RESUMO
The objective of this study was to evaluate the use of naphazoline hydrochloride in comparison with aluminum chloride for vertical gingival displacement. The inclusion criteria were: patients with a good general systemic condition; periodontal health; and thick gingival biotype. Moreover, the exclusion criteria were: smoking individuals; canine teeth or central incisors with carious lesions, abrasion, erosion, prosthetic abutments or unsatisfactory restorations; patients with periodontal disease; and users of continuous medication. 72 teeth were included and the Square Block Design was used to randomize the samples. Three measures were obtained from each tooth, and mean vertical gingival displacement was calculated. A descriptive analysis of the average displacement was performed. The normality test used was the Lilliefors' Test and for comparison between treatments, the Kruskal-Wallis Test was used. The Bartlett's Test for homogeneity of variances was used and a 5% (p ⟨ 0.05) significant level was considered. Thus, the Aluminum Chloride and Naphazoline Hydrochloride showed no statistically amount of gingival retraction than the control group (p = 0.3822). The average of gingival vertical displacement in all groups were less than 0,5 mm. The technique used did not allow any amount of horizontal displacement on obtained models.
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Técnicas de Retração Gengival , Nafazolina , Cloreto de Alumínio , Dente Canino , Gengiva , HumanosRESUMO
The COVID-19 pandemic has had major consequences for the organization of care. In France and around the world, centers practicing electroconvulsive therapy (ECT) have seen their activity decrease, or even stop for many reasons. In this context, maintaining or resuming this essential therapeutic activity for many patients suffering from psychiatric disorders requires material, human and logistical adaptations that should be supervised. The objective of this collective and national work is to offer simple recommendations that can be applied immediately by any healthcare establishment, public or private, practicing ECT. They are the result of feedback from multiprofessional and inter-establishment experiences. Declined in three stages, these recommendations are accompanied by a practical sheet which describes in detail the necessary conditions and prerequisites for any resumption of ECT activity.
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Betacoronavirus , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/prevenção & controle , Eletroconvulsoterapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , COVID-19 , Controle de Doenças Transmissíveis/legislação & jurisprudência , Infecções por Coronavirus/transmissão , Eletroconvulsoterapia/métodos , Eletroconvulsoterapia/normas , França , Hospitais Privados , Hospitais Públicos , Humanos , Casas de Saúde , Segurança do Paciente , Seleção de Pacientes , Pneumonia Viral/transmissão , Utilização de Procedimentos e Técnicas , Equipamentos de Proteção , SARS-CoV-2 , Isolamento SocialRESUMO
ECT or electroconvulsive therapy (ECT) is a therapeutic technique invented in 1935 but which was really developed after World War II and then spreading widely until the mid 1960s. The source of this technique, and some forms of stigma including films, have participated widely to make it suspect from a moral point of view. The ethical principles that support the establishment of a treatment by ECT are those relating to any action in psychiatry and are based on the one hand on the founding principles of bioethics: autonomy, beneficence, non-malfeasance, and justice, and on the other hand on the information on the technical and consent to this type of care.
