RESUMO
Sialorrhea is a common oral motor impairment related to various neurological disorders such as cerebral palsy (CP), generating both physical and psychological complications that affect the quality of life of patients and their caregivers. Objective: To determine the clinical reduction of sialorrhea after injection with onabotulinumtoxin A (BTXA) in children diagnosed with CP. Methods: In 8 children 4-15 years of age, with GMFCS between II and V, injection with BTXA was performed in parotid and submandibular glands under ultrasound guidance. Measurement of salivation was made at baseline and 2, 4, 16, and 24 weeks post-infiltration through the Drooling Impact Scale (DIE), the Drooling Quotient (DQ) and the Drooling Severity and Frequency Scale (DSFS). Results: All children showed a significant reduction in salivation measured with the DQ (p < 0.002), the DIE (p < 0.002). Similarly, all children showed a 1 point reduction in the frequency subcomponent of the DSFS at 4 weeks post-injection. The severity subcomponent of DSFS showed a 1 point reduction only in the group of children with GMFCS II and IV. Conclusion: The use of BTXA in parotid and submandibular glands under ultrasound guidance is an effective intervention to reduce salivation, the severity and frequency of drooling, as well as the impact that sialorrhea has on patients and caregivers.
La sialorrea es consecuencia de una alteración motora oral frecuente en diversos trastornos neurológicos, como la parálisis cerebral (PC), generando complicaciones tanto físicas como psicosociales que impactan en la calidad de vida de los pacientes y sus cuidadores. Objetivo: Determinar la reducción clínica de sialorrea después de la infiltración de Onabotulinumtoxin A (BTXA) en niños con diagnóstico de PC. Pacientes y Métodos: En 8 niños de 4 a 15 años de edad, con GMFCS entre II y V, se realizó una infiltración con BTXA en glándulas parótida y submandibular bajo guía ecográfica. Se efectuó una medición basal de la salivación y en diferentes semanas post infiltración (2ª, 4ª, 8ª, 16ª y 24ª), a través de la Escala de Impacto de la Sialorrea (EIS), el Cociente de Salivación (DQ) y la Escala de Severidad y Frecuencia de la Sialorrea (DSFS). Resultados: Todos los niños presentaron una reducción significativa de la salivación en la evaluación con el DQ (p < 0,002) y la EIS (p < 0,002). En la DSFS en el subcomponente de frecuencia baja 1 punto posterior a la 4ª semana de infiltración en el total de los niños. En cambio, en el subcomponente de severidad baja 1 punto sólo en el grupo de GMFCS II y IV. Conclusión: El uso de BTXA en glándulas parótidas y submandibulares bajo guía ecográfica es un método de intervención efectivo para disminuir la salivación, la severidad y frecuencia de la sialorrea, así como el impacto que causa esta patología en los pacientes y cuidadores.
Assuntos
Humanos , Masculino , Adolescente , Feminino , Pré-Escolar , Criança , Glândulas Salivares/fisiologia , Paralisia Cerebral/complicações , Sialorreia/tratamento farmacológico , Toxinas Botulínicas Tipo A/uso terapêutico , Salivação , Índice de Gravidade de Doença , Sialorreia/etiologiaRESUMO
Hydatid disease, also known as Echinococcosis is a zoonosis caused by the larval stage of Echinococcus. The human cystic variant primarily affects liver and lungs. The pelvic location of the disease is a rare finding usually secondary to a ruptured liver cyst, although it may also appear as a primary lesion affecting the genital organs. Despite its rarity, in endemic areas, pelvic hydatid disease should be considered in the differential diagnosis of complex adnexal cystic mass, to make an appropriate treatment strategy. The suspected diagnosis is based on imaging studies and serodiagnostic techniques, in which a new field of research attempts to find a standardized test with sufficient sensitivity and specificity. We report a case of primary pelvic hydatid disease in postmenopausal women operated for suspected ovarian cancer.
