalves Mauricio Lima Barreto Theolis Barbosa 《The Brazilian journal of infectious diseases》2017,21(3):317-324
Introduction
The Mycobacterium tuberculosis East African-Indian (EAI) spoligotyping family (belonging to lineage 1, Indo-Oceanic, defined by the region of deletion RD239) is distributed worldwide, but is more prevalent in Southeast Asia, India, and East Africa. Studies in Latin America have rarely identified EAI. In this study, we describe the occurrence of the EAI family in Brazil.Methods
EAI was identified in a systematic literature review of genetic diversity studies pertaining to M. tuberculosis in Brazil, as well as in a survey conducted in Salvador, Bahia, located in the northeastern region of this country.Results
The EAI6-BGD1 spoligotyping family and the EAI5 Spoligotype International Type (SIT) 1983 clade were the most frequently reported, with wide distribution of this particular clade described in Brazil. The distribution of other EAI spoligotyping patterns with broader worldwide distribution was restricted to the southeastern region of the country.Conclusions
EAI may be endemic at a low frequency in Brazil, with some clades indicating increased fitness with respect to this population. 相似文献3.
Maria Pipa-Muñiz Lluis Castells Sonia Pascual Javier Fernández-Castroagudín Iratxe Díez-Miranda Javier Irurzun Roberto Díaz-Beveridge María Senosiaín Juan Arenas Manuel de la Mata Juan Turnes María Isabel Monge-Romero Daniel Pérez-Enguix Javier Bustamante-Schneider Nora Otegui Esther Molina-Pérez José Eduardo Rodríguez-Menéndez Maria Varela 《Gastroenterologia y hepatologia》2017,40(8):515-524
Introduction
The appropriate selection of hepatocellular carcinoma (HCC) patients who are eligible for transarterial chemoembolization (TACE) remains a challenge. The ART score has recently been proposed as a method of identifying patients who are eligible or not for a second TACE procedure.Objective
To assess the validity of the Assessment for Retreatment with TACE (ART) score in a cohort of patients treated with drug-eluting bead TACE (DEB-TACE). Secondary objective: to identify clinical determinants associated with overall survival (OS).Method
A retrospective, multicentre study conducted in Spain in patients with HCC having undergone two or more DEB-TACE procedures between January 2009 and December 2014. The clinical characteristics and OS from the day before the second DEB-TACE of patients with a high ART score (ART ≥ 2.5) and a low ART score (ART 0–1) were compared. Risk factors for mortality were identified using Cox's proportional hazards model.Results
Of the 102 patients included, 51 scored 0–1.5 and 51 scored ≥2.5. Hepatitis C was more frequent in patients scoring ≥2.5. Median OS from the day before the second DEB-TACE was 21 months (95% CI, 15–28) in the group scoring 0–1.5, and 17 months (95% CI, 10–25) in the group scoring ≥2.5 (P = 0.3562). Platelet count and tumour size, but not the ART score, were independent baseline predictors of OS.Conclusions
The ART score is not suitable for guiding DEB-TACE retreatment according to Spanish clinical practice standards. 相似文献4.
Lidia Argüello Viúdez Henry Córdova Hugo Uchima Cristina Sánchez-Montes Àngels Ginès Isis Araujo Begoña González-Suárez Oriol Sendino Josep Llach Gloria Fernández-Esparrach 《Gastroenterologia y hepatologia》2017,40(8):507-514
Introduction
Gastric polyps are usually asymptomatic lesions incidentally discovered during endoscopy.Objective
To study the frequency of different types of gastric polyps in our population and their possible association with other factors.Patients and methods
Retrospective study of gastroscopies performed in a tertiary hospital over a ten-year period. Demographics, medical history, indication for gastroscopy and morphological and histological characteristics of polyps were collected.Results
Gastric polyps were found in 827 out of 41253 (2%) reviewed gastroscopies, corresponding to 709 patients. Mean age was 65.6 years, and 62% were female. 53.9% of patients had multiple polyps. The most common location was the fundus and 83.3% were smaller than 1 cm. Histopathology was obtained in 607 patients: hyperplastic polyps were the most common (42.8%), followed by fundic gland polyps (37.7%). Factors independently associated with hyperplastic polyps were age and single polyp, size ≥ 6 mm and location other than fundus. In contrast, fundic gland polyps were associated with reflux and multiple polyps, size < 6 mm and located in fundus. Adenomas were independently associated with single polyp.Conclusions
Fundic gland and hyperplastic polyps are the most common in our population and have characteristic features that can guide histological diagnosis. With single polyps it is advisable to take biopsies to rule out adenoma. 相似文献5.
