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1.
Braz J Otorhinolaryngol ; 90(3): 101401, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38428330

RESUMO

OBJECTIVES: To make recommendations on the diagnosis and treatment of post-extubation laryngitis (PEL) in children with or without other comorbidities. METHODS: A three-iterative modified Delphi method was applied. Specialists were recruited representing pediatric otolaryngologists, pediatric and neonatal intensivists. Questions and statements approached topics encompassing definition, diagnosis, endoscopic airway evaluation, risk factors, comorbidities, management, and follow-up. A consensus was defined as a supermajority >70%. RESULTS: Stridor was considered the most frequent symptom and airway endoscopy was recommended for definitive diagnosis. Gastroesophageal reflux and previous history of intubation were considered risk factors. Specific length of intubation did not achieve a consensus as a risk factor. Systemic corticosteroids should be part of the medical treatment and dexamethasone was the drug of choice. No consensus was achieved regarding dosage of corticosteroids, although endoscopic findings help defining dosage and length of treatment. Non-invasive ventilation, laryngeal rest, and use of comfort sedation scales were recommended. Indications for microlaryngoscopy and bronchoscopy under anesthesia were symptoms progression or failure to improve after the first 72-h of medical treatment post-extubation, after two failed extubations, and/or suspicion of severe lesions on flexible fiberoptic laryngoscopy. CONCLUSIONS: Management of post-extubation laryngitis is challenging and can be facilitated by a multidisciplinary approach. Airway endoscopy is mandatory and impacts decision-making, although there is no consensus regarding dosage and length of treatment.


Assuntos
Extubação , Laringite , Laringoscopia , Humanos , Laringite/etiologia , Laringite/diagnóstico , Laringite/tratamento farmacológico , Extubação/efeitos adversos , Criança , Técnica Delphi , Fatores de Risco
2.
Braz. j. otorhinolaryngol. (Impr.) ; 90(3): 101401, 2024. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1564171

RESUMO

Abstract Objectives To make recommendations on the diagnosis and treatment of post-extubation laryngitis (PEL) in children with or without other comorbidities. Methods A three-iterative modified Delphi method was applied. Specialists were recruited representing pediatric otolaryngologists, pediatric and neonatal intensivists. Questions and statements approached topics encompassing definition, diagnosis, endoscopic airway evaluation, risk factors, comorbidities, management, and follow-up. A consensus was defined as a supermajority >70%. Results Stridor was considered the most frequent symptom and airway endoscopy was recommended for definitive diagnosis. Gastroesophageal reflux and previous history of intubation were considered risk factors. Specific length of intubation did not achieve a consensus as a risk factor. Systemic corticosteroids should be part of the medical treatment and dexamethasone was the drug of choice. No consensus was achieved regarding dosage of corticosteroids, although endoscopic findings help defining dosage and length of treatment. Non-invasive ventilation, laryngeal rest, and use of comfort sedation scales were recommended. Indications for microlaryngoscopy and bronchoscopy under anesthesia were symptoms progression or failure to improve after the first 72-h of medical treatment post-extubation, after two failed extubations, and/or suspicion of severe lesions on flexible fiberoptic laryngoscopy. Conclusions Management of post-extubation laryngitis is challenging and can be facilitated by a multidisciplinary approach. Airway endoscopy is mandatory and impacts decision-making, although there is no consensus regarding dosage and length of treatment.

3.
Eur J Clin Microbiol Infect Dis ; 42(7): 873-882, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37160574

RESUMO

Acute respiratory infections (ARIs) are caused by a variety of microorganisms. Of all ARIs, 80% are caused by viruses such as human respiratory syncytial virus, metapneumovirus, influenza, parainfluenza, rhinovirus, and, more recently, Sars-CoV-2, which has been responsible for the COVID-19 pandemic. The objective of our study was to evaluate clinical data from a viral panel performed in children hospitalized with SARS or COVID-19 in the infirmary or ICU of 5 pediatric hospitals in the city of Goiânia, Goiás, Brazil. Demographic, clinical, and laboratory data were collected for analysis, and data on the outcomes underwent statistical treatment. A total of 128 patients were selected for the study, 54% of whom were male and 46% female. The viral panel included rhinovirus, COVID-19, metapneumovirus, adenovirus, and parainfluenza. Descriptive analyses of age profile showed differences in the involvement of particular viruses. The percentage of patients who required hospitalization in the ICU, infirmary, as well as individuals who were discharged after therapy or who died, were described. Our work shows that epidemiological surveillance measures are indispensable, especially if used in the continued analysis of viral panels in all pediatric patients with SARS.


Assuntos
COVID-19 , Metapneumovirus , Infecções por Paramyxoviridae , Infecções Respiratórias , Vírus , Criança , Humanos , Masculino , Feminino , Lactente , Pandemias , COVID-19/epidemiologia , SARS-CoV-2 , Infecções Respiratórias/epidemiologia , Infecções por Paramyxoviridae/epidemiologia , Rhinovirus
5.
Eur J Clin Microbiol Infect Dis ; 41(12): 1445-1449, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36287292

RESUMO

With the COVID-19 pandemic still ongoing, the annual season of influenza and other respiratory virus epidemics has arrived. Specimens from patients suspected of respiratory viruses infection were collected. Viral detection was performed following RNA extraction and real-time RT-PCR. During the study period, we received and tested a total of 606 specimens. Rhinovirus virus was the viral type most prevalent, detected in 186 (45.47%) specimens. The age range of patients positive for influenza A, influenza A (H1N1), and influenza B was 18 days to 13 years. With female prevalence for this viral type, cough and asthma were the main clinical manifestations presented by this viral type. Our results indicate that rhinoviruses, adenoviruses, metapneumoviruses, and influenza are among the most important agents of ARI in pediatrics. The epidemic period of respiratory infections observed in Goiânia can be useful for planning and implementing some prevention strategies.


