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An 11-year-old spayed female domestic shorthaired cat was diagnosed with severe dilated cardiomyopathy (DCM) and congestive heart failure. The cat had been eating cat foods that were high in pulses (e.g. peas, lentils, chickpeas). Neither plasma nor whole blood taurine concentrations were deficient. Primary treatment included furosemide, pimobendan, and clopidogrel, and changing to diets that did not contain pulses (a taurine supplements was not administered). The cat's clinical signs improved, high-sensitivity cardiac troponin I concentrations decreased, and echocardiographic measurements stayed relatively stable for over one year after initiating cardiac medications and changing the diet. Ultimately, the cat was euthanized for worsening congestive heart failure 374 days after the diagnosis of DCM. Infectious disease testing during the time of clinical surveillance was negative. Routine histopathology of the heart was unremarkable, but electron microscopy of the left ventricle showed large numbers of mitochondria of variable size and structure. A moderate number of lamellar bodies and autophagic vacuoles also were noted. This case report illustrates an unusual case of a cat with DCM unrelated to taurine deficiency. The relative roles of diet change, cardiac medications, and a dedicated owner are unclear, but this cat's relatively long survival time is similar to that seen after diet change in dogs and cats with DCM eating high-pulse diets.
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Cardiomiopatia Dilatada , Doenças do Gato , Doenças do Cão , Insuficiência Cardíaca , Gatos , Feminino , Animais , Cães , Cardiomiopatia Dilatada/veterinária , Cardiomiopatia Dilatada/diagnóstico , Doenças do Gato/diagnóstico , Doenças do Gato/tratamento farmacológico , Doenças do Cão/diagnóstico , Dieta/veterinária , Taurina/uso terapêutico , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/veterináriaRESUMO
Essential oils (EOs) are natural products currently used to control arthropods, and their interaction with insect odorant-binding proteins (OBPs) is fundamental for the discovery of new repellents. This in silico study aimed to predict the potential of EO components to interact with odorant proteins. A total of 684 EO components from PubChem were docked against 23 odorant binding proteins from Protein Data Bank using AutoDock Vina. The ligands and proteins were optimized using Gaussian 09 and Sybyl-X 2.0, respectively. The nature of the protein-ligand interactions was characterized using LigandScout 4.0, and visualization of the binding mode in selected complexes was carried out by Pymol. Additionally, complexes with the best binding energy in molecular docking were subjected to 500 ns molecular dynamics simulations using Gromacs. The best binding affinity values were obtained for the 1DQE-ferutidine (-11 kcal/mol) and 2WCH-kaurene (-11.2 kcal/mol) complexes. Both are natural ligands that dock onto those proteins at the same binding site as DEET, a well-known insect repellent. This study identifies kaurene and ferutidine as possible candidates for natural insect repellents, offering a potential alternative to synthetic chemicals like DEET.
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INTRODUCTION: There is no generalized consensus regarding perioperative prophylaxis of venous thromboembolism (VTE), either on using or timing it in patients undergoing spine surgery. VTE is a current concern because, even though being an uncommon event, it can cause serious complications. The aim of the present study is to propose guidelines for the prevention of thrombotic events in posterior spinal surgery, either as deep vein thrombosis or pulmonary thromboembolism. If the number of patients getting prophylaxis drugs is reduced a subsequent reduction of the incidence of epidural hematoma can be expected. MATERIALS AND METHODS: A number of 235 patients who had undergone posterior spinal arthrodesis in the previous five years were studied. Mechanical thromboprophylaxis measures consisting of compression stockings were applied in all of them. Anticoagulant drugs were also applied whenever risk factors for thrombosis were observed. Early weight-bearing was resumed immediately after surgery. Demographic, clinical, and surgical variables were collected, as well as complications appearing during the follow-up period, that was scheduled at one, two, four, six and twelve months after the surgery. Thrombotic events, if present, were diagnosed by clinical and imaging tests such as ultrasound and CT angiography. RESULTS: From the total 235 patients of this series, one hundred and fifty-three cases met the study inclusion criteria. A total of four thrombotic events appeared, one in the form of deep vein thrombosis and other three in the form of pulmonary thromboembolism. These last patients suffering an embolism died because of it. None of the variables studied had statistical significance for the occurrence of a thrombotic event. All four patients who suffered thrombotic events were receiving anticoagulant drugs, in addition to mechanical compression stockings, because of the presence of risk factors for thrombosis. CONCLUSIONS: By applying the fore mentioned protocol, adequate prevention of thromboembolic events was achieved in this study population of patients undergoing posterior spinal surgery.
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AIMS: Pannexin-1 (PANX1) is a hemichannel that releases ATP upon opening, initiating inflammation, cell proliferation, and migration. However, the role of PANX1 channels in colon cancer remains poorly understood, thus constituting the focus of this study. MAIN METHODS: PANX1 mRNA expression was analyzed using multiple cancer databases. PANX1 protein expression and distribution were evaluated by immunohistochemistry on primary tumor tissue and non-tumor colonic mucosa from colon cancer patients. PANX1 inhibitors (probenecid or 10Panx) were used to assess colon cancer cell lines viability. To study the role of PANX1 in vivo, a subcutaneous xenograft model using HCT116 cells was performed in BALB/c NOD/SCID immunodeficient mice to evaluate tumor growth under PANX1 inhibition using probenecid. KEY FINDINGS: PANX1 mRNA was upregulated in colon cancer tissue compared to non-tumor colonic mucosa. Elevated PANX1 mRNA expression in tumors correlated with worse disease-free survival. PANX1 protein abundance was increased on tumor cells compared to epithelial cells in paired samples, in a cancer stage-dependent manner. In vitro and in vivo experiments indicated that blocking PANX1 reduced cell viability and tumor growth. SIGNIFICANCE: PANX1 can be used as a biomarker of colon cancer progression and blocking PANX1 channel opening could be used as a potential therapeutic strategy against this disease.