N. Gensous L. Doassans-Comby E. Lazaro P. Duffau 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2017,38(6):358-367
Objective
The aim of our study was to evaluate the safety of contraceptive methods use among women with systemic lupus erythematosus (SLE).Methods
A systematic review of the literature was performed using the two databases MEDLINE and SCOPUS, in order to identify articles concerning the safety of contraceptive methods use among women with SLE, through May 2016. Information on study characteristics, objectives, population, contraception and outcomes were extracted.Results
A total of 907 articles were identified and 21 were selected for the systematic review. Two randomised controlled trials found no worsening of disease activity with the use of combined oral contraceptive in women with stable or inactive SLE. Disease activity was not exacerbated with the use of progestogens-only contraceptive. There was an increased risk of thrombosis with the use of combined contraceptive, particularly in women with positive antiphospholipid antibodies and this must lead to a restriction of use in these patients.Conclusion
Use of oral combined hormonal contraceptives should be limited to patients with non-severe and stable disease, without thrombosis risk factors. 相似文献6.
Marcio Nucci Paula Rocha Braga Simone A. Nouér Elias Anaissie 《The Brazilian journal of infectious diseases》2018,22(6):455-461
Background
The impact of central venous catheter (CVC) removal on the outcome of patients with candidemia is controversial, with studies reporting discrepant results depending on the time of CVC removal (early or any time during the course of candidemia).Objective
Evaluate the effect of time to CVC removal, early (within 48 h from the diagnosis of candidemia) vs. removal at any time during the course of candidemia, on the 30-day mortality.Methods
Retrospective cohort study of 285 patients with candidemia analyzing CVC removal within 48 h (first analysis) or at any time (second analysis).Results
A CVC was in place in 212 patients and was removed in 148 (69.8%), either early (88 patients, 41.5%) or late (60 patients, 28.3%). Overall, the median time to CVC removal was one day (range 1–28) but was six days (range 3–28) for those removed later. In the first analysis, APACHE II score (odds ratio [OR] 1.111, 95% confidence interval [95% CI] 1.066–1.158), removal at any time (OR 0.079, 95% CI 0.021–0.298) and Candida parapsilosis infection (OR 0.291, 95% CI 0.133–0.638) were predictors of 30-day mortality. Early removal was not significant. In the second analysis APACHE II score (OR 1.122, 95% CI 1.071–1.175) and C. parapsilosis infection (OR 0.247, 95% CI 0.103–0.590) retained significance.Conclusions
The impact of CVC removal is dependent on whether the optimal analysis strategy is deployed and should be taken into consideration in future analyses. 相似文献7.
A. Marchal F. Charlotte P. Maksud J. Haroche F. Lifferman M. Miyara S. Choquet Z. Amoura F. Cohen Aubart 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2017,38(9):619-622
Introduction
Sarcoidosis is a systemic granulomatous disorder of unknown cause. Apparition or flare of previously diagnosed sarcoidosis following hematopoietic stem cell transplantation (HSCT) has rarely been reported.Observation
We report a 62-year-old woman who presented a radiological flare of sarcoidosis post-autologous stem cell transplantation for a POEMS syndrome. Imaging findings and lymph node histology, which revealed non-caseating granuloma, were consistent with the sarcoidosis diagnosis. The patient was asymptomatic and was kept free of treatment.Conclusion
Sarcoidosis must be considered ahead of compatible clinicoradiological presentation occurring after HSCT. Sarcoidosis can mimic metastatic cancer or lymphatic relapse. Tissue biopsies and exclusion of differential diagnosis of granuloma diseases are warranted to confirm sarcoidosis diagnosis. 相似文献8.