Assuntos
COVID-19 , Vírus da Influenza A Subtipo H1N1 , Influenza Humana , Infecções Respiratórias , Vírus , Criança , Humanos , Feminino , Influenza Humana/epidemiologia , Vírus da Influenza A Subtipo H1N1/genética , Prevalência , Pandemias , Vírus/genética , Rhinovirus/genética
6.
Braz. j. otorhinolaryngol. (Impr.) ; 88(5): 803-811, Sept.-Oct. 2022. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1403939

RESUMO

Abstract Objectives To review the evidence pertaining to the association between cow's milk protein allergy and recurrent acute otitis media and otitis media with effusion. Methods The CENTRAL, Web of Science, EMBASE, MEDLINE, LILACS databases, and gray literature were searched. Results Four studies were included, identifying the prevalence rates: 0.2% of delayed speech due to chronic otitis media with effusion in 382 children with cow's milk protein allergy, 10.7% of cow's milk protein allergy in 242 children who underwent ENT procedures, 40% of cow's milk protein allergy in 25 children with recurrent otitis media with effusion and higher tendency to otitis media in children with cow's milk protein allergy of 186 children (1.5 + 0.6 vs. 0.4 + 0.1; p< 0.1). Conclusion Considering the characteristics and methodological variations of the identified studies, it is not possible to state that there is reliable evidence of an association between cow's milk protein allergy and otitis media.


Resumo Objetivo Revisar as evidências sobre a correlação entre alergia à proteína do leite de vaca e otite média aguda recorrente e otite média com efusão. Métodos As buscas foram feitas nas bases de dados Central, Web of Science, Embase, Medline, Lilacs e na literatura cinzenta. Resultados Quatro estudos foram incluídos, identificaram‐se as prevalências: 0,2% de fala atrasada devido a otite média com efusão crônica entre 382 crianças com alergia à proteína do leite de vaca, 10,7% de alergia à proteína do leite de vaca entre 242 crianças submetidas a procedimentos otorrinolaringológicos, 40% de alergia à proteína do leite de vaca entre 25 crianças com otite média com efusão recorrente e maior tendência à otite média em alérgicos à proteína do leite de vaca entre 186 crianças (1,5 + 0,6vs.0,4 + 0,1; p < 0,1). Conclusão Se considerarmos as características e variações metodológicas dos estudos identificados, não é possível afirmar a existência de evidência confiável sobre a correlação entre alergia à proteína do leite de vaca e otite média.

7.
Braz. j. otorhinolaryngol. (Impr.) ; 88(4): 497-504, July-Aug. 2022. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1394142

RESUMO

Abstract Introduction: Congenital laryngeal webs are rare, may be associated with other airway abnormalities and be one of many features of microdeletion 22q11. Meticulous evaluation is imperative when deciding which surgical technique to use. The choice of appropriate stenting may be decisive to avoid persistent anterior commissure synechia and poor voice results. Objective: To report outcomes for endoscopic and open surgical approaches in the treatment of congenital laryngeal webs and the challenges one may encounter while applying the current classification and deciding for the best treatment option. Methods: Retrospective review of medical and surgical charts for congenital laryngeal webs treated in two tertiary university centers. Results: Seven patients were included; following Cohen's classification there were: three type II webs, one of them with an atypical posterior synechia, two type III webs and two type IV webs. Six patients were submitted to laryngotracheal reconstruction and one was treated with an endoscopic approach. Description of precise glottic and subglottic involvement and tailored surgical options are presented. The LT mold® stent was used for long-term stenting that varied between 40 to 60 days. All patients were successfully decannulated with good voice quality and after follow-up of over one year, there were no complications associated with the surgeries. Conclusion: Congenital laryngeal webs should be suspected and thoroughly evaluated in the presence of neonatal dysphonia and early onset of laryngitis. Otolaryngologists must be familiar with associated lesions and genetic conditions that may be associated to congenital laryngeal webs. Congenital laryngeal webs may be successfully treated at an early age. The correct choice of surgical technique after meticulous evaluation of glottic and subglottic components of the web, presence of concomitant lesions and appropriate stenting, is imperative to avoid persistent scarring and poor voice quality.


Resumo Introdução: As membranas laríngeas congênitas são raras, podem estar associadas a outras anormalidades das vias aéreas e ser uma das muitas características da microdeleção 22q11. A avaliação cuidadosa é imprescindível na decisão de qual técnica cirúrgica deve ser usada. A escolha do stent apropriado pode ser decisiva para evitar sinéquia persistente da comissura anterior e maus resultados vocais. Objetivo: Relatar os resultados das abordagens cirúrgicas abertas e endoscópicas no tratamento das membranas laríngeas congênitas e os desafios que podem ser encontrados ao aplicar a classificação atual e decidir a melhor opção de tratamento. Método: Revisão retrospectiva de prontuários médicos e cirúrgicos de membranas laríngeas congênitas tratadas em dois centros universitários terciários. Resultados: Sete pacientes foram incluídos, de acordo com a classificação de Cohen: três membranas do tipo II, uma delas com sinéquia posterior atípica, duas membranas do tipo III e duas membranas do tipo IV. Seis pacientes foram submetidos à reconstrução laringotraqueal e um foi tratado por abordagem endoscópica. Descrição precisa do envolvimento glótico e subglótico e opções cirúrgicas personalizadas são apresentadas. O stent utilizado foi o LT mold® e o período variou entre 40 e 60 dias. Todos os pacientes foram decanulados com boa qualidade de voz e o seguimento foi superior a um ano, não houve complicações associadas às cirurgias. Conclusão: As membranas laríngeas congênitas devem ser suspeitadas e avaliadas minuciosamente na presença de disfonia neonatal e laringite de início precoce. Os otorrinolaringologistas devem estar familiarizados com lesões associadas e condições genéticas que podem estar associadas a membranas laríngeas congênitas. As membranas laríngeas congênitas são tratadas com sucesso em idades precoces. A escolha da técnica cirúrgica após avaliação meticulosa dos componentes glóticos e subglóticos da membrana, presença de lesões concomitantes e uso do stent adequado é imprescindível para evitar cicatrizes persistentes e má qualidade da voz.

