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
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...
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| Formato: | tesis de maestría |
| Estado: | Versión aceptada para publicación |
| Fecha de publicación: | 2021 |
| País: | Colombia |
| Recursos: | Universidad Nacional de Colombia |
| Repositorio: | Repositorio UN |
| Idioma: | español |
| OAI Identifier: | oai:repositorio.unal.edu.co:unal/78999 |
| Acesso em linha: | https://repositorio.unal.edu.co/handle/unal/78999 |
| Access Level: | acceso abierto |
| Palavra-chave: | 610 - Medicina y salud Mortality Spinal puncture Meningitis cryptococcal Cerebrospinal fluid pressure Intracranial pressure Criptococosis meníngea Mortalidad Presión de líquido cefalorraquídeo Presión intracraneana Punción lumbar |
| Resumo: | 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. |
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