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J. Grouille F. Maillot B. De Toffol D. Perrotin L. Bernard D. Garot 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2017,38(2):90-96
Introduction
Meningoencephalitis (ME) are central nervous system inflammations with many etiologies. The etiology remains unknown in nearly half of the cases. The last French study was performed in 2007. Besides some rare or emerging causes, such as limbic ME, which are curable, infectious ME are the most frequent. Long term ME outcome remains partly known. The study objectives were to assess etiologies and outcome of ME in a University hospital between 01/01/2011 and 31/12/2014.Methods
This is a retrospective epidemiological study based on computerized files from patients hospitalized in internal medicine, infectious diseases and intensive care departments. Included patients presented compatible clinical symptoms with ME (delirium, focal deficits, epilepsy) and confirmed meningitis after lumbar puncture.Results
The files of 79 patients were studied. In 37 patients (46.8%) ME was infectious: viral in 16 cases (mainly VZV), bacterial in 16 (mainly pneumococcus). Eight patients (10.1%) presented with a noninfectious cause, 2 of which being limbic ME. Etiology remains undetermined in 34 patients. The patients presenting with a ME of unknown etiology had a lesser serious initial presentation, a shorter time in intensive care department, and a better long-term outcome.Conclusion
Etiologic diagnosis of ME is difficult. Aside infectious ME, diagnosis of others curable ME is very important. 相似文献10.
Detection of high biliary and fecal viral loads in patients with chronic hepatitis C virus infection
Hugo Monrroy Jenniffer Angulo Karla Pino Pilar Labbé Juan Francisco Miquel Marcelo López-Lastra Alejandro Soza 《Gastroenterologia y hepatologia》2017,40(5):339-347
Background
The life cycle of the hepatitis C virus (HCV) is closely associated with lipid metabolism. Recently, NPC1L1 (a cholesterol transporter) has been reported to function as an HCV receptor. This receptor is expressed in the hepatocyte canalicular membrane and in the intestine; serving as a key transporter for the cholesterol enterohepatic cycle.Objectives
We hypothesized that HCV might have a similar cycle, so we aimed to study the presence of HCV in bile and stools of infected patients.Materials and methods
Blood, feces, and duodenal bile samples were collected from patients infected with HCV. The biliary viral load was normalized to the bile salt concentration of each sample and the presence of HCV core protein was also evaluated. A total of 12 patients were recruited. HCV RNA was detected in the bile from ten patients.Results
The mean viral load was 2.5 log10 IU/60 mg bile salt. In the stool samples, HCV RNA was detected in ten patients (mean concentration 2.7 log10 IU/g of feces).Conclusions
HCV RNA is readily detectable and is present at relatively high concentrations in the bile and stool samples of infected patients. This may be relevant as a source of infection in men who have sex with men. Biliary HCV secretion may perhaps play a role in the persistence of viral infection via an enterohepatic cycle of the virus or intrahepatic spread. 相似文献11.
Margalida Calafat Triana Lobatón Míriam Mañosa Laura Marín Noemí Caballero Macarena Larraín Eduard Cabré Eugeni Domènech 《Gastroenterologia y hepatologia》2017,40(10):663-668
Background
Ulcerative proctitis (UP) presents distinctive clinical characteristics, outcomes and therapeutic approaches as compared to left-sided and extensive ulcerative colitis (UC).Aim
To describe the current therapeutic requirements and clinical outcomes in patients with active UP.Methods
Retrospective observational study conducted in a referral IBD centre. Patients with UP in follow-up between 1989 and 2014 were included. The clinical characteristics, as well as the different treatments and drug formulations administered to treat flares, were recorded.Results
Out of 687 UC patients, 101 patients (15%) with UP were included. Median follow-up was 8 years (IQR 3–14) and 49% of patients presented disease activity during the study period. Topical mesalazine monotherapy (90%) was the most commonly administered treatment for disease activity (mostly as suppositories), followed by topical steroids (47%) and oral mesalazine (56%) in monotherapy or combination therapy. Only 14% and 16% of patients required oral prednisone and beclomethasone, respectively.Conclusions
In clinical practice, active UP presents mostly favourable outcomes. Mesalazine suppositories are by far the most used treatment for these patients. 相似文献12.