8.
Braz. j. otorhinolaryngol. (Impr.) ; 88(3): 427-433, May-June 2022. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1384178

RESUMO

Abstract Introduction Children undergoing tonsillectomy have severe pain in the postoperative period. One of the pharmacological options for analgesia is opioids, such as morphine. However, the risks of adverse effects, such as increased recovery time from anesthesia and respiratory depression, can limit its use. Objectives To evaluate the use of intraoperative intravenous morphine to reduce immediate postoperative pain in children undergoing tonsillectomy. Methods In this double-blind randomized study, children aged 3-10 years were submitted to tonsillectomy, with or without adenoidectomy, and divided into two groups. Children in group M received 0.1 mg/kg of intravenous morphine during anesthetic induction, while those in the control group received conventional anesthesia without morphine. Postoperative pain perceptions were assessed at 30, 60, 120, 180 and 240 min after recovery from anesthesia, by the children themselves and also by their parents or guardians, using a facial pain scale. Results A total of 57 children were included, 30 in the group with morphine and 27 in the group without morphine. According to the children themselves, the postoperative pain was less at the evaluations performed at 30 min after awakening from anesthesia (p= 0.023), while according to their parents/guardians, the pain was less intense in the evaluations performed at 30 (p= 0.002), 60 (p= 0.006) and 180 min (p= 0.007) after awakening. Moreover, postoperative analgesics were less requested by children in the morphine group. No observed side effects were associated with the use of morphine. Conclusion A single dose of intravenous morphine during anesthetic induction reduced the intensity of immediate postoperative pain in children undergoing tonsillectomy, without increasing the time of awakening from anesthesia and with lower consumption of rescue analgesics.


Resumo Introdução Crianças submetidas a amigdalectomias apresentam dor intensa no pós-operatório. Uma das opções farmacológicas de analgesia são os opioides, como a morfina. No entanto, os riscos de efeitos adversos, como aumento do tempo de recuperação da anestesia e depressão respiratória, podem limitar o seu uso. Objetivos Avaliar o uso de morfina endovenosa intraoperatória na redução da dor pós-operatória imediata de crianças submetidas a amigdalectomia. Método Neste estudo cego randomizado, crianças de 3 a 10 anos foram submetidas a amigdalectomia, com ou sem adenoidectomia, e divididas em dois grupos. As crianças do grupo M receberam 0,1 mg.kg-1 de morfina endovenosa na indução anestésica, enquanto as do grupo controle receberam anestesia convencional sem morfina. As percepções de dor no pós-operatório foram avaliadas aos 30, 60, 120, 180 e 240 min após a recuperação da anestesia, pelas próprias crianças e também pelos seus pais ou responsáveis, com uma escala de dor pela face. Resultados Foram incluídas 57 crianças, 30 no grupo com morfina e 27 no grupo sem morfina. De acordo com as próprias crianças, a dor pós-operatória foi menor durante as avaliações feitas aos 30 minutos após o despertar da anestesia (p = 0,023), enquanto segundo seus pais/responsáveis a dor foi menos intensa nas avaliações feitas aos 30 (p = 0,002), 60 (p = 0,006) e 180 minutos (p = 0,007) após o despertar. Além disto, analgésicos no pós-operatório foram menos solicitados pelas crianças do grupo da morfina. Não foram observados efeitos colaterais associados ao uso da morfina. Conclusão Uma dose única de morfina endovenosa durante a indução anestésica reduziu a intensidade da dor pós-operatória imediata de crianças submetidas a amigdalectomia, sem aumento do tempo de despertar da anestesia e com menor consumo de analgésicos de resgate.

9.
Rev. med. (São Paulo) ; 101(2): e-188644, mar.-abr. 2022.
Artigo em Inglês, Português | LILACS-Express | LILACS | ID: biblio-1391498

RESUMO

Introdução: Atualmente, estamos enfrentando uma pandemia causada pela síndrome respiratória aguda grave coronavirus 2 (SARS-CoV-2) que é um vírus de RNA de uma única cadeia pertencente à família de coronavírus. O método mais utilizado para confirmar o diagnóstico da infecção pelo SARSCoV-2 é através de testes moleculares usando rRT-PCR (reações em cadeia de transcrição reversa em tempo real polimerase) para detectar o RNA viral. A maneira usual de colher amostras virais é através de cotonetes nasofaríngeos. Uma das formas efetivas de controlar a transmissão dessa doença é o diagnóstico precoce e isolamento dos pacientes infectados. Nesse relato abordaremos dois casos de complicações com swab nasal na coleta de rRT-PCR para COVID-19, atendidos em um pronto socorro de otorrinolaringologia. Relato de caso: O primeiro foi de uma paciente que teve a haste do cotonete quebrada em sua fossa nasal esquerda, necessitando de remoção do corpo estranho com por nasoendoscopia. Enquanto o segundo foi de uma paciente que apresentou epistaxe grave devido trauma do cotonete em esporão no septo nasal esquerdo, necessitando de abordagem em centro cirúrgico. Conclusão: É importante ressaltar que mesmo sujeito a complicações possivelmente graves, a realização de testes RT-PCR com cotonete nasal é o padrão ouro no diagnóstico de COVID-19. É muito importante advertir que o profissional treinado ao suspeitar de algum acidente durante o exame deve, precocemente, solicitar avaliação do especialista competente para abordagem adequada. [au]


