RESUMO
The overarching goals of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) are to enable European citizens to lead healthy, active and independent lives whilst ageing. The EIP on AHA includes 74 Reference Sites. The aim of this study was to transfer innovation from an app developed by the MACVIA-France EIP on AHA reference site (Allergy Diary) to other reference sites. The phenotypic characteristics of rhinitis and asthma multimorbidity in adults and the elderly will be compared using validated information and communication technology (ICT) tools (i.e. the Allergy Diary and CARAT: Control of Allergic Rhinitis and Asthma Test) in 22 Reference Sites or regions across Europe. This will improve the understanding, assessment of burden, diagnosis and management of rhinitis in the elderly by comparison with an adult population. Specific objectives will be: (i) to assess the percentage of adults and elderly who are able to use the Allergy Diary, (ii) to study the phenotypic characteristics and treatment over a 1-year period of rhinitis and asthma multimorbidity at baseline (cross-sectional study) and (iii) to follow-up using visual analogue scale (VAS). This part of the study may provide some insight into the differences between the elderly and adults in terms of response to treatment and practice. Finally (iv) work productivity will be examined in adults.
Assuntos
Asma/epidemiologia , Rinite Alérgica/epidemiologia , Fatores Etários , Idoso , Tomada de Decisão Clínica , Comorbidade , Avaliação Geriátrica , Humanos , Avaliação de Resultados em Cuidados de Saúde , Vigilância da PopulaçãoRESUMO
The use of neuromuscular blockers (NMB) is a frequent practice in Intensive Care Units. However most of the experience with the use of these agents come from the operating room used to deal with patients with different characteristics from those admitted in the ICU. Recent advances on neuromonitoring and the commercialization of newer agents make necessary the update in the management of NMB in the ICU. The NMB agent should be chosen attending to its pharmacokinetics and the physiopathology of the critically ill patient. Those NMB with organ-independent metabolism as well as those with rapid onset of action are the preferred ones for the use in the critically ill patient substituting older depolarizing agents and those whose metabolism is dependent on the liver and/or kidney, organs frequently impaired in the critically ill patients. Neuromuscular blocking in the critically ill patient should be done according to protocols and monitor its effects in order to avoid complications related to its prolonged use.
Assuntos
Estado Terminal , Monitorização Fisiológica , Bloqueadores Neuromusculares/administração & dosagem , Algoritmos , Humanos , Unidades de Terapia Intensiva , Consumo de OxigênioRESUMO
A cross-sectional study of soil-transmitted helminthiases in the Northern Bolivian Altiplano was carried out over the 6-year period 1992-97. Prevalences, intensities and associations were analysed from coprological results obtained in 31 surveys (28 in schools and 3 in individuals of all age-groups) performed in 24 Aymara communities located between the city of La Paz and Lake Titicaca, at an altitude of 3800-4200 m. Ascaris lumbricoides and Trichuris trichiura were detected, with local prevalences in the range 1.2-28.0% and 0.0-24.0%, respectively. Significant differences in prevalence rates of trichuriasis were detected, with highest prevalences in male schoolchildren and in subjects aged > 40 years. The global intensity ranged from 24 to 86,544 eggs per gram of faeces (epg) and from 24 to 4560 epg for ascariasis and trichuriasis, respectively. Higher intensities were noted in girls. A. lumbricoides egg counts were statistically significantly higher in the 5-8-years age-group. A positive association between A. lumbricoides and T. trichiura infections was detected. The proportion of heavy infections for A. lumbricoides was 0.1% and 1.0% in the school and community surveys, respectively. No heavy infection for T. trichiura was detected. The very high altitude and its severe environmental conditions may determine the relatively low prevalences and intensities in this area.
