RESUMO
BACKGROUND: Invasive pneumococcal disease (IPD) leads to thousands of pediatric deaths annually. Pneumococcal colonization precedes IPD. In 2013, the Dominican Republic introduced the 13-valent pneumococcal conjugate vaccine (PCV13) into its routine infant immunization program, with doses at ages 2, 4, and 12 months. Prevalence of pneumococcal nasopharyngeal colonization was evaluated post-PCV13 introduction. METHODS: A prospective cohort study of 125 children aged 2-35 months was conducted in a rural Dominican Republic community November 2016 through July 2017. Nasopharyngeal swabs and clinical and vaccination data were collected at enrollment and 4-6 months later. Serotypes included in PCV13 were defined as vaccine-type. Colonization rates and serotype distribution were compared at baseline and follow-up, and the association between colonization and vaccination status among the entire cohort was evaluated at each time point. RESULTS: Of 125 children enrolled, 118 (94%) completed follow-up. Overall and vaccine-type pneumococcal colonization rates were 62% and 25%, respectively, at baseline and 60% and 28% at follow-up. Among children age-eligible for 3 doses, 50% and 51% were fully vaccinated at baseline and follow-up, respectively. At baseline assessment, children up-to-date for age for PCV13 were less likely to be colonized with vaccine-type pneumococci than children not up-to-date, and the same was found for fully vaccinated children (3 doses) compared to those not fully vaccinated (odds ratios [ORs], 0.38 [95% confidence interval {CI}, .18-.79], and 0.14 [95% CI, .04-.45], respectively). The same associations were not found at follow-up assessment. CONCLUSIONS: Three years post -PCV13 introduction, vaccine-type colonization rates remained high. Low vaccination coverage for 3 PCV13 doses may have contributed. The protective effect of PCV13 on vaccine-type carriage suggests an increase in PCV13 coverage could lead to substantial declines in pneumococcal vaccine-type carriage.
Assuntos
Nasofaringe/microbiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/administração & dosagem , Vacinas Pneumocócicas/imunologia , Streptococcus pneumoniae/imunologia , Vacinas Conjugadas/imunologia , Portador Sadio/epidemiologia , República Dominicana/epidemiologia , Feminino , Humanos , Lactente , Masculino , Infecções Pneumocócicas/epidemiologia , Estudos Prospectivos , População Rural , Sorogrupo , Vacinas Conjugadas/administração & dosagemRESUMO
BACKGROUND: In 2013, the Dominican Republic introduced 13-valent pneumococcal conjugate vaccine (PCV13) using a 3-dose schedule (at 2, 4 and 12 months of age). We evaluated the impact of PCV13 on serotypes causing pneumococcal pneumonia with pleural effusion. METHODS: Surveillance data after PCV13 introduction (July 2014 to June 2016) were compared with data before PCV13 introduction (July 2009 to June 2011). Cases were defined as radiologic evidence of pneumonia with pleural effusion in a child aged <15 years. Pneumococcus was detected in pleural fluid by either culture or polymerase chain reaction, and serotyping was performed. The Ministry of Health's PCV13 uptake data for 2014-2016 were obtained. RESULTS: The prevalence of pneumococcus among cases was similar before and after PCV13 introduction (56.4% and 52.8%, respectively). The proportion of pneumococcal cases caused by vaccine serotypes was 86% for children <2 years old both before and PCV13 introduction. Compared with before PCV13, serotype 14 accounted for a smaller (28% vs 13%, respectively; P = .02) and serotype 1 for a larger (23% vs 37%; P = .09) proportion of pneumococcal cases after PCV13 introduction. National uptake for the first, second, and third PCV13 doses was 94%, 81%, and 28%, respectively, in 2014 and 75%, 61%, and 26% in 2015. DISCUSSION: While the decrease in pneumococcal pneumonia with pleural effusion caused by serotype 14 may reflect an early effect of PCV13 implementation, other vaccine serotypes, including serotype 1, are not well controlled. Better PCV13 coverage for all 3 doses is needed.