Assuntos
Neoplasias do Colo , Conexinas , Progressão da Doença , Proteínas do Tecido Nervoso , Animais , Feminino , Humanos , Masculino , Camundongos , Biomarcadores Tumorais/metabolismo , Biomarcadores Tumorais/genética , Linhagem Celular Tumoral , Proliferação de Células , Sobrevivência Celular , Neoplasias do Colo/patologia , Neoplasias do Colo/metabolismo , Neoplasias do Colo/genética , Conexinas/metabolismo , Conexinas/genética , Regulação Neoplásica da Expressão Gênica , Células HCT116 , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos NOD , Camundongos SCID , Proteínas do Tecido Nervoso/metabolismo , Proteínas do Tecido Nervoso/genética , Probenecid/farmacologia , Ensaios Antitumorais Modelo de XenoenxertoRESUMO
Resumen Introducción: PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy) Es una técnica que, vía laparoscopía, permite administrar quimioterapia en aerosol intraperitoneal, para el tratamiento de la carcinomatosis, ya sea para disminuir masa tumoral y aumentar la resecabilidad, o como paliación sintomática. Objetivo: Presentar los dos primeros casos de PIPAC en Chile, las consideraciones técnicas y revisión de la literatura. Pacientes y Método: Se describe la forma en que un programa PIPAC fue implementado en Clínica Las Condes. Se describe la técnica. Este procedimiento se realizó en dos pacientes, ambas portadoras de carcinomatosis con ascitis refractaria. Resultados: No hubo complicaciones. Alta a las 24 h. Ambas pacientes presentaron disminución de la ascitis, la que se ha mantenido a los seis meses de seguimiento. Discusión: PIPAC es una técnica emergente, que ha demostrado ser segura, con escasas complicaciones, cuya indicación incluye carcinomatosis por cáncer de colon y ovario y que se está extendiendo a páncreas, vía biliar y estómago. Su rol exacto está por definirse. Conclusiones: PIPAC es una técnica factible de realizar en nuestro país; sus resultados preliminares son alentadores y exentos de complicaciones.
Introduction: PIPAC (Pressurized Intraperitoneal Aerosol Chemotherapy is a technique that allows laparoscopic administration of aerosol chemotherapy in the peritoneum. This procedure is utilized for treatment of carcinomatosis, for debulk abdominal tumors, increasing resectability, or for palliation of abdominal symptoms. Aim: To present the first two cases of PIPAC performed in Chile, technical considerations and review of the literature. Patients and Method: The way this program was started at Clínica Las Condes is presented. The technique is described. This procedure was performed in two females, both with refractory ascites due to carcinomatosis. Results: The procedure was uneventfully and patients were discharged 24 hours later. Both patients showed important reduction of ascites, maintained at 6 months of followup. Discussion: PIPAC is a safe emerging technique, with low complication rate. It is indicated in carcinomatosis of colonic and ovarían origin and in selected cases of pancreatic, bile duct and gastric carcinomatosis. More prospective, randomized studies should be done to stablish its exact role. Conclusions: PIPAC is a feasible technique to perform in our country. Preliminary results are encouraging and no complications were observed.
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Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Peritoneais/secundário , Neoplasias Gástricas/patologia , Nebulizadores e Vaporizadores , Biópsia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Doxorrubicina/administração & dosagem , Cisplatino/administração & dosagemRESUMO
Resumen Introducción: Los trastornos de la esfera mental son cada vez más frecuentes, estos deben ser medidos en los estudiantes que están sometidos a gran presión y según el lugar de influencia. Objetivos: Determinar las características y factores asociados a trastornos de la esfera mental en estudiantes de medicina de la costa, sierra y selva peruana. Metodología: Se realizó un estudio transversal analítico preliminar, a través de la aplicación del Inventario Clínico Multiaxial de Millon (MCMI-II), a 105 estudiantes, dicha encuesta midió los distintos trastornos de la esfera mental; a los cuales se les asoció con variables socio-educativas. Resultados: Grandes porcentajes de encuestados tuvieron compulsividad (29%) y narcisismo elevado (28%). En el análisis multivariado se encontró que las mujeres tuvieron menor frecuencia de trastorno esquizoide (p=0,027); conforme aumentó la edad también hubo mayor frecuencia de trastornos evitativo (p=0,049) y ansiedad (p= 0,043); a mayor año académico se encontró menor frecuencia de trastorno dilusional (p=0,010); los estudiantes de la universidad de la sierra tuvieron más narcisismo (p=0,011), compulsividad (p=0,018) y paranoide (p=0,041); los estudiantes de la universidad de la selva tuvieron más agresividad-sádica (p=0,021), narcisismo (p=0,020) y compulsividad (p=0,005); estas dos últimas fueron comparados versus los que estudiaban en la costa. Conclusión: Se encontró gran frecuencia de algunos trastornos, así como algunos factores asociados, lo que puede ser útil como análisis situacional, lo que debería generar mayores trabajos en la materia.
