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1.
J Eur Acad Dermatol Venereol ; 32(10): 1819-1826, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29704456

RESUMO

BACKGROUND: Topical tretinoin cream is the gold standard treatment for skin ageing, particularly photoaging. The purpose of tretinoin peel was to obtain similar results, but in a shorter time, however, there have been few controlled trials on its effectiveness. OBJECTIVE: To compare efficacy and safety of tretinoin 0.05% cream and 5% as a peeling agent on photoaging and field cancerization of the forearms. METHODS: Clinical trial with therapeutic intervention, prospective, randomized (computer-generated randomization list), parallel, comparative (intrasubject) and evaluator-blinded (except for histology and immunohistochemistry), including 24 women (48 forearms) aged over 60 years who have not undergone hormone replacement and categorized as Fitzpatrick skin phototype II or III. The forearms of the participants were randomized for treatment with 0.05% tretinoin cream three nights a week, or 5% tretinoin peel every 2 weeks. The opinion of the participant, severity of photoaging, corneometry, profilometry, high-frequency ultrasound, histology (haematoxylin-eosin and Verhoeff stainings) and immunohistochemistry (p53, bcl-2, Ki67 and collagen I) were assessed. RESULTS: One participant dropped out. The mean photoaging score reduced 20% and the mean actinic keratosis (AK) count reduced 60% with no difference between treatments. Three efficacy parameters showed opposite effects between the tretinoin treatments (P < 0.05%): (i) thickness of the corneal layer decreased with 0.05% tretinoin and increased by 5%; (ii) dermis echogenicity increased by 0.05% and decreased by 5% and (iii) Ki67 expression increased by 0.05% and decreased by 5%. There was good tolerability for both regimens. CONCLUSION: Tretinoin as a cream 0.05% or peeling (5%) is safe and effective for the treatment of moderate photoaging and forearm field cancerization. The cream was superior in improving ultrasonographic parameters of ageing. Peeling was shown a superior performance in the stabilization of field cancerization.


Assuntos
Antineoplásicos/administração & dosagem , Abrasão Química , Ceratose Actínica/tratamento farmacológico , Envelhecimento da Pele/efeitos dos fármacos , Creme para a Pele/administração & dosagem , Tretinoína/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/efeitos adversos , Derme/diagnóstico por imagem , Epiderme/diagnóstico por imagem , Feminino , Antebraço , Humanos , Ceratose Actínica/metabolismo , Ceratose Actínica/patologia , Antígeno Ki-67/metabolismo , Estudos Prospectivos , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Método Simples-Cego , Envelhecimento da Pele/patologia , Creme para a Pele/efeitos adversos , Fenômenos Fisiológicos da Pele/efeitos dos fármacos , Tretinoína/efeitos adversos , Proteína Supressora de Tumor p53/metabolismo , Ultrassonografia
2.
Int J Cosmet Sci ; 39(5): 564-571, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28563677

RESUMO

BACKGROUND: The intrinsic ageing and photoaged skin present biomechanical and morphological differences, which are reflected in the appearance of roughness, superficial and deep wrinkles, atrophy, reduced elasticity, hypo- and hyperpigmentation and actinic keratosis. OBJECTIVE: To evaluate and compare the characteristics of the flexor (with a predominance of intrinsic ageing) and extensor (chronically exposed to sunlight and other environmental factors, with a predominance of photoageing) skin surfaces of the forearms. METHODS: Interventional, prospective, diagnostic study, including 23 females, aged over 60 years. The extensor and flexor faces of forearms were compared in relation to clinical parameters and non-invasive instrumental measurements, such as skin surface, elasticity, hydration as well as dermal thickness and echogenicity. RESULTS: Regarding the water content of the stratum corneum, the flexor face presented an average value higher than the extensor face. The average of measures obtained through images of high-frequency ultrasound demonstrated greater echogenicity of flexor face compared to the extensor face. The measurements of the skin surface showed significant differences between the faces. The roughness and scaliness were lower in the flexor face. Regarding the depth of wrinkles, there was no significant difference between the faces. The average of the measurements was slightly higher in the flexor face, which demonstrated that wrinkles are present in the intrinsic ageing and photoageing. The presence of elastosis and the reduction in elasticity in the clinical aspect of the photoaged face of forearms were according to the results of the non-invasive measurements. CONCLUSION: Meaningful differences in the biophysical characteristics of the extensor and flexor faces of the forearms were detected. Because the non-invasive instrumental measurements correlated with clinical findings, they may represent useful tools to assess efficacy and safety of skin ageing treatments in clinical research.