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Eletroconvulsoterapia/ética , Ética Médica , Humanos , Consentimento Livre e Esclarecido , Autonomia Pessoal , Psiquiatria/éticaRESUMO
AIM: One of the aims of the TEMPPO study was to describe the sociodemographic and clinical characteristics of a cohort of adult outpatients with type I or type II bipolar disorders (as defined by DSM-IV criteria) in France. METHODS: TEMPPO is a multicenter, cross-sectional, non-interventional study conducted in France between November 2008 and May 2009, with a random sample of academic and private practice psychiatrists. Each psychiatrist who agreed to participate in the study had to: complete a register with data on all consecutive patients (up to 20 patients) consulting during a 2-month period and fulfilling inclusion criteria; include in the study the first five patients of the register with an on-going consultation for at least 6 months; for each of which a detailed questionnaire had been assessed, notably their sociodemographic and bipolar clinical characteristics. Adult outpatients diagnosed with bipolar disorders (BD) were enrolled if fulfilling the following inclusion criteria: man or woman, aged 18 and above, diagnosed bipolar type I or II according to DSM-IV criteria, treated (whatever the treatment strategy) or not, and followed-up for at least 6 months by the participating psychiatrist. RESULTS: One hundred and thirty-five psychiatrists included 619 patients with bipolar disorder (197 and 422 followed-up in public and private practice respectively). The estimated prevalence of patients with bipolar disorders consulting psychiatrists was 0.43%. Type I bipolar disorder was the most frequent condition (58% of the patients). As a whole, bipolar disorder was associated with severe handicap (mean global disease Clinical Global Impression [CGI]-Severity score of 4.4 and mean GAF [Global Assessment of Functioning] score of 59), with more depressive episodes than manic episodes (6 vs. 4) or hypomania (6 vs. 3), a high proportion of rapid cycles (11%), psychiatric comorbidities (45% of patients), obesity (16% of patients), libido dysfunction and associated psychotic symptoms. Current manic phase was associated with more pronounced illness severity and lowest functioning. More than half of the patients (57%) had a family history of psychiatric disorders. CONCLUSION: This study could shed some light for a better understanding of demographics and clinical patterns of patients with bipolar disorders consulting psychiatrists in France. The results emphasize the severity of bipolar disorders with mainly depressive episodes, a high proportion of rapid-cycling, comorbidities and associated psychotic symptoms; these characteristics being more marked in patients suffering from BD I. Furthermore, this study confirms the strong negative impact on social and professional life of French bipolar patients, requiring specific management in addition to the symptomatic treatment.
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Assistência Ambulatorial/estatística & dados numéricos , Transtorno Bipolar/epidemiologia , Adulto , Idoso , Antipsicóticos/uso terapêutico , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/psicologia , Estudos de Coortes , Estudos Transversais , Uso de Medicamentos , Feminino , Seguimentos , França , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/estatística & dados numéricos , Escalas de Graduação Psiquiátrica , Ajustamento Social , Fatores SocioeconômicosRESUMO
TEMPPO is an observational, cross-sectional and multicentre study, initiated in the French metropolitan territory in 2009. Set up from a random sample of 135 psychiatrists, it has observed the procedures for therapeutic management of a population (n=619) of their outpatients (respectively 197 and 422 in public and private practice) with bipolar disorder type I or II disorders (DSM-IV). The patients who were followed were mostly very sick. Every patient received a pharmacological treatment. The prescription included at least one mood stabilizer or an antipsychotic (71 % atypical) in 78 % and 56 % of cases respectively. Treatment regimen changes were frequent (61 % of patients had at least one change in treatment during the last 12 months). A single molecule by therapeutic class was generally prescribed. The presence of an antipsychotic in combination therapy was often associated with the severity or difficulty of care of the patient (mixed states, severity of the global functioning impairment, manic states, high number of hospitalizations and history of suicide attempt). The combination of two antipsychotics is found only in the difficult situations of manic states. Patients with severe depressive phase are those who benefit from the combination mood stabilizer+antipsychotic+antidepressant (16 % of the sample). In this study, the prescription of antidepressants significantly differs from recommendations for good prescribing practices. Indeed antidepressants were commonly prescribed in mixed-phase (63 %), particularly as a monotherapy in 5 % of cases. It was also found in patients in euthymic phase (48 %), manic phase (12 %) and hypomanic phase (29 %). The prescription of atypical antipsychotics (monotherapy or combination) is now fully established in the management of all phases of the disease. The importance of non-pharmacological treatment is acknowledged by psychiatrists and proposed whether a psychotherapeutic support, information about the disease and/or lifestyle changes. The data collected in this study allowed to demonstrate that the participant psychiatrists have a pharmacological management of patients with bipolar disorder mostly in line with national and international guidelines.