Assuntos
Infecções Pneumocócicas/epidemiologia , Vacinas Pneumocócicas/administração & dosagem , Vacinas Pneumocócicas/efeitos adversos , Pneumonia Pneumocócica/epidemiologia , Vacinas Conjugadas/efeitos adversos , Criança , Pré-Escolar , República Dominicana/epidemiologia , Feminino , Humanos , Lactente , Masculino , Derrame Pleural/epidemiologia , Derrame Pleural/etiologia , Infecções Pneumocócicas/complicações , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/imunologia , Pneumonia Pneumocócica/complicações , Pneumonia Pneumocócica/prevenção & controle , Complicações Pós-Operatórias , Prevalência , Sorogrupo , Streptococcus pneumoniae/imunologia , Streptococcus pneumoniae/isolamento & purificação , Vacinação , Vacinas Conjugadas/administração & dosagem , Vacinas Conjugadas/imunologiaRESUMO
BACKGROUND: Matrix metalloproteinases (MMPs) and myeloperoxidase (MPO) contribute to the inflammatory cascade in the cerebrospinal fluid (CSF) during bacterial meningitis. We determined levels of MPO, MMP-8, MMP-9, and tissue inhibitor of metalloproteinase- (TIMP-) 1 in the CSF of children with bacterial meningitis and investigated how these inflammatory mediators relate to each other and to the disease outcomes. METHODS: Clinical data and the diagnostic CSF samples from 245 children (median age eight months) with bacterial meningitis were obtained from a clinical trial in Latin America in 1996-2003. MMP-9 levels in the CSF were assessed by zymography, while MMP-8, MPO, and TIMP-1 concentrations were determined with immunofluorometric and enzyme-linked immunosorbent assays. RESULTS: MPO correlated positively with MMP-8 (rho 0.496, P < 0.001) and MMP-9 (rho 0.153, P = 0.02) but negatively with TIMP-1 (rho -0.361, P < 0.001). MMP-8 emerged as the best predictor of disease outcomes: a CSF MMP-8 concentration above the median increased the odds of death 4.9-fold (95% confidence interval 1.8-12.9). CONCLUSIONS: CSF MMP-8 presented as an attractive prognostic marker in children with bacterial meningitis.
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Metaloproteinase 8 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Meningites Bacterianas/enzimologia , Meningites Bacterianas/patologia , Peroxidase/metabolismo , Adolescente , Adulto , Criança , Pré-Escolar , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Estudos Retrospectivos , Inibidor Tecidual de Metaloproteinase-1/metabolismo , Adulto JovemRESUMO
BACKGROUND: Little is known about the impact of nutrition on the development of skin structure and function in infants. METHODS: We investigated epidermal, dermal, and subcutis parameters of aged-matched well-nourished and moderately undernourished infants in this single-center, cross-sectional, noninterventional study using noninvasive methods (skin caliper, 20-MHz sonography, transepidermal water loss, skin pH, and corneometry). Plasma fatty acids were determined as an indicator of nutritional differences. 310 infants from different age groups, i.e., 1 week, 4 weeks, and 6, 9, 12, 24, and 36 months were included. Approximately half of each age group was well-nourished (WHO reference values weight-for-height/length Zscore: -0.75 ≤ Z ≤ 0.75) and the other half was moderately undernourished (-3 ≤ Z < -2). RESULTS: Structural maturational differences in the deeper dermis and subcutis regions of the skin and subtle functional changes in the epidermis were observed in moderately undernourished infants without notable clinical symptoms. Reduced skin barrier function or skin hydration were not observed in the undernourished infants, and skin pH shifted to more acidic values in this group. CONCLUSION: These findings reveal a greater impact of moderate undernutrition on the development of the dermis and subcutis and suggest that critical epidermal functions such as skin barrier and pH are mostly maintained.