Introduction: The disorders of the mental sphere are increasingly frequent, these should be measured in students who are under great pressure and according to the place of influence. Objectives: To determine the characteristics and factors associated with disorders of the mental sphere in medical students of the coast, mountains and Peruvian jungle. Methodology: A preliminary analytical cross-sectional study was carried out, through the application of the Millon Multiaxial Clinical Inventory (MCMI-II), to 105 students, said survey measured the different disorders of the mental sphere; to which they were associated with socio-educational variables. Results: Large percentages of respondents had compulsivity (29%) and high narcissism (28%). In the multivariate analysis it was found that women had a lower frequency of schizoid disorder (p = 0.027); as age increased there was also a higher frequency of avoidance disorders (p = 0.049) and anxiety (p = 0.043); the higher the academic year, the lower the frequency of dilution disorder (p = 0.010); the students of the Universidad de la Sierra had more narcissism (p = 0.011), compulsivity (p = 0.018) and paranoid (p = 0.041); the students of the jungle university had more aggressive-sadistic (p = 0.021), narcissism (p = 0.020) and compulsivity (p = 0.005); These last two were compared versus those studying on the coast. Conclussion: We found a high frequency of some disorders, as well as some associated factors, which can be useful as a situational analysis, which should generate more work in the field.
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Humanos , Masculino , Feminino , Estudantes de Medicina , Universidades , Saúde Mental , Sintomas Afetivos , Peru , Estudos TransversaisRESUMO
Se expone el caso de una paciente remitida por complicaciones posteriores a la implantación superficial en el tercio medio facial de hilos de polidioxanona espiculados. Presentaba edema, equimosis, palpación superficial del hilo y plicación dérmica. Para el tratamiento planteamos un novedoso protocolo de degradación clínica de hilos de polidioxanona, empleando ácido hialurónico inyectándolo en el área de su implantación. Se infiltró ácido hialurónico no reticulado en el trayecto a lo largo del recorrido del hilo. El seguimiento a los siete, 21 y 45 días evidenció disminución del edema, de los pliegues e irregularidades dérmicas por la tracción del hilo y atenuación de rítides secundarias. Una muestra del hilo en ácido hialurónico fue observado en campana de flujo laminar evidenciándose degradación a las 72 horas. Administrar ácido hialurónico fue efectivo para inducir la biodegradación clínica del hilo. La hipótesis derivada sugiere que el ácido hialurónico no reticulado es un poderoso catalizador de la degradación hidrolítica de la polidioxanona.
We present the case of a female patient with complications from superficial implantation of polydioxanone spiculated threads in the facial middle third. The manifestations were edema, ecchymosis, superficial palpation of the thread and skin plication. For the treatment we propose a novel protocol of clinical degradation of polydioxanone threads, using hyaluronic acid injecting it into the implantation area of the polydioxanone threads. Non-cross linked hyaluronic acid was infiltrated along the path of the thread. The follow-up at seven, 21 and 45 days showed decreased edema, folds and skin irregularities due to wire traction and attenuation of secondary rhytides. A sample of the thread in hyaluronic acid was observed in a laminar flow campaign evidencing degradation at 72 hours. Administering hyaluronic acid was effective in inducing clinical biodegradation of the thread suggesting that non-crosslinked hyaluronic acid is a powerful catalyst for the hydrolytic degradation of polydioxanone.
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Humanos , Feminino , Adulto , Ritidoplastia/efeitos adversos , Polidioxanona/efeitos adversos , Ácido Hialurônico/química , Ritidoplastia/métodos , Envelhecimento da Pele , Seguimentos , Polidioxanona/química , Microscopia/métodosRESUMO
Los pequeños agricultores de arroz del sector informal en Colombia son una población vulnerable a la intoxicación aguda y crónica por plaguicidas, especialmente porque no han sido incluidos en programas nacionales de capacitación, vigilancia y control de intoxicaciones. El objetivo de este estudio fue identificar mediante una encuesta el estado de cumplimiento de las prácticas de salud ocupacional y disposición adecuada de residuos de plaguicidas en un grupo de agricultores del municipio de Natagaima en Colombia y evaluar el nivel de biomarcadores séricos de efecto por exposición a plaguicidas en esta población. Los resultados muestran un panorama en donde prevalece una aparente percepción del riesgo por el uso de plaguicidas, pero hay una gran carencia de prácticas de salud ocupacional en la población que los manipula. El análisis de los biomarcadores séricos permitió detectar un aumento significativo en los niveles de aspartato amino transferasa, creatinina y ácido úrico y descenso de los niveles de colinesterasa sérica demostrando posibles alteraciones subclínicas de la función renal y hepática en la población estudiada (AU)
Small farmers in rice informal sector in Colombia are vulnerable to acute and chronic pesticide poisoning population, especially because they have not been included in national training programs, monitoring and poison control. The aim of this study was to identify through a survey of the state of compliance with occupational health practices and proper disposal of pesticide residues in a group of farmers in the municipality of Natagaima in Colombia and assess the level of serum biomarkers of effect exposure pesticides in this population. The results show a scenario in which prevails an apparent perception of risk by the use of pesticides, but there is a lack of practical occupational health in the population that manipulates
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Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Biomarcadores/análise , Biomarcadores/sangue , Saúde Ocupacional/estatística & dados numéricos , Saúde Ocupacional/normas , Praguicidas/sangue , Praguicidas/normas , Praguicidas/toxicidade , Uso de Praguicidas , Exposição a Praguicidas , 24444 , Estudos Transversais/métodos , Estudos Transversais/estatística & dados numéricos , Exposição Ambiental/prevenção & controle , Exposição Ambiental/normas , Exposição Ocupacional/prevenção & controle , Exposição Ocupacional/normas , Exposição a Produtos QuímicosRESUMO
Introduction: Faecal incontinence (FI) represents an important psychological and social condition for an individual. There are several causes for FI, therefore its study and management is complex. Among different aetiologies, anatomical disruption of the external anal sphincter (EAS) as a consequence of anorrectal surgery or obstetric injury can be studied by endoanal ultrasound (EAUS). This study focus on anatomical assessment of sphincter muscle injury of EAS and its relationship with clinical presentation con FI. Objective: Compare anatomical and disruption of EAS features studied by 3D-EAUS between patients with FI, according to its severity. Methods: 3D-EAUS images were obtained from selected patients studied for FI between January 2008 and July 2010 at Clínica las Condes. Wexner Score (SW) was used to evaluate severity of FI, dividing patients into two categories: Mild FI (SW < 9) and Severe FI (SW ≥ 9). A single observer evaluated different morphological variables: width, length, percentage and angle of EAS disruption. Parametrical and non-parametrical analysis was used as appropriate. P-value < 0.05 was considered statistically significant. Results: From 31 female patients studied, mean SW was 11.7 +/- 0.8 points, range from 5 to 20 points. When dividing into two groups, 9 patients had mild FI and 22 had severe FI. Studied variables in EAUS 3D cubes: width, length, percentage and angle of EAS disruption, did not reach statistical significance between groups. Conclusion: No relationship was found between external anal sphincter anatomic injury variables studied and severity of faecal incontinence.