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Anticonvulsivantes/uso terapêutico , Antimaníacos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticonvulsivantes/efeitos adversos , Antimaníacos/efeitos adversos , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Estudos Transversais , Substituição de Medicamentos , Quimioterapia Combinada , Feminino , Seguimentos , França , Humanos , Masculino , Pessoa de Meia-Idade , Farmacoepidemiologia , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUCTION: The diagnosis of renal function impairment and deterioration in congenital urinary tract obstruction (UTO) continues to be extremely challenging. The use of new renal biomarkers in this setting may favor early renal injury detection, allowing for a reliable choice of optimal therapeutic options and the prevention or minimization of definitive renal damage. OBJECTIVE: The aim of the study was to investigate a selection of promising biomarkers of renal injury with the intention of evaluating and comparing their profile with clinically based decisions for surgical intervention of infants with congenital obstructive uropathies. STUDY DESIGN: The first-year profile of renal biomarkers, serum creatinine (sCr), serum and urine cystatin C (CyC), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), transforming growth factor beta-1 (TGF-ß1), retinol-binding protein (RBP), and microalbuminuria (µALB), was analyzed in a cohort of 37 infants with congenital UTO, divided into three subgroups, 14 cases with grade III unilateral hydro(uretero)nephrosis, 13 cases with grade III bilateral hydro(uretero)nephrosis, and 10 cases with low urinary tract obstruction (LUTO), compared with 24 healthy infants matched by gestational age and birth weight. Serum and urine samples were stored at -70 °C and thereafter analyzed by quantitative enzymatic immunoassay. RESULTS: Compared with the control group (Figure), all renal biomarker values were significantly increased in patients (P ≤ 0.02). In the unilateral hydronephrosis and LUTO group, RBP (P ≤ 0.043), NGAL (P ≤ 0.043), KIM-1 (P ≤ 0.03), and TGF-ß1 (P ≤ 0.034) values dropped significantly after surgery. Neutrophil gelatinase-associated lipocalin alone and in combination with urine and serum CyC demonstrated the best performance in determining the need for surgery (area under the curve, 0.801 and 0.881, respectively). Biomarker profile analysis was suggestive of surgical intervention in 55.4% (7/13) of non-operated cases, and most of the biomarker values were above the cutoff levels within at least 3 months before the clinically based surgical decision in 58% (14/24) of all operated patients. DISCUSSION: To the best of the authors' knowledge, this is the first study to present the clinical use of selected group of serum and urinary biomarkers in the setting of UTO to distinguish between patients who would benefit from surgery intervention. The most promising results were obtained using NGAL, RBP, TGF-ß1, and KIM-1, especially in the unilateral hydro(uretero)nephrosis and LUTO subgroups when compared with the control group. CONCLUSIONS: Urine biomarkers, alone and in combination, demonstrated high potential as a non-invasive diagnostic tool for identifying infants who may benefit from earlier surgical intervention.
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Tomada de Decisão Clínica , Obstrução Ureteral/metabolismo , Obstrução Ureteral/cirurgia , Obstrução Uretral/metabolismo , Obstrução Uretral/cirurgia , Obstrução do Colo da Bexiga Urinária/metabolismo , Obstrução do Colo da Bexiga Urinária/cirurgia , Biomarcadores/sangue , Feminino , Humanos , Lactente , Masculino , Valor Preditivo dos Testes , Obstrução Ureteral/congênito , Obstrução Uretral/congênito , Obstrução do Colo da Bexiga Urinária/congênito , Procedimentos Cirúrgicos UrológicosRESUMO
Unplanned tracheal extubation is an important quality issue in current medical practice as it is a common occurrence in paediatric intensive care units. We have assessed the effectiveness of a continuous quality improvement programme in reducing the incidence of unplanned extubation over a 5-year period. After a 2-year baseline period, we developed action plans to address the issues identified. Following implementation of the programme, the overall incidence of unplanned extubation decreased from 2.9 unplanned extubations per 100 intubated patient days in the first year to 0.6 in the last year (p = 0.0001). This reduction was the result of a decrease in unplanned extubation in children younger than 2 years of age. Although mortality was similar to that of children who did not experience an unplanned extubation, those with an unplanned extubation had a significantly longer duration of mechanical ventilation, longer stay in the intensive care unit, and longer hospital stay. We found that the implementation of a continuous quality improvement programme is effective in reducing the overall incidence of unplanned extubations.