Assuntos
Antebraço , Envelhecimento da Pele , Exposição Ambiental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Luz Solar
3.
Int J Cosmet Sci ; 38(2): 170-7, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26352387

RESUMO

OBJECTIVE: High-frequency ultrasound is a non-invasive tool used in skin ageing research to assess dermis thickness and echogenicity. This study evaluated the reliability of a range of high-frequency ultrasound parameters and tested their correlation with age and a validated clinical scale for the assessment of forearm skin photoageing; the difference between two body sites according to environmental exposition patterns was also investigated. METHODS: Twenty-three volunteers aged 28-82 years were divided into three groups according to forearm photoageing degree. A 20 MHz ultrasound unit was used to obtain cross-sectional images of the skin by two trained investigators on two different sites: the dorsal forearm (chronically photoexposed skin) and the proximal medial arm (non-photoexposed skin). Several echogenicity parameters were studied for each skin compartment: total dermis, upper dermis and lower dermis, and the ratio between upper and lower dermis. RESULTS: The intraclass correlation coefficient (for complete agreement) between investigators was higher for upper and total dermis echogenicity measures compared with the lower dermis. At the non-photoexposed site, the upper and lower dermis parameter ratio was better correlated with age. At the photoexposed area, total dermis parameters demonstrated higher correlations with clinical score. CONCLUSION: The authors discuss the choice of parameters for forearm photoageing assessment using high-frequency ultrasound.


Assuntos
Antebraço/efeitos da radiação , Luz , Envelhecimento da Pele , Ultrassom , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Humanos , Pessoa de Meia-Idade
4.
Int J Cosmet Sci ; 37(1): 134-40, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25367191

RESUMO

BACKGROUND: Cellulite refers to skin relief alterations in women's thighs and buttocks, causing dissatisfaction and search for treatment. Its physiopathology is complex and not completely understood. Many therapeutic options have been reported with no scientific evidence about benefits. The majority of the studies are not controlled nor randomized; most efficacy endpoints are subjective, like not well-standardized photographs and investigator opinion. Objective measures could improve severity assessment. Our purpose was to correlate non-invasive instrumental measures and standardized clinical evaluation. METHODS: Twenty six women presenting cellulite on buttocks, aged from 25 to 41, were evaluated by: body mass index; standardized photography analysis (10-point severity and 5-point photonumeric scales) by five dermatologists; cutometry and high-frequency ultrasonography (dermal density and dermis/hypodermis interface length). Quality of life impact was assessed. Correlations between clinical and instrumental parameters were performed. RESULTS: Good agreement among dermatologists and main investigator perceptions was detected. Positive correlations: body mass index and clinical scores; ultrasonographic measures. Negative correlation: cutometry and clinical scores. Quality of life score was correlated to dermal collagen density. CONCLUSION: Cellulite caused impact in quality of life. Poor correlation between objective measures and clinical evaluation was detected. Cellulite severity assessment is a challenge, and objective parameters should be optimized for clinical trials.


