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1.
J Pediatr Gastroenterol Nutr ; 62(1): 90-2, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26252917

RESUMO

Accidental corrosive ingestion is not rare in pediatric patients in developing countries. We report a case of gastric outlet obstruction after the accidental ingestion of an acidic substance by a child who was successfully treated with endoscopic balloon dilatation.


Assuntos
Queimaduras Químicas/complicações , Cáusticos/toxicidade , Endoscopia Gastrointestinal/métodos , Obstrução da Saída Gástrica/cirurgia , Estômago/lesões , Cateterismo/métodos , Feminino , Obstrução da Saída Gástrica/induzido quimicamente , Humanos , Lactente , Estenose Pilórica/induzido quimicamente , Estenose Pilórica/cirurgia , Estômago/cirurgia
2.
Am J Emerg Med ; 33(6): 862.e5-7, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25601163

RESUMO

There are more than 1 million cases of scorpion envenomation worldwide. Severe complications due to myocardial depression can happen in some patients, mainly children. A catecholamine-induced myocarditis probably causes this cardiac dysfunction. We describe a case of a 7-year-old boy with a severe scorpion envenomation complicated by pulmonary edema in which the cardiac magnetic resonance (CMR)was performed during the acute phase. The CMR showed an apical ballooning in the left ventricle associated with a left ventricle ejection fraction of 29% and a global edema of the midmyocardium and apical myocardiumin the T2-weighted triple inversion recovery images. The CMR was repeated after 7 months and showed complete recovery of the wall motion in the apical region and of the myocardial function (left ventricle ejection fraction, 60%) associated with normalization of the signal in the T2-weighted triple inversion recovery images. These clinical and laboratory findings, mainly the CMR images, are similar to those observed in stress-induced cardiomyopathy (Takotsubo) reinforcing the hypothesis that the catecholamine's excess has a pivotal function in the pathophysiology of the cardiac dysfunction in these 2 conditions.


Assuntos
Imageamento por Ressonância Magnética/métodos , Picadas de Escorpião/complicações , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/etiologia , Animais , Antivenenos/uso terapêutico , Criança , Meios de Contraste , Ecocardiografia , Eletrocardiografia , Humanos , Masculino , Edema Pulmonar/etiologia , Picadas de Escorpião/tratamento farmacológico , Escorpiões
3.
Rev Saude Publica ; 56: 89, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36259914

RESUMO

OBJECTIVES: To investigate the impact of complex chronic conditions on the use of healthcare resources and hospitalization costs in a pediatric ward of a public tertiary referral university hospital in Brazil. METHODS: This is a longitudinal study with retrospective data collection. Overall, three one-year periods, separated by five-year intervals (2006, 2011, and 2016), were evaluated. Hospital costs were calculated in three systematic samples of 100 patients each, consisting of patients with and without complex chronic conditions in proportion to their participation in the studied year. RESULTS: Over the studied period, the hospital received 2,372 admissions from 2,172 patients. The proportion of hospitalized patients with complex chronic conditions increased from 13.3% in 2006 to 16.9% in 2016 as a result of a greater proportion of neurologically impaired children, which rose from 6.6% to 11.6% of the total number of patients in the same period. Patients' complexity also progressively increased, which greatly impacted the use of healthcare resources and costs, increasing by 11.6% from 2006 (R$1,300,879.20) to 2011 (R$1,452,359.71) and 9.4% from 2011 to 2016 (R$1,589,457.95). CONCLUSIONS: Hospitalizations of pediatric patients with complex chronic conditions increased from 2006 to 2016 in a Brazilian tertiary referral university hospital, associated with an important impact on hospital costs. Policies to reduce these costs in Brazil are greatly needed.