Assuntos
Transtornos da Nutrição do Lactente/fisiopatologia , Estado Nutricional/fisiologia , Pele/fisiopatologia , Pré-Escolar , Estudos Transversais , Ácidos Graxos/metabolismo , Feminino , Humanos , Lactente , Recém-Nascido , MasculinoRESUMO
BACKGROUND: Limited data are available on the effectiveness of 13-valent pneumococcal conjugate vaccine (PCV13) in resource-poor settings and PCV naïve populations. The Dominican Republic introduced PCV13 in September 2013 using a 2 + 1 schedule (2, 4, and 12 months) without a catch-up campaign. We evaluated PCV13 effectiveness against vaccine-type (VT) invasive pneumococcal disease (IPD) among children in the Dominican Republic. METHODS: We conducted a matched case-control study. A case-patient was defined as VT-IPD identified by culture or polymerase chain reaction (PCR) from a normally sterile-site in a hospitalized child who was age-eligible to have received ≥1 PCV13 dose. Four age- and neighborhood-matched controls were enrolled for each case-patient. We collected demographic, vaccination history, and risk factor data. Conditional logistic regression was performed. Vaccine effectiveness was calculated as (1- adjusted matched odds ratio for vaccination) X 100%. RESULTS: We enrolled 39 case-patients and 149 matched-controls. Most case-patients had pneumonia with pleural effusion (64%), followed by meningitis (28%) and septicemia (13%). The most common pneumococcal serotypes identified included 14 (18%), 3 (13%), 19A (10%), and 1 (8%). Fewer case-patients had ≥1 PCV13 dose as compared to controls (61.5% vs. 80.0%; p = 0.006). Adjusting for malnutrition and socioeconomic status, VE of ≥1 PCV13 dose compared to no doses was 67.2% (95% CI: 2.3% to 90.0%). Only 44% of controls were up-to-date for PCV13, suggesting low vaccine coverage in the population. CONCLUSIONS: We found that PCV13 provided individual protection against VT-IPD in this resource-poor setting with a PCV-naïve population, despite low PCV13 coverage. Expanding vaccination coverage might increase PCV13 impact.
Assuntos
Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/uso terapêutico , Vacinas Conjugadas/uso terapêutico , Estudos de Casos e Controles , Criança Hospitalizada , República Dominicana/epidemiologia , Feminino , Humanos , Lactente , Masculino , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/patologia , Sepse/epidemiologia , Sepse/prevenção & controle , Classe Social , Resultado do Tratamento , Vacinação/estatística & dados numéricosRESUMO
AIM: Vitamin D deficiency impairs the immunological system and has been associated with worse outcomes of infectious diseases, but its role in bacterial meningitis remains unknown. We investigated whether serum 25-hydroxyvitamin D concentrations related to disease outcomes and to cerebrospinal fluid (CSF) cathelicidin concentrations in childhood bacterial meningitis. METHODS: All consecutively enrolled patients in a clinical trial on childhood bacterial meningitis in Latin America in 1996-2003 were considered, and 142 children, with a median age of seven months who had a confirmed bacterial aetiology and frozen serum available for further analyses, were included in this study. Serum 25-hydroxyvitamin D concentrations were determined with a chemiluminescence immunoassay analyser, while CSF cathelicidin was measured by enzyme-linked immunosorbent assay. RESULTS: The median serum 25-hydroxyvitamin D concentration was 96 (range 19-251) nmol/L. No relationship was found with patient survival, but children with any neurological sequelae had lower serum 25-hydroxyvitamin D levels than children without sequelae. Serum 25-hydroxyvitamin D was unrelated to cathelicidin concentrations in CSF. CONCLUSION: Although serum 25-hydroxyvitamin D in children with bacterial meningitis was not associated with survival or CSF cathelicidin concentrations, its relationship with more detailed disease outcomes warrants further study.
Assuntos
Peptídeos Catiônicos Antimicrobianos/líquido cefalorraquidiano , Meningites Bacterianas/sangue , Vitamina D/análogos & derivados , Método Duplo-Cego , Feminino , Humanos , Lactente , América Latina/epidemiologia , Masculino , Meningites Bacterianas/líquido cefalorraquidiano , Meningites Bacterianas/mortalidade , Estudos Prospectivos , Vitamina D/sangue , CatelicidinasRESUMO
We investigated cerebrospinal fluid (CSF) cathelicidin concentrations in childhood bacterial meningitis on admission and during antimicrobial treatment. CSF cathelicidin concentrations on admission correlated with CSF white cell counts and protein levels but not with bacterial etiology. A greater decrease in the concentration in response to treatment was associated with a better outcome. Since the CSF cathelicidin concentration reflects the degree of central nervous system (CNS) inflammation, it may be used as a novel biomarker in childhood bacterial meningitis. An early decrease during treatment likely signals more rapid mitigation of the disease process and thus a better outcome.