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S. Thietart A. Mekinian S. Delorme M. Lequoy D. Gobert L. Arrivé O. Fain 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2017,38(12):847-849
Introduction
Vasculitis usually have a systemic involvement. Rare cases of localized vasculitis have been described, but the exclusive involvement of the hepatic artery is exceptional. We report the case of a patient who developed a vasculitis of the right and left hepatic arteries.Case report
A 63-year-old woman presented with unexplained abdominal pain. A computed tomography of the abdomen was suggestive of vasculitis of the hepatic arteries, showing a sequence of stenosis and aneurysmal dilatations of the hepatic arteries. There were no other arterial involvement, in particular of the abdomen and the brain. No other systemic disease or infection was found. The outcome was favorable, with corticosteroids alone.Discussion
The exclusive involvement of the hepatic artery is an exceptional form of localized vasculitis, with only one other case reported. This diagnosis could therefore be discussed, in the presence of unexplained hepatic hematoma or pain. 相似文献14.
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Manuel Monsonís Cabedo Susana Rives Solá Antoni Noguera-Julian Mireia Urrea Ayala Ofelia Cruz Martinez Amadeu Gené Giralt 《Enfermedades infecciosas y microbiología clínica》2017,35(1):33-36
Introduction
The routine use of a single aerobic bottle for blood culture in pediatric patients has become commonplace, as anaerobic bacteria are not frequently involved in clinically significant infections. The aim of this study was to assess the usefulness of routinely performing anaerobic blood cultures in pediatric oncology patients.Methods
Prospective study was conducted on pediatric (<18 years) patients affected with febrile syndrome after receiving chemotherapy for hematological or solid malignancies. Samples were inoculated into pediatric aerobic and standard anaerobic bottles (BacT/Alert automatic system). Strains were considered clinically significant, or deemed as contaminants, depending on isolation circumstances and clinical criteria.Results
A total of 876 blood cultures from 228 patients were processed during the 21-month study period (January 2014 to September 2015). Baseline diagnosis included 143 solid tumors and 67/18 cases of leukemia/lymphoma. Bacterial growth was detected in 90 (10.2%) blood cultures for 95 different isolates, of which 62 (7.1%)/63 isolates were considered clinically significant. Among the latter, 38 (60.3%) microorganisms grew in both aerobic and anaerobic bottles, 18 (28.6%) only in aerobic bottles, and 7 (11.1%) only in anaerobic bottles. Gram-negative bacilli (33; 52.4%), mainly from the Enterobacteriaceae family, were the most frequently isolated microorganisms. Overall, only 3 out of 90 isolates (3.3%) were strict anaerobes (Propionibacterium acnes), and all of them were deemed contaminants.Conclusion
Strict anaerobes did not cause significant infections in febrile pediatric oncology patients, and anaerobic blood culture bottles offered no additional advantages over aerobic media. Our results suggest that routine blood cultures should be solely processed in aerobic media in this group of patients. 相似文献16.
Vaishali Kolgiri Vinayak Wamanrao Patil 《The Brazilian journal of infectious diseases》2017,21(1):35-41
Background
The major complications of “treated” Human Immunodeficiency Virus (HIV) infection are cardiovascular disease, malignancy, renal disease, liver disease, bone disease, and perhaps neurological complications, which are phenomena of the normal aging process occurring at an earlier age in the HIV-infected population. The present study is aimed to explore protein carbonyl content as a biomarker for detecting oxidative DNA damage induced ART toxicity and/or accelerated aging in HIV/AIDS patients.Objective
To investigate the potential of carbonyl content as a biomarker for detecting oxidative Deoxyribonucleic acid (DNA) damage induced Antiretroviral Theraphy (ART) toxicity and/or accelerated aging in HIV/AIDS patients.Methods
In this case–control study a total 600 subjects were included. All subjects were randomly selected and grouped as HIV-negative (control group) (n = 300), HIV-infected ART naive (n = 100), HIV-infected on first line ART (n = 100), and HIV-infected on second line ART (n = 100). Seronegative control subjects were age- and sex-matched with the ART naive patients and the two other groups. Carbonyl protein was determined by the method described in Levine et al. DNA damage marker 8-OH-dG was determined using 8-hydroxy-2-deoxy Guanosine StressXpress ELA Kit by StressMarq Biosciences.Results
Protein carbonyl content levels and oxidative DNA damage were significantly higher (p < 0.05) in HIV-infected patients on second line ART and HIV-infected patients on first line ART than ART naive patients and controls. In a linear regression analysis, increased protein carbonyl content was positively associated with increased DNA damage (OR: 0.356; 95% CI: 0.287–0.426) p < 0.05.Conclusions
Carbonyl content may has a role as a biomarker for detecting oxidative DNA damage induced ART toxicity and/or accelerated aging in HIV/AIDS patients. Larger studies are warranted to elucidate the role of carbonyl content as a biomarker for premature aging in HIV/AIDS patients. 相似文献17.