Assuntos
Doenças dos Anexos/diagnóstico , Equinococose/diagnóstico , Doenças dos Anexos/patologia , Animais , Biópsia , Diagnóstico Diferencial , Equinococose/cirurgia , Feminino , Humanos , Laparotomia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Pelve/diagnóstico por imagem , Pelve/patologia , Pós-Menopausa , Resultado do Tratamento , UltrassonografiaRESUMO
CASE REPORT: A 74 year-old woman present with blurry vision of 12 hour duration in her right eye, and with no other symptoms. Biomicroscopic examination revealed a 3 mm hyphaema in her right eye and multiple nodular structures in the pupillary margin of both eyes. DISCUSSION: Iris tufts are vascular anomalies unrelated to ischaemia that must be included in the differential diagnosis of spontaneous hyphaema.
Assuntos
Hamartoma/diagnóstico , Hifema/etiologia , Doenças da Íris/diagnóstico , Administração Tópica , Idoso , Tartarato de Brimonidina , Ciclopentolato/uso terapêutico , Dexametasona/administração & dosagem , Dexametasona/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Feminino , Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/tratamento farmacológico , Hamartoma/complicações , Hamartoma/diagnóstico por imagem , Humanos , Doenças da Íris/complicações , Doenças da Íris/diagnóstico por imagem , Latanoprosta , Microscopia Acústica , Soluções Oftálmicas , Prostaglandinas F Sintéticas/uso terapêutico , Quinoxalinas/uso terapêutico , Transtornos da Visão/etiologiaRESUMO
This study aimed at identifying and quantifying the parasites of wild and cultured dusky grouper Epinephelus marginatus. During a year and thereby all four seasons, 20 wild and 20 cultured groupers were examined for the presence of parasites, except in the last season, in which 19 wild and 20 cultured fish were examined, totalling 159 groupers analysed from Ubatuba, southeastern Brazil. Prevalence, mean intensity of infection, mean abundance and mean relative dominance were calculated. Five species of parasites were identified in fish from both origins: Pseudorhabdosynochus beverleyburtonae (Monogenea), Neobenedenia melleni (Monogenea), Pseudempleurosoma sp. (Monogenea), Helicometrina nimia (Digenea) and larvae of Contracaecum sp. (Nematoda). The prevalence of ectoparasites, in most cases, was higher than endoparasites. The most abundant parasite was the monogenea Pseudorhabdosynochus beverleyburtonae in both wild and cultured fish, along all seasons. Neobenedenia melleni was observed in wild and cultured fish in all seasons, with a gradual increase in the number of parasites from the coldest to the hottest seasons, with the highest prevalence and mean intensity in the summer. Helicometrina nimia was found in all seasons in both wild and cultured fish, except for summer, where its presence was detected only in wild fish. Pseudempleurosoma sp. and larvae of Contracaecum sp. showed low prevalence occurring in wild and cultured fish in the autumn and spring, respectively. This study revealed high intensities of potentially pathogenic parasites that could favour disease outbreaks in culture conditions.
Este estudo teve como objetivo identificar e quantificar os parasitos da garoupa verdadeira Epinephelus marginatus selvagem e cultivada. Durante um ano, nas quatro estações, 20 garoupas selvagens e 20 cultivadas foram examinadas quanto à presença de parasitos, exceto na última estação, em que foram examinados 19 peixes selvagens e 20 cultivados, totalizando 159 peixes examinados em Ubatuba, Sudeste do Brasil. A prevalência, intensidade média de infecção, abundância média and dominância média relativa foram calculados. Cinco espécies de parasitos foram identificadas nos peixes de ambas as origens: Pseudorhabdosynochus beverleyburtonae (Monogenea), Neobenedenia melleni (Monogenea), Pseudempleurosoma sp. (Monogenea), Helicometrina nimia (Digenea) e larvas de Contracaecum sp. (Nematoda). A prevalência de ectoparasitos foi, na maioria das vezes, maior do que a de endoparasitos. O parasito mais abundante foi o monogenea Pseudorhabdosynochus beverleyburtonae em ambos os peixes selvagens e cultivados, durante todas as estações. Neobenedenia melleni foi observado e, peixes selvagens e cultivados em todas as estações, com aumento gradativo no número de parasitos das estações mais frias para as mais quentes, com as maiores prevalências e intensidades médias no verão. Helicometrina nimia foi encontrado em todas as estações em ambos os peixes selvagens e cultivados, exceto no verão, em que foi observada sua presença apenas em peixes selvagens. Pseudempleurosoma sp. e larvas de Contracaecum sp. apresentaram baixas prevalências, ocorrendo em peixes selvagens e cultivados no outono e na primavera, respectivamente. Este estudo revelou altas intensidades de parasitos potencialmente patogênicos que podem favorecer surtos de doenças em situações de cultivo.