Assuntos
Anti-Infecciosos/uso terapêutico , Peptídeos Catiônicos Antimicrobianos/líquido cefalorraquidiano , Biomarcadores/líquido cefalorraquidiano , Líquido Cefalorraquidiano/química , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/patologia , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Resultado do Tratamento , CatelicidinasRESUMO
Rabies is a rapidly progressive lyssavirus encephalitis that is statistically 100% fatal. There are no clinically effective antiviral drugs for rabies. An immunologically naïve teenager survived rabies in 2004 through improvised supportive care; since then, 5 additional survivors have been associated with use of the so-called Milwaukee Protocol (MP). The MP applies critical care focused on the altered metabolic and physiologic states associated with rabies. The aim of this study was to examine the metabolic profile of cerebrospinal fluid (CSF) from rabies patients during clinical progression of rabies encephalitis in survivors and nonsurvivors and to compare these samples with control CSF samples. Unsupervised clustering algorithms distinguished three stages of rabies disease and identified several metabolites that differentiated rabies survivors from those who subsequently died, in particular, metabolites related to energy metabolism and cell volume control. Moreover, for those patients who survived, the trajectory of their metabolic profile tracked toward the control profile and away from the rabies profile. NMR metabolomics of human rabies CSF provide new insights into the mechanisms of rabies pathogenesis, which may guide future therapy of this disease.
Assuntos
Metabolômica , Vírus da Raiva , Raiva , Adolescente , Adulto , Antivirais/líquido cefalorraquidiano , Antivirais/imunologia , Feminino , Perfilação da Expressão Gênica , Humanos , Masculino , Raiva/líquido cefalorraquidiano , Raiva/tratamento farmacológico , Raiva/imunologia , Raiva/metabolismo , Raiva/patologia , Vacina Antirrábica/líquido cefalorraquidiano , Vacina Antirrábica/imunologia , Vacina Antirrábica/metabolismo , Vacina Antirrábica/uso terapêutico , Vírus da Raiva/efeitos dos fármacos , Vírus da Raiva/imunologia , Vírus da Raiva/patogenicidadeRESUMO
OBJECTIVES: To document the clinical and histopathological characteristics of basaloid squamous cell carcinoma (BSCC). To add five new cases to the literature and compare them with another published series. CASES: retrospective review of five cases with the diagnosis of BSCC of the larynx. RESULTS: all the patients were male. They were heavy smokers and drinkers. Most of the tumours were supraglottic. Three patients presented with stage-IV disease and the other two with stage-I disease. Surgery supplemented with radiation was used in three patients, partial surgery was used in another case and radiation and associated chemotherapy in the other one. Eight neck dissections were performed, six of them were functional and the other two radical dissections. Two cases were found to have metastatic lymph nodes. There were not any distant metastases but two patients had tumoral relapse. CONCLUSIONS: BSCC has well defined histological features. Central comedonecrosis within the cells nests, cell with nuclear palisading and high-grade dysplasia in overlaying mucosa are the main characteristics.
Assuntos
Carcinoma de Células Escamosas , Neoplasias Laríngeas , Idoso , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Humanos , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/terapia , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
INTRODUCTION: Obesity surgery is the best treatment for extreme obesity, with demonstrated long-term positive outcomes. The potential cost-savings generated by the improvement of comorbidities after surgery can justify the allocation of more resources in the surgical treatment of obesity. METHODS: This was an observational, descriptive, longitudinal and retrospective study. Eligible patients underwent Roux-en-Y gastric bypass surgery at the Hospital Universitario Central de Asturias between 2003 and 2012. The established minimum follow-up period was two years. We calculated the individualized cost per patient treated (bottom-up) as well as per Diagnosis-Related Group (DRG) codes (top-down). RESULTS: Our study included 307 patients. The average cost per hospitalization calculated by DRG codes was 6,545.90, and the average cost per patient was 10,572.20. DRG 288 represented 91% of the series, with a value of 4,631. The number of medications also decreased during this period, from 2.86 to 0.78 per medically treated patient, representing a cost reduction of 4,433 per patient with all the obesity-related comorbidities analyzed. CONCLUSIONS: Two years after Roux-en-Y gastric bypass conducted at Hospital Universitario Central de Asturias, the savings in drug costs for patients with multiple pathologies would compensate the inherent costs of the surgical treatment itself. Our results showed that DRG-related costs was insufficient to make a correct economic evaluation, so we recommend an individualized cost calculating method.
Assuntos
Custos de Medicamentos/estatística & dados numéricos , Derivação Gástrica/economia , Obesidade/economia , Obesidade/cirurgia , Adulto , Comorbidade , Análise Custo-Benefício , Grupos Diagnósticos Relacionados/normas , Feminino , Seguimentos , Derivação Gástrica/métodos , Humanos , Laparoscopia/métodos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Estudos Retrospectivos , Espanha/epidemiologia , Redução de PesoRESUMO
A post hoc analysis of 654 children with bacterial meningitis showed that the level of consciousness is the most important predictor of death and/or neurological sequelae, more than is etiology per se. This finding emphasizes the need of including a measurement of the presenting status in all studies examining treatment efficacy.
