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Klin Padiatr ; 230(1): 5-12, 2018 01.
Artigo em Alemão | MEDLINE | ID: mdl-29258161


Expertise in a variety of fields is required for the diagnostic process of epilepsies in children and adolescents as well as for their treatment with anticonvulsants. Patients benefit in the process from the cooperation of different health care professionals. It is of critical importance for risks to be minimised and for the efficacy shown in controlled clinical trials to be maintained in routine conditions. In the first instance, drug prescription procedures, including the choice of anticonvulsants and combinations of drugs and dosing, have to be considered. The administration of drugs has, of course, also to be taken into account. Only if patients are given their anticonvulsants appropriately, the intended success of the therapy can be accomplished. Strategies aimed at improving drug administration have to be directed not only at nurses but also at parents, children and adolescents themselves, as well as caregivers in schools and children's day-care facilities. By providing theoretical teaching, practical training, and routinely including pharmacists in the therapeutic team, drug-related problems that may result in limited effectiveness and increased risks are prevented. As a result, drug (therapy) safety is not only qualitatively improved, but the degree of participation and quality of life of patients and families is improved as well.

Anticonvulsivantes/uso terapêutico , Comunicação Interdisciplinar , Hanseníase/tratamento farmacológico , Pediatria , Farmacêuticos , Adolescente , Criança , Humanos , Hanseníase/psicologia , Pais , Qualidade de Vida
J Pediatr Orthop B ; 25(5): 478-83, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26999061


Comminuted diaphyseal fractures in the pediatric age group represent a major orthopedic problem. It is associated with a high incidence of complications and poor outcomes because of the instability and difficulty in treatment. The aim of this study was to evaluate the efficacy of combined external skeletal fixation and flexible intramedullary nails in reconstruction of comminuted diaphyseal fracture in skeletally immature patients. Combined external fixator and elastic stable intramedullary nails were used in the management of 27 pediatric patients (15 males and 12 females) with unstable comminuted diaphyseal fractures of the tibia and femur. There were 19 fractures of the femur and eight fractures of the tibia. The average age of the patients was 8.7 years (range 7-14 years) for the femur and 10.8 years (range 6-15 years) for the tibia. Fractures were classified according to the system of Winquist and Hansen as grade II (five cases), grade III (nine cases), and grade IV (13 cases). All cases were operated within 6 days (range 0-6 days) after injury. The mean follow-up period was 2.8 years (range 2-3.5 years). The average duration of the external fixation was 1.6 months for fractures of the tibia, whereas it was 1.4 months for fractures of the femur. The average time for tibia fracture union was 2.8 months for fractures of the tibia, whereas it was 1.9 months for fractures of the femur. Malalignment in varus less than 5° was noted in one patient. One patient had a limb-length discrepancy of 1.5 cms. There were five cases (18.5%) with pin-tract infection. According to the Association for the Study and Application of the Methods of Ilizarov evaluation system, bone results were excellent in 23 cases (85.2%), good in three cases (11.1%), and poor in one case (3.7%). Functional results were excellent in 22 (81.5%) cases and good in five (18.5%) cases. Combined use of external fixators and elastic intramedullary nails is a good method for the treatment of comminuted long bone fractures in children.

Fixadores Externos , Fixação Intramedular de Fraturas/métodos , Fraturas Cominutivas/cirurgia , Fraturas da Tíbia/cirurgia , Adolescente , Pinos Ortopédicos , Criança , Elasticidade , Feminino , Fraturas do Fêmur/cirurgia , Seguimentos , Fraturas Expostas/cirurgia , Humanos , Desigualdade de Membros Inferiores/cirurgia , Masculino , Pediatria/métodos , Período Pós-Operatório , Tíbia/cirurgia
São Paulo; s.n; 2014. [79] p. tab, ilus.
Tese em Português | LILACS | ID: lil-720629