Cristina Dacoll Jordi Sánchez-Delgado Henia Balter Ximena Pazos María Di Pace Gabriela Sandoya Henry Cohen Xavier Calvet 《Gastroenterologia y hepatologia》2017,40(7):447-454
Background
Strong acid inhibition increases cure rates with triple therapy and 14-day are more effective than 7-day treatments. The combination of amoxicillin plus metronidazole at full doses has been shown to overcome metronidazole resistance and to achieve good eradication rates even in patients harboring resistant strains. No previous studies have been reported in Latin-America with this optimized triple-therapy scheme.Aims
The aim of the present study was to assess the eradication rate and tolerance of a new first-line treatment regimen associating strong acid inhibition, amoxicillin and metronidazole.Methods
Patients from the Clínica de Gastroenterología of the Hospital de Clínicas (Montevideo, Uruguay) were included. Hp status was mainly assessed by at least one of the following: histologyor urea breath test (UBT). A 14-day treatment was prescribed comprising esomeprazole 40 mg twice a day plus amoxicillin 1 g and metronidazole 500 mg, both three times a day. H. pylori cure was assessed by UBT.Results
Forty-one patients were enrolled. Mean age was 53.3 ± 13 years and 17.1% of patients were male. Main indications for treatment were: functional dyspepsia (27.5%), gastritis (45%), gastric or duodenal erosions (20%), gastric ulcer (5%) and intestinal metaplasia (2.5%). H. pylori eradication was achieved in 33 of the 37 patients who returned for follow-up. Eradication rates were 80.5% (95% CI: 68.4–92.6) by intention-to-treat (ITT) analysis and 89.2% (95% CI; 79.2–99.2) per protocol (PP). No major side effects were reported; 26 patients (65.8%) complained of mild side effects (nausea, diarrhea and headache).Conclusions
Cure rates of this triple therapy including esomeprazole, amoxicillin and metronidazole were 81% per ITT and the treatment was well tolerated. These optimal results with a simple clarithromycin-free triple therapy are better than described for standard triple therapy but there is still room for improvement to reach the desired target of 90% per ITT. 相似文献18.
J. Tahiri F. Fouyssac O. Morel A. Maatouk 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2017,38(5):337-339
Introduction
Good syndrome is a rare condition in which thymoma is associated with hypogammaglobulinemia. It is characterized by an increased susceptibility to infections.Case report
We report a woman with Good's syndrome diagnosed after severe congenital toxoplasmosis in her daughter, even though she was immunized against this infection during pregnancy.Conclusion
This presentation is very unusual by its early diagnosis and to our knowledge is the first report of parasitic infection in this syndrome. 相似文献19.
S. Vildy K. Osmaeva F. Closs-Prophette H. Maillard 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2017,38(2):143-146
Introduction
Skin necrosis with vitamin k antagonists are rare. They affect more frequently middle-aged and obese women, often within 10 days after initiating of treatment. They occur most often in a context of thrombophilia.Case report
An 18-year-old obese woman was treated with heparin and fluindione for a lower limb deep venous thrombosis. On day 5, the patient presented fever and skin necrosis, which extended rapidly. We identified an activated protein C resistance and a major inflammatory syndrome related to Mycoplasma pneumoniae infection. The outcome was favorable after discontinuation of the fluindione, introduction of heparin and vitamin K, despite amputation of a toe.Conclusion
Skin necrosis is due to a transient hypercoagulable state during the initiation of vitamin K antagonist treatment due to an imbalance between pro- and anticoagulant factors. In our case, it was caused by an activated protein C resistance and an inflammatory syndrome. 相似文献20.
P. Garrigues T. de Roux E. Georgilopoulos E. Wanono A. Mathieu 《La Revue de médecine interne / fondée ... par la Société nationale francaise de médecine interne》2017,38(8):551-554