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Remoção de Dispositivo , Unidades de Terapia Intensiva Pediátrica/normas , Intubação Intratraqueal/instrumentação , Garantia da Qualidade dos Cuidados de Saúde , Distribuição por Idade , Brasil , Pré-Escolar , Falha de Equipamento , Feminino , Humanos , Lactente , Tempo de Internação , Masculino , Prognóstico , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Respiração ArtificialRESUMO
The work describes the biocompatibility and biodegradation studies of anionic collagen membranes casted form collagen gels collagen, that were selective hydrolyzed at the carboxyamide groups, as a function of the degree of cross-links induced by glutaraldehyde. Independently from the degree of cross-links, all membranes studied were characterized by a similar inflammatory response, inversely dependent on glutaraldehyde reaction time, that decreased from the time of the implant. Cell alterations, mineralization or contact necrosis were not observed in any of the membranes studied. Rates for membrane tissue biodegradation were directly related to glutaraldehyde reaction time, and ranged from 30 to periods longer than 60 days, associated with good biocompatibility. Although other properties must be considered, their use in the treatment of periodontal diseases, the biological behavior observed with the 8 h GA cross-linked membrane suggests that, anionic collagen membrane described in this work may be of potential use, not only in association with guided tissue regeneration technique for periodontal tissue reconstruction, but also in other collagen biomaterial applications where controlled biodegradability is required.
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Materiais Biocompatíveis , Colágeno/química , Reagentes de Ligações Cruzadas , Glutaral , Membranas Artificiais , Tendões , Animais , Biodegradação Ambiental , Bovinos , Colágeno/farmacocinética , Estabilidade de Medicamentos , Géis , Temperatura Alta , Masculino , Próteses e Implantes , Ratos , TermodinâmicaRESUMO
[Beginning of abstract missing from journal] were studied. Every female patient presented normal ovulation, tubal patency and morphologic and functional integrity of her genital tract. Their husbands presented normal spermogram in 45 cases (23.4%), oligospermy in 145 (75.5%) and azoospermy in 2 (0.96%). The number of the inseminations ranged from 1 to 10 series, in each of which a daily trial was attempted, three times every other day in the ovulatory period. The insemination technique included vaginal, intracervical and intra-uterine deposition of homologous fresh semen. The results expressed in terms of pregnancy achieved rates of 28.12% with 24.07% abortions.
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Inseminação Artificial Homóloga , Inseminação Artificial , Aborto Espontâneo , Adulto , Feminino , Humanos , Inseminação Artificial/métodos , Inseminação Artificial Homóloga/métodos , Masculino , Detecção da Ovulação , Gravidez , Fatores de TempoRESUMO
In this study we used the yeast Candida guilliermondii FTI 20037 immobilized by entrapment in Ca-alginate beads (2.5-3 mm diameter) for xylitol production from concentrated sugarcane bagasse hemicellulosic hydrolysate in a repeated batch system. The fermentation runs were carried out in 125- and 250-ml Erlenmeyer flasks placed in an orbital shaker at 30 degrees C and 200 rpm during 72 h, keeping constant the proportion between work volume and flask total volume. According to the results, cell viability was substantially high (98%) in all fermentative cycles. The values of parameters xylitol yield and volumetric productivity increased significantly with the reutilization of the immobilized biocatalysts. The highest values of xylitol final concentration (11.05 g/l), yield factor (0.47 g/g) and volumetric productivity (0.22 g/lh) were obtained in 250-ml Erlenmeyer flasks containing 80 ml of medium plus 20 ml of immobilized biocatalysts. The support used in this study (Ca-alginate) presented stability in the experimental conditions used. The results show that the use of immobilized cells is a promising approach for increasing the xylitol production rates.