Assuntos
Animais , Estações do Ano , Nematoides/patogenicidade , Peixes/parasitologia , Platelmintos/patogenicidade , BrasilRESUMO
This study aimed at identifying and quantifying the parasites of wild and cultured dusky grouper Epinephelus marginatus. During a year and thereby all four seasons, 20 wild and 20 cultured groupers were examined for the presence of parasites, except in the last season, in which 19 wild and 20 cultured fish were examined, totalling 159 groupers analysed from Ubatuba, southeastern Brazil. Prevalence, mean intensity of infection, mean abundance and mean relative dominance were calculated. Five species of parasites were identified in fish from both origins: Pseudorhabdosynochus beverleyburtonae (Monogenea), Neobenedenia melleni (Monogenea), Pseudempleurosoma sp. (Monogenea), Helicometrina nimia (Digenea) and larvae of Contracaecum sp. (Nematoda). The prevalence of ectoparasites, in most cases, was higher than endoparasites. The most abundant parasite was the monogenea Pseudorhabdosynochus beverleyburtonae in both wild and cultured fish, along all seasons. Neobenedenia melleni was observed in wild and cultured fish in all seasons, with a gradual increase in the number of parasites from the coldest to the hottest seasons, with the highest prevalence and mean intensity in the summer. Helicometrina nimia was found in all seasons in both wild and cultured fish, except for summer, where its presence was detected only in wild fish. Pseudempleurosoma sp. and larvae of Contracaecum sp. showed low prevalence occurring in wild and cultured fish in the autumn and spring, respectively. This study revealed high intensities of potentially pathogenic parasites that could favour disease outbreaks in culture conditions.
Assuntos
Doenças dos Peixes/parasitologia , Animais , Brasil/epidemiologia , Doenças dos Peixes/epidemiologia , Prevalência , Estações do AnoRESUMO
CLINICAL CASE: A 69-year-old man with a history of acute myeloblastic leukemia-M1 presented with bilateral conjunctival injection. Ophthalmological examination revealed lesions located at the upper tarsal conjunctiva of the right eye and lower tarsal conjunctiva of both eyes. Histological and immunohistochemical studies confirmed conjunctival myeloid sarcoma. The patient died due to multiorgan failure three months later. DISCUSSION: Extramedullary recurrence of leukemia can appear as an ocular manifestation that brings about a recurrence of the leukemia, leading to a poor prognosis.
Assuntos
Túnica Conjuntiva/patologia , Leucemia Mieloide Aguda/patologia , Infiltração Leucêmica/patologia , Sarcoma Mieloide/etiologia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia , Evolução Fatal , Humanos , Leucemia Mieloide Aguda/tratamento farmacológico , Infiltração Leucêmica/tratamento farmacológico , Masculino , Insuficiência de Múltiplos Órgãos/etiologia , Mucosa Nasal/patologia , Recidiva , Sarcoma Mieloide/tratamento farmacológico , Sarcoma Mieloide/patologia , Pele/patologiaRESUMO
Kounis syndrome was described in 1991 by Kounis and Zavras as the coincidental occurrence of acute coronary syndromes with allergic reactions (anaphylactic or anaphylactoid). Today, allergic angina and allergic myocardial infarction are referred to as Kounis syndrome, and the latter has been reported in association with a variety of drugs, insect stings, food, environmental exposures and medical conditions, among other factors. The incidence is not known, as most of the available information comes from case reports or small case series. In this article, the clinical aspects, diagnosis, pathogenesis, related conditions and therapeutic management of the syndrome are discussed.