Introducción: La incontinencia fecal (IF) se refleja en una condición psicológica y social importante para el individuo. Las causas de IF son múltiples, siendo su estudio y manejo complejo. La disrupción anatómica del esfínter anal externo (EAE), secundaria, entre otras, a cirugía anorrectal o lesión obstétrica, es posible de ser estudiada por endosonografía anal (EAUS). El presente artículo se centra en el daño anatómico del EAE y su relación con la presentación clínica de la IF. Objetivo: Comparar las características anatómicas y daño del EAE objetivadas mediante endosonografía en 3 dimensiones (EAUS3D), entre los pacientes con IF según su severidad. Material y Método: Se obtuvo las EAUS3D realizadas en Clínica Las Condes por estudio de IF entre enero de 2008 y julio de 2010. Se utilizó el score de Wexner (SW) para separar la población en dos grupos, IF leve (SW < 9) e IF grave (SW ≥ 9). Un único observador evaluó las diferentes variables: grosor, longitud, porcentaje de defecto y ángulo de lesión del EAE. Se utilizó estadística paramétrica o no-paramétrica según corresponda. Se consideró significativo p < 0,05. Resultados: De un total de 31 pacientes femeninas estudiadas, el SW promedio fue de 11,7 +/- 0,8 con rango entre 5 y 20 puntos. Al separar según grupos, 9 pacientes tenían IF leve y 22 IF grave. De las variables estudiadas por EAUS3D: el promedio, grosor, longitud, porcentaje de defecto y el ángulo de lesión del EAE no lograron diferencia estadística entre los grupos. Conclusión: No existe una relación directa entre las variables estudiadas de daño anatómico del EAE y el grado de IF.
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Humanos , Feminino , Pessoa de Meia-Idade , Canal Anal/patologia , Incontinência Fecal/patologia , Índice de Gravidade de Doença , Canal Anal , Endossonografia , Incontinência Fecal , Qualidade de VidaRESUMO
Introducción. Los pólenes anemófilos son una causa reconocida de rinoconjuntivitis alérgica y asma bronquial a nivel mundial. Sin embargo, existe poca información acerca de su rol en pediatría. Objetivo. Determinar la prevalencia de reactividad cutánea a pólenes de árboles, gramíneas y malezas en pacientes pediátricos con rinitis alérgica de la localidad de Granadero Baigorria, Argentina. Material y método. Estudio observacional de corte transversal que evaluó a 280 pacientes de ambos sexos de 1 a 10 años de edad con diagnóstico de rinitis alérgica persistente según ARIA. Los mismos fueron agrupados en 4 grupos etarios de setenta pacientes cada uno. Se realizó prick test utilizando extractos comerciales de pólenes comunes en nuestra área (Laboratorio Diater, Buenos Aires, Argentina). Las pruebas cutáneas se realizaron además en 80 niños sanos no atópicos elegidos al azar de la misma población de estudio como grupo control. Resultados. De los 280 pacientes evaluados, 29 (10,3%) tenían pruebas cutáneas positivas a al menos un extracto de polen. Las gramíneas representaron el 47,3% del total, los árboles el 44,4%, y las malezas un 8,3%. Ligustrum lucidum fue positivo en 10 oportunidades (27,7%), seguidos de Cynodon dactylon en 7 (19,4%), Poa annua, en 3 (8,3%), Sorghum vulgare en 3 (8,3%), Platanus acerifolia en 3 (8,3%), Fraxinus excelsior en 3 (8,3%), Morus alba en 3 (8,3%), Ambrosia elatior en 3 (8,3%) y Zea mays en 1 (2,7%). Ningún paciente menor a 2 años resultó positivo. Conclusión. Nuestro estudio muestra que de 280 pacientes con rinitis alérgica, el 10,3% presentó prick test positivo a pólenes. Los árboles y las gramíneas fueron responsables de 91,7% de la sensibilización total. Ligustrum lucidum fue el polen más sensibilizante seguido de Cynodon dactylon. La positividad de los test con pólenes aumenta con la edad del paciente. En base a estos resultados y estudios anteriores, se podría sugerir que aquellos pacientes con rinitis alérgica cuyos síntomas comienzan o empeoran en la primavera o el verano deberían ser testeados con extractos polínicos.(AU)
Background. Pollens are considered as major source of allergic rhinoconjuntivitis and asthma around the world. However, in pediatric population limited evidence about its role is available. Aim. To determine the prevalence of skin reactivity to pollens (trees, grasses and weeds) in pediatric patients with diagnosis of allergic rhinitis from Granadero Baigorria, Argentina. Material and method. A cross-sectional study that evaluated 280 patients of both sexes from 1 to 10 years of age with diagnosis of persistent allergic rhinitis according to ARIA guidelines. Prick tests were performed to all patients using commercial extracts of common pollens in our area (Diater Laboratories, Buenos Aires, Argentina). Seventy patients were included for each group. Skin tests were also carried out on 20 healthy children per group randomly chosen from the same study population as control group. Results. From 280 patients tested, 29 (10.3%) had positive skin tests to at least one extract of pollen. Grasses account for 47.3% (17 positive). Trees account for 44.4% from total positive prick test (16 positive). Weeds were responsible for 8.3 % (3 positive). Ligustrum lucidum was 10 times positive (27.7%) followed by Cynodon dactylon in 7 (19.4%), Poa annua in 3 (8.3%), Sorghum vulgare in 3 (8.3%), Platanus acerifolia in 3 (8.3%), Fraxinus excelsior in 3 (8.3%), Morus alba in 3 (8.3%), Ambrosia elatior in 3 (8.3%), and Zea mayz in 1 (2.7%). No patient less than two years was positive. Conclusion. Our study shows that from 280 rhinitis allergic patients, 10.3 % were sensitive to pollens. Trees and grasses were responsible for 91.7 % of total sensitization. Grasses were the most allergenic pollens. Ligustrum lucidum was the single most allergenic pollen followed by Cynodon dactylon. Sensitiveness rate to pollens increases with age. Based on these results and previous studies, we could suggest that patients with allergic rhinitis whose symptoms begin or worse in spring or summer should be tested with pollens.(AU)
