E-mail: [email protected] the construction of a network of care and support for tuberculosis patients and their families, contributing to days past the scheduled return date.3 .. ou portadores de tuberculose pulmonar – estudo. João Pessoa, PB, Brazil. [email protected] 3 RN, Ph.D. Professor, Medical-Surgical Nursing and Administration . The control of Tuberculosis (TB) is an area of concern in the state .. the search for pulmonary TB in respiratory symptomacs . and the date of the diagnosis, with an intervals of more. Email: [email protected] [a] Conflict of interests: All authors .. Guía Guía de atención de la tuberculosis pulmonar y extrapulmonar.
Hepatic artery stenosis was observed in 4 patients.
EBSCOhost | | Anemia em pacientes internados com tuberculose pulmonar.
It appeared at late stages and required percutaneous endovascular management. One patient had late-stage hemodynamically significant portal vein stenosis. Stenosis was more frequent than thrombosis. Likewise, one of the patients required reoperation since the stenosis occurred at a very early stage; the other patients were successfully treated by the endovascular route.
Biliary complications A total of 35 patients In almost all of the cases of bile leaks, they were concomitant with injuries due to stenosis. Other foci of infection, in order of frequency, were: These infections occurred at late stages, except for one case. Invasive fungal infections were observed in 6 patients 2.
Two patients were diagnosed with Aspergillus infection. One of them had pulmonary disease with early diagnosis and well-timed treatment, thus yielding a favorable outcome. The other patient, however, had a disseminated disease with infectious endocarditis and late diagnosis. The outcome was death, despite surgical management and treatment with voriconazole and echinocandin. Both were diagnosed during the first weeks of symptom onset and the treatment was well-timed and successful; thus no patients died.
Liver retransplantation was performed in 6.
The main causes were ischemic cholangiopathy, chronic rejection, and hepatic artery thrombosis. There was no single case of fibrosing cholestatic hepatitis.
Eight percent of the patients with hepatocellular carcinoma experienced relapses.
However, only one of them had a severe condition, metastasis, and death due to neoplasia. As to the quality of life of patients undergoing liver transplantation there was no formal assessment, however we documented that patients without serious complications returned more quickly after 3 months to their normal daily activities, led a normal family life including the possibility of parenthood and returned to work.
Discussion The liver transplantation had to undergo a number of modifications in recent years in order to generate the results we see today. For the last 3 decades it has been accepted as a therapeutic option for patients with advanced liver disease 6. Although there are various reports of results obtained in different medical centers around the world, with more than 1, patients and over 10 years of follow-up, this is one of the few documents which reports the liver transplantation experiences of a center in Colombia.
These rates are comparable to those reported in the U. This is relevant, considering that our country has economic limitations and less experience in carrying out this kind of procedure. As for other reports from the region, Buckel et al. We therefore aim to achieve the same excellent results.
In this study, there were high mortality rates during the first year. The leading causes were sepsis with multiple organ failure and massive bleeding. This situation improved in the later years because the surgical team became more experienced and perioperative care improved.
Indeed, the length of stay in the ICU may seem long; however, the early extubation protocol has reduced this time to 2 days in recent years. Likewise, hospital stay has been reduced to 12 days.
Results were also comparable to those recently obtained by large medical centers Of these complications, bacterial infections were the most common. They appeared especially during the first 2 months and the most common source was the abdomen, followed by the lungs and the urinary tract. This is consistent with international data.
- An experience of liver transplantation in Latin America: a medical center in Colombia
- Anemia em pacientes internados com tuberculose pulmonar.
Viral infections and invasive fungal infections occurred at a rate similar to the one reported by other studies, despite the fact that the antimicrobial prophylaxis protocol for cytomegalovirus and fungi is only applied in patients with known risk factors 13 Mycobacterial infections, in turn, occurred in 0. The clinical presentation was extrapulmonary disease, which is not uncommon in this population and hinders early diagnosis.
They consisted of hepatic artery thromboses, which appeared early, and in 3. This percentage is similar to the one described by Duffy et al As for biliary tract complications, they occurred in Anastomotic stenosis was the most frequent type of injury in this study.
It is related to an increase in infections, procedures, and hospitalizations, thus leading to an increase in costs. Biliary leaks, which are associated with not using the biliary T-tube, occurred in low proportions. In terms of acute and chronic rejection, the results of this study are similar to those recently reported by Pfitzmann et al.
