Pulmonary thromboembolism in Occupational Medicine Reinoso-Barbero, Luis; Díaz-Garrido, Ramón; Fernández-Fernández, Miguel ...
Archivos de prevención de riesgos laborales,
2015 Jul-Sep, Letnik:
18, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Occupational physicians should be familiar with the risk factors and clinical presentation of pulmonary thromboembolism (PTE). PTE belongs to the group ofis a cardiovascular diseases, which are the ...main cause (40%) of death in Spanish workplaces; at present, they may be considered a work-related injury because of the doctrinal evolution in the legal interpretation of the presumption of iuris tantum. We present the case of a hypertensive and obese adult male who suffered a PTE at his workplace. The availability of a portable pulse oximeter (room air SpO2, 92%) was critical in guiding the decision to refer him urgently to the hospital, where the diagnosis was confirmed. We can conclude that, independently of whether this event is later deemed to be work-related (in this case it was not), occupational physicians must know how to correctly manage and refer affected workers.
El derrame biliar y la caída de cálculos a la cavidad abdominal es una complicación menor de las colecistectomías laparoscópicas. Sin embargo, puede asociarse a graves complicaciones posoperatorias ...si no se lava la cavidad y se extraen los cálculos. Se documenta el caso de una paciente operada mediante colecistectomía laparoscópica por litiasis vesicular, en la que se decidió la conversión a cirugía abierta dada la caída de cálculos hacia la cavidad abdominal. En el posoperatorio presentó infección de la herida y fístula cutánea, con salida de cálculos por la herida quirúrgica. Cuatro años después presentó síndrome febril y dolor lumbar, y se diagnosticó entonces un absceso del psoas cuya causa fue la presencia de cálculos biliares que se desplazaron hacia ese sitio. Se intervino quirúrgicamente y se le drenó el absceso por vía posterior. La evolución fue satisfactoria. Estas complicaciones refuerzan la necesidad de una extracción exhaustiva de todos los cálculos que caen a cavidad durante las colecistectomías laparoscópicas.
La Moringa (M.) oleifera es altamente valorada a nivel mundial por las propiedades que posee. Una de las partes aprovechables del árbol es la semilla, ya que estas contienen entre un 30 y 45 % de ...aceite. El presente trabajo tiene como objetivo fundamental desarrollar la extracción de aceite a partir de las semillas de M. oleifera, variedad (var.) Supergenius de origen cubano mediante el empleo de hexano como disolvente. El porcentaje de extracción de aceite se estableció como variable respuesta en un diseño experimental del tipo factorial 22, donde la relación soluto-solvente y el tiempo de extracción fueron los factores estudiados a dos niveles. Ambos factores influyeron de manera significativa en la variable respuesta, (con valores) asociados de P < 0,05. El modelo matemático obtenido explicó el comportamiento de la variable respuesta en 91,45 %. A partir del comportamiento del porcentaje de extracción de aceite con el tiempo de extracción, se propone un reajuste en dicho tiempo, garantizando un ahorro de energía. Las propiedades físico químicas y el perfil de ácidos grasos del aceite extraído están en correspondencia con reportes hechos para otras variedades de M. oleifera. Solamente existieron diferencias en cuanto al índice de acidez. El comportamiento reológico demostró que el aceite de M. oleifera es Newtoniano.
El presente estudio examinó las propiedades psicométricas del Addiction Severity Index-6 (ASI-6) en su versión traducida y adaptada al español. Se realizó un estudio multicéntrico, observacional y ...prospectivo donde participaron un total de 258 sujetos, siendo 217 pacientes (35 estables y 182 inestables) y 41 controles. Los resultados muestran que el ASI-6 presentó un buen comportamiento psicométrico. Los niveles de consistencia interna de las puntuaciones objetivas estandarizadas de las escalas del ASI-6 oscilaron entre 0,47 y 0,95. Por su parte, los valores de fiabilidad test-retest fueron aceptables, oscilando entre 0,36 y 1. El estudio de la estructura interna del ASI-6 informó que todas las escalas, considerándolas de forma independiente, se ajustaron a una solución esencialmente unidimensional. En cuanto a la obtención de evidencias de validez convergente-discriminante, las correlaciones entre las escalas primarias y secundarias del ASI-6 y las puntuaciones en la Impresión Clínica Global de Gravedad fueron bajas, oscilando entre 0,01 y 0,26. Asimismo, ocho de las quince escalas del ASI-6 lograron diferenciar entre controles y pacientes inestables. La versión española del ASI-6 presenta propiedades psicométricas que pueden ser consideradas aceptables, aunque sería necesario llevar a cabo nuevos estudios que continúen examinando su calidad métrica en muestras independientes de pacientes.