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Humanos , Lactente , Pré-Escolar , Criança , Pólen , Hipersensibilidade , Argentina , RiniteRESUMO
El huevo de gallina es una fuente de proteínas de alto valor biológico de bajo costo y de vitaminas del complejo B, importantes para la alimentación del niño. Culturalmente es uno de los alimentos básicos de nuestra dieta y, debido a esto, la alergia a sus proteínas es una de las más frecuentes en la infancia y tiene su mayor impacto en niños en edad preescolar. Estos niños representan una población vulnerable debido a que se encuentran en una etapa importante de su crecimiento y desarrollo, y el tratamiento de esta patología genera la adopción de dietas restrictivas que pueden impactar en forma negativa en su salud y calidad de vida. Este impacto está dado en parte por la ubicuidad de sus proteínas, que limita ampliamente la dieta y genera riesgos de reacciones alérgicas que se incrementan a medida que el niño crece y alcanza una mayor independencia. Teniendo en cuenta la importancia de esta patología, el Comité de Pediatría realizó una revisión actualizada con el fin de proveer herramientas útiles para el manejo adecuado de la misma. (AU)
Eggs are a source of low cost high biological value protein and complex B vitamins important for the child's nutrition. Culturally it is one of the staples of our diet and because of this, egg allergy is one of the most common food allergies in childhood and has its greatest impact on preschool children. These children represent a vulnerable population because they are at an important stage in their growth and development and the treatment of this condition generates the adoption of restrictive diets that may impact negatively on their health and quality of life. This impact is given in part by the ubiquity of their proteins that largely restrict the diet and generates risks of allergic reactions that increase as the child grows and earns greater independence. Given the importance of this issue the Pediatrics Committee conducted an updated review to provide useful tools to manage this condition.(AU)
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Humanos , Recém-Nascido , Pré-Escolar , Criança , Alérgenos , Proteínas do Ovo , Hipersensibilidade a Ovo , Pediatria , Alergia e Imunologia , Hipersensibilidade AlimentarRESUMO
Single port access for minimally invasive surgery is feasible nowadays. We report a 55 years old female presenting with hematochezia. During a colonoscopy, a villous adenoma of 2 cm in diameter located 5 cm above the anal margin, was found. This lesion was excised through the anus, using a single port trocar. The procedure lasted 45 minutes, the postoperative evolution was uneventful and the patient was discharged 24 hours after the procedure.
Posterior al advenimiento de la cirugía laparoscópica colorrectal, desde comienzos de la década de los 90, se han desarrollado diversos tipos de accesos minimamente invasivos, siendo hoy en día el acceso por un puerto único una alternativa factible. Se presenta el caso clínico de una paciente de 55 años, a la cual por sintomatología se le diagnóstica una lesión rectal, la que luego de ser estudiada endoscópica y endosonográficamente, es resecada por monopuerto via anal. La cirugía duró 45 minutos y no presentó eventos adversos intraoperatorios. Su evolución quirúrgica fue satisfactoria con alta hospitalaria al día siguiente de la cirugía.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Adenoma Viloso/cirurgia , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Canal Anal , Adenoma Viloso/diagnóstico , Endoscopia Gastrointestinal , Endossonografia , Laparoscopia , Neoplasias Retais/diagnóstico , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Resultado do TratamentoAssuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Hipersensibilidade a Amendoim , Hipersensibilidade , Proteínas , AnafilaxiaRESUMO
El Cryptosporidium spp e Isospora belli son parásitos emergentes, que representan la cuarta causa de diarrea a nivel mundial, principalmente en niños y en pacientes inmunocomprometidos. Producen diarrea aguda o crónica dependiendo de la edad del paciente, estado nutricional e inmunológico asociado a factores sanitarios desfavorables. El diagnostico se realiza por visualización directa en heces con tinción de Zelh Neelsen modificado o Kinyou y biopsia intestinal con presencia de protozoos en las criptas y atrofia vellositaria de acuerdo al grado de infestación. Se reporta el caso de preescolar de 2 años de edad, eutrófico e inmunocompetente, perteneciente a estrato social bajo; con episodios de diarreas acuosas autolimitadas, dolor y distensión abdominal frecuentes. La biopsia intestinal revelo atrofia vellositaria e infestación simultanea por Cryptosporidium spp e Isospora belli corroborado por Tinción de Kinyou en heces; se descarto además Alergia Alimentaria, Enfermedad Celiaca e Inmunodeficiencias. El propósito de este caso clínico es alertar sobre la necesidad de incluir dentro del protocolo de estudio de diarrea crónica, la búsqueda de protozoarios formadores de esporas, mediante tinción especial en heces; un método no invasivo y sencillo, no solicitado en forma rutinaria.