Background: We are currently facing a pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is a single-stranded RNA virus belonging to the coronavirus family. The most widely used method to confirm the diagnosis of SARSCoV-2 infection is through molecular tests using rRT-PCR (real-time reverse transcription polymerase chain reaction) to detect viral RNA. The usual way to collect viral samples is through nasopharyngeal swabs. One of the effective ways to control the transmission of this disease is the early diagnosis and isolation of infected patients. In this report, we will approach two cases of complications with nasal swabs in the collection of rRT-PCR for COVID-19, treated in an otolaryngology emergency room. Case Report: The first was from a patient who had the swab rod broken in her left nasal cavity, requiring removal of the foreign body through nasoendoscopy. While the second was from a patient who had severe epistaxis due to trauma of the spur swab in the left nasal septum, requiring an approach in the surgery center. Conclusion: It is important to emphasize that, even subject to possibly serious complications, the performance of RT-PCR tests with a nasal swab is the gold standard in the diagnosis of COVID-19. It is very important to enhance that the trained professional, when suspecting an accident during the exam, should, early on, request an evaluation from the competent specialist for an adequate approach. [au]

10.
Braz. j. otorhinolaryngol. (Impr.) ; 87(6): 742-752, Nov.-Dec. 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1350345

RESUMO

Abstract Introduction: Allergic rhinitis is a chronic inflammatory disease of the nasal mucosa, mediated by immunoglobulin E, affecting 1 in 6 individuals. The treatment aims at attaining symptomatic control with minimal side effects, a requirement for new alternative therapies, including phototherapy, as it has an immunosuppressive and immunomodulatory effect. Objective: To identify the effectiveness of phototherapy in the treatment of allergic rhinitis through a meta-analysis. Methods: We searched Web of Science, Scielo, PubMed, SCOPUS, PEDro, and LILACS databases, using the terms: ''intranasal irradiation'', ''phototherapy'' and ''allergic rhinitis''. The R software Metafor package was used for the meta-analysis and the effect size was calculated for each symptom individually. Results: All symptoms decreased considerably after phototherapy: rhinorrhea (ES• = -1.35; p < 0.0001; I2 = 91.84%), sneezing (ES• = -1.24; p < 0.0001; I2 = 91.43%), nasal pruritus (ES• = -1.10; p < 0.0001; I2 = 91.43%); nasal obstruction (ES• = -1.11; p < 0.0001; I2 = 91.88%). The effects were more significant in perennial allergic rhinitis than in the seasonal type. Conclusion: Considering the effect size and the statistical significance attained in our study, rhinophototherapy showed to be an effective treatment for reducing the nasal symptom scores triggered by AR.


Resumo Introdução: A rinite alérgica é uma doença inflamatória crônica da mucosa nasal, imunomediada por imunoglobulina E, que afeta 1/6 dos indivíduos. O tratamento visa o controle dos sintomas com efeitos colaterais mínimos, uma prerrogativa para novas terapias alternativas, como a fototerapia, por apresentar efeitos imunossupressor e imunomodulador. Objetivo: Identificar, mediante uma metanálise, a eficácia da fototerapia no tratamento da rinite alérgica. Método: Usamos as bases de dados: Web of Science, Scielo, PubMed, SCOPUS, PEDro e LILACS, com os termos de busca: intranasal irradiation, phototherapy, allergic rhinitis. Para a metanálise foi usado o pacote metafor do software R, o tamanho do efeito foi calculado para cada sintoma separadamente. Resultados: Todos os sintomas apresentaram diminuição significante após a fototerapia: coriza (ES =-1,35; p < 0,0001; I2 = 91,84%), espirros (ES =-1,24; p < 0,0001; I2 = 91,43%), prurido nasal (ES =-1,10; p < 0,0001; I2 = 91,43%); obstrução nasal (ES =-1,11; p < 0,0001; I2 = 91,88%), com efeitos mais expressivos na rinite alérgica perene do que na rinite alérgica sazonal. Conclusão: Considerando-se a magnitude do efeito e a significância estatística alcançadas em nosso estudo, a rinofototerapia demonstrou-se um tratamento eficaz para a redução dos escores dos sintomas nasais desencadeados pela rinite alérgica.


Assuntos
Humanos , Obstrução Nasal , Rinite Alérgica Perene , Rinite Alérgica/terapia , Fototerapia , Mucosa Nasal
11.
Int Arch Otorhinolaryngol ; 25(1): e123-e128, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33542762

RESUMO

Introduction Adenotonsillectomy is the first-line treatment for obstructive sleep apnea secondary to adenotonsillar hypertrophy in children. The physical benefits of this surgery are well known as well as its impact on the quality of life (QoL), mainly according to short-term evaluations. However, the long-term effects of this surgery are still unclear. Objective To evaluate the long-term impact of adenotonsillectomy on the QoL of children with sleep-disordered breathing (SDB). Method This was a prospective non-controlled study. Children between 3 and 13 years of age with symptoms of SDB for whom adenotonsillectomy had been indicated were included. Children with comorbities were excluded. Quality of life was evaluated using the obstructive sleep apnea questionnaire (OSA-18), which was completed prior to, 10 days, 6 months, 12 months and, at least, 18 months after the procedure. For statistical analysis, p -values lower than 0.05 were defined as statistically significant. Results A total of 31 patients were enrolled in the study. The average age was 5.2 years, and 16 patients were male. The OSA-18 scores improved after the procedure in all domains, and this result was maintained until the last evaluation, done 22 ± 3 months after the procedure. Improvement in each domain was not superior to achieved in other domains. No correlation was found between tonsil or adenoid size and OSA-18 scores. Conclusion This is the largest prospective study that evaluated the long-term effects of the surgery on the QoL of children with SDB using the OSA-18. Our results show adenotonsillectomy has a positive impact in children's QoL.