Assuntos
Síndrome Coronariana Aguda/complicações , Anafilaxia/complicações , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/imunologia , Síndrome Coronariana Aguda/fisiopatologia , Síndrome Coronariana Aguda/terapia , Corticosteroides/uso terapêutico , Anafilaxia/diagnóstico , Anafilaxia/imunologia , Anafilaxia/fisiopatologia , Anafilaxia/terapia , Angina Pectoris/etiologia , Fármacos Cardiovasculares/uso terapêutico , Terapia Combinada , Doença das Coronárias/complicações , Técnicas de Diagnóstico Cardiovascular , Hipersensibilidade a Drogas/complicações , Stents Farmacológicos/efeitos adversos , Hidratação , Hipersensibilidade Alimentar/complicações , Antagonistas dos Receptores Histamínicos/uso terapêutico , Liberação de Histamina , Humanos , Hipersensibilidade Imediata/complicações , Infarto do Miocárdio/complicações , Prognóstico , Síndrome , VasoconstriçãoRESUMO
BACKGROUND: The clinical value of routine chest X-rays in critical care has been questioned, but has not been studied in the trauma environment to date. The objective of this study was to identify easy to use clinical predictors of utility in this setting. MATERIAL AND METHODS: A prospective observational study was made in an 8-bed traumatology ICU. Severe trauma patients (ISS > 15), aged 15 or older and admitted for 48 h or longer were included. Pregnant women and radiographs obtained during initial care or for reasons other than routine indication were excluded. A staff physician, separated from clinical duties, independently reviewed the films in search of changes, as described in a closed checklist. Following closed criteria, the attending physicians reported previous day clinical events and changes in clinical management after chest X-ray obtainment. Demographic and epidemiological data were also recorded. The associations among variables were studied by univariate and multivariate analysis. RESULTS: A total of 1440 routine chest X-rays were obtained from 138 consecutive patients during one year. Young males prevailed (82%; 39 ± 16 years). The most common process was severe blunt trauma (97%). Fifty-two percent suffered severe chest trauma. The mean length of stay was 12.9 ± 10.1 days. Mechanical ventilation was used in 86.8% of the cases. A median of 10.4 ± 9.3 films were obtained from each patient. A total of 14% of the X-rays showed changes, most commonly malpositioning of an indwelling device (6.8%) or infiltrates (4.9%). Those findings led to a change in care in 84.6% of the cases. Multivariate analysis identified the following significant (p < 0.05) risk factors for radiographic changes: first two days of evolution, mechanical ventilation, worsening of PaO2/FiO2, worsening of lung compliance and changes in respiratory secretions. CONCLUSIONS: Based on the results obtained, the risk of not identifying dangerous conditions by restricting routine chest X-rays prescription to the described conditions is low. Observing this policy would probably mean substantial savings and a reduction in radiation exposure.
Assuntos
Radiografia Torácica , Traumatismos Torácicos/diagnóstico por imagem , Adulto , Feminino , Previsões , Humanos , Unidades de Terapia Intensiva , Masculino , Estudos ProspectivosRESUMO
The prevention of ventilator-associated pneumonia (VAP) is a priority in the Intensive Care Unit (ICU). To achieve this goal, clinical practice guidelines recommend the simultaneous application of a heterogeneous group of preventive measures of proven effectiveness. That is why we are presently seeing a reduction in VAP incidence to values previously considered unreachable. Better compliance with clinical practice guidelines has resulted in VAP rates approaching zero in multiple studies. Faced with the measures recommended in these guidelines, selective digestive decontamination (SDD), used together with other infection control practices, has shown efficacy in hospitals with high baseline incidence of pneumonia. However, its effectiveness in hospitals with good compliance of clinical practice guidelines and lower rates of VAP is highly unlikely. A serious drawback of DDS is the risk of favoring the selection of resistant microorganisms that can spread easily through the ICU and the hospital. With current standards of infection prevention, DDS is an unnecessary and risky measure, which should not be used on a widespread basis. Those situations in which the DDS may increase the effectiveness of properly implemented standard measures are still unknown.
