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1.
An. pediatr. (2003. Ed. impr.) ; 92(4): 241.e1-241.e11, abr. 2020. mapas, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-186847

RESUMO

El 31 de diciembre de 2019, la Comisión Municipal de Salud y Sanidad de Wuhan (provincia de Hubei, China) informó sobre la existencia de 27 casos de neumonía de etiología desconocida con inicio de síntomas el 8 de diciembre, incluyendo 7 casos graves, con exposición común a un mercado de marisco, pescado y animales vivos en la ciudad de Wuhan. El 7 de enero de 2020, las autoridades chinas identificaron como agente causante del brote un nuevo tipo de virus de la familia Coronaviridae, denominado temporalmente «nuevo coronavirus», 2019-nCoV. El 30 de enero de 2020 la Organización Mundial de la Salud (OMS) declara el brote una Emergencia Internacional. El día 11 de febrero la OMS le asigna el nombre de SARS-CoV2 e infección COVID-19 (Coronavirus Infectious Disease). El Ministerio de Sanidad convoca a las Sociedades de Especialidades para la elaboración de un protocolo clínico de manejo de la infección. La Asociación Española de Pediatría nombra un grupo de trabajo de las Sociedades de Infectología Pediátrica y Cuidados Intensivos Pediátricos que se encargan de elaborar las presentes recomendaciones con la evidencia disponible en el momento de su realización


On 31 December 2019, the Wuhan Municipal Committee of Health and Healthcare (Hubei Province, China) reported that there were 27 cases of pneumonia of unknown origin with symptoms starting on the 8 December. There were 7 serious cases with common exposure in market with shellfish, fish, and live animals, in the city of Wuhan. On 7 January 2020, the Chinese authorities identified that the agent causing the outbreak was a new type of virus of the Coronaviridae family, temporarily called «new coronavirus», 2019-nCoV. On January 30th, 2020, the World Health Organisation (WHO) declared the outbreak an International Emergency. On 11 February 2020 the WHO assigned it the name of SARS-CoV2 and COVID-19 (SARS-CoV2 and COVID-19). The Ministry of Health summoned the Specialties Societies to prepare a clinical protocol for the management of COVID-19. The Spanish Paediatric Association appointed a Working Group of the Societies of Paediatric Infectious Diseases and Paediatric Intensive Care to prepare the present recommendations with the evidence available at the time of preparing them


Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Coronavirus/classificação , Coronavirus/genética , Reação em Cadeia da Polimerase em Tempo Real , Índice de Gravidade de Doença , Sociedades Médicas , Espanha
3.
Emergencias (Sant Vicenç dels Horts) ; 32(4): 233-241, ago. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-190940

RESUMO

OBJETIVO: Describir las características clínicas de los pacientes con COVID-19 atendidos en los servicios de urgencias hospitalarios (SUH) españoles y evaluar su asociación con los resultados de su evolución. MÉTODOS: Estudio multicéntrico, anidado en una cohorte prospectiva. Participaron 61 SUH que incluyeron pacientes seleccionados aleatoriamente de todos los diagnosticados de COVID-19 entre el 1 de marzo y el 30 de abril de 2020. Se recogieron características basales, clínicas, de exploraciones complementarias y terapéuticas del episodio en los SUH. Se calcularon las odds ratio (OR) asociadas a la mortalidad intrahospitalaria y al evento combinado formado por el ingreso en unidad de cuidados intensivos (UCI), la intubación orotraqueal o ventilación mecánica invasiva (IOT/ VMI), crudas y ajustadas con modelos de regresión logística para tres grupos de variables independientes: basales, clínicas y de exploraciones complementarias. RESULTADOS: La edad media fue de 62 años (DE 18). La mayoría manifestaron fiebre, tos seca, disnea, febrícula y diarrea. Las comorbilidades más frecuentes fueron las enfermedades cardiovasculares, seguidas de las respiratorias y el cáncer. Las variables basales que se asociaron independientemente y de forma directa a peores resultados evolutivos (tanto a mortalidad como a evento combinado) fueron edad y obesidad; las variables clínicas fueron disminución de consciencia y crepitantes a la auscultación pulmonar, y de forma inversa cefalea; y las variables de resultados de exploraciones complementarias fueron infiltrados pulmonares bilaterales y cardiomegalia radiológicos, y linfopenia, hiperplaquetosis, dímero-D > 500 mg/dL y lactato-deshidrogenasa > 250 UI/L en la analítica. CONCLUSIONES: Conocer las características clínicas y la comorbilidad de los pacientes con COVID-19 atendidos en urgencias permite identificar precozmente a la población más susceptible de empeorar, para prever y mejorar los resultados


OBJECTIVES: To describe the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) treated in hospital emergency departments (EDs) in Spain, and to assess associations between characteristics and outcomes. METHODS: Prospective, multicenter, nested-cohort study. Sixty-one EDs included a random sample of all patients diagnosed with COVID-19 between March 1 and April 30, 2020. Demographic and baseline health information, including concomitant conditions; clinical characteristics related to the ED visit and complementary test results; and treatments were recorded throughout the episode in the ED. We calculated crude and adjusted odds ratios for risk of in-hospital death and a composite outcome consisting of the following events: intensive care unit admission, orotracheal intubation or mechanical ventilation, or in-hospital death. The logistic regression models were constructed with 3 groups of independent variables: the demographic and baseline health characteristics, clinical characteristics and complementary test results related to the ED episode, and treatments. RESULTS: The mean (SD) age of patients was 62 (18) years. Most had high- or low-grade fever, dry cough, dyspnea, and diarrhea. The most common concomitant conditions were cardiovascular diseases, followed by respiratory diseases and cancer. Baseline patient characteristics that showed a direct and independent association with worse outcome (death and the composite outcome) were age and obesity. Clinical variables directly associated with worse outcomes were impaired consciousness and pulmonary crackles; headache was inversely associated with worse outcomes. Complementary test findings that were directly associated with outcomes were bilateral lung infiltrates, lymphopenia, a high platelet count, a D-dimer concentration over 500 mg/dL, and a lactate-dehydrogenase concentration over 250 IU/L in blood. CONCLUSION: This profile of the clinical characteristics and comorbidity of patients with COVID-19 treated in EDs helps us predict outcomes and identify cases at risk of exacerbation. The information can facilitate preventive measures and improve outcomes