12.
Int. arch. otorhinolaryngol. (Impr.) ; 25(1): 123-128, Jan.-Mar. 2021. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1154430

RESUMO

Abstract Introduction Adenotonsillectomy is the first-line treatment for obstructive sleep apnea secondary to adenotonsillar hypertrophy in children. The physical benefits of this surgery are well known as well as its impact on the quality of life (QoL), mainly according to short-term evaluations. However, the long-term effects of this surgery are still unclear. Objective To evaluate the long-term impact of adenotonsillectomy on the QoL of children with sleep-disordered breathing (SDB). Method This was a prospective non-controlled study. Children between 3 and 13 years of age with symptoms of SDB for whom adenotonsillectomy had been indicated were included. Children with comorbities were excluded. Quality of life was evaluated using the obstructive sleep apnea questionnaire (OSA-18), which was completed prior to, 10 days, 6 months, 12 months and, at least, 18 months after the procedure. For statistical analysis, p-values lower than 0.05 were defined as statistically significant. Results A total of 31 patients were enrolled in the study. The average age was 5.2 years, and 16 patients were male. The OSA-18 scores improved after the procedure in all domains, and this result was maintained until the last evaluation, done 22 ± 3 months after the procedure. Improvement in each domain was not superior to achieved in other domains. No correlation was found between tonsil or adenoid size and OSA-18 scores. Conclusion This is the largest prospective study that evaluated the long-term effects of the surgery on the QoL of children with SDB using the OSA-18. Our results show adenotonsillectomy has a positive impact in children's QoL.

13.
Einstein (Säo Paulo) ; 19: eAO6204, 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1339829

RESUMO

ABSTRACT Objective To assess the clinical and epidemiological profile of patients with olfactory dysfunction in the scenario of COVID-19 pandemic. Methods The study selected patients with loss of smell, previously screened by telemonitoring system of the Municipal Health Department of Goiânia (GO), Brazil, who agreed to answer a questionnaire about COVID-19 symptoms and findings of exams. The interviews were conducted by six otolaryngologists, who applied the specific questionnaire, over the phone. Results A total of 13,910 patients underwent telemonitoring, and 627 (4.51%) had olfactory loss complaints. Out of them, 330 were included in the survey. We observed a higher prevalence of altered smell in women (67%), and in patients aged under 50 years (86%). In most cases the manifestations had a sudden onset (70%), and in the first 5 days of illness (80%). The most prevalent associated symptom was a change in taste (89%), and only 2.7% of interviewed patients required hospitalization. Conclusion Anosmia in COVID-19 is more prevalent in females and individuals aged under 50 years. It is a relevant initial symptom predictive of the disease, together with dysgeusia.


RESUMO Objetivo Avaliar o perfil clínico-epidemiológico dos pacientes com distúrbios olfatórios no cenário de pandemia da COVID-19. Métodos Foram selecionados pacientes com queixa de perda de olfato, previamente triados pelo sistema de telemonitoramento da Secretaria Municipal de Saúde de Goiânia (GO), Brasil, que concordaram em responder um questionário sobre sintomas e achados de exame em relação à COVID-19. As entrevistas foram realizadas por seis médicos otorrinolaringologistas que, via telefonema, submeteram os participantes a questionário específico. Resultados Dos 13.910 pacientes em telemonitoramento, 627 (4,51%) apresentavam queixas de alteração do olfato, e, destes, 330 foram incluídos na pesquisa. A maior prevalência de alteração do olfato se deu em mulheres (67%), e em pacientes com menos de 50 anos (86%). Na maioria dos casos, as manifestações ocorreram de forma súbita (70%), e nos primeiros 5 dias de doença (80%). O sintoma associado mais prevalente foi alteração do paladar (89%), e houve necessidade de internação hospitalar somente em 2,7% dos pacientes entrevistados. Conclusão A anosmia na COVID-19 é mais prevalente no sexo feminino e em pacientes com menos de 50 anos. Juntamente da disgeusia, trata-se de importante sintoma inicial preditivo da doença.


Assuntos
Humanos , Feminino , Idoso , COVID-19 , Transtornos do Olfato/diagnóstico , Transtornos do Olfato/epidemiologia , Olfato , Pandemias , SARS-CoV-2
14.
Eur Arch Otorhinolaryngol ; 277(6): 1815-1822, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32157434

RESUMO

INTRODUCTION: Post-tonsillectomy pain is mediated by nociceptive C-fibers located at peritonsillar space. Peritonsillar infiltration of medication could relieve post-operative pain blocking the afferent via. PURPOSE: To evaluate the effect of peritonsillar infiltration of tramadol, ketamine, and placebo on post-operative pain in cases of adenotonsillectomy. METHODS: This is a double-blind randomized placebo-controlled study. Children ASA I-II aged 3-13 years scheduled for adenotonsillectomy were included in the study. Patients were randomized to receive either 2 mg/kg of peritonsillar tramadol (Group T), 0.5 mg/kg of peritonsillar ketamine hydrochloride (Group K), and 3 mL of peritonsillar saline (Group P). Post-operative pain was recorded using the modified visual analogue scale at 2 h, 6 h, 12 h, and 24 h. Side effects, analgesia requirement, and first oral intake were also recorded. RESULTS: There were included 112 patients and five were excluded until final evaluation. We evaluated 36 children of Group T, 36 of Group K, and 35 of Group P. Groups were similar regarding to age, weight, height, gender, tonsil and adenoid size, hemodynamic parameters during the surgery, surgery, and anesthesia time. There were no differences between the groups in relation to pain scores, analgesia requirement, or first time of oral intake (p > 0.05). Group T presented a higher incidence of vomit between 2 and 6 h after surgery (p > 0.05). CONCLUSION: This study showed that peritonsillar infiltration of tramadol or ketamine were not superior to placebo in reducing post-operative pain in children undergone adenotonsillectomy. The use of tramadol increased the risk of nausea and vomit between 2 and 6 h after surgery.