Assuntos
Custos Hospitalares , Criança , Humanos , Centros de Atenção Terciária , Estudos Retrospectivos , Estudos Longitudinais , Brasil , Doença Crônica
5.
Nat Commun ; 11(1): 5433, 2020 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-33116136

RESUMO

Scorpion envenomation is a leading cause of morbidity and mortality among accidents caused by venomous animals. Major clinical manifestations that precede death after scorpion envenomation include heart failure and pulmonary edema. Here, we demonstrate that cardiac dysfunction and fatal outcomes caused by lethal scorpion envenomation in mice are mediated by a neuro-immune interaction linking IL-1 receptor signaling, prostaglandin E2, and acetylcholine release. IL-1R deficiency, the treatment with a high dose of dexamethasone or blockage of parasympathetic signaling using atropine or vagotomy, abolished heart failure and mortality of envenomed mice. Therefore, we propose the use of dexamethasone administration very early after envenomation, even before antiserum, to inhibit the production of inflammatory mediators and acetylcholine release, and to reduce the risk of death.


Assuntos
Acetilcolina/metabolismo , Dinoprostona/biossíntese , Insuficiência Cardíaca/etiologia , Receptores Tipo I de Interleucina-1/metabolismo , Venenos de Escorpião/toxicidade , Animais , Antivenenos/administração & dosagem , Atropina/farmacologia , Dexametasona/administração & dosagem , Modelos Animais de Doenças , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/fisiopatologia , Humanos , Mediadores da Inflamação/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Modelos Cardiovasculares , Neuroimunomodulação/efeitos dos fármacos , Receptores Tipo I de Interleucina-1/deficiência , Receptores Tipo I de Interleucina-1/genética , Picadas de Escorpião/complicações , Escorpiões , Transdução de Sinais , Vagotomia
6.
Bull Environ Contam Toxicol ; 83(4): 565-9, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19479173

RESUMO

The purpose of this study was to determine the concentrations of aluminum (Al) and other metals in water samples from elderly people's houses and retirement homes. Forty-six duplicate water samples from kitchen taps were collected in Ribeirão Preto/SP, Brazil. Metal levels were measured by atomic absorption spectrophotometer. Aluminum concentration exceeded the maximum allowed values in 26% of samples according to the Decree 518/2004 of the Brazilian Health Ministry. It was noted that 11% of elderly living at monitored houses, as well as 19% living at retirement homes presented Alzheimer disease diagnostic. These results suggest taking into account Al risks among vulnerable elderly population groups.


Assuntos
Alumínio/análise , Habitação para Idosos , Abastecimento de Água/normas , Idoso , Doença de Alzheimer/epidemiologia , Brasil/epidemiologia , Monitoramento Ambiental , Monitoramento Epidemiológico , Humanos , Metais Pesados/análise , Pessoa de Meia-Idade
7.
Front Immunol ; 9: 890, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29755470

RESUMO

Interleukin (IL)-1ß is a potential target for treatment of several inflammatory diseases, including envenomation by the scorpion Tityus serrulatus. In this context, bioactive lipids such as prostaglandin (PG)E2 and leukotriene (LT)B4 modulate the production of IL-1ß by innate immune cells. Pattern recognition receptors (PRRs) that perceive T. serrulatus venom (TsV), and orchestrate LTB4, PGE2, and cyclic adenosine monophosphate (cAMP) production to regulate IL-1ß release are unknown. Furthermore, molecular mechanisms driving human cell responses to TsV remain uncharacterized. Here, we identified that both CD14 and CD36 control the synthesis of bioactive lipids, inflammatory cytokines, and mortality mediated by TsV. CD14 induces PGE2/cAMP/IL-1ß release and inflammation. By contrast, CD36 shunts eicosanoid metabolism toward production of LTB4, which represses the PGE2/cAMP/IL-1ß axis and mortality. Of importance, the molecular mechanisms observed in mice strongly correlate with those of human cell responses to TsV. Overall, this study provides major insights into molecular mechanisms connecting CD14 and CD36 with differential eicosanoid metabolism and inflammation mediated by IL-1ß.