Background: The immigrant populations from sub-Saharan
and Maghreb countries are groups in high risk of contracting
tuberculosis. An analysis is made of the prevalence of tuberculosis
infection among ...one group of these immigrants in
Ceuta for the purpose of finding possible differences in their incidental
behavior according to the country or geographical region
from which they came.
Methods: A descriptive cross-sectional study of a sample
of 2,223 immigrants (1979 males and 244 females) from different
African countries (mainly Nigeria, Mali, Guinea-Bissau,
Cameroon, Ghana, Sierra Leona, Democratic Republic of Congo
and Liberia) at the Calamocarro refugee camp in Ceuta. A
Mantoux intradermic reaction test was performed following the
previously-established protocol, the data for three cut-off
points being presented.
Results: The immigrants came from 36 African countries,
89.0% being males and 11.0% females (p < 0.001), respectively
averaging in age from 24.9 ± 4.3 to 23.4 ± 4.1. A reaction
to the Mantoux text of 10 mm or more was found in 32.6%, that
is 33.2% among males and 27.9% among females (p = 0.09).
Solely 1.1% showing 5-10 mm hardening of probable vaccination-
related cause. By geographical regions, the highest rates
were found among immigrants from the Democratic Republic
of Congo (65.1%) and Cameroon (48.4%), followed far behind
by Nigeria (34.0%), Liberia (32.7%), Mauritania (29.1%), Sierra
Leona (28.8%), Ivory Coast (27.8%), Guinea-Bissau
(27.4%), Ghana (26.3%), Algeria (25.6%), Mali (24.1%) and
the Republic of Guinea (20.9%) (p < 0.0001).
Conclusions: The immigrant population from central African
countries shows a higher prevalence of tuberculosis infection,
comprising a group at risk of contracting this disease.
Therefore, it is of fundamental importance to implement specific
programs to actively detect tuberculosis infection during
their stay in our city, taking advantage of their being grouped
together upon entry into our country, prior to their final emigration
to localities throughout the mainland and subsequent mixing
among the host country population.
Fundamento: La tuberculosis es la enfermedad infecciosa
más extendida en el mundo. Los objetivos de este estudio fueron
conocer la prevalencia de infección tuberculosa en los inmigrantes
que durante 1998 estuvieron en el campamento de
Calamocarro en Ceuta y analizar si existen diferencias según
país o región geográfica de procedencia.
Métodos: Estudio descriptivo transversal sobre la población
total de inmigrantes en el campamento de Calamocarro en
1998. Se practicó la intradermorreacc ión según la técnica de
Mantoux según protocolo ya establecido, a los 2.223 inmigrantes
(1979 varones y 244 mujeres) procedentes de distintos países
africanos (Nigeria, Mali, Guinea Bissau, Camerún, Ghana,
Sierra Leona, Rep Dem Congo, y Liberia, principalmente) en el
campamento de refugiados de Calamocarro de Ceuta. Los resultados
se presentan para tres puntos de corte de la induración:
<5mm; entre 5 y 10mm; e igual o superior a 10mm.
Resultados: Los inmigrantes procedían de 36 países africanos,
el 89,0% eran varones y el 11,0% mujeres (p < 0,001) con
una edad media de 24,9 ± 4,3 y 23,4 ± 4,1 años respectivamente.
El 32,6% presentaron una respuesta al test de Mantoux igual o superior
a 10 mm, 33,2% en varones y 27,9% en mujeres (p = 0,09).