Introdução: A hanseníase é uma doença infecciosa crônica causada pelo Mycobacterium leprae. É considerada um dos maiores problemas de saúde pública nos países em desenvolvimento. Os principais sinais clínicos são manchas de pele com perda de sensibilidade e envolvimento de nervos periféricos. Manifestações musculoesqueléticas são descritas em adultos, mas este envolvimento é raramente descrito na população pediátrica. Objetivo: Avaliar envolvimento musculoesquelético e auto-anticorpos em pacientes pediátricos com hanseníase. Métodos: Foram avaliados 50 pacientes com hanseníase e 47 crianças e adolescentes saudáveis de acordo com manifestações musculoesqueléticas (artralgia, artrite e mialgia), síndromes dolorosas musculoesqueléticas (fibromialgia juvenil, síndrome de hipermobilidade articular benigna, síndrome miofascial e tendinite) e painel de auto-anticorpos e crioglobulinas. Escores de avaliação de saúde e tratamento foram realizados nos pacientes com hanseníase. Resultados: A frequência de manifestações musculoesqueléticas foi maior em pacientes com hanseníase comparada aos controles (14% vs. 0%, p=0,0012). Cinco pacientes com hanseníase tinham poliartrite assimétrica das pequenas articulações das mãos (10% vs. 0%, p=0,057). Comprometimentos da função do nervo, reação tipo I hansênica, e neuropatia silenciosa foram observados nos pacientes com hanseníase (p=0,0006; p=0,003; p=0,0059; respectivamente). Nenhum dos pacientes e controles apresentou síndromes de dor musculoesquelética e as frequências dos anticorpos e crioglobulinas foram semelhantes nos dois grupos (p > 0,05). Comprometimentos da função nervosa, reação hansênica tipo I e neuropatia silenciosa foram observados em pacientes com versus sem manifestações musculoesqueléticas (p=0,0036; p=0,0001; p=0,309; respectivamente), bem como subtipos de hanseníase multibacilar (86% vs. 42%, p=0,045). A escala visual analógica do médico (VAS), dos pacientes (VAS), de dor (VAS) e CHAQ foram maiores em...

Introduction: Leprosy is a chronic infectious disease caused by Mycobacterium leprae. It is considered one of major public health issue in developing countries. The important clinical signs of leprosy are hypopigmented or reddish localized skin lesions with loss of sensation and peripheral nerves involvement. Musculoskeletal manifestations were described in leprosy adult patients and these involvements were rarely described in pediatric leprosy population. Objective: To evaluate musculoskeletal involvement and autoantibodies in pediatric leprosy patients. Methods: 50 leprosy patients and 47 healthy children and adolescents were assessed according to musculoskeletal manifestations (arthralgia, arthritis and myalgia), musculoskeletal pain syndromes (juvenile fibromyalgia, benign joint hypermobility syndrome, myofascial syndrome and tendinitis) and a panel of autoantibodies and cryoglobulins. Health assessment scores and treatment were performed in leprosy patients. Results: The frequency of at least one musculoskeletal manifestation was significantly higher in leprosy patients compared to controls (14% vs. 0%, p=0.0012) and five leprosy patients had asymmetric polyarthritis of small hands joints (10% vs. 0%, p=0.057), Nerve function impairment, type I leprosy reaction and silent neuropathy were significantly observed in leprosy patients (p=0.0006; p=0.003; p=0.0059; respectively). None of the patients and controls presented musculoskeletal pain syndromes and the frequencies of all antibodies and cyoglobulins were similar in both groups (p>0.05). Further analysis of leprosy patients showed that the frequencies of nerve function impairment, type I leprosy reaction and silent neuropathy were significantly observed in patients with versus without musculoskeletal manifestations (p=0.0036; p=0.0001; p=0.309; respectively), as well as multibacillary subtypes in leprosy (86% vs. 42%, p=0.045). The median of physician visual analogue scale (VAS)...

Humanos , Criança , Adolescente , Adolescente , Artralgia , Artrite , Autoanticorpos , Criança , Crioglobulinas , Hanseníase/fisiopatologia , Manifestações Neuromusculares , Nervos Periféricos/patologia , Pediatria
Artigo em Inglês | MEDLINE | ID: mdl-22565424


Fever with rash is common among children and are seen by both dermatologists and pediatricians. Most of them are benign viral exanthems without much clinical significance. This article gives an overview of the infectious and noninfectious causes of fever with rash in children and how to diagnose them, with special emphasis on the Indian scenario as well. It also differentiates them from fever with rash caused by drugs. This review emphasizes that although benign in many cases, it is necessary to identify the signs of serious illnesses to prevent mortality or sequelae.