Assuntos
Tecido Adiposo/patologia , Pele , Adulto , Feminino , Humanos , Índice de Gravidade de Doença
5.
Int J Cosmet Sci ; 35(5): 502-9, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23786487

RESUMO

BACKGROUND: Cellulite refers to changes in skin relief on the thighs and buttocks of women, with a prevalence of 80-90%, causing dissatisfaction and search for treatment. Etiopathogenesis is multifactorial, as follows: herniation of the hypodermis towards the dermis, facilitated by perpendicular fibrous septa, changes in the dermal extracellular matrix, decreased adiponectin, genetic polymorphism, microcirculation alterations and inflammatory process. There are numerous therapeutic approaches, with little evidence of effectiveness. The long-wave infrared (LWIR) radiation interacts with water, improves microcirculation and stimulates metabolic processes. To date, the use of tissues with potential reflection of LWIR radiation has not been systematically investigated as adjuvant treatment for cellulite. OBJECTIVE: To investigate the efficacy and safety of the treatment of cellulite through the use of compression stockings made with thread reflecting LWIR radiation. PATIENTS AND METHODS: Clinical study of therapeutic intervention, controlled and double-blind, including 30 women, aging from 25 to 40 years, with cellulite of grades II and III on the thighs and buttocks who used compression stockings, "pantyhose" model, made with reflector thread of LWIR radiation, on only one randomized side. Women under other treatments for cellulite and with venous and/or blood insufficiencies were excluded. Evaluation of efficacy by clinical parameters, photographs, Dermatology Life Quality Index (DLQI), cutometry and high frequency ultrasonography and security by observation of adverse events and venous EcoDoppler recordings. RESULTS: DLQI scores showed significant reduction; the two-dimensional high-frequency ultrasonography showed an insignificant increase in dermal echogenicity as well as other efficacy parameters demonstrated no or slight improvement, with no differences between the sides exposed or not to LWIR; and there were no severe adverse events. CONCLUSION: Compression stockings, with or without thread reflector of LWIR, showed slight effects in the appearance of cellulite, but the treatment determined a positive impact on women quality of life.


Assuntos
Tecido Adiposo/fisiopatologia , Nádegas/fisiopatologia , Técnicas Cosméticas , Meias de Compressão , Coxa da Perna/fisiopatologia , Tecido Adiposo/diagnóstico por imagem , Tecido Adiposo/efeitos da radiação , Adulto , Nádegas/diagnóstico por imagem , Método Duplo-Cego , Feminino , Humanos , Qualidade de Vida , Coxa da Perna/diagnóstico por imagem , Ultrassonografia
6.
Int J Cardiol Hypertens ; 2: 100019, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33447750

RESUMO

Paragangliomas and pheocromocytomas are rare neuroendocrine tumors with different clinical presentation, being responsible for secondary arterial hypertension with target-organ lesions. Surgery is a curative therapy in these tumors and demands a multidisciplinary approach. These tumors are more frequent between the 4th and 5th decades of life and their clinical manifestations are related to catecholamines production: headache, palpitations, variable blood pressure. This article presents 13 clinical cases of patients with neuroendocrine tumors, with an median-age of 56,7 years, submitted to surgery between 2014 and 2017. The diagnosis was made based on clinical suspicion, serum and urinary catecholamines and metanephrins, imagiologic evaluation with CT or abdominal and pelvic MRI and MIBG scintigraphy. After surgery, the majority of patients remained with normal blood pressure, without anti-hypertensive therapy and follow-up was maintained in Outpatient Clinic, with periodic blood tests and imaging reevaluation.

7.
J Am Soc Hypertens ; 12(9): 637-640, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30042049

RESUMO

Juxtaglomerular cell tumors are rare, generally benign, and they are one of the secondary surgically treatable causes of arterial hypertension. There are about 100 reported cases on literature, and the diagnosis is usually carried out based on a high clinic suspicion index, mostly in patients with hypokalemia and arterial hypertension. The diagnosis involves blood tests and imaging studies, but it is only definite with histopathological exam after surgical treatment. We present a case of a 22-year-old woman with resistant arterial hypertension and renal and cardiovascular target-organ lesions. High plasmatic renin and a nodular renal mass on magnetic resonance imaging were present. A tumorectomy was performed and the histological exam confirmed a reninoma. After surgery, blood pressure and serum renin values returned to normal without medication. This work focuses on the need to exclude rare secondary causes of hypertension in young patients with resistant forms of this disease.