Assuntos
Candida/metabolismo , Plantas/metabolismo , Xilitol/biossíntese , FermentaçãoRESUMO
In a prospective study, with the objective of determining the metabolic profile, response to nutrient supply, and role of nutritional and metabolic assessment parameters in children admitted to a pediatric ICU, 11 patients in the age group 2-12 were studied. The assessment was carried out during the first 72 hours of admission, and again seven days later, and included the following parameters; caloric supply; nitrogen supply; prealbumin serum level; urinary urea nitrogen; nitrogen balance and creatinine-height index. The evolution of the parameters in the two stages of the study showed the following results: The urinary urea nitrogen median value at admission was 7.5 g/m2 of corporeal surface, and did not present significant changes seven days later. There was a significant increase in caloric supply from 42.9 to 70.3 kcal/kg, and in nitrogen supply, from 4.7 to 10.2 g/m2 of corporeal surface p 0.01. The level of nitrogen balance rose from -5.6 to 2.5 g/24 h (p < 0.03), and that of prealbumin, from 16.7 to 26.3 mg/dl (p < 0.03). There was a significant reduction in the creatinine-height index, from 86.2 percent to 55.0 percent p 0.01. The magnitude of urinary urea nitrogen excretion at admission varied 2.5-13.8 g/m2 of corporeal surface. Based on this parameter, it was not possible to establish a characteristic metabolic profile for the conditions studied. Notwithstanding an increase in the protein and caloric supply, prealbumin level and nitrogen balance observed in the second stage of the study, the patients lost muscle mass and entered into a malnutrition process, probably due to intense protein catabolism and the poor response to nutrition supply that occurs in metabolic stress.
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Estado Terminal/terapia , Avaliação Nutricional , Apoio Nutricional , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Metabolismo , Estado Nutricional , Estudos ProspectivosRESUMO
CONTEXT: A high number of hospitalized children do not receive adequate sedation due to inadequate evaluation and use of such agents. With the increase in knowledge of sedation and analgesia in recent years, concern has also risen, such that it is now not acceptable that incorrect evaluations of the state of children's pain and anxiety are made. OBJECTIVE: A comparison between the Comfort and Hartwig sedation scales in pediatric patients undergoing mechanical lung ventilation. DESIGN: Prospective cohort study. SETTING: A pediatric intensive care unit with three beds at an urban teaching hospital. PATIENTS: Thirty simultaneous and independent observations were conducted by specialists on 18 patients studied. DIAGNOSTIC TEST: Comfort and Hartwig scales were applied, after 3 minutes of observation. MAIN MEASUREMENTS: Agreement rate (kappa). RESULTS: On the Comfort scale, the averages for adequately sedated, insufficiently sedated, and over-sedated were 20.28 (SD 2.78), 27.5 (SD 0.70), and 15.1 (SD 1.10), respectively, whereas on the Hartwig scale, the averages for adequately sedated, insufficiently sedated, and over-sedated were 16.35 (SD 0.77), 20.85 (SD 1.57), and 13.0 (SD 0.89), respectively. The observed agreement rate was 63% (p = 0.006) and the expected agreement rate was 44% with a Kappa coefficient of 0.345238 (z = 2.49). CONCLUSIONS: In our study there was no statistically significant difference whether the more complex Comfort scale was applied (8 physiological and behavioral parameters) or the less complex Hartwig scale (5 behavioral parameters) was applied to assess the sedation of mechanically ventilated pediatric patients.
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Sedação Consciente/métodos , Respiração Artificial , Pré-Escolar , Estudos de Coortes , Cuidados Críticos , Humanos , Lactente , Recém-Nascido , Medição da Dor , Estudos ProspectivosRESUMO
Five patients with ages ranging from 6 months to 3 years were analyzed. All received inhaled nitric oxide (NO--20 parts per million (ppm)) and oxygen (O2--at a concentration of 90-95%) by means of an oxygen hood. Mean Pulmonary Artery Pressure (MPAP), Mean Aortic Pressure (MAoP), Pulmonary Vascular Resistance (PVR) and Systemic Vascular Resistance (SVR) were measured and the calculation of their relationship to pulmonary/systemic flow (Qp/Qs) was performed by the catheterization of the femoral artery vein. Three patients presented reduction in PVR and increase in Qp/Qs. There were no systemic alterations or any side effect from using NO.