Assuntos
Sistema Digestório/microbiologia , Pneumonia Bacteriana/prevenção & controle , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Antibioticoprofilaxia , Descontaminação , Farmacorresistência Bacteriana , Humanos , Guias de Prática Clínica como AssuntoRESUMO
The epidural analgesia is one of the most effective techniques for pain relief when it is indicated, but it can present potentially serious complications that must precociously be diagnosed and be treated. In the Critical Care setting, epidural analgesia is used for pain control after surgery or major trauma. The technique is simple, a catheter is placed into a virtual cavity, so the administered drugs are absorbed through the epidural space into nerve roots. The administration of local anesthetics, opioids or the combination of both by epidural route (administered in continuous infusion or bolus), provides better analgesia. Also the clonidine can be used. In order to diagnose and to treat suitably the possible complications (pain, urinary retention, nauseas and vomits, itching, motor block, infection, respiratory depression, hypotension) a series of safety measures must be adopted (respiratory and heart rate, blood pressure, sedation score, sensory and motor level assessment, rate of diuresis, temperature and signs of infection).
Assuntos
Anestesia por Condução/métodos , Dor Pós-Operatória/prevenção & controle , Analgesia Epidural , Humanos , Injeções Espinhais , Entorpecentes/uso terapêuticoRESUMO
OBJECTIVE: Diabetes is one of the main causes of end-stage renal disease (ESRD) and admission to hemodialysis, and the demand for kidney transplantation in this population has increased. Our aim was to evaluate the clinical aspects and survival of diabetic patients with kidney transplants by comparing them with the nondiabetic population. MATERIALS AND METHODS: Patients transplanted during the period from 1994 to 2003 were evaluated for this study. The transplant and demographic characteristics were analyzed by the chi-square test and Student t test according to the type of variable. Kaplan-Meier curves and the log-rank test were used to evaluate the graft and patient survival. RESULTS: From a total of 523 consecutive renal transplants, 35 (6.6%) were diabetics who were older than nondiabetics (47 +/- 11 years vs 37 +/- 16, P < .002). Patients received immunosuppression with cyclosporine (84.3%), tacrolimus (11.2%), azathioprine (46.6%), mycophenolate mofetil (43.5%), and steroids (all patients). The diabetic patients had a higher percentage of living donors (33.5% vs 17.2%; P = .04). Graft survival rates at 1, 3, and 5 years were 82.7%, 70.9%, and 63.0% in the diabetic patients and 87.6%, 79.0%, and 72.5% (P = .6) in the nondiabetic patients. Patient survival at 5 years was 90.5% in diabetic patients vs 89.0% in nondiabetic patients (P = .9). CONCLUSIONS: No differences were found in our series in transplant complications or survival in the diabetic patients compared with the nondiabetic patients. Kidney transplants, even with living donors, must be offered to well-selected diabetic patients without reservations.