8.
J Food Prot ; 65(1): 146-52, 2002 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-11808786

RESUMO

An international multicenter study of ready-to-eat foods, sandwiches, and ice creams or sorbets sold in the streets and their vendors was carried out to assess the microbiological quality of these foods and to identify characteristics of the vendors possibly associated with pathogens. Thirteen towns in Africa, America, Asia, and Oceania were involved in the study. A single protocol was used in all 13 centers: representative sampling was by random selection of vendors and a sample of foods bought from each of these vendors at a time and date selected at random. Microbiological analyses were carried out using standardized Association Française de Normalisation methods, and the use of a standardized questionnaire to collect data concerning the characteristics of the vendors. Fifteen surveys were carried out, with 3,003 food samples from 1,268 vendors. The proportion of unsatisfactory food samples was between 12.7 and 82.9% for ice creams and sorbets and between 11.3 and 92% for sandwiches. For ice creams and sorbets, the sale of a large number of units (>80 per day) increased the risk of unsatisfactory food by a factor of 2.8 (95% confidence interval [CI]: 1.5 to 5.1), lack of training in food hygiene by 6.6 (95% CI: 1.1 to 50). and by a factor of 2.8 (95% CI: 1.4 to 5.4) for mobile vendors. These risk factors were not identified for sandwiches, this difference may be due to the presence of a cooking step in their preparation. These results show that the poor microbiological quality of these street foods constitutes a potential hazard to public health, that the extent of this hazard varies between the cities studied, and that vendors' health education in food safety is a crucial factor in the prevention of foodborne infections.


Assuntos
Contaminação de Alimentos/análise , Manipulação de Alimentos/métodos , Contagem de Colônia Microbiana , Qualidade de Produtos para o Consumidor , Análise de Alimentos , Microbiologia de Alimentos , Humanos , Higiene , Sorvetes/microbiologia , Sorvetes/normas , Saúde Pública , Segurança
9.
Onderstepoort J Vet Res ; 66(2): 129-33, 1999 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-10486830

RESUMO

In order to provide relevant therapeutic answers to human patients exposed to risk of rabies infection who visit the Institut Pasteur du Cambodge for post-exposure treatment and to improve control of rabies in Cambodia, a pilot study was carried out in Phnom Penh Province in November and December 1997 with three objectives: characterization of the population of animals responsible for the exposure to rabies, observation of the animals concerned, and confirmation of the presence of rabies virus in the province. Between 18 November 1997 and 19 December 1997, 409 of the 741 patients treated at the Institut Pasteur du Cambodge because of an exposure to a known rabies vector were included in the study. The animals concerned were: 401 dogs (98%), six monkeys (1.5%) and two cats (0.5%). Three-hundred-and-seventy of the animals (90.5%) were owned, 4 (1%) were unowned but were available for characterization and observation, and 35 (8.6%) had an unknown ownership status and were not available for further study. The exposures occurred on private property in 84% of the cases, and 80 of the 370 owned animals (22%) lived in the same home as had the patient. The 374 animals with known ownership status were examined. Five were already dead and two of these five dogs had presented clinical signs typical of those of rabies. The male:female sex ratio of the dogs was 2.1:1. The 369 live animals were placed under observation for 10 d immediately after exposure of the humans had taken place. At the end of the period none of the animals had developed clinical signs of rabies, three had died of diseases other than rabies, and one was lost. Tests for the rabies nucleocapsid antigen were positive in two cases (the two suspected rabid dogs), confirming the presence of rabies in Phnom Penh Province. Consequently, we recommend measures to improve the control of rabies in Cambodia.