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Cardiopatias Congênitas/tratamento farmacológico , Hipertensão Pulmonar/tratamento farmacológico , Óxido Nítrico/uso terapêutico , Administração por Inalação , Pré-Escolar , Cardiopatias Congênitas/complicações , Humanos , Hipertensão Pulmonar/complicações , Lactente , Exposição por Inalação , Óxido Nítrico/farmacologia , Oxigênio/farmacologia , Artéria Pulmonar/efeitos dos fármacos , Resistência Vascular/efeitos dos fármacosRESUMO
OBJECTIVES: To evaluate patterns of usage and monitoring of nutritional support in a Pediatric ICU of a teaching hospital and the role of an education program in nutritional support given throughout the resident physician training. DESIGN: In a historical cohort study, records from children who received nutritional support during the year 1992 were analyzed. Thereafter a continuing education program in Nutritional Support was conveyed to the residents. In a second phase of the study, the same parameters were reevaluated in children who received nutritional support throughout the year 1995. SETTING: Pediatric Intensive Care Unit of Department of Pediatrics, Escola Paulista de Medicina. PATIENTS: All the children who were given nutritional support during a period of five days or more. Based on this criteria 37 children were selected for the first phase of this study, and 35 for the second one. INTERVENTION: The education program included theoretical lectures about basic themes of nutritional support and journal article reading sessions. It was given to successive groups of residents on a weekly schedule. MEASUREMENTS: Daily records of fluid, protein, caloric and micronutrient supply, nutritional assessment and metabolic monitoring. RESULTS: In the first phase of the study, an exclusively parenteral route was utilized for 80.5%, and a digestive route 19.5% of the time period. Nutritional assessment was performed on 3 children; no patient had the nutritional goals set. The nitrogen to nonprotein calories ratio and the vitamin supply were inadequate, whilst the supply of trace elements was adequate except for zinc. Nutritional monitoring was performed on almost all patients but without uniformity. In the second phase, the exclusive parenteral route was used for 69.7% and the digestive route for 30.3% of the time period; no significant increase in the use of the digestive route was detected. The nonprotein calories to nitrogen ratio and micronutrient supply were adequate. The frequency of nutritional assessment increased, but deficiency in nutritional monitoring and infrequent enteral feeding were still detected. CONCLUSION: There were deficiencies in the implementation of nutritional support, which were partially corrected in the second phase of the study by the training of the residents. Reinforcement of the education program, which should be applied to the whole medical staff, and the organization of a multidisciplinary team in charge of coordinating the provision of nutritional support are suggested.
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Educação Continuada , Unidades de Terapia Intensiva Pediátrica , Apoio Nutricional/normas , Criança , Estudos de Coortes , Nutrição Enteral , Humanos , Corpo Clínico Hospitalar/educação , Avaliação Nutricional , Distúrbios Nutricionais/terapia , Ciências da Nutrição/educaçãoAssuntos
Transtorno Depressivo Maior/terapia , Transtorno Depressivo/terapia , Eletroconvulsoterapia/métodos , Antidepressivos/uso terapêutico , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Resistência a Medicamentos , Humanos , Resultado do TratamentoRESUMO
Deletion of chromosome 22q11 concerns nearly 1/5.000 births, and is the most frequent interstitial microdeletion. The deletion generates various phenotypes which were initially regarded as distinct syndromes. 1) Di George syndrome was described in 1962 by immunologists, and associates thymic and parathyroid hypoplasia, cardiac malformation, and dysmorphic face; the prognosis is severe, as Di George syndrome is a life-threatening condition. 2) The velocardiofacial syndrome was described in 1978 by stomatologists, and associates palate abnormalities, cardiac malformations, dysmorphic faces, and learning disabilities. 3) The Takao syndrome was described in the late seventies by cardiologists as a clinical condition associating cardiac abnormalities and dysmorphic faces. During the nineties, a common molecular etiology was identified, and a new name proposed: CATCH 22, an acronyme for Cardiac abnormalities, Abnormal face, Thymic hypoplasia, Cleft palate, Hypocalcemia, deleted chromosome 22. Furthermore, new phenotypes have been recently recognized, most of them belonging to the psychiatric spectrum. Descriptive studies of large samples of children with 22q11 deletion, conducted, both in the United States and european countries, have shown the following pattern of associated symptoms:--abnormal face (100%), which expression varies with age, and can be discrete;--cardiac abnormalities (84%), including cardiac malformations