Assuntos
Antígenos CD36/imunologia , Interleucina-1beta/imunologia , Receptores de Lipopolissacarídeos/imunologia , Picadas de Escorpião/imunologia , Venenos de Escorpião/imunologia , Adulto , Animais , Antígenos CD36/metabolismo , Modelos Animais de Doenças , Eicosanoides/metabolismo , Feminino , Voluntários Saudáveis , Humanos , Interleucina-1beta/metabolismo , Leucócitos Mononucleares , Receptores de Lipopolissacarídeos/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Pessoa de Meia-Idade , Cultura Primária de Células , Picadas de Escorpião/sangue , Picadas de Escorpião/mortalidade , Escorpiões/imunologia , Transdução de Sinais/imunologia , Adulto Jovem
8.
Rev. saúde pública (Online) ; 56: 89, 2022. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1410037

RESUMO

ABSTRACT OBJECTIVES To investigate the impact of complex chronic conditions on the use of healthcare resources and hospitalization costs in a pediatric ward of a public tertiary referral university hospital in Brazil. METHODS This is a longitudinal study with retrospective data collection. Overall, three one-year periods, separated by five-year intervals (2006, 2011, and 2016), were evaluated. Hospital costs were calculated in three systematic samples of 100 patients each, consisting of patients with and without complex chronic conditions in proportion to their participation in the studied year. RESULTS Over the studied period, the hospital received 2,372 admissions from 2,172 patients. The proportion of hospitalized patients with complex chronic conditions increased from 13.3% in 2006 to 16.9% in 2016 as a result of a greater proportion of neurologically impaired children, which rose from 6.6% to 11.6% of the total number of patients in the same period. Patients' complexity also progressively increased, which greatly impacted the use of healthcare resources and costs, increasing by 11.6% from 2006 (R$1,300,879.20) to 2011 (R$1,452,359.71) and 9.4% from 2011 to 2016 (R$1,589,457.95). CONCLUSIONS Hospitalizations of pediatric patients with complex chronic conditions increased from 2006 to 2016 in a Brazilian tertiary referral university hospital, associated with an important impact on hospital costs. Policies to reduce these costs in Brazil are greatly needed.


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Atenção Terciária à Saúde/tendências , Criança , Doença Crônica , Hospitalização/economia
9.
Rev Soc Bras Med Trop ; 48(6): 642-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26676487

RESUMO

Scorpion stings are currently the leading cause of venom-related injury to humans in Brazil and are a significant public health problem globally. Only scorpions of the Tityus genus are of medical importance in Brazil, and Tityus serrulatus is responsible for the most serious envenomations and deaths. The toxic effects of scorpion envenomation are due to a massive release of sympathetic and parasympathetic neurotransmitters; the severity is related to cardiac and hemodynamic changes, with cardiogenic shock and pulmonary edema contributing to the main causes of death. The pathophysiology of cardiac involvement has been discussed for decades and has been attributed to adrenergic discharge and a possible toxic effect of venom on the myocardium, while acute pulmonary edema may have a cardiogenic and/or non-cardiogenic origin. Currently, the clinical data point to catecholamine excess as the cause for reversible scorpion cardiomyopathy . These data include electrocardiographic changes, profiling of cardiac enzymes and troponin I, echocardiographic data with global or regional left ventricle dysfunction, and myocardial perfusion alterations compatible with spasm in the coronary microcirculation. Furthermore, recent data on cardiac magnetic resonance imaging findings, which are similar to those observed for stress-induced cardiomyopathy, have also been linked to catecholamine excess. The efficiency of antivenom serum treatment is controversial in the literature. Our experience in Brazil is that the management of patients with systemic manifestations of scorpion stings is based on three approaches, all of which are extremely important. These include symptomatic treatment, antivenom serum, and cardiorespiratory support.


