RESUMO
Usually solar keratoses (SK) are diagnosed clinically. However other diseases may clinically present as erythematous macules, papules or patches on sun-exposed areas; therefore the histopathology remains the gold standard diagnostic tool. Our study, which assessed the efficacy of photodynamic therapy (PDT), showed that one in 20 clinically diagnosed SK lesions grade I-II identified by board-certified dermatologists were rosacea and only one in 40 were malignant lesions. These findings should be considered by clinicians who treat clinically diagnosed grade I-II SK without response to treatment or diagnose the recurrence of SK after PDT.
Assuntos
Ceratose Actínica/diagnóstico , Ceratose Actínica/tratamento farmacológico , Fotoquimioterapia , Neoplasias Cutâneas/patologia , Erros de Diagnóstico , Humanos , Ceratose Actínica/patologia , Pessoa de Meia-Idade , Estudos Prospectivos , Rosácea/patologiaRESUMO
BACKGROUND AND OBJECTIVE: The aim of the study was to determine the correlation of hypoxic-ischemic (HI) brain injury in full-term neonates detected via ultrasonography (USG) and blood flow parameters evaluated via Doppler sonography (DS) with long-term outcomes of mental and neuromotor development at the age of 1-year. MATERIALS AND METHODS: In total, 125 full-term neonates (78 subjects of case group and 47 subjects of control group) were studied. During the first five days of life, the subjects daily underwent cerebral USG and DS. At the age of 1-year the neuromotor condition and mental development was evaluated. RESULTS: The HI injury groups detected during USG significantly correlated with the mental development groups (r=0.3; P=0.01) and the neurological evaluation groups (r=0.3; P<0.001). In the presence of brain swelling (edema) and thalamus and/or basal ganglia (E/T/BG) injury, USG demonstrated high accuracy values when prognosticating spastic quadriparesis and severe mental development impairment in 1-year-old subjects: sensitivity - 100%, specificity - 93-100%, positive predictive value (PPV) - 60-100%, and NPV - 100%. In subjects with spastic quadriparesis, mean end-diastolic velocity (Vd) values were significantly higher (P≤0.05), and mean resistive index (RI) values were significantly lower (P<0.05) than those in subjects with normal neuromotor development. In subjects with severe mental retardation, mean Vd values in ACA were statistically significantly higher, and mean RI values in ACA and ACM were statistically significantly lower than those in subjects with normal mental development. CONCLUSIONS: Hypoxic-ischemic brain changes detected during ultrasonography and cerebral blood flow parameters associated with long-term outcomes of mental and neuromotor development at the age of 1-year.
Assuntos
Asfixia Neonatal/diagnóstico por imagem , Hipóxia-Isquemia Encefálica/diagnóstico por imagem , Asfixia Neonatal/complicações , Encéfalo/irrigação sanguínea , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/etiologia , Ecocardiografia Doppler , Feminino , Hemodinâmica , Humanos , Hipóxia-Isquemia Encefálica/etiologia , Recém-Nascido , Lituânia , Masculino , Prognóstico , Quadriplegia/diagnóstico por imagem , Quadriplegia/etiologia , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Pain is the major drawback of photodynamic therapy (PDT), an otherwise effective treatment for actinic keratoses (AKs). OBJECTIVE: To determine pain intensity and its dependence upon various factors during PDT with 5-aminolevulinic acid for face/scalp AKs. METHODS: A prospective, randomized, within-patient comparison study was performed. Thirty-eight patients with at least two clearly definable, mild or moderate AKs were randomized to receive either a red light dose of 70 or 100 J/cm(2) as a first or second split face/scalp treatment. They were blinded to the light dose administered. Pain during treatment was assessed using a visual analog scale (VAS). RESULTS: The mean intensity of pain during the first treatment session was 5.00 (± 1.78), while during the follow-up VAS score was 4.50 (± 1.51). Bigger AKs (> 130 mm(2) ) were more painful than the smaller ones (P = 0.003) and AKs on the face were twice more painful than the ones on the scalp (P = 0.002). Gender and patient age were poor pain predictors. Pain was independent of the patient's Fitzpatrick skin type, AK clinical grade, pretreatment fluorescence intensity, and the light dose during PDT. CONCLUSION: Pain during PDT is associated with AK location and size. Treatment of bigger lesions (> 130 mm(2) ) results in more pain than smaller ones and treatment of the face is more painful than the scalp area.