of conotroncal types;--mouth abnormalities (49%), including cleft palate (14%), and velar dysfunction (20%);--urinary tract abnormalities (36%), including ureteric reflux, lung dysplasia;--transitory hypocalcemia (60%) mostly during infancy, and due to transitory hypoparathyroid dysfunction;--seizures (21%), which are usually a consequence of hypocalcemia;--immunodeficiency (1%), which worsens the prognosis. Deletion of chromosome 22q11 has been also associated with various psychiatric phenotypes, which can be classified into two groups, developmental abnormalities and psychiatric conditions. The great majority of patients with the deletion exhibit impairment of language and motor development, mild mental retardation, persistent coordination deficits, and poor academic performance. The deletion of chromosome 22q11 is also associated with high frequency of behavioral disorder with attention deficit during childhood, and with high frequency of psychotic disorder (bipolar disorder, and schizophrenia) during adolescence and young adulthood. The link between the 22q11 deletion and schizophrenia has been also supported by recent studies showing that the rate of 22q11 deletion in adults with schizophrenia (2%) is higher than it is in the general population. The rate may even be higher (6%) in subjects with childhood onset schizophrenia. The present work reviews the psychiatric literature associated with 22q11 deletion. We also report a case of 22q11 deletion in a 17-year-old girl that was initially diagnosed as paranoid schizophrenia. We will discuss the diagnostic, prognostic, and therapeutic consequences that such a genetic diagnosis implies. In the case reported here, transitory hypocalcemia induced: 1) dystonic symptoms that was believed to be catatonic symptoms or neuroleptic secondary effects, by clinicians; 2) a poor response to neuroleptic medication.
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Deleção Cromossômica , Cromossomos Humanos Par 22 , Esquizofrenia/genética , Adolescente , Adulto , Mapeamento Cromossômico , Anormalidades Craniofaciais/diagnóstico , Anormalidades Craniofaciais/genética , Feminino , Humanos , Transtornos do Desenvolvimento da Linguagem/diagnóstico , Transtornos do Desenvolvimento da Linguagem/genética , Esquizofrenia/diagnóstico , SíndromeRESUMO
OBJECTIVE - A prospective, nonrandomized clinical study to assess splanchnic perfusion based on intramucosal pH in the postoperative period of cardiac surgery and to check the evolution of patients during hospitalization. METHODS - We studied 10 children, during the immediate postoperative period after elective cardiac surgery. Sequential intramucosal pH measurements were taken, without dobutamine (T0) and with 5mcg/kg/min (T1) and 10 (T2) mcg/kg/min. In the pediatric intensive care unit, intramucosal pH measurements were made on admission and 4, 8, 12, and 24 hours thereafter. RESULTS - The patients had an increase in intramucosal pH values with dobutamine 10mcg/kg/min [7.19+/- 0.09 (T0), 7.16+/-0.13(T1), and 7.32+/-0.16(T2)], (p=0.103). During the hospitalization period, the intramucosal pH values were the following: 7.20+/-0.13 (upon admission), 7.27+/-0.16 (after 4 hours), 7.26+/-0.07 (after 8 hours), 7.32+/-0.12 (after 12 hours), and 7.38+/-0.08 (after 24 hours), (p=0.045). No deaths occurred, and none of the patients developed multiple organ and systems dysfunction. CONCLUSION - An increase in and normalization of intramucosal pH was observed after dobutamine use. Measurement of intramucosal pH is a type of monitoring that is easy to perform and free of complications in children during the postoperative period of cardiac surgery.
Assuntos
Cardiotônicos/farmacologia , Dobutamina/farmacologia , Cardiopatias Congênitas/cirurgia , Circulação Esplâncnica/efeitos dos fármacos , Criança , Pré-Escolar , Mucosa Gástrica , Humanos , Concentração de Íons de Hidrogênio , Lactente , Manometria , Período Pós-Operatório , Estudos ProspectivosRESUMO
The Acute Respiratory Distress Syndrome (ARDS) is a pulmonary lesion of multifactorial cause in which the surfactant system is altered owing to inactivation and impairment of composition and metabolism. The use of exogenous pulmonary surfactant is a therapeutic option with the objective to maintain alveolar stability thus improving the pulmonary compliance (increasing the residual functional capacity), oxygenation and ventilatory mechanics. A study carried out on two pediatric patients with ARDS submitted to mechanic pulmonary ventilation, applying a single dose of exogenous pulmonary surfactant is described. The patients were evaluated using arterial and venous gasometry before and after the use of surfactant, observing increment in oxygenation, reduction of shunt fraction, improvement in ventilation immediately after exogenous pulmonary surfactant instillation and return to the previous situation after 240 minutes in case 1 and 120 minutes in case 2. More prospective clinical and randomized studies are needed to effectively evaluate this therapeutic modality.