Assuntos
Meningites Bacterianas/mortalidade , Meningites Bacterianas/patologia , Causas de Morte , Estado de Consciência , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Análise Multivariada , Prognóstico , Fatores de RiscoRESUMO
BACKGROUND: Myriad infectious and noninfectious causes of encephalomyelitis (EM) have similar clinical manifestations, presenting serious challenges to diagnosis and treatment. Metabolomics of cerebrospinal fluid (CSF) was explored as a method of differentiating among neurological diseases causing EM using a single CSF sample. METHODOLOGY/PRINCIPAL FINDINGS: 1H NMR metabolomics was applied to CSF samples from 27 patients with a laboratory-confirmed disease, including Lyme disease or West Nile Virus meningoencephalitis, multiple sclerosis, rabies, or Histoplasma meningitis, and 25 controls. Cluster analyses distinguished samples by infection status and moderately by pathogen, with shared and differentiating metabolite patterns observed among diseases. CART analysis predicted infection status with 100% sensitivity and 93% specificity. CONCLUSIONS/SIGNIFICANCE: These preliminary results suggest the potential utility of CSF metabolomics as a rapid screening test to enhance diagnostic accuracies and improve patient outcomes.
Assuntos
Doenças do Sistema Nervoso Central/líquido cefalorraquidiano , Líquido Cefalorraquidiano/química , Espectroscopia de Ressonância Magnética/métodos , Metabolômica/métodos , Adolescente , Sistema Nervoso Central/imunologia , Doenças do Sistema Nervoso Central/diagnóstico , Doenças do Sistema Nervoso Central/imunologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Adulto JovemRESUMO
BACKGROUND: Despite favorable meta-analyses, no study involving third-generation cephalosporins for the treatment of childhood bacterial meningitis has documented a benefit of adjuvant dexamethasone therapy if the outcomes are examined individually. METHODS: We conducted a prospective, randomized, double-blind trial comparing adjuvant dexamethasone or glycerol with placebo in children aged from 2 months through 16 years in Latin America. Ceftriaxone was administered to all children; children were randomized to also receive dexamethasone intravenously, glycerol orally, both agents, or neither agent. Primary end points were death, severe neurological sequelae, or deafness, with the first 2 end points forming a composite end point. A subgroup analysis for Haemophilus influenzae type b meningitis was undertaken. Intention-to-treat analysis was performed using binary logistic regression models. RESULTS: H. influenzae type b, pneumococci, and meningococci were the main agents found among 654 patients; dexamethasone was given to 166, dexamethasone and glycerol were given to 159, glycerol was given to 166, and placebo was given to 163. No adjuvant therapy significantly affected death or deafness. In contrast, glycerol and dexamethasone plus glycerol reduced severe neurological sequelae, compared with placebo; the odds ratios were 0.31 (95% confidence interval [95% CI], 0.13-0.76; P=.010) and 0.39 (95% CI, 0.17-0.93; P=.033), respectively. For neurological sequelae and death, the odds ratios were 0.44 (95% CI, 0.25-0.76; P=.003) and 0.55 (95% CI, 0.32-0.93; P=.027), respectively. Dexamethasone therapy prevented deafness in patients with H. influenzae type b meningitis only if patients were divided grossly into dexamethasone recipients and nonrecipients and if timing between dexamethasone and ceftriaxone administration was not taken into account (odds ratio, 0.27; 95% CI, 0.09-0.77; P=.014). CONCLUSION: Oral glycerol therapy prevents severe neurological sequelae in patients with childhood meningitis. Safety, availability, low cost, and oral administration also add to its usefulness, especially in resource-limited settings.