Assuntos
Analgesia , Ketamina , Tonsilectomia , Tramadol , Adenoidectomia , Adolescente , Analgésicos Opioides , Criança , Pré-Escolar , Método Duplo-Cego , Humanos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle
15.
Rev Paul Pediatr ; 38: e2018068, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31939504

RESUMO

OBJECTIVE: To carry out a systematic literature review on the surgical treatment of chronic rhinosinusitis in the pediatric population. DATA SOURCES: A bibliographic review methodology was used, based on data from National Library of Medicine (Medline), PubMed, Latin American and Caribbean Health Sciences Literature (LILACS) and Scientific Electronic Library Online (SciELO), of the indexed works from 2006 to 2016, including the pediatric population from zero to 13 years of age. The search keywords according to Medical Subject Heading (MESH) and Health Sciences Descriptors (DeCS) were: child, surgery, sinusitis and chronic disease. A total of 318 articles were collected, five of which met the inclusion criteria and were used as a basis for this review. All articles were prospective cohort studies, level of evidence 2B, according to the criterion used by evidence-based medicine. DATA SYNTHESIS: The literature agreed that the next step for the cases refractory to drug treatment in chronic rhinosinusitis in childhood would be surgery. Adenoidectomy would be the initial method, for the safety of the procedure and improvement in about 50% of the cases, although more significant results were found in patients who associated this procedure with facial sinus surgery. CONCLUSIONS: Surgical treatment should be indicated for chronic rhinosinusitis in childhood after treatment failure. The results pointed out that adenoidectomy, when associated with some type of approach to the facial sinus, present better results.


Assuntos
Adenoidectomia/normas , Seio Maxilar/cirurgia , Rinite/cirurgia , Sinusite/cirurgia , Adenoidectomia/métodos , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Doença Crônica , Terapia Combinada , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Segurança , Irrigação Terapêutica/métodos
16.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 38: e2018068, 2020. tab, graf
Artigo em Inglês, Português | LILACS | ID: biblio-1057216

RESUMO

ABSTRACT Objective: To carry out a systematic literature review on the surgical treatment of chronic rhinosinusitis in the pediatric population. Data sources: A bibliographic review methodology was used, based on data from National Library of Medicine (Medline), PubMed, Latin American and Caribbean Health Sciences Literature (LILACS) and Scientific Electronic Library Online (SciELO), of the indexed works from 2006 to 2016, including the pediatric population from zero to 13 years of age. The search keywords according to Medical Subject Heading (MESH) and Health Sciences Descriptors (DeCS) were: child, surgery, sinusitis and chronic disease. A total of 318 articles were collected, five of which met the inclusion criteria and were used as a basis for this review. All articles were prospective cohort studies, level of evidence 2B, according to the criterion used by evidence-based medicine. Data synthesis: The literature agreed that the next step for the cases refractory to drug treatment in chronic rhinosinusitis in childhood would be surgery. Adenoidectomy would be the initial method, for the safety of the procedure and improvement in about 50% of the cases, although more significant results were found in patients who associated this procedure with facial sinus surgery. Conclusions: Surgical treatment should be indicated for chronic rhinosinusitis in childhood after treatment failure. The results pointed out that adenoidectomy, when associated with some type of approach to the facial sinus, present better results.


RESUMO Objetivo: Realizar uma revisão sistemática da literatura sobre o tratamento cirúrgico da rinossinusite crônica na população pediátrica. Fonte de dados: Utilizou-se metodologia de revisão bibliográfica, por meio de levantamentos nas bases de dados científicas National Library of Medicine (Medline), PubMed, Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Electronic Library Online (SciELO), dos trabalhos indexados no período entre 2006 e 2016, incluindo a população pediátrica de zero a 13 anos. Os descritores de busca, segundo o Medical Subject Heading (MESH) e os Descritores em Ciências da Saúde (DeCS), foram: Child, Surgery, Sinusitis e Chronic Disease. Foram levantados 318 artigos, dos quais cinco preencheram os critérios de inclusão e foram usados como base para esta revisão. Todos os artigos foram estudos de coorte prospectivos, nível de evidência 2B, segundo critério usado pela medicina baseada em evidências. Síntese dos dados: Foi consenso na literatura que, para os casos refratários ao tratamento medicamentoso na rinossinusite crônica na infância, o próximo passo seria a cirurgia. A adenoidectomia seria o método inicial, pela segurança do procedimento e pela melhora em cerca de 50% dos casos, embora resultados mais significativos terem sido encontrados em pacientes que associaram esse procedimento à cirurgia dos seios da face. Conclusões: O tratamento cirúrgico pode ser indicado na rinossinusite crônica na infância após falha terapêutica. Os resultados apontaram que a adenoidectomia, quando associada a algum tipo de abordagem aos seios, apresenta melhores resultados.