Assuntos
Altitude , Helmintíase/transmissão , Solo/parasitologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Bolívia/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Helmintíase/epidemiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por SexoRESUMO
Over a 6-year period, an epidemiological study of human infection by Fasciola hepatica in the Northern Bolivian Altiplano was carried out. Prevalences and intensities were analysed from coprological results obtained in 31 surveys performed in 24 localities and proved to be the highest known so far. The global prevalence was 15.4%, with local prevalences ranging from 0% to 68.2%. Significant differences between prevalence rates were detected and the highest prevalences were in subjects aged < 20 years. However, prevalences showed no gender difference. The global intensity (eggs per gram of faeces, epg) ranged from 24 to 5064 epg and showed arithmetic and geometric means respectively of 446 and 191 epg, with highest local arithmetic and geometric means of 1345 and 678 epg. Significant differences in mean egg output were detected between localities. The significantly higher F. hepatica egg counts shown by girls in school surveys is worth mentioning. Although the distributions of intensities according to age-groups did not show any significant difference, a decrease of egg output counts with an increase of age was detected. It is concluded that fascioliasis is a very important human health problem in this region.
Assuntos
Fasciolíase/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Animais , Bolívia/epidemiologia , Criança , Pré-Escolar , Fasciola hepatica/isolamento & purificação , Fezes/parasitologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Contagem de Ovos de Parasitas , PrevalênciaRESUMO
The worldwide importance of human infection by Fasciola hepatica has been recognized in recent years. The endemic region between Lake Titicaca and the valley of La Paz, Bolivia, at 3800-4100 m altitude, presents the highest prevalences and intensities recorded. Large geographical studies involving Lymnaea truncatula snails (malacological, physico-chemical, and botanic studies of 59, 28 and 30 water bodies, respectively, inhabited by lymnaeids; environmental mean temperature studies covering a 40-year period), livestock (5491 cattle) and human coprological surveys (2723 subjects, 2521 of whom were school children) were conducted during 1991-97 to establish the boundaries and distributional characteristics of this endemic Northern Altiplano region. The endemic area covers part of the Los Andes, Ingavi, Omasuyos and Murillo provinces of the La Paz Department. The human endemic zone is stable, isolated and apparently fixed in its present outline, the boundaries being marked by geographical, climatic and soil-water chemical characteristics. The parasite distribution is irregular in the endemic area, the transmission foci being patchily distributed and linked to the presence of appropriate water bodies. Prevalences in school children are related to snail population distribution and extent. Altiplanic lymnaeids mainly inhabit permanent water bodies, which enables parasite transmission during the whole year. A confluence of several factors mitigates the negative effects of the high altitude.
Assuntos
Doenças Endêmicas , Fasciola hepatica/isolamento & purificação , Fasciolíase/epidemiologia , Adolescente , Altitude , Animais , Bolívia/epidemiologia , Bovinos , Criança , Métodos Epidemiológicos , Fasciolíase/transmissão , Fezes/parasitologia , Humanos , Lymnaea/parasitologia , Prevalência , OvinosRESUMO
BACKGROUND: Reimplantation disease (RD) is a postoperative complication in lung transplantation. It is defined as hypoxemia (PaO2/FiO2 ratio < 150 mmHg), radiologic infiltrates and decrease of lung compliance. The aim of the study was to analyze the incidence, predictive factors, prognosis and outcome of the patients with RD. PATIENTS AND METHOD: 49 patients submitted to lung transplantation (June 1991-December 1996) were admitted in our intensive care unit (ICU). Donor and recipient conditions, surgical parameters and outcome in ICU were analyzed. Mann-Whitney, Kruskall-Wallis, Fisher, Pearson and ANOVA-Friedman tests were used for statistical analysis according to the different variables. RESULTS: 49% of the patients (29/49) developed RD, which was influenced neither by lung disease, nor by the kind of transplantation or by ischemia time. All patients with a long surgical time developed RD, versus only 41% in those where surgery was undertaken in a shorter period of time, OR: 2.8 (1.5-5.7; p = 0.0016). The patients with RD improved showing a PaO2/FiO2 ratio of 176 and 235 mmHg at 24 and 48 h respectively (ANOVA, p < 0.00001). The patients with RD needed 14 days of mechanical ventilation versus 7 days in those without RD (p = 0.013). There were no statistically significant differences in stay and mortality in ICU. CONCLUSIONS: RD is a common complication in the postoperative phase of lung transplantation. It is present in almost all the patients with long surgical time. Almost all of them improve, with the same survival but a longer period of mechanical ventilation.