Assuntos
Antivenenos/uso terapêutico , Picadas de Escorpião , Venenos de Escorpião/intoxicação , Animais , Brasil , Humanos , Prognóstico , Picadas de Escorpião/complicações , Picadas de Escorpião/diagnóstico , Picadas de Escorpião/tratamento farmacológico , Índice de Gravidade de Doença
10.
Toxicon ; 40(6): 823-30, 2002 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12175620

RESUMO

Eight children aged 2-9 years, with signs and symptoms of severe scorpion envenoming by Tityus serrulatus were studied. All patients showed clinical manifestations of cardiac dysfunction, with ECG and echocardiographic alteration and five developed pulmonary edema. Troponin I levels were normal in all patients on admission, except for two who arrived later, and increased thereafter, with maximum values being observed 24-36 h after the sting. The detection of TnI in patients with severe scorpion envenoming, and the observed temporal pattern and serum levels meet the criteria established for the diagnosis of acute myocardial infarction. The rapid reversibility of cardiac dysfunction, together with the normalization of the enzymatic, ECG and echocardiographic data, indicates the occurrence of an acute myocardial lesion without underlying or associated coronary disease.


Assuntos
Cardiomiopatias/sangue , Picadas de Escorpião/sangue , Escorpiões , Troponina I/sangue , Animais , Antivenenos/uso terapêutico , Cardiomiopatias/etiologia , Cardiomiopatias/fisiopatologia , Criança , Pré-Escolar , Quimioterapia Combinada , Ecocardiografia , Feminino , Glucocorticoides/uso terapêutico , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Antagonistas dos Receptores H2 da Histamina/uso terapêutico , Humanos , Masculino , Edema Pulmonar/sangue , Edema Pulmonar/etiologia , Edema Pulmonar/fisiopatologia , Picadas de Escorpião/complicações , Picadas de Escorpião/fisiopatologia
11.
Toxicon ; 42(7): 741-5, 2003 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-14757204

RESUMO

The myotoxic activity of the venom of Crotalus durissus terrificus is demonstrable by increased serum levels of the enzymes creatine kinase (CK), lactate dehydrogenase (LD), and aspartate aminotransferase. Serial measurements of CK, LD and their isoenzymes in bite victims showed a pattern similar to that observed in acute myocardial infarction, although the clinical course and electro- and echocardiographic data did not suggest cardiac involvement. These data have raised the hypothesis that crotalid venom preferentially causes damage to type I and/or type IIa fibers, which contain quantities of CK-MB and LD1 similar to those found in cardiac fibers. In order to detect a possible concomitant silent cardiac involvement, seven children with severe crotalid envenoming were studied. Serum troponin I, determined more than once in each patient, were found to be normal. These data demonstrate the absence of cardiac involvement in these patients envenomed by C. durissus terrificus and confirmed the skeletal muscle origin of the elevated CK-MB.


Assuntos
Creatina Quinase/sangue , Crotalus , Coração/efeitos dos fármacos , Mordeduras de Serpentes/sangue , Troponina I/sangue , Animais , Aspartato Aminotransferases/sangue , Biomarcadores/sangue , Criança , Pré-Escolar , Feminino , Frutose-Bifosfato Aldolase/sangue , Humanos , L-Lactato Desidrogenase/sangue , Masculino , Infarto do Miocárdio/sangue , Infarto do Miocárdio/enzimologia , Miocárdio/enzimologia
12.
Arch Latinoam Nutr ; 53(1): 59-64, 2003 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-12942873

RESUMO

The purpose of this study was to analyze the levels of lead (Pb), cadmium (Cd), aluminum (Al), zinc (Zn), cooper (Cu) and chromium (Cr) in the water of drinking fountains distributed in the Campus of the University of São Paulo. Ribeirão Preto, Brazil. Thirty random samples were collected in different parts of the Campus that were analyzed by Atomic Absorption Spectrophotometry. According to WHO's Drinking Water Guidelines; lead, cadmium and zinc were found in concentrations higher than those recommended in 40%, 20% and 13% of the samples, respectively. The results were analyzed considering nutritional and toxicological aspects related to the presence of essential and toxic elements for the human being. Reviewing the regulatory limits established in ten countries of America, authors focus in the necessity to find a consensus in the establishment of the higher levels of heavy metals in potable water. The tolerable daily intake, have to be the basis to assure the prevention of diseases associated with a long-term ingestion of these elements through foods.


