RESUMEN
PURPOSE: To detect problems related to secondary prophylaxis of rheumatic fever in the setting out patient follow-up. METHODS: Among 113 pediatric patients admitted with diagnosis of this disease, in a period of five years, we selected 80 records. They were divided in group 1 (60 cases), that only received prescription of benzathine penicillin for prophylaxis and group 2 (20 patients) to whom it was changed from parenteral to oral antibiotics after the detection problems using the first scheme. RESULTS: In group 1, among 53 who had carditis, 27 (45%) had severe disease; 22 cases (37%) were re-admitted with relapsed carditis following the refusal to use benzathine penicillin. Also, we observed that after discharged 32 (55%) did not return to the out-patient clinic in HUAP. In group 2, from 16 who had carditis, 10 (50%) had severe disease. Only two (10%) did not return to ambulatory control and there was no case of readmission. The difference between the groups was statistically significant. (p < 0.01). CONCLUSION: It was very high the percentage of cases that missed the control visits and abandoned the prophylaxis when it was insisted on parenteral penicillin. We should evaluate every case and remember that oral antibiotics might avoid a major problem.
Asunto(s)
Antibacterianos/uso terapéutico , Antiinfecciosos/uso terapéutico , Eritromicina/uso terapéutico , Penicilina G Benzatina/uso terapéutico , Penicilinas/uso terapéutico , Fiebre Reumática/tratamiento farmacológico , Sulfadiazina/uso terapéutico , Administración Oral , Adolescente , Niño , Preescolar , Humanos , Pacientes Desistentes del TratamientoRESUMEN
PURPOSE: To describe the cardiac findings in children with AIDS, the follow-up with treatment and the correlation between clinical and pathological features. METHODS: We studied prospectively 25 children with clinical-laboratorial diagnosis of AIDS, ages between 3 months and 11 years, even those without cardiac symptoms. We classified the signs of AIDS following that of CDC-Atlanta 1994. Eight children died and it was done necropsy in six with macro and microscopic examinations. RESULTS: Fifteen cases had already complications of AIDS and were classified as C2 and C3, 5 as B2, 3 B1 and 2 as A1. Beside the symptoms related to the disease and infections we found signs of congestive heart failure III and IV (NYHA) in 5 children, pericardial effusion in 5, (one of them had cardiac tamponade). In the electrocardiogram (EKG), 8 children had repolarization abnormalities. In 1st echocardiogram (ECHO) we found some features of dilated myocardiopathy in 8 (6 were asymptomatic) 5 of those had pericardial effusion, one child had huge amount of pericardial liquid and also increased measures of intraventricular septum and posterior wall of left ventricle by ECHO and confirmed by necropsy examination. All cases of diagnosis of myocardiopathy received treatment with captopril and 4 also received furosemide and digoxina. Even under oral treatment three of them had deterioration of heart failure but after combined anti-retroviral drugs they showed better cardiac functions. From the six necropsied cases, two had increased heart weight without myocarditis, one had toxoplasma pancarditis and other one had fibrocalcic vasculopathy. CONCLUSION: We found several assymptomatic cases already with decreased ventricular function. Some worsened of heart failure even under apropriate treatment and showed better cardiac index after combined anti-retroviral drugs.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Cardiopatías/complicaciones , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Niño , Preescolar , Cardiopatías/diagnóstico , Humanos , Lactante , Estudios ProspectivosRESUMEN
A técnica da reaçäo em cadeia pela DNA polimerase (PCR) foi usada para a amplificaçäo rápida de um fragmento de 456bp da regiäo única curta (Us) do genoma do BHV-1. Iniciadores de 18pb do gene da ORF1 foram usados para a amplificaçäo das amostras-padräo e brasileiras. Uma amplificaçäo clássica näo foi bem sucedida. A amplificaçäo foi obtida quando se escolheu uma regiäo com baixa concentraçäo de GC no DNA do BHV-1 e através da desnaturaçäo térmica (95§C para 5min) seguida de ciclos térmicos (94§C por 1min e 30seg; 52§C por 1min; 72§C por 1min e 30 seg; e ainda por 35 ciclos de 94§C por 1min; 52§C por 1min; 72§C por 1min e 30 seg; usando um tempo de extensäo final de 72§C por 5min). A clivagem com Pst I confirmou a especificidade do fragmento da ORF 1 do BHV-1. A amplificaçäo do fragmento em todas as amostras testadas sugere que a regiäo é fortemente conservada no genoma do BHV-1. Este PCR poderá detectar rapidamente amostras clínicas, sendo sensível e específico para diagnosticar infecçöes pelo BHV-1