Exantema/diagnóstico , Exantema/mortalidade , Febre de Causa Desconhecida/diagnóstico , Febre de Causa Desconhecida/mortalidade , Criança , Dermatologia , Humanos , Índia/epidemiologia , Pediatria
Artigo em Inglês | MEDLINE | ID: mdl-20657113


Although erythroderma is a well-recognized entity in the adult age groups and has been studied by various authors, there is a paucity of studies on erythroderma in the pediatric age group. It poses a greater challenge to the dermatologist and pediatrician because of its potential life threatening nature. In a study conducted by us in a large Indian hospital to delineate the causes of neonatal and infantile erythroderma, the causes identified were infections (40%), ichthyosiform erythroderma (25%), atopic dermatitis (15%), infantile seborrheic dermatitis (10%) and unidentified (10%). In another study of childhood erythroderma, etiologically, drugs (29%) showed the highest incidence, followed equally (18%) by genodermatoses, psoriasis and staphylococcal scalded skin syndrome (SSSS). The management of childhood erythroderma is mainly supportive with correction of the hematologic, biochemical and metabolic imbalance if required. In this review, the causes of childhood erythroderma, the clinical features useful to the diagnosis and management are discussed.

Dermatite Esfoliativa , Dermatologia/métodos , Pediatria/métodos , Doença Aguda , Dermatite Esfoliativa/diagnóstico , Dermatite Esfoliativa/etiologia , Dermatite Esfoliativa/terapia , Humanos , Índia , Lactente , Recém-Nascido
Artigo em Inglês | MEDLINE | ID: mdl-20657114


Scleroderma is a set of rare connective tissue diseases of unknown etiology. It is characterized by thickening and hardening of the skin. Scleroderma is divided into two main subgroups: systemic and localized. The systemic form, also known as systemic sclerosis, involves diffuse skin involvement associated with fibrotic changes in internal organs. Juvenile localized scleroderma is a more common entity and is usually confined to a specific region of the body with no internal organ involvement. Therapeutics are divided into three main subgroups for juvenile systemic sclerosis: antifibrotics, anti-inflammatories, and vasodilators. For localized disease, anti-inflammatories, vitamin D analogues, and UV irradiation have been investigated. The rarity of scleroderma in children and the self-limiting nature of the disease together make randomized controlled trials very difficult. Therefore, most data on therapeutic modalities for this condition have to be extrapolated from studies conducted on adults. International cooperation, following a standardized operation protocol, is needed to validate these and future interventions such as autologous stem cell transplant and cytokine-directed therapies.

Dermatologia/métodos , Pediatria/métodos , Esclerodermia Limitada/terapia , Escleroderma Sistêmico/terapia , Criança , Humanos
Orthopedics ; 33(1): 19, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20055347


The extension-type pediatric supracondylar humerus fracture accounts for nearly two-thirds of all pediatric hospitalizations due to elbow trauma. The Gartland classification guides the standard of care for treatment of this entity. Type I injuries are treated with cast immobilization while type II and III injuries are treated operatively. The reported interobserver reliability ranges from moderate to full agreement, which is on par with other frequently referenced classification systems such as Lauge-Hansen for adult ankle fractures. In this study, 4 fellowship-trained pediatric orthopedic surgeons reviewed radiographs of 72 pediatric supracondylar fractures and classified them based on Gartland's system. They recommended their preferred treatment of cast immobilization for type I fractures and of closed reduction and pinning in the operating room for type II and type III fractures. The interobserver and intraobserver reliability for each set of radiographs was then analyzed. There was moderate agreement comparing all fractures and comparing types I and II fractures, while there was full agreement for type III fractures. There was full agreement for the intraobserver reliability. The preferred treatment (casting vs operative intervention) differed in 35% of patients, if based on the fracture classification.

Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Criança , Humanos , Variações Dependentes do Observador , Pediatria/métodos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
Pediatr. (Asunción) ; 33(2): 108-111, 2006. tab, graf
Artigo em Espanhol | LILACS, BDNPAR | ID: lil-598986


Introducción: La Lepra infantil sigue siendo una patología poco descripta y sub valorada en la consulta diaria. El diagnóstico exige buena habilidad clínica porque las lesiones cutáneas son asintomáticas y pueden pasar desapercibidas. Objetivo: Presentar una casuística pediátrica y dar ponderancia a los criterios clínicos y epidemiológicos para el diagnóstico. Material y Método: Estudio descriptivo, retrospectivo. En 73 casos se observó contacto familiar intradomiciliario. La clínica y la epidemiología fueron los pilares básicos del diagnóstico, pues la baciloscopía resultó negativa en el 78% de los casos. Conclusión: La lepra figura dentro de las enfermedades reemergentes en nuestro país y a nivel mundial, razón por la cual el pediatra debe pensar en ella para el diagnóstico diferencial ante un paciente con lesiones cutáneas y/o alteraciones sensitivas, y orientar el interrogatorio en la búsqueda de antecedentes familiares de la afección.