Assuntos
Transplante de Pulmão , Complicações Pós-Operatórias , APACHE , Adulto , Análise de Variância , Estudos de Coortes , Interpretação Estatística de Dados , Feminino , Humanos , Hipóxia/diagnóstico , Hipóxia/etiologia , Complacência Pulmonar , Transplante de Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Prognóstico , Radiografia Torácica , Reimplante , Respiração Artificial , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
We have developed an ELISA for the diagnosis of human fascioliasis based on the detection of IgG4 antibodies to Fasciola hepatica cathepsin LI cysteine protease. Use of this assay in the Bolivian Altiplano, a region with a high prevalence of the disease, was hampered by the reluctance of the indigenous population to provide blood. To overcome this problem, we have investigated the method of collecting small quantities of blood from the finger onto filter paper, followed by the elution of antibodies for use in the diagnostic assay. Serum samples and blood samples collected onto filter paper were obtained from 57 individuals living in the village of Cutusuma in 1987 and from 11 individuals in Chijipata in 1996. Analysis of the IgG4-ELISA results revealed that there is highly significant linear relationship (P < 0.001) between the two methods of sampling. Most importantly, a reliable diagnosis was made with the blood-filter samples from Cutusuma, which had been stored for 10 years at 40 degrees C. While some deterioration of the blood-filter samples from Cutusuma had occurred over the 10-year storage period, no deterioration occurred with the Chijipata samples, which were stored for one year. Therefore, the method of collecting blood onto filter paper should prove useful for large-scale epidemiologic studies on human fascioliasis in the Bolivian Altiplano and in other regions where this disease is prevalent.
Assuntos
Anticorpos Anti-Helmínticos/sangue , Catepsinas/imunologia , Cisteína Endopeptidases/imunologia , Endopeptidases , Fasciola hepatica/imunologia , Fasciolíase/diagnóstico , Animais , Catepsina L , Ensaio de Imunoadsorção Enzimática , Fasciola hepatica/enzimologia , Humanos , Imunoglobulina G/sangueRESUMO
Our laboratory recently developed a diagnostic test (ELISA) for human fascioliasis based on the detection of serum IgG4 antibodies reactive with Fasciola hepatica cathepsin L1 (CL1). In the present study, we have used recombinant CL1, generated by functional expression of the cDNA in Saccharomyces cerevisiae, in this immunodiagnostic test and compared its performance with native CL1. Sera obtained from 64 individuals living in Cutusuma village in the northern Altiplano of Bolivia, a region with a high prevalence of human fascioliasis, were analyzed by the IgG4-ELISA. A highly statistically significant correlation (r2 = 0.751, P < 0.001) was demonstrated between the absorbances obtained using the recombinant and native proteins. These assays showed that 38 (59%) of the individuals tested were seropositive for fascioliasis, whereas only 26 of them were coprologically positive for F. hepatica eggs. All seronegative patients were also coprologically negative. Serum from individuals infected with schistosomiasis mansoni, cysticercosis, hydatidosis, and Chagas disease did not contain antibodies reactive with the recombinant or native CL1. Therefore, recombinant CL1 shows excellent potential for the development of the first standardized assay for the sensitive and specific diagnosis of human fascioliasis. Finally, our data supports earlier reports on the high prevalence of human fascioliasis in the Bolivian Altiplano, which collectively suggest that the disease has been endemic there for more than a decade.