Assuntos
Antibacterianos/uso terapêutico , Quimioterapia Adjuvante/métodos , Dexametasona/uso terapêutico , Glicerol/uso terapêutico , Meningites Bacterianas/tratamento farmacológico , Doenças do Sistema Nervoso/prevenção & controle , Adolescente , Anti-Inflamatórios/efeitos adversos , Anti-Inflamatórios/uso terapêutico , Ceftriaxona/uso terapêutico , Criança , Pré-Escolar , Surdez/prevenção & controle , Morte , Dexametasona/efeitos adversos , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Glicerol/efeitos adversos , Humanos , América Latina , Masculino , Meningites Bacterianas/complicações , Meningites Bacterianas/microbiologia , Meningite por Haemophilus/complicações , Meningite por Haemophilus/tratamento farmacológico , Meningite por Haemophilus/microbiologia , Meningite Meningocócica/complicações , Meningite Meningocócica/tratamento farmacológico , Meningite Meningocócica/microbiologia , Placebos/administração & dosagem , Estudos Prospectivos , Resultado do TratamentoRESUMO
Millions are infected with dengue yearly. We evaluated the epidemiological and clinical characteristics of pediatric patients infected with dengue in the Dominican Republic. The applicability of World Health Organization (WHO) warning signs for predicting severe dengue and mortality was also studied. This study was a cross-sectional retrospective review of patients with a clinical diagnosis of dengue. Univariate and multivariate analyses were performed to evaluate characteristics associated with severity and mortality. The study included 796 subjects: 288 subjects were classified as dengue, 290 subjects had alarm signs, and 207 subjects were classified as severe dengue. Common findings included thrombocytopenia (96%), abdominal pain (71%), and vomiting (59%). The most important factors associated with severe dengue were rash (P < 0.01), severe thrombocytopenia (P < 0.01), and anemia (P < 0.01). These signs and symptoms were also associated with mortality. This study validates the current WHO warning signs of severity. Rash and severe thrombocytopenia may be early warning signs and need additional study.
Assuntos
Dengue/mortalidade , Dengue/patologia , Adolescente , Anemia/etiologia , Criança , Pré-Escolar , Dengue/epidemiologia , República Dominicana/epidemiologia , Feminino , Humanos , Lactente , Masculino , Análise Multivariada , Razão de Chances , Fatores de RiscoRESUMO
Introducción: el síndrome de Nicolau, embolia cutis o dermatitis livedoide, es una reacción adversa poco frecuente a la administración de inyección intramuscular, subcutánea o intraarticular de medicamentos, inicia con dolor intenso y eritema que evoluciona a lesión livedoide que se torna hemorrágica, progresa a necrosis isquémica de piel y tejidos más profundos. Caso clínico: niño de 7 meses de edad, luego de inyección intramuscular de metamizol sódico presenta llanto continuo, seguido de lesión purpúrica afectando espalda, glúteo, muslo y pierna derechos, evolucionando hasta cicatrización total en 18 semanas. Conclusión: el síndrome de Nicolau, condición iatrogénica por inyección de múltiples medicamentos, produce lesión necrótica en área de irrigación de vasos afectados. El conocimiento de este síndrome facilitaría su prevención, al igual que su diagnóstico y manejo tempranos
Introduction: Nicolau syndrome, embolism cutis or livedoid dermatitis, is a rare adverse reaction to the administration of intramuscular, subcutaneous or intra-articular injection of drugs, begins with intense pain and erythema that progresses to a livedoid lesion that becomes hemorrhagic, progresses to ischemic necrosis of skin and deeper tissues. Clinical case: A 7-month-old boy, after intramuscular injection of sodium metamizole, presented continuous crying followed by a purpuric lesion affecting the right back, gluteus, thigh and leg, evolving to total healing in 18 weeks. Conclusion: Nicolau Syndrome, iatrogenic condition by injection of multiple drugs, produces necrotic lesion in irrigated area of affected vessels. The knowledge of this syndrome would facilitate its prevention, as well as its early diagnosis and management.
Assuntos
Humanos , Masculino , Criança , Síndrome de Nicolau , Extremidade Inferior , Injeções IntramuscularesRESUMO
RESUMEN La colaboración internacional es un rasgo distintivo de la política emprendida por el Estado cubano y materializada por su Ministerio de Salud Pública. Los autores suman sus experiencias adquiridas en el cumplimiento de misiones internacionalistas por profesionales cubanos en el campo de la educación médica, a otras ya publicadas en EDUMECENTRO; esta vez refieren la confección de un glosario inglés-portugués con más de 600 términos médicos, el cual constituyó una fortaleza para la calidad del proceso docente educativo al ser utilizado como medio de enseñanza en la hermana República Popular de Angola.