Assuntos
Diabetes Mellitus Tipo 1/cirurgia , Nefropatias Diabéticas/cirurgia , Transplante de Rim , Seleção do Doador , Humanos , Imunossupressores/uso terapêutico , Transplante de Rim/imunologia , Transplante de Rim/mortalidade , Estudos Retrospectivos , Análise de Sobrevida , Resultado do TratamentoRESUMO
The early urinary tract infection (EUTI) in kidney transplant recipients is an infection develop during the first 3 months post transplant surgery. The effect of EUTI on graft survival and risk factors have been scarcely studied. Our objetives were the evaluation of risk factors to EUTI, the assessment of the causal agent and graft survival impact. A retrospective analysis of kidney transplantation, period 1997-2000 in Hospital Privado-Centro Médico de Córdoba was carried out. There were two groups of patients with (EUTI group) and without EUTI (control group). Cox model was used to analyze risk factors and Kaplan-Meier method for graft survival. A total of 226 consecutive patients received kidney transplantation. In 55 patients (24.3%) EUTI was detected. Risk factors for EUTI were: invasive urological maneuvers (RR = 4.34, CI 95% 1.42-13.21), diabetes mellitus (RR = 3.79, CI 95% 1.42-10.14), cytomegalovirus infection (RR = 2.9, CI 95% 1.02-8.24) and previous transplants (RR = 2.83, CI 95% 1.08-7.45). Delayed graft function was associated with lower incidence of EUTI (RR = 0.38, CI 95% 0.15-0.94). The causal agents were: Klebsiella pneumoniae (36%), Pseudomonas aeruginosa (24%) and Escherichia coli (9%). Graft survival at 2 years was similar in EUTI (87.2%) and control group (81.2%, p = 0.32). This series shows that invasive urological maneuvers were the main risk factors for EUTI. Graft survival was similar. High prevalence of non coli bacteria need further evaluation.
La infección urinaria temprana del injerto (IUTI), definida como infección urinaria sintomática en los primeros 3 meses del trasplante, su efecto sobre la sobrevida del injerto y los factores de riesgo han sido poco estudiados. Los objetivos del presente análisis fueron conocer factores de riesgo para IUTI,analizar agentes causantes e impacto en la sobrevida del injerto. En forma retrospectiva se analizaron pacientesque recibieron trasplante renal durante 1997-2000 en el Hospital Privado Centro Médico de Córdoba. Sedividió en dos grupos de pacientes, según presencia (grupo IUTI) o ausencia (grupo control) de IUTI. Los factores de riesgo se analizaron con el modelo de riesgos proporcionales de Cox y la sobrevida del injerto con elmétodo de Kaplan-Meier. Recibieron trasplante renal 226 pacientes consecutivos. La IUTI se presentó en 55(24.3%). Factores de riesgo asociados con IUTI: antecedentes de maniobras urológicas invasivas (RR=4.34,IC 95% 1.42-13.21), diabetes mellitus (RR=3.79, IC 95% 1.42-10.14), infección por citomegalovirus (RR=2.9,IC 95% 1.02-8.24) y antecedente de trasplante previo (RR=2.83, IC 95% 1.08-7.45). El retardo en la función delinjerto (RR=0.38, IC 95% 0.15-0.94) se asoció con menor incidencia de IUTI. Agentes más frecuentes: Klebsiellapneumoniae (36%), Pseudomonas aeruginosa (24%) y Escherichia coli (9%). La sobrevida del injerto a los 2años en el grupo IUTI (87.2%) no fue diferente del control (81.2%, P = 0.32). En esta serie las maniobras urológicas invasivas fueron el principal factor de riesgo asociado a IUTI. No hubo disminución de la sobrevida del injerto asociada a IUTI. La alta prevalencia de uropatógenos no coli requiere mayor evaluación
Assuntos
Feminino , Adulto , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Sobrevivência de Enxerto , Infecções Urinárias/etiologia , Transplante de Rim , Complicações Pós-Operatórias/microbiologia , Métodos Epidemiológicos , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Klebsiella pneumoniae/isolamento & purificação , Pseudomonas aeruginosa/isolamento & purificação , Rejeição de Enxerto/etiologiaRESUMO
Se trata de un lactante menor de 6 meses de edad que fue ingresada en el hospital Dr. Arturo Grullón de Santiago y cuyo diagnóstico de ingreso fue D/C Testículo feminizante derecho. Los hallazgos intrahoperatorios fueron una hernia deslizante, cuyos componentes fue Tuba uterina, ovario y útero. Lactante, Testículo feminizante, hernia deslizante