Assuntos
Anticorpos Anti-Helmínticos/sangue , Catepsinas/imunologia , Cisteína Endopeptidases/imunologia , Endopeptidases , Fasciola hepatica/imunologia , Fasciolíase/diagnóstico , Adolescente , Adulto , Idoso , Animais , Antígenos de Helmintos/imunologia , Catepsina L , Catepsinas/genética , Criança , Cisteína Endopeptidases/genética , Ensaio de Imunoadsorção Enzimática/métodos , Fasciola hepatica/enzimologia , Fasciola hepatica/genética , Humanos , Imunoglobulina G/sangue , Pessoa de Meia-Idade , Proteínas Recombinantes/imunologia , Sensibilidade e EspecificidadeRESUMO
Human infection with Fasciola hepatica has recently been recognized as an important health problem worldwide, and particularly at very high altitudes in South America. The highest prevalences and intensities of human fascioliasis known are those of the northern Bolivian Altiplano, where infected Lymnaea truncatula occur at altitudes of 3800-4100 m. In the present study, the climatic data for this area of the Altiplano, which differ markedly from those of endemic areas in the lowlands, were analysed. There is no marked seasonality in temperature but there are large variations in temperature within a daily, 24-h period. Rainfall is seasonal, with a long dry season, coinciding with the lowest minimum temperatures, and a long wet season. The rate of evapotranspiration is very high, and temporary water bodies dry out very quickly. Solar radiation at ground level is intense, not only because of the altitude but also because of the lack of trees and shrubs. Two climatic indices for forecasting fascioliasis, Mt and Wb-bs, were calculated. Modifications in these forecast indices are proposed, to reflect the environment at high altitude and low latitude. Estimates, based on climadiagrammes, of the durations of the wet and dry seasons were greatly effected by the inclusion of an aridity-index modification. The usefulness of the modified indices was examined using prevalence data for human and cattle fascioliasis collected in the neighbourhoods of the stations providing the meteorological data. Values for both indices indicated that conditions were optimum for transmission between December and March. The results were statistically significant for the modified Wb-bs index when the data for a meteorological station in which no lymnaeids were found were excluded. The modified Mt index did not appear sufficiently accurate to be useful. The values for the modified Wb-bs index permitted the study areas to be designated low-, moderate- or high-risk areas for the transmission of fascioliasis to man and domestic animals.
Assuntos
Altitude , Clima , Fasciolíase/epidemiologia , Previsões , Animais , Bolívia/epidemiologia , Bovinos , Doenças dos Bovinos/epidemiologia , Ritmo Circadiano , Vetores de Doenças , Humanos , Umidade , Incidência , Lymnaea , Prevalência , Chuva , TemperaturaRESUMO
Some studies have suggested that nitric oxide (NO) may cause platelet dysfunction. We present an ARDS patient who need this treatment, with a transient alteration of platelet function and a significant prolongation of bleeding time.
Assuntos
Broncodilatadores/efeitos adversos , Hemostasia/efeitos dos fármacos , Óxido Nítrico/efeitos adversos , Síndrome do Desconforto Respiratório/tratamento farmacológico , Doença Aguda , Administração por Inalação , Tempo de Sangramento , Evolução Fatal , Humanos , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Agregação Plaquetária/efeitos dos fármacos , Síndrome do Desconforto Respiratório/sangue , Fatores de TempoRESUMO
Cathepsin L1 (CL1), an immunogenic cysteine proteinase secreted by juvenile and adult Fasciola hepatica, was assessed for its potential as a diagnostic agent for the serologic detection of human fascioliasis. Using ELISAs, we compared the ability of liver fluke homogenates (LFH), excretory/secretory (ES) products, and CL1 to discriminate between seropositive (infected) and seronegative (noninfected) individuals within a population of 95 patients from the Bolivian Altiplano. A high prevalence of human fascioliasis has been reported in this region. The division between the seropositive and seronegative individuals was poorly defined when LFH was used as the antigen. A greater discrimination between these populations was achieved with both ES and CL1. A K-means cluster analysis using the combined ES and CL1 ELISA data identified a cluster of seropositive individuals. Cathepsin L1 detected a subset (20) of these seropositive individuals while ES detected all 26; however, ES detected nine additional individuals that were in the seronegative cluster. The ratio of the mean absorbance readings between seropositive and seronegative individuals was markedly improved by using conjugated second antibodies to IgG4, the predominant isotype elicited by infection. In these IgG4-ELISAs, CL1 again identified fewer individuals as seropositive than did ES, but improved the discrimination between the seropositive and seronegative individuals and thus provided a more conclusive diagnosis. Sera obtained from patients infected with schistosomiasis mansoni, cysticercosis, hydatidosis, and Chagas' disease were negative in these assays, which demonstrated the specificity of the IgG4-ELISA for detecting fascioliasis. Twenty of the 95 patients (21%) were seropositive for fascioliasis by the CL1 IgG4-ELISA, confirming the earlier reports of the high prevalence of disease in this region. A standardized diagnostic test for human fascioliasis, based on an ELISA that detects IgG4 responses to CL1, could be available to all diagnostic centers if sufficient quantities of recombinant CL1 can be produced.