Assuntos
Metais Pesados/análise , Abastecimento de Água/análise , Água/química , Concentração Máxima Permitida , Espectrofotometria Atômica
14.
Case Rep Med ; 2014: 251870, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24715906

RESUMO

We describe a case of severe scorpion envenomation in an adult patient, with the presence of very rapid sustained ventricular tachycardia followed by cardiogenic shock, which was reversed by scorpion antivenom administration. Scorpion venom causes cardiac changes that can lead to an environment favoring arrhythmogenesis.

15.
BMC Res Notes ; 6: 178, 2013 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-23641965

RESUMO

BACKGROUND: Body packing is used for international drug transport, immediate drug concealment during a police searching or introducing drugs inside prisons. Despite the high level of specialization of dealers who have started to manufacture more complex packs, up to 5% of patients could develop intoxication due to pack rupture. Bowel obstruction is another acute complication. CASE PRESENTATION: A 27-year-old black male patient was sent to the hospital by court order for clinical evaluation and toxicological examination. The patient was conscious, oriented, had good color, normal arterial pressure and heart rate, and no signs of acute intoxication. Abdominal examination revealed discrete pain upon deep palpation and a small mass in the left iliac fossa. A plain abdominal radiograph revealed several oval structures located in the rectum and sigmoid. Fasting and a 50 g dose of activated charcoal every six hours were prescribed. After three days, the patient spontaneously evacuated 28 cocaine packs. CONCLUSION: Adequate clinical management and prompt identification of potential complications are of fundamental importance in dealing with body packing.


Assuntos
Cocaína , Crime , Reto , Adulto , Humanos , Masculino
16.
Growth Horm IGF Res ; 22(5): 186-91, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22901623

RESUMO

UNLABELLED: Hypoxia is one of many factors involved in the regulation of the IGF system. However, no information is available regarding the regulation of the IGF system by acute hypoxia in humans. OBJECTIVE: The aim of this study was to evaluate the effect of acute hypoxia on the IGF system of children. DESIGN: Twenty-seven previously health children (14 boys and 13 girls) aged 15 days to 9.5 years were studied in two different situations: during a hypoxemic state (HS) due to acute respiratory distress and after full recovery to a normoxemic state (NS). In these two situations oxygen saturation was assessed with a pulse-oximeter and blood samples were collected for serum IGF-I, IGF-II, IGFBP-1, IGFBP-3, ALS and insulin determination by ELISA; fluoroimmunometric assay determination for GH and also for IGF1R gene expression analysis in peripheral lymphocytes by quantitative real-time PCR. Data were paired and analyzed by the Wilcoxon non-parametric test. RESULTS: Oxygen saturation was significantly lower during HS than in NS (P<0.0001). IGF-I and IGF-II levels were lower during HS than in NS (P<0.0001 and P=0.0004, respectively). IGFBP-3 levels were also lower in HS than in NS (P=0.0002) while ALS and basal GH levels were higher during HS (P=0.0015 and P=0.014, respectively). Moreover, IGFBP-1 levels were higher during HS than in NS (P=0.004). No difference was found regarding insulin levels. The expression of IGF1R mRNA as 2(-ΔΔCT) was higher during HS than in NS (P=0.03). CONCLUSION: The above results confirm a role of hypoxia in the regulation of the IGF system also in humans. This effect could be direct on the liver and/or mediated by GH and it is not restricted to the hepatocytes but involves other cell lines. During acute hypoxia a combination of alterations usually associated with reduced IGF action was observed. The higher expression of IGF1R mRNA may reflect an up-regulation of the transcriptional process.