Assuntos
Vetores de Doenças , Raiva/terapia , Raiva/transmissão , Animais , Camboja , Gatos , Técnicas de Laboratório Clínico/normas , Gerenciamento Clínico , Cães , Exposição Ambiental , Feminino , Haplorrinos/virologia , Humanos , Masculino , Propriedade , Raiva/epidemiologia
10.
Bull Soc Pathol Exot ; 94(5): 411-4, 2001 Dec.
Artigo em Francês | MEDLINE | ID: mdl-11889944

RESUMO

A study of the microbiological quality of ice lice creams/sorbets sold on the streets of Phnom Penh city was conducted from April 1996 to April 1997. Socio-demographic and environmental characteristics with two ice/ice creams samples were collected from vendors selected in the city. A total of 105 vendors and 210 ice/ice creams samples were randomly selected for the study period. Ice/ice cream vendors in the streets of Phnom Penh were adults (mean age: 28 years old) with a male predominance (86.5%). Mean educational level of vendors was 5 years with no training in mass catering. Most ice creams and sorbets (81.7%) were made using traditional methods. Microbiological analysis performed in the laboratory of Pasteur Institute of Cambodia indicated the poor bacteriological quality of the samples. The proportions of samples classified unsafe according to microbiological criteria were 83.3% for total bacterial count at 30 degrees C, 70% for total coliforms, 30% for faecal coliforms, 12.2% for Staphylococcus aureus and 1.9% for presence of Salmonella spp. These bacterial results suggest that many other food products sold in the streets may be similarly poor. Safety measures should be undertaken to avoid potential threats. Regulation of the street food sector should be part of a larger strategy for enhanced food safety and environmental quality in the city.


Assuntos
Microbiologia de Alimentos , Sorvetes , Gelo , Microbiologia da Água , Camboja , Contagem de Colônia Microbiana , Enterobacteriaceae/isolamento & purificação , Salmonella/isolamento & purificação , Staphylococcus aureus/isolamento & purificação
11.
Bull Soc Pathol Exot ; 90(5): 299-302, 1997.
Artigo em Francês | MEDLINE | ID: mdl-9507756

RESUMO

The authors relate their experience controlling an epidemic of meningitis which broke out in the refugee camps of the Goma region, in northern Zaire, after the dramatic events which had happened in Rwanda in April and June 1994. Out of the 348 cases of purulent meningitis diagnosed by the Bioforce team, meningococcal etiology was confirmed 327 times. The isolated meningococci were all of the serogroup A, serotype A; 4; P 1,9. They were resistant to streptomycin and to sulphamides. The epidemic lasted one month, touched people of all ages and spread progressively to all the camps. The epidemic surveillance set up meant that vaccination was carried out very quickly and the epidemic brought rapidly under control, even if other factors did intervene. All those called upon to intervene in such a context should be made aware of the interest of the basic triad to fight these epidemics: rapid vaccination, treatment of cases with oily chloramphenicol and bio-epidemiological surveillance.


Assuntos
Meningite por Haemophilus/epidemiologia , Meningite Meningocócica/epidemiologia , Meningite Pneumocócica/epidemiologia , Adolescente , Adulto , Vacinas Bacterianas , Criança , República Democrática do Congo , Resistência Microbiana a Medicamentos , Feminino , Humanos , Masculino , Meningite por Haemophilus/tratamento farmacológico , Meningite por Haemophilus/prevenção & controle , Meningite Meningocócica/tratamento farmacológico , Meningite Meningocócica/prevenção & controle , Meningite Pneumocócica/tratamento farmacológico , Meningite Pneumocócica/prevenção & controle , Sorotipagem
12.
Bull Soc Pathol Exot ; 89(3): 204-8, 1996.
Artigo em Francês | MEDLINE | ID: mdl-8998416

RESUMO

After the outbreaks of cholera, dysenteriae, meningitidis of which the rwandese refugees have been the victims in August and September 1994 in the camps of the Goma's area (Zaïre), the medical teams were confronted with a great number of fevers of unknown origin. In order to explore the possible etiologies, we have conducted a cases/controls study (n = 96). Clinically, the cases occur more frequently than controls headache (p < 0.001), splenomegaly (p = 0.02) and neutropeny (p < 0.001) Serologically, it has been constated non significantly difference between cases and controls, but prevalence of HIV-1 infections (19 and 6%) and arbovirus (23 and 10%) infections are very high. Arbovirosis could explain, partially or associated with HIV and tuberculosis, the presence of these fevers undeterminated more than malaria or typhus epidemic.