Cryptosporidium spp and Isospora belli parasites are emerging that represent the fourth leading cause of diarrhea worldwide, mainly in children and in immunocompromised patients. Acute or chronic diarrhea occur depending on the patient's age, nutritional status and immunological factors associated with adverse health. The diagnosis is made by direct visualization in feces Neelsen stain Zelh Kinyou modified or intestinal biopsy and the presence of protozoa in the crypts and villous atrophy according to the degree of infestation. We report the case of preschool age 2, eutrophic immunocompetent, belonging to low socioeconomic levels, with self-limiting episodes of acute watery diarrhea, frequent abdominal pain and bloating. The intestinal biopsy revealed villous atrophy and simultaneous infestation by Cryptosporidium spp and Isospora belli Kinyou confirmed by staining in feces, while discarding also Food Allergy, Celiac disease and immunodeficiencies. The purpose of this case to alert about the need to include in the study protocol of chronic diarrhea, the search for spore-forming protozoa by special staining in feces, a noninvasive and simple method, not routinely requested.
Assuntos
Humanos , Masculino , Pré-Escolar , Cryptosporidium/imunologia , Cryptosporidium/parasitologia , Diarreia/imunologia , Diarreia/parasitologia , Imunocompetência/imunologia , Isospora/imunologia , Isospora/parasitologia , Gastroenterologia , PediatriaRESUMO
Introducción: El tratamiento ideal para erradicar el H. pylori en niños, no se ha encontrado. Existe poco consenso sobre indicación de reendoscopia y tratamiento, con preocupación sobre la resistencia bacteriana. Objetivo: determinar la erradicación de H. pylori post-tratamiento en pacientes con indicación de segunda endoscopia, revisión de esquemas terapéutico y seguimiento. Pacientes y Métodos: estudio prospectivo, 73 pacientes seleccionados de 268 niños tratados con triple terapia por 14 días. Variables estudiadas: indicación de segunda endoscopia, tratamiento recibido, porcentaje de erradicación, falla de tratamiento y seguimiento por dos años. Resultados: edad promedio 7,94 años (rango:1-15); 27 (36,98%) varones y 46 (63,01%) hembras. Indicación de segunda endoscopia: dolor abdominal (63,01%), gastritis crónica activa severa (16,43%), cúmulos linfoides (8,21%), atrofia glandular focal (9,58%), metaplasia intestinal (2,73%). Tratamiento inicial indicado: amoxicilina-metronidazol-inhibidores de bomba 47/73 (63,01%), amoxicilinaclaritromicina-inhibidores de bomba 18/73 (24,65%), metronidazol-claritromicina-inhibidores de bomba 6/73/ (8,21%) y amoxicilina-furoxona-inhibidores de bomba 2/73 (2,73%). Se encontró positividad de H. pylori en la segunda biopsia 31/73 (42,46%). Comparando primera y segunda biopsia, una erradicación de 57,53%, (p=0.0001). Una eficacia de amoxicilinaclaritromicina-inhibidores de bomba 77,77% vs. Amoxicilinametronidazol-inhibidores de bomba 48,93%, p= 0.0356. Falla en la erradicación en triple terapia con metronidazol 51,06%. No hubo diferencias significativas con los otros esquemas. En el seguimiento, tercera endoscopia en 10/31(32,25%), en 8/10 la bacteria presente y 4/8 de ellos, con cuarta endoscopia, 3/4 con persistencia de la infección y uno con curación, no pudiéndose determinar si se trataba de recurrencia o re-infección...
Introduction: The ideal treatment to eradicate H. pylori in children has not been found. There is little consensus on the indication of reendoscopy and treatment, with concern over bacterial resistance. Objective: To determine the eradication of H. pylori after treatment in patients with an indication of second endoscopy, review of therapeutic and monitoring schemes. Patients and Methods: A prospective study, 73 patients selected from 268 children treated with triple therapy for 14 days. Studied variables: indication of second endoscopy, treatment received, percentage of eradication, failure of treatment and monitoring for two years. Results: Mean age 7.94 years (range: 1-15); 27 (36.98%) males and 46 (63.01%) females. Indication of second endoscopy: abdominal pain (63.01%), severe active chronic gastritis (16.43%), lymphoid clusters (8.21%), focal glandular atrophy (9.58%), intestinal metaplasia (2.73%). Initial treatment indicated: amoxicillin-metronidazole-pump inhibitors 47/73 (63.01%), amoxicillin-clarithromycin-pump inhibitors 18/73 (24.65%), metronidazole-clarithromycin-pump inhibitors 6 / 73 / ( 8.21%) and amoxicillin-Furoxone-pump inhibitors for 2 / 73 (2.73%). Were positive for H. pylori in the second biopsy 31/73 (42.46%). Comparing first and second biopsy, an eradication of 57.53% (p = 0.0001). Efficacy of amoxicillin-clarithromycin-pump inhibitors 77.77%. vs. amoxicillin-metronidazole-pump inhibitors 48.93%, p = 0.0356. Failure to eradicate metronidazole triple therapy 51.06%. There were no significant differences with the other schemes. Upon follow up, a third endoscopy in 10/31 (32.25%), in 8/10 the bacteria were present and 4/8 of them, with fourth endoscopy, 3/4 with persistent infection and one with healing, unable to determine whether it was a recurrence or reinfection. Eradication therapy is complex, it requires improving the therapeutic strategy and monitoring to increase the healing of the infection.