Sólo hubo un 1,1% con induración 5-10 mm de probable origen
vacunal. Por zonas geográficas, las tasas más altas se presentaron
en inmigrantes procedentes de la República Democrática del Congo
(65,1%) y de Camerún (48,4%), seguidos a distancia por Nigeria
(34,0%), Liberia (32,7%), Mauritania (29,1%), Sierra Leona
(28,8%), Costa de Marfil (27,8%), Guinea Bissau (27,4%), Ghana
(26,3%), Argelia (25,6%), Mali (24,1%) y R.Guinea (20,9%)
(p<0,0001).
Conclusiones: La población inmigrante procedente de países
centroafricanos presenta una alta prevalencia de infección
tuberculosa, constituyendo un grupo de riesgo de padecer la enfermedad.
Por tanto, es fundamental la implantación de programas
específicos de búsqueda activa de infección tuberculosa
durante su estancia en nuestra ciudad, aprovechando su concentración
a la entrada en nuestro país, antes de su emigración
definitiva a localidades peninsulares y posterior dilución demográfica
en la población de acogida.
Objectives
Chronic oxidative stress (OS) may play a role in cardiovascular disease in HIV‐infected patients, and increased bilirubin levels may have a beneficial role in counteracting OS. Atazanavir ...(ATV) inhibits UDP‐glucuronosyl‐transferase 1A1 (UGT1A1), thus increasing unconjugated bilirubin levels. We aimed to compare changes in OS markers in patients on ATV/ritonavir (ATV/r)‐ vs. efavirenz (EFV)‐based first‐line antiretroviral therapy (ART).
Methods
A multicentre, prospective cohort study of HIV‐infected patients who started first‐line ART with either ATV/r or EFV was conducted. Lipoprotein‐associated phospholipase A2 (Lp‐PLA2), myeloperoxidase (MPO) and oxidized low‐density lipoprotein (oxLDL) were measured for 145 patients in samples obtained at baseline and after at least 9 months of ART during which the initial regimen was maintained and the patient was virologically suppressed. The change in OS markers was modelled using multiple linear regressions adjusting for baseline values and confounders.
Results
After adjustment for baseline variables, patients on ATV/r had a significantly greater decrease in Lp‐PLA2 estimated difference −16.3; 95% confidence interval (CI) −31.4, −1.25; P = 0.03 and a significantly smaller increase in OxLDL (estimated difference −21.8; 95% CI −38.0, −5.6; P < 0.01) relative to those on EFV, whereas changes in MPO were not significantly different (estimated difference 1.2; 95% CI −14.3, 16.7; P = 0.88). Adjusted changes in bilirubin were significantly greater for the ATV/r group than for the EFV group (estimated difference 1.33 mg/dL; 95% CI 1.03, 1.52 mg/dL; P < 0.01). Changes in bilirubin and changes in OS markers were significantly correlated.
Conclusions
When compared with EFV, ATV/r‐based therapy was associated with lower levels of oxidative stress biomarkers, which was in part attributable to increased bilirubin levels.
Transplantation-associated thrombotic microangiopathy (TA-TMA) is associated with high morbidity and mortality. Although survival has improved significantly with the introduction of eculizumab, the ...need for improvement remains, especially in high-risk patients. This study aimed to describe the results obtained with eculizumab in a pediatric cohort with the attempt to define which risk factors could determine the response to treatment. We designed a national multicenter retrospective study of children treated with eculizumab for high-risk TA-TMA. The study cohort comprised 29 patients who had undergone a first (n = 28) or second (n = 1) allogeneic hematopoietic stem cell transplantation (HSCT) for malignant (n = 17) or nonmalignant (n = 12) disease. The median time from HSCT to TA-TMA diagnosis was 154 days (interquartile range IQR, 103 to 263 days). Eleven patients (38%) who were initially diagnosed with low- to intermediate-risk TA-TMA progressed to high-risk TA-TMA (hrTA-TMA), within a median time of 4 days (IQR, 1 to 33 days). SC5b-9 was increased in 90% of 20 patients in whom it was measured. Renal (n = 12), pulmonary (n = 1), and intestinal (n = 1) biopsy confirmed the diagnosis in 12 of 14 patients (85%). Seventeen patients (58%) had extrarenal involvement with serositis (n = 13; 44,8%), pulmonary (n = 12; 41,4%), gastrointestinal (n = 8; 27.6%), cardiovascular (n = 7; 24.1%), or central nervous system (CNS) (n = 2; 6.9%) involvement. The median time from hrTA-TMA diagnosis to the initiation of eculizumab was 7 days (IQR, 1 to 8 days). Overall, 19 patients (65.5%) responded to eculizumab, of whom 17 (58.6%) achieved a complete response and 2 (6.9%) achieved a partial response. The remaining 10 patients (34.5%) did not show any of response. The overall response rate to eculizumab for TA-TMA was 27.59% (95% confidence interval CI, 14.87% to 47.66%) at 1 month, 55.17% (95% CI, 38.43% to 73.48%) at 3 months, and 62.07% (95% CI, 45.10% to 79.13%) at 6 months after eculizumab initiation. In multivariate analysis, the pulmonary involvement decreased the probability of response (hazard ratio HR, .18; P = .0298). The 1-year overall survival (OS) was 55.2% (95% CI, 35.6% to 71.0%) for the whole cohort and 83.3% (95% CI, 56.7% to 94.3%) for patients who responded to eculizumab. Pulmonary involvement (HR, 14.93; P = .0043) and CNS involvement (HR, 8.63; P = .0497) were associated with a statistically significant decrease in survival. We found that patients diagnosed with hrTA-TMA with pulmonary involvement had a poor response to eculizumab, and that patients with pulmonary and CNS involvement had significantly decreased survival. Given these results, we hypothesize that providing eculizumab therapy at an early stage of the disease before organ damage is established might significantly improve the response and, consequently, survival.
The rising incidence of urinary bladder cancer is alarming and potential relationships with different risk factors have been postulated. The purpose of this study was to examine the possible ...relationship between different environmental risk factors and urinary bladder cancer. All men with urinary bladder cancer who were admitted to the Department of Urology of Reina Sofia University Hospital of Cordoba, Spain over 1 year were included in our study. Men were administered an interview questionnaire, which included data on history of known urinary bladder cancer risk factors. Comparisons between men with urinary bladder cancer (cases) and those with nonmalignant urological disease (controls) were made. The study included 74 cases and 89 controls. The variables associated with malignant lesions on univariate analysis were age, smoking and drinking alcohol. Meanwhile, fish, poultry and beef consumption were proved to be protective factors. The risk factors identified by the logistic regression analysis were age, smoking and fluid intake. The independent protective factors on the multivariate analysis were fish and poultry consumptions. Smoking was found to be the principal independent risk factors for urinary bladder cancer. Our results call for further investigation of urinary bladder cancer risk factors; future studies should preferably be performed on large prospective cohorts, to increase their validity.
Controversies about laparoscopic appendectomy (LA) focus mainly on the high intraabdominal infection rate. In 2005, Serour et al described a distinct complication specific to LA, termed ..."postlaparoscopic appendectomy complication" (PLAC). This complication is an intraabdominal infection, without abscess formation, which develops after laparoscopic appendectomy for non-complicated appendicitis (simple, phlegmonous, or normal appendix) and is observed in patients discharged after an uneventful postoperative period. We reviewed our case series to establish our intraabdominal infection rate in appendectomy and to identify cases similar to this newly described complication.
We retrospectively reviewed 651 clinical records of appendectomy performed by the laparoscopic (LA) or open approach (OA) over an 11-year period in our hospital. The criteria for a diagnosis of PLAC were as follows: a) clinical criteria: uneventful appendectomy (OA or LA), asymptomatic status on hospital discharge, and onset of right lower quadrant pain, fever, and elevated white blood cell count after discharge; b) pathologic criteria: non-complicated appendicitis (gangrenous or perforated appendicitis were excluded), and c) ultrasound scan showing characteristic features.
A total of 432 LA and 219 OA were reviewed. The conversion rate was 11.1%. The main complications (intention-to-treat analysis) were wound infection (6.3% in LA versus 7.8% in OA) and intraabdominal infection (4.2% in LA versus 2.3% in OA). Four out of 18 cases of intraabdominal infection after LA fulfilled PLAC criteria, representing 1% of all LA and 22% of intraabdominal infections after LA.
LA seems to be associated with an increased risk of intraabdominal infection. Our results suggest that a distinct form of intraabdominal infection specific to laparoscopic appendectomy may exist.
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