Assuntos
Febre de Causa Desconhecida/epidemiologia , Refugiados , Síndrome da Imunodeficiência Adquirida/complicações , Adulto , Infecções por Arbovirus/complicações , República Democrática do Congo , Feminino , Febre de Causa Desconhecida/etiologia , Humanos , Masculino , Ruanda/etnologia , Tuberculose/complicações
13.
Bull Soc Pathol Exot ; 95(1): 3-7, 2002 Mar.
Artigo em Francês | MEDLINE | ID: mdl-12012960

RESUMO

In July 1999, after the return of the Kosovar refugees to their country, an outbreak of acute hepatitis A (HAV) and E (HEV) occurred. Epidemic hepatitis and diarrhoea are closely monitored communicable diseases which had been singled out as priorities by the health authorities of the former Republic of Yougoslavia. Several field surveys were undertaken: description of reported cases, serological study of clinical patients, study of anti-HAV seroprevalence in a school and a case control study to assess risk factors. The analysis of the reports indicates an epidemic peak at the end of September, 2 or 3 weeks after the start of the new school year, with an increase of cases relative to the age of the children in school. In a serologic study of 104 samples, we found an anti-HAV IgM positivity in 88% of the cases. Children were more likely to be positive when compared to teenagers and adults; likewise, consumers of well-water as versus those drinking network water (p = 0.03). The study of seroprevalence showed that transmission had taken place within the school. The case control study, in spite of its imperfections, indicated that consumption of water melon, the only fruit cultivated locally, is a factor which facilitates the HAV transmission. Circulation of the hepatitis E virus was confirmed for 4 sick persons (including 2 co-infected HAV-HEV) and in 4 persons without clinical symptoms. These results show the permanent risk of faeco-oral infections in this area and the need to develop a relevant prevention policy.


Assuntos
Hepatite A/epidemiologia , Hepatite E/epidemiologia , Estudos Soroepidemiológicos , Testes Sorológicos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Frutas , Hepatite A/diagnóstico , Hepatite A/transmissão , Vírus da Hepatite A/imunologia , Anticorpos Anti-Hepatite/sangue , Hepatite E/diagnóstico , Humanos , Imunoglobulina M/sangue , Lactente , Masculino , Pessoa de Meia-Idade , Refugiados , Instituições Acadêmicas , Iugoslávia/epidemiologia
14.
Rev Port Cardiol ; 21(5): 585-92, 2002 May.
Artigo em Inglês, Português | MEDLINE | ID: mdl-12174521

RESUMO

Heart failure is a common disease with major social and economic repercussions for the health system. All potentially curable or reversible causes of heart failure should be investigated and treated if possible. Several experimental and clinical studies have demonstrated that supraventricular tachycardias can induce a form of dilated cardiomyopathy (tachycardiomyopathy), which may be reversible with ventricular frequency response control. In this article we present a clinical case, and review this clinical entity, so often underdiagnosed.