Assuntos
Ácido Aminolevulínico/efeitos adversos , Dor/induzido quimicamente , Dor/fisiopatologia , Fotoquimioterapia/efeitos adversos , Transtornos de Fotossensibilidade/tratamento farmacológico , Fármacos Fotossensibilizantes/efeitos adversos , Idoso , Ácido Aminolevulínico/administração & dosagem , Animais , Face/patologia , Face/fisiopatologia , Feminino , Humanos , Masculino , Medição da Dor/métodos , Fotoquimioterapia/métodos , Transtornos de Fotossensibilidade/patologia , Transtornos de Fotossensibilidade/fisiopatologia , Fármacos Fotossensibilizantes/administração & dosagem , Estudos Prospectivos , Couro Cabeludo/patologia , Couro Cabeludo/fisiopatologiaRESUMO
OBJECTIVES: Congenital anomalies have been inconsistently associated with maternal crude estimated exposure to drinking water trihalomethane (THM). We investigated the relationship between individual THM uptake during the first trimester of pregnancy and congenital anomalies. METHODS: We estimated maternal THM uptake for 3074 live births using residential tap water concentrations, drinking water ingestion, showering and bathing, and uptake factors of THM in the blood. Multiple logistic regression was used to investigate the association of THM exposure with congenital anomalies. RESULTS: We observed no statistically significant relationships between congenital anomalies and the total THM internal dose. We found little indication of a dose-response relationship for brominated THM and congenital heart anomalies. The relationship was statistically significant for bromodichloromethane (BDCM) (OR=2.16, 95% CI 1.05 to 4.46, highest vs lowest tertile) during the first month of pregnancy. During the first trimester of pregnancy, the probability of developing heart anomalies increased for every 0.1 µg/d increase in the BDCM and for every 0.01 µg/d increase in the internal dibromochloromethane (DBCM) dose (OR 1.70, 95% CI 1.09 to 2.66, and OR 1.25, 95% CI 1.01 to 1.54, respectively). A dose-response relationship was evident for musculoskeletal anomalies and DBCM exposure during the first and second months of pregnancy, while BDCM exposure tended to increase the risk of urogenital anomalies. CONCLUSIONS: This study shows some evidence for an association between the internal dose of THM and the risk of congenital anomalies. In particular, increased prenatal exposure to brominated THM might increase the risk of congenital heart and musculoskeletal anomalies.
Assuntos
Anormalidades Induzidas por Medicamentos/etiologia , Água Potável/química , Exposição Materna/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal , Trialometanos/toxicidade , Abastecimento de Água , Anormalidades Induzidas por Medicamentos/sangue , Relação Dose-Resposta a Droga , Feminino , Cardiopatias Congênitas/sangue , Cardiopatias Congênitas/induzido quimicamente , Humanos , Modelos Logísticos , Anormalidades Musculoesqueléticas/sangue , Anormalidades Musculoesqueléticas/induzido quimicamente , Razão de Chances , Gravidez/sangue , Trimestres da Gravidez , Trialometanos/sangue , Anormalidades Urogenitais/sangue , Anormalidades Urogenitais/induzido quimicamente , Poluentes Químicos da Água/sangue , Poluentes Químicos da Água/toxicidadeRESUMO
UNLABELLED: Escherichia coli is one of the leading causes of early-onset neonatal sepsis in many industrialized countries. However, there is a lack of studies on Escherichia coli colonization in women and neonates. The study aimed at determining the prevalence Escherichia coli among pregnant women and newborns, perinatal transmission, antimicrobial susceptibility, and risk factors for neonatal colonization. MATERIAL AND METHODS: In this prospective, cross-sectional study, 827 infants born to 808 mothers were enrolled. The study was carried out from October 1, 2006, to June 30, 2007. Women were screened for E. coli carriage at 35-37 weeks of gestation or on admission for premature rupture of membranes and delivery; neonates, within 15 minutes of their lives. Risk factors for colonization were collected by a questionnaire and were recorded during labor. RESULTS: Maternal E. coli colonization rate was 19.9%; neonatal, 14.4%; and transmission rate, 21.4%. Less than one-fourth (22.7%) of neonatal E. coli strains were resistant to ampicillin. Logistic regression analysis revealed that anal sexual intercourse (OR, 3.91; 95% CI, 1.87-8.19), one sexual partner (OR, 2.01; 95% CI, 1.30-3.11), maternal vaginal Escherichia coli colonization (OR, 1.81; 95% CI, 1.12-2.93), maternal body mass index of ≤27 (OR, 1.77; 95% CI, 1.15-2.73), and maternal education lower than university level (OR, 1.70; 95% CI, 1.06-2.74) were associated with neonatal Escherichia coli colonization. CONCLUSIONS: The prevalence of maternal Escherichia coli colonization was higher in this study than other studies (19.9%). Neonatal Escherichia coli colonization was 14.4%. The resistance of Escherichia coli isolates to ampicillin was not high (22.7%). Improvement of maternal education and modification of mothers' sexual habits need to be undertaken to prevent neonatal Escherichia coli colonization.