Assuntos
Humanos , Masculino , Feminino , Criança , Claritromicina/administração & dosagem , Claritromicina/uso terapêutico , Helicobacter pylori , Metronidazol/administração & dosagem , Metronidazol/uso terapêutico , Resultado do Tratamento , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Fármacos Gastrointestinais , PediatriaRESUMO
La dilatación precoz en esofagitis caústica no está bien establecida. Objetivo: Evaluar el beneficio de la dilatación precoz, en la evolución y complicaciones de esofagitis caústicas grado II y III. Pacientes y Métodos: Estudio prospectivo de 32 niños, grupo A (dilatación precoz) y B (dilatación tardía). Se utilizo el índice de dilatación periódica para evaluar beneficio de la dilatación precoz. Resultados: edad promedio 2,3 años; 13 (40,62%) hembras y 19 (59,38%) varones; 21/32 (65,62%) desarrollaron estenosis esofágica, 6/15 (40,00%) grupo A, 15/17 (88,23%) grupo B (p=0,0041). Estenosis simples en 12/21 (57,14%), complejas 9/21 (42,85%), recurrentes 2/6 y refractaria 2/6, grupo A; 6/15 recurrente y 5/15 refractarias, 1/15 perforación esofágica, grupo B. El promedio de sesiones de dilatación 17 vs 44,6 (p=0,0297) e índice de dilatación periódica de 3,04 vs 4,11 (p=0.0002) grupo A y B respectivamente. Conclusiones: la dilatación precoz en esofagitis caústica es segura y contribuye a disminuir el número de sesiones de dilatación y complicaciones. Se destaca, la importancia de la prevención de la ingesta accidental de cáusticos.
Early dilatation in caustic esophagitis is not well established. Objective: Evaluate the benefits of early dilatation in the evolution and complications of grade I and II caustic esophagitis in children. Patients and Methods: Prospective study of 32 children, group A (early dilatation) and B (late dilatation). The periodic dilatation index was used to evaluate the benefits of early dilatation. Results: Average age 2,3 years old; 13 (40,62%) female and 19 (59,38%) male; 21/32 (65,62%) developed esophageal stenosis. 6/15 (40,00%) group A, 15/17 (88,23%) group B (p=0,0041). Simple stenosis in 12/21 (57,14%), complex 9/21 (42,85%), recurrent 2/6 and refractory 2/6, group A; 6/15 recurrent and 5/15 refractory, 1/15 esophageal perforation, group B. The average of dilatation sessions was 17 vs. 44,6 (p=0,0297) and periodic dilatation index was 3,04 vs. 4,11 (p=0.0002) group A and B respectively. Conclusions: early dilatation in caustic esophagitis is safe and contributes to decrease the number of dilatation sessions and complications.
Assuntos
Humanos , Masculino , Feminino , Criança , Dilatação Gástrica/complicações , Esofagite/diagnóstico , Esofagite/patologia , Estenose Esofágica/complicações , Gastroenterologia , PediatriaRESUMO
La deglución es uno de los actos instintivos del niño al nacer, comprende un complejo mecanismo, que re-quiere una adecuada secuencia y buena coordinada con los procesos de succión y respiración. La alteración de la deglución, orgánica o funcional, pueden ocasionar desnutrición, deshidratación, neumopatía aspirativa y otopatía entre otras. Se presentan tres pacientes referidos para evaluación por dificultad en la alimentación o disfagia. Caso 1: Lactante menor, masculino, 11 meses de edad, con Epilepsia refractaria al tratamiento y disfagia a alimentos líquidos y sólidos. Caso 2: Preescolar masculino, 2 años, con Encefalopatía epiléptica, Retardo Global del Desarrollo, y dificultad respiratoria con la alimentación. Caso 3: Lactante menor, masculino, 2 meses, quién ingreso a terapia neonatal por succión débil y egresa con dificultad en la alimentación. Se realiza video-deglutoscopia, como parte de los estudios exploratorios y se hace el diagnóstica en el primer caso, fase oral y faríngea alterada con disfagia severa, y se indica gastrostomía; en el segundo caso, disfagia fase oral moderada y faríngea severa, con mejor tolerancia de alimentos blandos o lubricados, se indica modificar consistencia de alimentos, medidas posturales y terapia deglutoria; el tercer caso, trastorno severo de fase oral con aspiración laríngea, se indica terapia degluto-ria y espesante para fórmula láctea y agua. La video-deglutoscopia es una técnica diagnóstica que permite estudiar la fisiología de la deglución, estimar el riesgo de aspiración y orientar sobre la forma más segura de alimentar al paciente, en especial en pacientes con patologías neurológicas.
Swallowing is one of the instinctive actions of the child at birth, includes a complex mechanism, which requires adequate sequence and good coordination with the processes of sucking and breathing. Altera-tion of swallowing, organic or functional, may result in malnutrition, dehydration, aspiration pneumonia and otopatía among others. We present three patients referred for evaluation by feeding difficulty or dyspha-gia. Case 1: Infant child, male, 11 months of age with refractory epilepsy and dysphagia for liquid and solid foods. Case 2: Preschool male, 2 years with epilep-tic encephalopathy, Global Developmental Delay, and diffi culty breathing with food. Case 3: Infant child, male, 2 months, was admitted in neonatal therapy and graduated with a weak suction feeding difficulty. Videodeglutoscopia is performed as part of exploratory studies, the diagnosis is made in the first case, oral and pharyngeal altered with severe dysphagia, and gastrostomy is indicated in the latter case, dyspha-gia, oral and pharyngeal moderate severe, with bet-ter tolerability soft food or lubricated, states modify food consistency, measures of posture and swallow-ing therapy, the third case, oral disorder severe laryn-geal aspiration, and swallowing therapy is indicated for formula milk thickener and water. The videodeglu-toscopia is a diagnostic technique that allows study-ing the physiology of swallowing, to estimate the risk of aspiration and guidance on the safest way to feed the patient, especially in patients with neurological diseases.