Assuntos
Cardiomiopatia Dilatada/etiologia , Taquicardia Supraventricular/complicações , Idoso , Animais , Cardiomiopatia Dilatada/fisiopatologia , Modelos Animais de Doenças , Cães , Humanos , Masculino , Taquicardia Supraventricular/fisiopatologia
15.
Rev Port Cardiol ; 15(7-8): 585-9, 549, 1996.
Artigo em Português | MEDLINE | ID: mdl-8991395

RESUMO

OBJECTIVE: Functional evaluation of Autonomic Nervous System in patients with Mitral Valve Prolapse Syndrome. DESIGN: Study of cardiovascular reflexes. SETTING: Out patients studied in the Laboratory for Study of Autonomic Nervous System Function of Santa Maria Hospital, Lisbon, Portugal. MATERIAL AND METHODS: We studied 20 patients with clinical and echocardiographic diagnosis of mitral valve prolapse, who presented Mitral Valve Prolapse Syndrome, without significant mitral regurgitation, and with normal left ventricular function. Cardiovascular reflexes were analysed by mean of five tests. RESULTS: In 75% of the cases, patients had results according to vagal hypofunction. Orthostatic hypotension was present in 40%. Among patients with orthostatic hypotension, 75% had postural phenomena. Among patients with postural phenomena, 75% had orthostatic hypotension. CONCLUSIONS: In the present study, patients behaviour hasn't been uniform. Vagal hypofunction was present in 75% and orthostatic hypotension in 40% of the cases. A relation has been found between orthostatic hypotension and postural into.


Assuntos
Prolapso da Valva Mitral/fisiopatologia , Reflexo , Adulto , Idoso , Sistema Nervoso Autônomo/fisiopatologia , Sistema Cardiovascular/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
Med Trop (Mars) ; 54(4): 319-23, 1994.
Artigo em Francês | MEDLINE | ID: mdl-7746123

RESUMO

In 1994, an outbreak of dysentery caused by Shigella dysenteriae type I resistant to all public health antibiotics in vitro occurred among rwandan refugees in Zaïre. The only active antimicrobial agent available was ciprofloxacin. It was administered to hospitalized patients in a conventional 5-day schedule. To ration the supply for the benefit of the greatest number, a randomized blinded study was performed to compare the effectiveness of short-term treatment (1 g of ciprofloxacin in a single daily doses for 2 days) with that of the standard treatment (1 g of ciprofloxacin in two daily doses for 5 days). The study included 57 refugees over the age of 15 years with dysentery. Shigella dysenteriae type I was identified in 26 patients. Except for sex distribution, there was no significant difference in clinical and bacteriologic features of the two populations. Treatment failed in 12 cases, i.e., 7 of 29 patients who received the short-term treatment and 5 of 28 patients who received the standard treatment. Efficacy of ciprofloxacin was not dependent on the mode of treatment, taking into account clinical or bacteriologic criteria. These results indicated that the duration of ciprofloxacin treatment for dysentery caused by Shigella dysenteriae type 1 could be shortened to two days. Short-term treatment has several advantages. One is cost-effectiveness since fluoroquinolones are costly and scarce. Another is to allow treatment of a greater number of patients by improving compliance.


Assuntos
Ciprofloxacina/administração & dosagem , Disenteria Bacilar/tratamento farmacológico , Adulto , Ciprofloxacina/economia , Análise Custo-Benefício , Relação Dose-Resposta a Droga , Método Duplo-Cego , Esquema de Medicação , Disenteria Bacilar/microbiologia , Fezes/microbiologia , Feminino , Humanos , Masculino , Refugiados , Ruanda , Shigella dysenteriae/isolamento & purificação
17.
Sante ; 5(4): 253-7, 1995.
Artigo em Francês | MEDLINE | ID: mdl-7582647

RESUMO

We report a retrospective study of a group of 440 children following an outbreak of infectious food poisoning in Goma in 1994. The study was part of the epidemiological surveillance in a non-accompanied child refugee reception centre. There were 11 cases (rate 2.5%). We evidence a problem of hygiene in the food preparation chain. Despite the numerous epidemics in the region (cholera, dysentery) this study demonstrated that they were not responsible. Similarly, the findings removed any existing doubts about the quality of the food supplied as part of the international aid.