Introduction: Leprosy in children remains a pathology that is little described, and is underestimated in routine examination. Diagnosis of leprosy requires superior clinical skills because the lesions of the skin are asymptomatic and can pass unnoticed. Objective: To present pediatric case material and offer considerations concerning clinical and epidemiological criteria for diagnosis. Materials and Methods: A retrospective descriptive study. We evaluated 88 patient records stored in the archives of the Mennonite Hospital loca-ted at Kilometer 81, Route 2, Paraguay, from the time period of January 2000 until June of 2003, analyzing age, gender, clinical signs leading to diagnosis, time of progression, bacilloscopy the form of leprosy (lepromatous or tuberculoid), and history of contacts. Results: The most affected age group (42%) was that of ages 10- to 14-years of age, among males (58%), the most common form is tuberculoid, or paucibacillary leprosy (27 cases) and lepromatous, or multibacillary leprosy (25 cases). In 73 cases, intra-household contact was observed. Clinical examination and epidemiology were the primary tools for diagnosis, given that bacilloscopy was negative in 78% of patients. Conclusion: Leprosy is a disease that is re-emerging in Paraguay and around the world, for that reason pediatricians should consider it in differential diagnosis when faced with a patient with lesions of the skin or changes in sensitivity, and should ask questions to elicit any family history of the disease.

Criança , Hanseníase , Paraguai , Pediatria
Sao Paulo; Manole; 2 ed; 2000. viii,232 p. ilus, tab, 29cm.
Monografia em Português | LILACS, HANSEN, SESSP-ILSLACERVO, SES-SP | ID: biblio-1086318
Rev. mex. pueric. ped ; 7(38): 38-49, nov.-dic. 1999. tab
Artigo em Espanhol | LILACS | ID: lil-276197


En los últimos años la inmunoterapia ha tomado un gran auge debido, primordialmente, a la variedad de alternativas descritas, fundamentadas en una gran cantidad de estudios clínicos, lo que ha permitido que enfermedades aparentemente poco complicadas, pero cuya resolución es frecuentemente problemática, como las infecciones recurrentes de las vías respiratorias, hasta enfermedades crónicas como tuberculosis, lepra, colagenopatías y enfermedades malignas, etc., ahora puedan tener un mejor pronostico. Es importante resaltar la importancia de conocer las características farmacologicas de estos medicamentos, así como sus indicaciones precisas. con el fin de no caer en el mal uso de los mismos y poder ofrecer a los pacientes un recurso valioso y eficaz de cara al nuevo milenio

Humanos , Adjuvantes Imunológicos/administração & dosagem , Adjuvantes Imunológicos/química , Adjuvantes Imunológicos/uso terapêutico , Formação de Anticorpos/imunologia , Imunidade Celular/imunologia , Imunoterapia , Pediatria , Doenças Respiratórias , Terapêutica , Relação Dose-Resposta Imunológica , Interferon-alfa/metabolismo , Interferon-alfa/uso terapêutico
In. Farhat, Calil Kairalla; Carvalho, Eduardo da Silva; Carvalho, Luiza Helena Falleiros Rodrigues; Succi, Regina Célia de Menezes. Infectologia pediátrica. Säo Paulo, Atheneu, 2 ed; 1998. p.263-7, ilus, tab.
Monografia em Português | LILACS, SES-SP, SESSP-IIERPROD, SES-SP, SESSP-ILSLACERVO, SES-SP | ID: biblio-1068786
In. Farhat, Calil Kairalla; Carvalho, Eduardo da Silva; Carvalho, Luiza Helena Falleiros Rodrigues; Succi, Regina Célia de Menezes. Infectologia pediátrica. Säo Paulo, Atheneu, 2 ed; 1998. p.263-7, ilus, tab.
Monografia em Português | LILACS | ID: lil-260892
St. Louis; Bosby; 2 ed; 1996. xi,389 p. ilus, tab, 27cm.
Monografia em Inglês | LILACS, HANSEN, SESSP-ILSLACERVO, SES-SP | ID: biblio-1086319
In. Cohen, Bernard A; Martins, Heidi Pinto; Peroco, Aparecida Marilda; Lima, Maria Aparecida Nogueira de; Assis, Vera Yukie de Paula; Oliveira, Nelson Gomes de. Atlas colorido de dermatologia pediátrica. São Paulo, Manole, 1995. p.2.2-42, ilus.
Monografia em Português | LILACS, SES-SP, HANSEN, SESSP-ILSLACERVO, SES-SP | ID: biblio-1246163