ABSTRACT International collaboration is a distinctive feature of the policy undertaken by the Cuban State and materialized by its Ministry of Public Health. The authors add their experiences acquired in the fulfillment of internationalist missions by Cuban professionals in the field of medical education, to others already published in EDUMECENTRO; this time they refer to the preparation of an English-Portuguese glossary with more than 600 medical terms, which constituted a strength for the quality of the teaching-learning process to be used as a teaching aid in the sister Republic of Angola.
Assuntos
Dicionário , Comunicação , Educação MédicaRESUMO
Pleural effusion is a serious complication of pneumonia, and Streptococcus pneumoniae is a leading cause. We describe the aetiology of pneumonia with effusion among children in the Dominican Republic before the introduction of the 13-valent pneumococcal conjugate vaccine (PCV) in 2013 and the performance characteristics of a rapid immunochromatographic test (ICT) for detecting S. pneumoniae in pleural fluid. From July 2009 to June 2011, we enrolled children <15 years old admitted with pneumonia and pleural effusion to Robert Reid Cabral Children's Hospital, Dominican Republic. Pleural fluid was tested by culture, polymerase chain reaction (PCR) for bacterial (S. pyogenes, S. pneumoniae) and viral (respiratory syncytial virus and human rhinovirus) pathogens, and by ICT for S. pneumoniae. We calculated the performance of ICT and culture compared with PCR. Among 121 cases, the median age was 31 months (range 1 week to 14 years). Pleural fluid culture (n = 121) and PCR testing (n = 112) identified an aetiology in 85 (70.2%) cases, including 62 S. pneumoniae (51.2%) and 19 Staphylococcus aureus (15.7%). The viruses tested were not detected. The most prevalent pneumococcal serotypes were 14 (n = 20), 1 (n = 13), and 3 (n = 12). Serotype coverage of the 10- and 13-valent PCVs would be 70.5% and 95.1%, respectively. The sensitivity of point-of-care ICT was 100% (95% confidence interval [CI] 94.1%-100%), while specificity was 86.3% (95% CI 73.7%-94.3%). S. pneumoniae caused more than half of paediatric pneumonia with effusion cases; introduction of PCV in the Dominican Republic could reduce the burden by 36-49%. ICT is a practical, valid diagnostic tool for clinical care and surveillance in settings with limited laboratory capacity.
RESUMO
Impetigo is a highly contagious bacterial skin infection affecting children worldwide that is caused by the Gram-positive bacteria Staphylococcus aureus, Streptococcus pyogenes, or both. Staphylococcus species can quickly develop drug resistance rendering mupirocin, fusidic acid, and erythromycin ineffective. Preclinical and clinical studies demonstrated that NVC-422 (N, N-dichloro-2, 2-dimethyltaurine) rapidly kills pathogens without the development of drug resistance. 129 patients with clinically diagnosed impetigo were randomized to three dose groups (0.1, 0.5, or 1.5% NVC-422 topical gel) in a study conducted at 2 centers; 125 patients (97%) had microbiologically confirmed infection. Treatment was administered three times a day (TID) for 7 days to all randomized subjects. Response was measured at the completion of treatment (Day 8) and 1 week post treatment (Day 15) by the Skin Infection Rating Scale (SIRS) and by microbiological response. A total of 120 subjects (96%) completed all 7 days of treatment and were assessed at end of treatment (EOT). Clinical response rate at EOT in the PPC population was excellent in each of the dose groups (84.6%, 87.2%, and 92.3% in the 0.1%, 0.5% and 1.5% dose groups respectively). The majority of the infections were caused by S. aureus, alone (106/125, 85%) of which approximately 10% were MRSA. There were no clinical recurrences in any treatment groups. Treatment-emergent adverse events were seen in 5.4% of the subjects (7/129) and were mild to moderate and resolved. NVC-422 topical gel administered TID was well tolerated, with high rates of clinical and microbiological responses for treating impetigo.