Assuntos
Anticorpos Anti-Helmínticos/sangue , Catepsinas/imunologia , Cisteína Endopeptidases/imunologia , Endopeptidases , Fasciola hepatica/imunologia , Fasciolíase/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Anticorpos Anti-Helmínticos/imunologia , Antígenos de Helmintos/imunologia , Bolívia/epidemiologia , Catepsina L , Criança , Pré-Escolar , Análise por Conglomerados , Ensaio de Imunoadsorção Enzimática , Fasciola hepatica/enzimologia , Fasciola hepatica/isolamento & purificação , Fasciolíase/epidemiologia , Fasciolíase/imunologia , Fezes/parasitologia , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Sensibilidade e EspecificidadeRESUMO
The prevalence of Cryptosporidium infection was determined in four Aymara communities in the Bolivian Altiplano, between the city of La Paz and Lake Titicaca, at an altitude of 3,800-4,200 meters. Single stool specimens were randomly collected from 377 5-19-year-old students, all apparently asymptomatic. The total prevalence (31.6%) is possibly the highest reported among healthy humans (a maximum of 9.8% and 2.0% in coprologic surveys in underdeveloped and developed countries, respectively) and one of the highest even in symptomatic subjects. No significant age and sex differences were observed. Such an infection prevalence is probably related to the poor sanitation conditions, contaminated water supplies, overcrowding, and close contact with domestic animals. Continuous exposure to the parasite could be associated with protection against parasite-related symptoms in the children examined.
Assuntos
Criptosporidiose/epidemiologia , Adolescente , Adulto , Fatores Etários , Animais , Animais Domésticos/parasitologia , Bolívia/epidemiologia , Criança , Pré-Escolar , Fezes/parasitologia , Feminino , Humanos , Masculino , Prevalência , Saneamento , Fatores Sexuais , Abastecimento de ÁguaRESUMO
Balantidium coli infection was coprologically studied in 2,124 Aymara children 5-19 years of age from the schools of 22 communities of the northern Bolivian Altiplano over a five-year period. Infection with B. coli was found in 11 of the communities surveyed, with prevalences of 1.0-5.3% (overall prevalence=1.2%). The prevalences observed are some of the highest reported and did not differ significantly among the various age groups or between boys and girls. These prevalences, the apparent absence of symptoms or signs of illness due to this parasite in the schoolchildren surveyed at the time of stool sampling, and the consistency of stool samples of the infected students suggest that they are apparently asymptomatic carriers. Infection with B. coli must be considered as an endemic anthropozoonosis in the area studied. A relationship between B. coli infection and Altiplanic pigs is suggested.
Assuntos
Balantidíase/epidemiologia , Adolescente , Adulto , Animais , Bolívia/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Prevalência , Suínos/parasitologiaRESUMO
The community of Chijipata Alta, at an altitude of 3850 m, near the southern coast of Lake Titicaca in the northern Altiplano of Bolivia, was surveyed for human fascioliasis. The global prevalence (66.7%) and intensity (eggs per gram of faeces--epg: range: 24-4440; arithmetic mean: 1001; geometric mean: 390) proved to be the highest known in the world by means of coprological techniques. These results suggest the existence of highly hyperendemic subzones among the large human fascioliasis-endemic zone of the Bolivian northern Altiplano. Despite the decrease in prevalence and intensity from children (75.0%, 24-4440 epg) to adults (41.7%, 144-864 epg), our findings show that in an hyperendemic zone adult subjects either maintain the parasites acquired when young or are newly infected as the consequence of inhabiting a zone of high infection risk.