Assuntos
Infecções por Escherichia coli/epidemiologia , Escherichia coli/isolamento & purificação , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Escherichia coli/efeitos dos fármacos , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/transmissão , Feminino , Humanos , Lactente , Recém-Nascido , Lituânia/epidemiologia , Testes de Sensibilidade Microbiana , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Prevalência , Fatores de RiscoRESUMO
BACKGROUND: The aim was to analyze the impact of obesity on women with gestational diabetes mellitus (GDM) and the association of obesity and GDM with the metabolic syndrome. METHODS: In a retrospective study, the data of 233 obese women with GDM were compared with the data of 96 women with GDM and normal weight. RESULTS: Significantly higher fasting glycemia before the oral glucose tolerance test (5.2±1.1 mmol/L vs. 4.5±0.8 mmol/L, P<0.00001) and higher frequency of hypertensive disorders of pregnancy (26.2% vs. 9.4%, P=0.0003) were found in obese women with GDM than in GDM women of normal weight. These women needed insulin therapy more often (18.9% vs. 8.3%, P=0.007). Also 31 (13.3 %) of them had chronic hypertension as compared with 3.1% in women of normal weight (P=0.003). These 31 women had three components necessary for diagnosing of metabolic syndrome according to the World Health Organization-impaired glucose tolerance, obesity, and hypertension. No difference in gestational age and mean weight of their newborns was found, but newborns of obese GDM women with metabolic syndrome components more often were significantly macrosomic with features of diabetic fetopathy and had more often symptoms of hypoglycemia after birth. CONCLUSIONS: The presence of obesity and GDM has a significant impact on both maternal and fetal complications. The metabolic syndrome can be diagnosed not only after pregnancy but also during pregnancy.
Assuntos
Diabetes Gestacional/epidemiologia , Síndrome Metabólica/epidemiologia , Obesidade/epidemiologia , Adulto , Biomarcadores/sangue , Glicemia/análise , Pressão Sanguínea , Distribuição de Qui-Quadrado , Diabetes Gestacional/sangue , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/tratamento farmacológico , Feminino , Teste de Tolerância a Glucose , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Lituânia/epidemiologia , Síndrome Metabólica/sangue , Síndrome Metabólica/diagnóstico , Obesidade/sangue , Obesidade/diagnóstico , Valor Preditivo dos Testes , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Adulto JovemRESUMO
Incontinentia pigmenti, also known as Bloch-Sulzberger syndrome, is a hereditary, X-linked dominant disorder characterized by abnormalities of skin, hair, teeth, eyes, and the central nervous system. It is classically considered a male-lethal disorder leading to recurrent miscarriages of male fetuses. We report a rare case of a surviving baby boy with the classic clinical features of incontinentia pigmenti that can be explained by Klinefelter syndrome.
Assuntos
Aberrações Cromossômicas , Incontinência Pigmentar/etiologia , Incontinência Pigmentar/genética , Síndrome de Klinefelter/complicações , Síndrome de Klinefelter/genética , Humanos , Recém-Nascido , MasculinoRESUMO
OBJECTIVE OF THE STUDY. To evaluate the correlation between total serum bilirubin (TSB) and transcutaneous bilirubin (TcB) levels in newborn infants at risk of ABO hemolytic disease. MATERIAL AND METHODS. During a prospective study, 130 full-term (>or=37 weeks of gestation) newborn infants with diagnosed ABO blood group incompatibility were examined. TSB level was measured at the age of 6 hours; further measurements were performed at 24, 48, and 72 hours following the first measurement. Blood samples were collected from the peripheral veins. In clinical laboratory, total serum bilirubin level was measured using Jendrassik-Grof method. TcB level in the forehead was measured using a noninvasive bilirubinometer BiliCheck (SpectRX Inc, Norcross, GA) according to the manufacturer's instructions within +/-30 min after getting a blood sample. RESULTS. During the study, 387 double tests were performed to measure TSB and TcB levels. TSB level (114.83 [62.85] micromol/L) closely correlated with TcB level (111.51 [61.31] micromol/L) (r=0.92, P<0.001). The strongest correlation was reported at the age of 54 hours (r=0.873, P<0.001), the weakest - at the age of 6 hours (r=0.729, P<0.001). TSB and TcB levels showed a strong correlation; the difference between these values was significant (95% CI, 0.70; 5.93; P<0.05). The greatest difference between TSB and TcB levels was detected at the age of 6 hours (5.58 [17.46] micromol/L, 95% CI, 2.55; 8.61; P<0.001). No significant difference was reported at the age of 30, 54, and 78 hours. Using linear regression analysis, it was established that correlation of TSB and TcB was described by equation y=14.13+0.903x. Transcutaneously measured bilirubin level underestimated serum bilirubin level. When at the age of 6 hours TcB level is >or=98 micromol/L, ABO hemolytic disease in newborns may be diagnosed with 100% sensitivity and 98% specificity; positive predictive value was 62% and negative predictive value was 100%. While a newborn's age increases, TcB sensitivity and specificity for diagnosing ABO hemolytic disease decrease. CONCLUSION. While evaluating bilirubin level transcutaneously according to nomograms of serum bilirubin level, the results should be considered with caution, especially for newborns with a risk of ABO hemolytic disease. The hour-specific nomograms of transcutaneous bilirubin level should be used to evaluate hyperbilirubinemia using only a noninvasive method.