Assuntos
Humanos , Feminino , Recém-Nascido , Lactente , Adolescente , Sinusite/cirurgia , Adenoidectomia/normas , Rinite/cirurgia , Seio Maxilar/cirurgia , Segurança , Adenoidectomia/métodos , Estudos de Casos e Controles , Doença Crônica , Estudos Prospectivos , Terapia Combinada , Irrigação Terapêutica/métodos
17.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 65(12): 1502-1507, Dec. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1057085

RESUMO

SUMMARY INTRODUCTION Despite the benefits, tracheostomized children are susceptible to respiratory infections, since the tube is located in a strategic region where there is colonization by several bacteria and biofilm formation. Biofilm is formed when the bacteria adhere strongly to the surfaces of the tubes, providing protection against various types of aggression, such as antibiotic treatment. OBJECTIVE To carry out a literature review of the last ten years on tracheostomized pediatric patients, in order to characterize the bacteria isolated in children's tracheal secretions, and verify which ones are the most frequent. METHODS Two authors searched the Lilacs, SciELO, Medline Plus, and PubMed databases. The MeSH terms used were: 'tracheostomy' and 'tracheotomy' associated with 'infections', 'children', 'child', and 'bacterial' as qualifiers. RESULTS Of the 512 studies on the subject, 19 were selected for review. The total number of children evaluated in the studies was 4,472, with a mean age of 7.5 years. As for the bacteria found in the secretions of tracheostomized children, 12 species of bacteria were more frequent, P. aeruginosa was the predominant bacterium, followed by S. aureus (63.1%), Klebsiella pneumoniae (57.8%), Streptococcus pneumoniae (47.3%), and Stenotrophomonas maltophilia (47.3%). CONCLUSION One of the main complications treated in tracheostomized patients were infections, since the respiratory system is colonized by several bacteria that can cause serious infections, which are associated with the formation of biofilms. The predominant bacterium in most of the studies was P. aeruginosa, and the second species commonly reported was S. aureus.


RESUMO INTRODUÇÃO Apesar dos benefícios, crianças traqueostomizadas estão suscetíveis a adquirir infecções respiratórias, pois o tubo se encontra em uma região estratégica, na qual existe colonização de diversas bactérias e formação de biofilme. O biofilme é formado quando as bactérias aderem fortemente às superfícies dos tubos, conferindo proteção contra diversos tipos de agressões, como o tratamento por antibióticos. OBJETIVO Realizar uma revisão de literatura dos últimos dez anos sobre pacientes pediátricos traqueostomizados, no intuito de caracterizar as bactérias isoladas em secreções traqueais de crianças, verificando-se quais são as mais frequentes. MÉTODOS Dois autores pesquisaram nas bases de dados do Lilacs, SciELO, Medline Plus e PubMed. Termos MeSH utilizados: tracheostomy e tracheotomy usados associados a infections, children, chlid e bacterial como qualificadores. RESULTADOS Dos 512 estudos relacionados ao tema, 19 foram selecionados para a revisão. O total de crianças avaliadas nos estudos foi de 4.472, com idade média de 7,5 anos. Quanto às bactérias encontradas nas secreções de crianças traqueostomizadas, 12 espécies de bactérias foram mais frequentes; P. aeruginosa foi a bactéria predominante, seguida de S. aureus (63,1%), Klebsiella pneumoniae (57,8%), Streptococcus pneumoniae (47,3%) e Stenotrophomonas maltophilia (47,3%). CONCLUSÃO Umas das principais complicações abordadas em pacientes traqueostomizados foram as infecções, já que o sistema respiratório é colonizado por diversas bactérias, que podem causar infecções graves, sendo estas associadas à formação de biofilmes. A bactéria predominante na maioria dos estudos foi a P. aeruginosa, e a segunda espécie comumente relatada foi a S. aureus.


Assuntos
Humanos , Masculino , Feminino , Criança , Traqueia/microbiologia , Traqueostomia/métodos , Infecções Respiratórias/microbiologia , Bactérias/isolamento & purificação
18.
Sci Rep ; 9(1): 11722, 2019 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409861

RESUMO

Cancer is the deadliest human disease and the development of new diagnosis methods is important to increase the chances of a cure. In this work it was developed a new method, named here for the first time as cerumenogram, using cerumen (earwax) as a new biomatrix for diagnosis. Earwax samples collected from cancer patients (cancer group) and cancer-free patients (control group) were analyzed by Headspace/Gas Chromatography-Mass Spectrometry (HS/GC-MS), following with multivariate analysis steps to process the raw data generated. In total, 158 volatile organic metabolites (VOMs) were identified in the cerumen samples. The 27 selected as potential VOMs biomarkers for cancer provided 100% discrimination between the cancer and control groups. This new test can thus be routinely employed for cancer diagnoses that is non-invasive, fast, cheap, and highly accurate.


Assuntos
Biomarcadores , Cerume/metabolismo , Metabolômica/métodos , Neoplasias/diagnóstico , Neoplasias/metabolismo , Estudos de Casos e Controles , Cromatografia Gasosa-Espectrometria de Massas/métodos , Humanos , Imageamento por Ressonância Magnética/métodos , Neoplasias/etiologia , Tomografia Computadorizada por Raios X/métodos , Compostos Orgânicos Voláteis/análise
19.
ROBRAC ; 27(83): 223-228, out./dez. 2018. tab
Artigo em Português | LILACS | ID: biblio-997354

RESUMO

Objetivo: investigar a associação entre duração do aleitamento materno, hábitos de sucção não nutritiva e deglutição em crianças pré-escolares. Material e métodos: a amostra foi constituída por 150 crianças com 4 e 5 anos que frequentavam diariamente Centros Municipais de Educação Infantil (CMEI) do município de Goiânia-GO. Os dados foram coletados por meio de entrevista com os pais e exame clínico das crianças. As variáveis analisadas foram relativas à deglutição e hábitos de sucção não nutritiva (variáveis dependentes); duração de aleitamento materno; dados demográficos da criança e condição socioeconômica das famílias; história médica pré-natal; uso de mamadeira; e visita ao dentista alguma vez na vida. Para a análise dos dados foi utilizado o teste do Qui-quadrado e Regressão de Poisson. Resultados: Deglutição atípica foi observada em 60,4% das crianças. A prevalência de sucção não nutritiva (chupeta e/ou dedo) foi 39,2%, sendo 23% de chupeta e 20,2% sucção digital. A maior parte das crianças (95,3%) foram amamentadas com leite materno e 33,6% receberam esse tipo de aleitamento por até 6 meses. Maior tempo de aleitamento foi associado a menor prevalência de sucção de chupeta e/ou dedo entre as crianças. No modelo ajustado, esta associação se manteve, independente das demais variáveis. Não houve associação significativa entre duração do aleitamento e deglutição. Conclusões: A duração do aleitamento materno foi associada à presença de hábitos de sucção não nutritiva (chupeta e dedo), independente das características sociodemográficas e outros fatores relacionados à saúde das crianças.