Survival rates for patients with hepatocellular carcinoma were similar to those of other transplant patients. Regarding long-term complications such as chronic renal failure, diabetes mellitus, arterial hypertension and dyslipidemia, rates were lower than those reported in the literature; this could be explained by the fact that our follow-up period was shorter than that of the studies in other centers around the world.
Tuberculosis diagnosis in the aged: barriers to accessing health services
Likewise, long-term follow-up was difficult to maintain for some patients due to a local health system which allows for changes in the sites at which patients are seen. This report is a good example for other liver transplant centers in developing countries with limited economic resources, e. The high quality of the donors is worth mentioning, particularly in terms of age and cause of death.
The long-term follow-up of some patients and the limited number of cases can be considered to be the limitations of this study. We chose to analyze only the patients who underwent their first liver transplantation and excluded individuals who underwent retransplants, as well as those with combined liver-kidney transplantation and multivisceral transplantation, since the features of these groups of patients are not comparable.
Conclusion Liver transplantation is an effective and proven therapy for acute and chronic liver diseases in selected patients.
It is now available in Colombia, and its results in the Pablo Tobon Uribe Hospital in Medellin, Colombia, are comparable to those of other medical centers in the world in terms of complications and medium-term survival.
The authors would like to thank the sustainability program of the Office of the Vice-Chancellor for Research at the University of Antioquia. References 1 Murray K, Carithers R.
Evaluation of the Patient for Liver Transplantation. Orthotopic homotransplantation of the human liver. Liver Transplantation in the United States, Transplantation of the liver. Liver transplantation in Medellin, Colombia: Outcomes of Orthotopic Liver Transplantation in Chile. Survival before and after model for end-stage liver disease score introduction on the Brazilian liver transplant waiting list.
Twenty years of liver transplantation in Brazil.
Mycobacterium triviale Presenting as Endobronchial Lesion in a Young Immunocompetent Girl
Infections following orthotopic liver transplantation. September 08, ; Accepted date: November 29, ; Published date: December 02, Citation: J Pulmonar Respirat Med 1: This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
There are few case reports of lung involvement by Mycobacterium terrae complex. We reported a 13 years old immunompetent girl with a cavitary opacity seen on chest imaging and bronchoscopy revealed an endobronchial lesion, sputum and tissue specimens revealed growth of Mycobacterium triviale. Our patient is unique as it is the first case reported in Saudi Arabia with this type of Mycobacteria, in addition there is no case reported in the literature with Mycobacterium triviale with endobronchial lesion, the patient treated with a combination of rifampicin, ciprofloxacin and ethambutol for six months, she showed good response with resolution of radiological abnormalities and she did not have relapse after one year of follow up.
Keywords Immunompetent girl; Mycobacterium triviale; Bronchial asthma Case Report A 13 years old girl referred to king Khalid university hospital, Riyadh, from another hospital, she is a known case of bronchial asthma on PRN inhalers, the patient had history of recurrent chest infections since 7 years, in the referring hospital the patient was admitted with 3 weeks history of productive cough, dyspnea, fever and chest discomfort.
There was no history of hemoptysisanorexiaweight loss or night sweats, no history of contact with sick person or exposure to pets or animals, she has no previous Hx of extra pulmonary infections. In the referring hospital she was managed as community acquired pneumonia with cefuroxim and moxifloxacin, the patient showed improvement of symptoms. Examination in our hospital revealed young girl, thin and short for her age, pale but looking will, fully conscious, not dyspnic, she is a febrile and other vital signs were normal, there was no clubbing or preferal lymphadenopathy, chest exam revealed decrease breath sounds on the right side otherwise normal, other systemic examination was normal.
Initial investigations revealed CBC: Chest roentgenogram before surgical intervention showing right paratracheal and hilar lymphadenopathy with right parahilar cavitary airspace pneumonic opacity. Two CT scan sections at lower zones showing right lower lobe consolidation with cavitation with bilateral hilar lymphadenopathy. Upper lobe bronchi which were explored and lymph nodes specimens taken for investigation. Histopathology results of the specimens revealed: Reactive follicular lymphoid hyperplasia with histiocytic proliferation with mixed inflammation, no malignant cells, there are filamentous acid fast bacilli organisms suggestive of either nocardiosis or atypical mycobacteria Figure 3From TB lab Bx stain revealed: Pt was referred to infectous group who started the patient on Rifampicin, Clarithromycin, Ciprofloxacin and etahmbutol.