Assuntos
Antibacterianos/uso terapêutico , Impetigo/tratamento farmacológico , Taurina/análogos & derivados , Administração Tópica , Antibacterianos/farmacologia , Resistência a Medicamentos/efeitos dos fármacos , Feminino , Humanos , Impetigo/patologia , Análise de Intenção de Tratamento , Masculino , Staphylococcus aureus Resistente à Meticilina/metabolismo , Testes de Sensibilidade Microbiana , Pele/efeitos dos fármacos , Pele/microbiologia , Pele/patologia , Staphylococcus aureus/isolamento & purificação , Streptococcus pyogenes/isolamento & purificação , Taurina/farmacologia , Taurina/uso terapêutico , Resultado do TratamentoRESUMO
OBJECTIVE: Several studies have evaluated dexamethasone for prevention of hearing loss in childhood bacterial meningitis, but results have varied. We compared dexamethasone and/or glycerol recipients with placebo recipients, and measured hearing at 3 threshold levels. METHODS: Children aged 2 months to 16 years with meningitis were treated with ceftriaxone but were double-blindly randomly assigned to receive adjuvant dexamethasone intravenously, glycerol orally, both agents, or neither agent. We used the Glasgow coma scale to grade the presenting status. The end points were the better ear's ability to detect sounds of >40 dB, >or=60 dB, and >or=80 dB, with these thresholds indicating any, moderate-to-severe, or severe impairment, respectively. All tests were interpreted by an external audiologist. Influence of covariates in the treatment groups was examined by binary logistic regression. RESULTS: Of the 383 children, mostly with meningitis caused by Haemophilus influenzae type b or Streptococcus pneumoniae, 101 received dexamethasone, 95 received dexamethasone and glycerol, 92 received glycerol, and 95 received placebo. Only the presenting condition and young age predicted impairment independently through all threshold levels. Each lowering point in the Glasgow scale increased the risk by 15% to 21% (odds ratio: 1.20, 1.21, and 1.15 [95% confidence interval: 1.06-1.35, 1.07-1.37, and 1.01-1.31]; P = .005, .003, and .039) for any, moderate-to-severe, or severe impairment, respectively. Each increasing month of age decreased the risk by 2% to 6% (P = .0001, .0007, and .041, respectively). Neither dexamethasone nor glycerol prevented hearing loss at these levels regardless of the causative agent or timing of antimicrobial agent. CONCLUSIONS: With bacterial meningitis, the child's presenting status and young age are the most important predictors of hearing impairment. Little relief is obtained from current adjuvant medications.
Assuntos
Ceftriaxona/administração & dosagem , Dexametasona/administração & dosagem , Glicerol/administração & dosagem , Perda Auditiva/tratamento farmacológico , Meningites Bacterianas/complicações , Administração Oral , Adolescente , Audiometria , Criança , Pré-Escolar , Intervalos de Confiança , Relação Dose-Resposta a Droga , Método Duplo-Cego , Esquema de Medicação , Quimioterapia Combinada , Feminino , Seguimentos , Perda Auditiva/etiologia , Perda Auditiva/prevenção & controle , Humanos , Lactente , Infusões Intravenosas , Modelos Logísticos , Masculino , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/microbiologia , Meningite por Haemophilus/complicações , Meningite por Haemophilus/diagnóstico , Meningite por Haemophilus/tratamento farmacológico , Meningite Pneumocócica/complicações , Meningite Pneumocócica/diagnóstico , Meningite Pneumocócica/tratamento farmacológico , Razão de Chances , Probabilidade , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: The objective of the current study was to identify risk factors for intrathoracic tuberculosis among children living in migrant populations in the Dominican Republic. DESIGN: Cross-sectional study. SETTING: Dominican Republic bateyes, economic migrant communities of Haitian origin. PARTICIPANTS: Children 18 months to 18 years of age. MAIN EXPOSURE: Unpasteurized milk consumption. OUTCOME MEASURES: Probable or possible intrathoracic tuberculosis. Probable intrathoracic tuberculosis was defined as any child with a tuberculin skin test >or=10 mm (or >5 mm in the presence of a known immunocompromising condition or household contact with intrathoracic tuberculosis) or malnutrition in the setting of an abnormal chest radiograph with features of tuberculosis or lymph node disease. The diagnosis of "possible intrathoracic tuberculosis" was assigned if an abnormal chest radiograph had features that did not meet the definition of "probable intrathoracic tuberculosis." RESULTS: Probable or possible tuberculosis was diagnosed in 83 (20.8%) of 400 children. Unpasteurized milk consumption was identified as an independent risk factor for intrathoracic tuberculosis (adjusted odds ratio, 3.2; 95% confidence interval: 1.4-7.4) even after adjusting for Bacille Calmette-Guérin vaccination, household size, tuberculosis contacts and age and under varying assumptions about children diagnosed with "possible" tuberculosis. CONCLUSIONS: Our data raise the possibility that the high prevalence of tuberculosis in the Dominican Republic bateyes may be attributable to Mycobacterium bovis rather than Mycobacterium tuberculosis infection.