Assuntos
Reservatórios de Doenças , Fasciola/isolamento & purificação , Fasciolíase/parasitologia , Fezes/parasitologia , Contagem de Ovos de Parasitas , Adolescente , Adulto , Distribuição por Idade , Idoso , Animais , Bolívia/epidemiologia , Criança , Pré-Escolar , Reservatórios de Doenças/estatística & dados numéricos , Fasciolíase/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PrevalênciaRESUMO
Coprological studies of school children from four communities in the Northern Bolivian Altiplano were carried out in order to estimate the prevalences and intensities of Fasciola hepatica infection. Single stool specimens were collected at random from 558 school children (308 boys and 250 girls) aged 5-19 years old. Nineteen different parasite species (13 protozoan and six helminths) were detected. Of the children examined, 98.7% (96.5-100%) presented infection with at least one parasite species. The mean prevalence of 27.6% by Fasciola hepatica (range, 5.9-38.2%) was the highest not only with respect to the helminth species found in the Northern Bolivian Altiplano but also among the fasciolosis prevalences reported in children in other parts of the world to date. Prevalences were significantly different among the communities surveyed and was significantly higher in the 9-12 years age group. There were, however, no significant differences between sexes. Among the 154 children presenting F. hepatica eggs in stools, intensities ranged from 24-5064 eggs per gram of faeces (epg), with arithmetic and geometric means of 474 and 201 epg, respectively. Significant differences in mean egg output were detected between communities, sexes and age groups. Individual fasciolosis infections coexisting with other pathogenic parasite species (Entamoeba histolytica and/or E. dispar, Giardia intestinalis, Balantidium coli, Dientamoeba fragilis, Cryptosporidium sp., Hymenolepis nana, Taenia spp., Trichuris trichiura, Ascaris lumbricoides and Enterobius vermicularis) were detected. A significant positive association with F. hepatica was only found in the case of G. intestinalis. This coprological study not only verifies the existence of high prevalences of F. hepatica among humans in the Northern Bolivian Altiplano, but also demonstrates the need to expand the Southern boundaries of this high endemic zone to include the Southeastern region of Lake Titicaca.
Assuntos
Fasciolíase/epidemiologia , Adolescente , Animais , Bolívia/epidemiologia , Criança , Fasciola hepatica , Feminino , Humanos , Masculino , PrevalênciaRESUMO
A population genetic study using starch gel electrophoresis was performed on populations of several species of lymnaeid snails acting as intermediate hosts for Fasciola hepatica (Trematoda, Plathyhelminth). Lymnaea viatrix was collected in 16 sites from the Bolivian Northern Altiplano. L. cubensis were obtained in one site from Venezuela, one site from Guadeloupe, three sites from Cuba and one site from the Dominican Republic. L. truncatula were collected in one site from France, one from Portugal and one from Morocco. Multilocus enzyme electrophoresis (MEE) were determined for 282 snails at 18 loci. A complete monomorphism was encountered at each geographic site. However, among these 18 loci, 13 are polymorphic and low and high levels of genetic divergence were observed between samples. Two genotypic groups can be differentiated by their multilocus genotypes. The western genotypic group associates together samples from Venezuela, Guadeloupe, Cuba and Dominican Republic (L. cubensis) while samples from France, Portugal and Morocco (L. truncatula) belong to the eastern genotypic group. Surprisingly, the Northern Bolivian Altiplano populations (L. viatrix) do not present any genetic divergence with the Portuguese sample. Therefore, the Bolivian snails belong entirely to the eastern genetic group. Within each group slight genetic divergences were observed. These results strongly support the European origin of the lymnaeid snails from the Northern Bolivian Altiplano.
Assuntos
Reservatórios de Doenças/classificação , Genética Populacional , Lymnaea/classificação , Lymnaea/genética , Animais , Bolívia , Cuba , República Dominicana , Eletroforese em Gel de Poliacrilamida , Fasciolíase/epidemiologia , França , Guadalupe , Humanos , Lymnaea/parasitologia , Marrocos , Filogenia , Polimorfismo Genético , Portugal , VenezuelaRESUMO
The clinical picture, treatment and evolution of seven patients presenting snake bites are analyzed. Local symptoms were constant, with a spontaneous favorable evolution in 7 to 10 days. The most relevant systemic manifestations were coagulation anomalies which appeared in two patients. Treatment always included local wound care, antitetanicum antibiotic and anticoagulant prophylaxis with specific antiophidic serum in five patients.
Assuntos
Mordeduras de Serpentes/fisiopatologia , Mordeduras de Serpentes/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , EspanhaRESUMO
61 patients with postoperative enterocutaneous fistulas of the small intestine, were admitted to the Intensive Care Unit from 1983 to 1989 and divided in two groups. Group A (n = 46) was treated with Total Parenteral Nutrition (TPN), while B (n = 15) received a combination of TPN and Somatostatin. The reduction of fistula output was significantly greater in group B. Spontaneous closure was observed in 30.4% of the cases in group A and in 53.3% in group B. A significant difference in the time taken to close the fistula between group A and B (29.7 +/- 18 versus 11.1 +/- 1.6 days) was observed.