Assuntos
Surfactantes Pulmonares/farmacologia , Ventilação Pulmonar/efeitos dos fármacos , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico , Doença Aguda , Gasometria , Humanos , Lactente , Recém-Nascido , Surfactantes Pulmonares/uso terapêutico , Respiração ArtificialRESUMO
OBJECTIVE: Comparison of three modes of MV: intermittent mandatory ventilation with positive end expiratory pressure (IMV + PEEP), APRV and continuous positive airway pressure (CPAP) in children during cardiac surgery post operative with pulmonary hypertension and mild or moderate pulmonary lesion. METHODS: Ten patients were studied with respiratory monitoring (Bear Neonatal Volume Monitor-1) in MV with a continuous flow, time cycled and pressure limited ventilator. The cardiocirculatory variables analyzed were central venous pressure (CVP), oxygen extraction ratio, cardiac rate, systolic arterial pressure, and arterial-mixed venous CO2 difference. Friedman's test (nonparametric) was used to compare the variables in three modalities of ventilation and the Wilcoxon test was used for the variables obtained in two of the modalities. RESULTS: The mean airway pressure (MAP) showed a significant increasing during APRV compared to IMV + PEEP (p = 0.012). The positive inspiratory pressure (PIP), the minute volume and the ratio of oxygen arterial pressure to oxygen inspired fraction (PaO2/FiO2) didn't show statistical difference. During APRV there was a significant decrease in respiratory rate (p = 0.004) and an increase in tidal volume (p = 0.045) when compared to CPAP and IMV + PEEP. In the cardiocirculatory system only CVP showed a significant increased (p = 0.019) during APRV. CONCLUSION: Due to the methodology utilized MAP was higher with APRV resulting in an increased tidal volume without respiratory or cardiocirculatory adverse effects when the three modes were compared. Our results suggest that APRV is a simple and safe method of ventilation.
Assuntos
Cardiopatias Congênitas/cirurgia , Hipertensão Pulmonar/terapia , Respiração Artificial/métodos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Ventilação com Pressão Positiva Intermitente/métodos , Masculino , Respiração com Pressão Positiva/métodos , Período Pós-Operatório , Estudos ProspectivosRESUMO
UNLABELLED: Nutritional support has been considered an important part of the treatment of critically ill patients. The information about the current clinical pattern of nutrition support in hospitals may provide a basis for future modification and improvement of its prescription and use. OBJECTIVES: 1) To evaluate patterns of usage and monitoring of nutritional support in critically ill children; 2) To recommend policies aiming at the improvement of the nutritional support quality. PATIENTS AND METHOD: Records of 37 patients receiving nutritional support throughout one year were reviewed. RESULTS: From a total of 425 days of therapy, the single parenteral route was utilized in 80.50% the digestive route (tube feeding or oral route) in 19.5% of this time. A previous nutritional assessment was performed in 3 children; no patient had the nutrition goals set. The nitrogen to nonprotein calories ratio ranged between 1:80 and 1:250. Only 29.7% of the patients had their estimated caloric needs supplied and this goal was achieved only in those patients who were on enteral tube feeding. Patients did not achieved their goals for vitamins. The supply of oligoelements was adequate except zinc. Nutritional monitoring parameters including weight, serum albumin and serum triglycerides were performed in almost all the patients but without uniformity. CONCLUSION: There was a lack in the implementation of nutritional support. Inadequacy of protein and micronutrients supply, irregular nutritional monitoring and infrequent enteral feeding were detected. A minimal standard for nutritional and metabolic monitoring and the organization of a multidisciplinary team in charge of coordinating the providing of nutritional support are suggested.