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Efecto de la punción lumbar terapéutica en mortalidad durante la terapia de inducción en pacientes mayores de 18 años con diagnóstico de novo de criptococosis meníngea en 2 hospitales de Bogotá 2010- 2018
dc.rights.license | Atribución-NoComercial-SinDerivadas 4.0 Internacional |
dc.contributor.advisor | Saavedra Estupiñan, Miriam |
dc.contributor.advisor | Saavedra Trujillo, Carlos Humberto |
dc.contributor.author | Hurtado García, Steven |
dc.date.accessioned | 2021-01-29T22:14:54Z |
dc.date.available | 2021-01-29T22:14:54Z |
dc.date.issued | 2021-01-25 |
dc.identifier.citation | Hurtado García, S. (2021). Efecto de la punción lumbar terapéutica en mortalidad durante la terapia de inducción en pacientes mayores de 18 años con diagnóstico de novo de criptococosis meníngea en 2 hospitales de Bogotá 2010- 2018 [Tesis de especialidad, Universidad Nacional de Colombia]. Repositorio Institucional. |
dc.identifier.uri | https://repositorio.unal.edu.co/handle/unal/78999 |
dc.description.abstract | Meningeal cryptococcosis is a serious infection of the central nervous system that occurs mainly in people with HIV infection and is associated with high morbidity and mortality. A frequent complication of this disease is the elevation of intracranial pressure, its aggressive treatment has shown an effect in reducing mortality, however it is not yet clear what is the best way to treat it. By reviewing the medical records of adult patients with a de novo diagnosis of meningeal cryptococcosis between 2010 and 2018, exposure (having received at least one therapeutic lumbar puncture (TLP) during the follow-up period), mortality and other study variables were identified. Forty-three patients were included, 79 % men, with an average age of 45.7 years and were followed for 15.8 days on average. 25 patients (58 %) had at least one TLP. When comparing exposed versus unexposed, a significant correlation was found between having positive India ink and high initial opening intracranial pressure with receiving at least one TLP, the mortality rates did not have significant differences 2.02 vs 0.52 deaths / 100 people- day (p: 0.09). When comparing patients who died against those who survived, a correlation was found between being older, Glasgow <15, seizures and late diagnosis (> 2 weeks of symptoms) with being in the mortality group. The desired sample size was not reached, the power of the study with collected sample was 73%. The effect on mortality of the performance or not of therapeutic lumbar punctures in patients with meningeal cryptococcosis could not be established. |
dc.description.abstract | La criptococosis meníngea es una infección grave del sistema nervioso central que se presenta principalmente en personas con infección por VIH y se asocia a una alta morbimortalidad. Una complicación frecuente de esta enfermedad es la elevación de la presión intracraneana, su tratamiento agresivo ha mostrado un efecto en reducción de mortalidad, sin embargo aún no es claro cuál es la mejor forma de tratarla. Mediante revisión de historias clínicas de pacientes adultos con diagnóstico de novo de criptococosis meníngea entre 2010 y 2018, se identificó la exposición (haber recibido al menos una punción lumbar terapéutica (PLT) durante el periodo de seguimiento), mortalidad y demás variables del estudio. Se incluyeron 43 pacientes, 79% hombres, con edad promedio 45,7 años y se siguieron por 15,8 días en promedio. 25 pacientes (58 %) tuvieron al menos una PLT. Al comparar expuestos contra no expuestos, se encontró correlación significativa entre tener tinta china positiva y presión intracraneana de apertura inicial elevada con recibir al menos una PLT, las tasas de mortalidad no tuvieron diferencias significativas 2,02 vs 0,52 muertes/100 personas-día (p: 0,09). Al comparar pacientes que murieron contra los que sobrevivieron, se encontró correlación entre tener mayor edad, Glasgow <15, crisis epilépticas y diagnóstico tardío (> 2 semanas de síntomas) con estar en el grupo mortalidad. No se alcanzó el tamaño de muestra deseado, el poder del estudio con muestra recolectada fue del 73%. No se pudo establecer el efecto en mortalidad que tiene la realización o no de punciones lumbares terapéuticas en pacientes criptococosis meníngea. |
dc.format.extent | 41 |
dc.format.mimetype | application/pdf |
dc.language.iso | spa |
dc.rights | Derechos reservados - Universidad Nacional de Colombia |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/4.0/ |
dc.subject.ddc | 610 - Medicina y salud |
dc.title | Efecto de la punción lumbar terapéutica en mortalidad durante la terapia de inducción en pacientes mayores de 18 años con diagnóstico de novo de criptococosis meníngea en 2 hospitales de Bogotá 2010- 2018 |
dc.type | Otro |
dc.rights.spa | Acceso abierto |
dc.description.additional | Línea de investigación: Neuroinfectología. |
dc.type.driver | info:eu-repo/semantics/other |
dc.type.version | info:eu-repo/semantics/acceptedVersion |
dc.publisher.program | Bogotá - Medicina - Especialidad en Neurología Clínica |
dc.description.degreelevel | Especialidades Médicas |
dc.publisher.branch | Universidad Nacional de Colombia - Sede Bogotá |
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dc.rights.accessrights | info:eu-repo/semantics/openAccess |
dc.subject.proposal | Mortality |
dc.subject.proposal | Criptococosis meníngea |
dc.subject.proposal | Spinal puncture |
dc.subject.proposal | Mortalidad |
dc.subject.proposal | Presión de líquido cefalorraquídeo |
dc.subject.proposal | Meningitis cryptococcal |
dc.subject.proposal | Cerebrospinal fluid pressure |
dc.subject.proposal | Presión intracraneana |
dc.subject.proposal | Punción lumbar |
dc.subject.proposal | Intracranial pressure |
dc.type.coar | http://purl.org/coar/resource_type/c_1843 |
dc.type.coarversion | http://purl.org/coar/version/c_ab4af688f83e57aa |
dc.type.content | Text |
oaire.accessrights | http://purl.org/coar/access_right/c_abf2 |
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