Objective: To investigate the association between duration of breastfeeding, non-nutritive sucking habits and deglutition in preschool children. Material and methods: the sample consisted of 150 children aged 4 and 5 who attended daily Municipal Centers for Early Childhood Education (CMEI) in the city of Goiânia-GO. Data were collected through an interview with the parents and clinical examination of the children. The variables analyzed were related to swallowing and non-nutritive sucking habits (dependent variables), duration of breastfeeding; demographic data of the child and socioeconomic status of the families; prenatal medical history; use of bottle; and visit to the dentist sometime in life. The Chi-square test and the Poisson regression were used to analyze the data. Results: Atypical swallowing was observed in 60.4% of the children. The prevalence of non-nutritive sucking (pacifier and/or finger) was 39.2%, being 23% pacifier and 20.2% digital sucking. The majority of the children (95.3%) were breastfed and 33.6% received breastfeeding for up to 6 months. Longer breastfeeding time was associated with lower prevalence of pacifier and/or finger sucking among children. In the adjusted model, this association remained, independent of the other variables. There was no significant association between duration of breastfeeding and swallowing. Conclusions: Duration of breastfeeding was associated with the presence of non-nutritive sucking habits (pacifier and finger), regardless of sociodemographic characteristics and other factors related to the children's health.

20.
Braz. j. otorhinolaryngol. (Impr.) ; 84(3): 265-279, May-June 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-951826

RESUMO

Abstract Introduction: Bacterial resistance burden has increased in the past years, mainly due to inappropriate antibiotic use. Recently it has become an urgent public health concern due to its impact on the prolongation of hospitalization, an increase of total cost of treatment and mortality associated with infectious disease. Almost half of the antimicrobial prescriptions in outpatient care visits are prescribed for acute upper respiratory infections, especially rhinosinusitis, otitis media, and pharyngotonsillitis. In this context, otorhinolaryngologists play an important role in orienting patients and non-specialists in the utilization of antibiotics rationally and properly in these infections. Objectives: To review the most recent recommendations and guidelines for the use of antibiotics in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, adapted to our national reality. Methods: A literature review on PubMed database including the medical management in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, followed by a discussion with a panel of specialists. Results: Antibiotics must be judiciously prescribed in uncomplicated acute upper respiratory tract infections. The severity of clinical presentation and the potential risks for evolution to suppurative and non-suppurative complications must be taken into 'consideration'. Conclusions: Periodic revisions on guidelines and recommendations for treatment of the main acute infections are necessary to orient rationale and appropriate use of antibiotics. Continuous medical education and changes in physicians' and patients' behavior are required to modify the paradigm that all upper respiratory infection needs antibiotic therapy, minimizing the consequences of its inadequate and inappropriate use.


Resumo Introdução: A resistência bacteriana a antibióticos nos processos infecciosos é um fato crescente nos últimos anos, especialmente devido ao seu uso inapropriado. Ao longo dos anos vem se tornando um grave problema de saúde pública devido ao prolongamento do tempo de internação, elevação dos custos de tratamento e aumento da mortalidade relacionada às doenças infecciosas. Quase a metade das prescrições de antibióticos em unidades de pronto atendimento é destinada ao tratamento de alguma infecção de vias aéreas superiores, especialmente rinossinusites, otite média aguda supurada e faringotonsilites agudas, sendo que uma significativa parcela dessas prescrições é inapropriada. Nesse contexto, os otorrinolaringologistas têm um papel fundamental na orientação de pacientes e colegas não especialistas, para o uso adequado e racional de antibióticos frente a essas situações clínicas. Objetivos: Realizar uma revisão das atuais recomendações de utilização de antibióticos nas otites médias, rinossinusites e faringotonsilites agudas adaptadas à realidade nacional. Método: Revisão na base PubMed das principais recomendações internacionais de tratamentos das infecções de vias aéreas superiores, seguido de discussão com um painel de especialistas. Resultados: Os antibióticos devem ser utilizados de maneira criteriosa nas infecções agudas de vias aéreas superiores não complicadas, a depender da gravidade da apresentação clínica e dos potenciais riscos associados de complicações supurativas e não supurativas. Conclusões: Constantes revisões a respeito do tratamento das principais infecções agudas são necessárias para que sejam tomadas medidas coletivas no uso racional e apropriado de antibióticos. Somente com orientação e transformações no comportamento de médicos e pacientes é que haverá mudanças do paradigma de que toda infecção de vias aéreas superiores deva ser tratada com antibióticos, minimizando por consequência os efeitos de seu uso inadequado.


Assuntos
Humanos , Infecções Respiratórias/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Prescrição Inadequada/estatística & dados numéricos , Antibacterianos/administração & dosagem , Otite Média/tratamento farmacológico , Sinusite/tratamento farmacológico , Faringite/tratamento farmacológico , Tonsilite/tratamento farmacológico , Rinite/tratamento farmacológico , Doença Aguda
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