Assuntos
Regulação da Expressão Gênica , Somatomedinas/genética , Hipóxia Celular/genética , Hipóxia Celular/fisiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Proteína 1 de Ligação a Fator de Crescimento Semelhante à Insulina/sangue , Proteína 3 de Ligação a Fator de Crescimento Semelhante à Insulina/sangue , Fator de Crescimento Insulin-Like I/metabolismo , Fator de Crescimento Insulin-Like II/metabolismo , Masculino , Reação em Cadeia da Polimerase em Tempo Real , Somatomedinas/metabolismo , Regulação para Cima
19.
Rev. Soc. Bras. Med. Trop ; 48(6): 642-649, Nov.-Dec. 2015. graf
Artigo em Inglês | LILACS | ID: lil-767831

RESUMO

Abstract: Scorpion stings are currently the leading cause of venom-related injury to humans in Brazil and are a significant public health problem globally. Only scorpions of the Tityus genus are of medical importance in Brazil, and Tityus serrulatus is responsible for the most serious envenomations and deaths. The toxic effects of scorpion envenomation are due to a massive release of sympathetic and parasympathetic neurotransmitters; the severity is related to cardiac and hemodynamic changes, with cardiogenic shock and pulmonary edema contributing to the main causes of death. The pathophysiology of cardiac involvement has been discussed for decades and has been attributed to adrenergic discharge and a possible toxic effect of venom on the myocardium, while acute pulmonary edema may have a cardiogenic and/or non-cardiogenic origin. Currently, the clinical data point to catecholamine excess as the cause for reversible scorpion cardiomyopathy . These data include electrocardiographic changes, profiling of cardiac enzymes and troponin I, echocardiographic data with global or regional left ventricle dysfunction, and myocardial perfusion alterations compatible with spasm in the coronary microcirculation. Furthermore, recent data on cardiac magnetic resonance imaging findings, which are similar to those observed for stress-induced cardiomyopathy, have also been linked to catecholamine excess. The efficiency of antivenom serum treatment is controversial in the literature. Our experience in Brazil is that the management of patients with systemic manifestations of scorpion stings is based on three approaches, all of which are extremely important. These include symptomatic treatment, antivenom serum, and cardiorespiratory support.


Assuntos
Humanos , Animais , Venenos de Escorpião/intoxicação , Índice de Gravidade de Doença , Antivenenos/uso terapêutico , Picadas de Escorpião/complicações , Picadas de Escorpião/diagnóstico , Picadas de Escorpião/tratamento farmacológico , Prognóstico , Brasil
20.
J Bras Pneumol ; 36(4): 513-6, 2010.
Artigo em Inglês, Português | MEDLINE | ID: mdl-20835601

RESUMO

Paraquat is a nonselective contact herbicide of great toxicological importance, being associated with high mortality rates, mainly due to respiratory failure. We report the case of a 22-year-old male admitted to the emergency room with a sore throat, dysphagia, hemoptysis, and retrosternal pain after the ingestion of 50 mL of a paraquat solution, four days prior to admission. Chest CT scans revealed pulmonary opacities, pneumomediastinum, pneumothorax, and subcutaneous emphysema. The patient was submitted to two cycles of immunosuppressive therapy with cyclophosphamide, methylprednisolone, and dexamethasone. The pulmonary gas exchange parameters gradually improved, and the patient was discharged four weeks later. The clinical and tomographic follow-up evaluations performed at four months after discharge showed that there had been further clinical improvement. We also present a brief review of the literature, as well as a discussion of the therapeutic algorithm for severe paraquat poisoning.


Assuntos
Pulmão/diagnóstico por imagem , Paraquat/intoxicação , Humanos , Masculino , Intoxicação/diagnóstico por imagem , Radiografia , Tentativa de Suicídio , Adulto Jovem
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