Assuntos
Humanos , Masculino , Lactente , Pré-Escolar , Endoscopia Gastrointestinal , Doenças do Sistema Nervoso/diagnóstico , Transtornos de Deglutição/complicações , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição , Gastroenteropatias , PediatriaRESUMO
The development of laparoscopic colorectal surgery began 20 years ago; however it took several years before gaining its acceptance by the international surgical community. The first report in Chile was published in 1995. However, were necessary many years, until the middle of this decade, to know the first prospective series experiences. Out of these reports, no reliable data exist regarding the development of laparoscopic colorectal surgery in Chile, related to the number of centers performing laparoscopic colorectal surgery or the number of procedures performed. For record these data, a standardized questionnaire was send to colorectal chairmans of all hospitals that had reported to be developing laparoscopic colorectal surgery in our country. Ten of 15 hospitals responded to the survey. Most of the procedures performed were hemicolectomies, principally for cancer and diverticular disease. The average conversion rate was 7 percent and hospital stay was 5 days. Morbidity and mortality rates were 12 percent and 0.4 percent respectively. In the last year was seen an increase in the number of laparoscopic procedures in relation to the previous period. In conclusion, laparoscopic colorectal surgery is a recent technique in Chile, which is being implemented progressively, with good overall results.
El desarrollo de la cirugía laparoscópica colorrectal (CLCR) se inició en la década de los 90, sin embargo, pasaron varios años antes de lograr su aceptación por la comunidad quirúrgica internacional. En Chile, los primeros relatos en congresos datan del año 1995 y las primeras experiencias de series prospectivas fueron publicadas 10 años más tarde. Fuera de estos reportes, no existe información fidedigna en relación al desarrollo de la cirugía laparoscópica colorrectal en Chile, relacionados con el número de centros que la realizan, la formación actual de los cirujanos colorrectales en esta técnica ni en cuanto al número de procedimientos realizados. Para conocer estos datos se envió una encuesta estandarizada a los jefes de equipo de los centros que habían comunicado estar desarrollando la CLCR en nuestro país. Diez de 15 centros respondieron la encuesta. La mayor parte de los procedimientos corresponden a hemicolectomías, siendo las principales indicaciones el cáncer y la enfermedad diverticular. La tasa de conversión promedio fue de 7 por ciento y la estadía hospitalaria de 5 días. La morbilidad y mortalidad fue de 12 por ciento y 0,4 por ciento respectivamente. En el último año se ha visto un aumento del número de procedimientos laparoscópicos en relación al período previo. En conclusión, La CLCR es una técnica de reciente incorporación en Chile, que está siendo implementada en forma progresiva, con buenos resultados globales.
Assuntos
Humanos , Doenças do Colo/cirurgia , Doenças Retais/cirurgia , Laparoscopia/estatística & dados numéricos , Chile , Competência Clínica , Colectomia/estatística & dados numéricos , Coleta de Dados , Aprendizagem , Laparoscopia/mortalidade , Morbidade , Neoplasias Colorretais/cirurgiaRESUMO
El uso de medios de contraste con gadolinio en resonancia magnética nuclear (RMN) ha sido considerado como un elemento de diagnóstico eficiente y seguro. Sin embargo, se han comunicado reacciones alérgicas severas. A pesar de ser infrecuentes, las reacciones anafilácticas deberían ser consideradas como una complicación potencial y por ende conducirnos a tomar medidas para su temprano diagnóstico y tratamiento. El propósito de este artículo es describir cinco casos de anafilaxia luego de la administración de este medio de contraste.(AU)
The use of gadolinium contrast media has been considered as a safe and efficient method for diagnosis. However, severe anaphylactic reactions have been reported. Although infrequent, they must be considered a potential complication in this diagnostic procedure and must therefore lead us to take measures for an early recognition and treatment. Five cases of anaphylactic reaction to gadolinium are described in this article.(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Meios de Contraste/efeitos adversos , Gadolínio , Anafilaxia , Espectroscopia de Ressonância MagnéticaRESUMO
Gastrointestinal stromal tumors (GIST) are the most common mesenchymatic neoplasm in the digestive tract, representing about 1 percent of malignant gastrointestinal lesions. Seventy to eighty percent are benign according to their size and mitotic index as predictors of malignancy. However, in the presence of relapses in patients with low risk according to the current classification and in light of new adjuvant therapies (Imatinib Mesylate), have defined new parameters for estimation of malignant potential.
Los tumores del estroma gastrointestinal (GIST) son las neoplasias mesenquemáticas más comunes del tracto digestivo representando cerca del 1 por ciento de las lesiones neoplásicas gastrointestinales. El 70 por ciento-80 por ciento de ellas son benignas siendo clasificados según su tamaño e índice mitótico como predictores de malignidad. Sin embargo, ante la presencia de recidivas en pacientes con bajo riesgo según la clasificación actual y a la luz de nuevas terapias adyuvantes (Mesilato de Imatinib), se han definido nuevos parámetros para su estimación de potencial maligno.