Assuntos
Surtos de Doenças , Doenças Transmitidas por Alimentos/etiologia , Refugiados , Pré-Escolar , República Democrática do Congo/epidemiologia , Feminino , Manipulação de Alimentos , Doenças Transmitidas por Alimentos/epidemiologia , Humanos , Higiene , Masculino , Vigilância da População , Estudos Retrospectivos , Fatores de Risco , Saúde da População Urbana
18.
Allerg Immunol (Paris) ; 34(10): 361-4, 2002 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-12575619

RESUMO

Capillary leakage Syndrome (CLS) is a rare clinical syndrome, that was first described in 1960, characterized by acute episodes of generalized edema, hemoconcentration, hypoproteinemia and monoclonal gammopathy, in the vast majority of cases. We describe a 39-year-old man with anasarca, bilateral pleural and pericardial effusions, ascites and diffuse alveolo-intersticial edema. Clinical and laboratory findings were consistent with an acute episode of CLS. Treatment with prednisone, furosemide and aminophylline was started, which lead to a gradual improvement in 48 hours. Pathophysiologically there is an increase in capillary permeability with the extravasation of fluid and plasmatic proteins to the extravascular space that can lead to hypovolaemic shock. In the second phase there is a reentry of the fluid overload leading to pulmonary edema. The etiology of this hyperpermeability still remains unclear. The role of cytokines has become central in the comprehension of pathophysiology of CLS. Adhesion molecules are probably also involved in the genesis of capillary leakage. CLS treatment remains empirical. However, at present it seems that the association of steroids with furosemide, aminophylline and terbutaline are capable of controlling the clinical manifestation of the acute episodes in most cases. To our knowledge no prophylatic therapy has clearly proven its efficacy. There are only a few series analyzing the long-term evolution of patients with CLS. Further studies are necessary with the objective to collect enough patients with CLS to observe natural history of the disease and evaluate the efficacy of empiric treatments.


Assuntos
Síndrome de Vazamento Capilar/fisiopatologia , Citocinas/fisiologia , Edema/etiologia , Adulto , Albuterol/uso terapêutico , Antibacterianos/uso terapêutico , Síndrome de Vazamento Capilar/complicações , Síndrome de Vazamento Capilar/tratamento farmacológico , Quimioterapia Combinada , Transfusão de Eritrócitos , Evolução Fatal , Furosemida/uso terapêutico , Hemorragia Gastrointestinal/etiologia , Doença de Hodgkin/complicações , Humanos , Ipratrópio/uso terapêutico , Masculino , Pancitopenia/etiologia , Pancitopenia/terapia , Transfusão de Plaquetas , Prednisolona/uso terapêutico
19.
Acta Med Port ; 8(7-8): 425-32, 1995.
Artigo em Português | MEDLINE | ID: mdl-7484256

RESUMO

Autonomic Nervous System (ANS) dysfunctions may be localized or not, and determine either states of hypo or hyperactivity. This article reviews the structure and function of ANS, methods of evaluation, the main clinical features of its dysfunctions, as well as the most common causes involved and current therapeutic possibilities. Localized dysfunctions and states of hyperactivity are not considered.


Assuntos
Doenças do Sistema Nervoso Autônomo , Sistema Nervoso Autônomo/fisiologia , Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Doenças do Sistema Nervoso Autônomo/terapia , Humanos
20.
Acta Med Port ; 11(1): 53-8, 1998 Jan.
Artigo em Português | MEDLINE | ID: mdl-9542179

RESUMO

Orthostatic tachycardia may be due to several physiologic abnormalities. Normal regulation of cardiac frequency in relation to postural changes is described; main causes of orthostatic tachycardia are described, in particular hypovolemia, beta-adrenergic hypersensitivity and segmental autonomic neuropathy. The current therapeutic attitudes are discussed.


Assuntos
Postura/fisiologia , Taquicardia/etiologia , Doenças do Sistema Nervoso Autônomo/complicações , Humanos , Receptores Adrenérgicos beta/fisiologia , Choque/complicações , Taquicardia/fisiopatologia , Taquicardia/terapia
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