Assuntos
Sistema ABO de Grupos Sanguíneos , Bilirrubina/análise , Incompatibilidade de Grupos Sanguíneos , Eritroblastose Fetal/diagnóstico , Hiperbilirrubinemia Neonatal/diagnóstico , Fatores Etários , Bilirrubina/sangue , Interpretação Estatística de Dados , Humanos , Recém-Nascido , Modelos Lineares , Triagem Neonatal , Valor Preditivo dos Testes , Curva ROC , Fatores de Risco , Sensibilidade e EspecificidadeRESUMO
A female newborn presented with emerging skin lesions, systemic eosinophilia, and eosinophilic reaction in the skin, liver, lungs, spleen, lymphatic nodes, porencephalia, convulsions, and disorders of thermoregulation. In addition to that, respiratory and heart failure, as well as brain edema were progressing. The suspected diagnosis of incontinentia pigmenti (Bloch-Sulzberger syndrome) was confirmed postmortem by skin biopsy.
Assuntos
Incontinência Pigmentar , Autopsia , Eosinofilia/complicações , Eosinofilia/diagnóstico , Feminino , Humanos , Incontinência Pigmentar/complicações , Incontinência Pigmentar/diagnóstico , Incontinência Pigmentar/mortalidade , Incontinência Pigmentar/patologia , Recém-Nascido , Pele/patologiaRESUMO
The aim of this study was to determine the prevalence of and some risk factors for impaired glucose tolerance (IGT) in 2- to 5-yr-old offspring of diabetic mothers (ODM). The glucose tolerance of 51 offspring born to women with pregnancies complicated by diabetes (type 1) and of 109 children of the control group was analyzed. Our results showed that the fasting glycemia of ODM was similar, when compared to the controls, but 2 h after the glucose loading the glycemia of ODM was significantly higher than that in the control group (5.47 +/- 1.79 mmol/L vs. 4.86 +/- 1.13 mmol/L). Normal glucose tolerance was found in 68.6% of ODM and 86.2% of controls; IGT was found in 17.6% of ODM and 4.6% of controls. Children with macrosomia at birth or overweight at 2-5 yr had IGT at 2-5 yr more often than children with normal weight at birth or normal weight at 2-5 yr. A significant, though relatively low, positive correlation was found between the duration of breastfeeding and fasting glycemia (r=0.241, p <0.01), and positive correlation was found between the duration of breastfeeding and glycemia 2 h after glucose loading (r=0.458, p=0.002) in the offspring of diabetic mothers. In conclusion, the average glycemia of ODM after glucose loading was higher than that in the control group. Macrosomia after birth, overweight, and obesity in childhood had a significant influence on the glucose tolerance of the ODM. The results of the oral glucose tolerance test correlated with the length of breastfeeding.
Assuntos
Diabetes Mellitus Tipo 1/complicações , Intolerância à Glucose/epidemiologia , Gravidez em Diabéticas/complicações , Peso ao Nascer , Glicemia/análise , Peso Corporal , Aleitamento Materno , Pré-Escolar , Feminino , Macrossomia Fetal/complicações , Teste de Tolerância a Glucose , Humanos , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Fatores de TempoRESUMO
The aim of this study was to review and to analyze treatment patterns of early and late obstetric brachial plexus palsy. Eighty-one children with early and late obstetric brachial plexus palsy were treated in the Department of Pediatric Orthopedics and in the Postintensive Care Unit within the period 1988-2002. Children were classified into 2 groups according to age: Ist group (67 newborns) was treated conservatively, and IInd group (14 children with late obstetric brachial plexus palsy with deformity) underwent operative treatment. Active hand movements and innervation were evaluated before and after treatment. Thirty newborns had full recovery, 32 newborns had incomplete recovery, and in 5 cases no improvement was seen. Fourteen children with late obstetric brachial plexus palsy underwent the following operations: rotation osteotomy of the humerus was performed in 10 cases, lengthening of biceps and brachialis muscle tendons--in 6 cases, transposition of triceps muscle tendon--in 1 case, transposition of pectoralis major tendon--in 3 cases and flexor carpi transposition--in 1 case. There was an improvement in active hand movements after operative treatment and rehabilitation. According to our experience, in most cases newborns recover spontaneously or after conservative treatment. Secondary reconstructive surgery of late brachial plexus palsy can improve the condition of these patients.