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Serviços Médicos de Emergência/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Evolução Clínica/métodos , Betacoronavirus , Estudos Prospectivos , Razão de Chances , Intubação Intratraqueal , Respiração Artificial , Modelos Logísticos , Mortalidade Hospitalar
7.
Enferm. intensiva (Ed. impr.) ; 31(2): 52-59, abr.-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-190921

RESUMO

OBJETIVO: Determinar las opiniones del equipo asistencial (EA) ante la visita de menores en una unidad de cuidados intensivos de adultos. MÉTODO: Estudio descriptivo transversal en una unidad de cuidados intensivos de adultos con un EA de 62 personas, entre septiembre-diciembre 2017. Se utilizó el cuestionario de Knutsson con 10 preguntas cerradas con espacio para comentarios y 2 abiertas. Selección de los encuestados mediante muestreo de conveniencia. Estadística descriptiva con frecuencias absolutas y porcentajes. Prueba de Chi2 o Fisher. Significación p < 0,05. RESULTADOS: Se recogieron 61 cuestionarios: 70,5% correspondían a personal de enfermería (PE). El 50% de profesionales médicos (PM) restringiría la entrada de menores de 0-6 años frente al 76,2% de PE (p = 0,04). Entre 7-12 años, el 16,7% de PM la limitaría frente al 46,5% del PE (p = 0,02). El 75% del EA opinó que la entrada podía significar riesgo de infección para el menor. El 60% creyó que el entorno podía intimidarlo y el 66,7% que podía impresionarlo el estado del paciente. Permitirían la entrada de menores de 0-6 años, si el paciente se estuviera muriendo (70,6% PM y 41% PE) p = 0,04), despierto (77,8% PM y 57,5% PE) o parentesco cercano (padre/madre) (66,7% PM y 60% PE). CONCLUSIONES: El EA es partidario de la visita con una edad > 6 años. En circunstancias especiales: parentesco cercano, paciente despierto o muerte son más permisivos independientemente de la edad. Los motivos de restricción son: entorno, estado y riesgo de infección. El PE es más restrictivo ante la visita


AIM: To determine the opinion of healthcare staff (HS) on the presence of minors in an adult intensive care unit. METHOD: Transversal descriptive research study in an adult intensive care unit with 62 people, between September/December 2017. The Knutsson questionnaire was used with 10 closed questions with space for comments, and 2 open questions. Selection of the respondents was by means of convenience sampling. Descriptive statistics with absolute frequencies and percentages. Chi-squared-test or Fisher. Significance p < .05. RESULTS: 61 questionnaires were collected: 70.5% nursing staff (NS). Fifty percent of medical staff (MS) would restrict the entry of 0 to 6-year old minors versus 76.2% NS (p = .04). Of the MS, 16.7% would restrict the visits of minors between the ages of 7 and 12 versus 46.5% NS (p=.02). Seventy-five percent of HS thought that minors' access could entail a risk of infection for the children. Of the survey respondents, 60% believed that the environment could intimidate the minor, and 66.7% thought that the patient's condition could affect the child. They would permit 0-6-year-old minors to access the ICU if the patient was dying (70.6% MS/41% NS, p = .04), awake and alert (77.8% MS/57.5% NE) and close relatives (parents) (66.7% MS/60% NS). CONCLUSIONS: HS support minors visiting an adult adult intensive care unit if they are > 6 years old. HS show a more positive attitude towards visits in special circumstances such as close relatives, awake patient, and death regardless of their age. The reasons for restriction of visits are: environment, patient's condition and risk of infection. NS show a less positive attitude in relation to visits


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Visitas a Pacientes , Unidades de Terapia Intensiva/normas , Atitude do Pessoal de Saúde , Recursos Humanos de Enfermagem no Hospital , Estudos Transversais , Inquéritos e Questionários , Pessoal de Saúde/estatística & dados numéricos , Psicologia da Criança , Papel do Profissional de Enfermagem/psicologia
8.
Ars pharm ; 61(2): 97-103, abr.-jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-191329

RESUMO

INTRODUCCIÓN: La OMS recomienda que durante los seis primeros meses de vida, los lactantes debieran ser alimentados exclusivamente con leche materna. A partir de ese momento, deberían recibir alimentos complementarios adecuados e inocuos, sin abandonar la lactancia natural al menos hasta los dos años de edad. El tratamiento farmacológico es una de las razones de abandono de la lactancia materna a pesar de que la mayoría de los medicamentos actuales son compatibles con la lactancia. OBJETIVO: Determinar las causas de la interrupción de la lactancia materna en mujeres participantes dedos plataformas virtuales nacionales. MÉTODO: Estudio observacional, descriptivo utilizando una encuesta virtual en 33 mujeres que hayan suspendido la lactancia materna de abril 2015 a abril 2017, participantes de dos plataformas virtuales de apoyo a la lactancia y maternidad del Paraguay. El muestreo no probabilístico por conveniencia. RESULTADOS: La edad promedio de 28±4,2 años, la mayoría universitarias, residentes en el departamento Central. Se detectó 30,3% de destetes antes de los 6 meses, y solo 9,0% alcanzaron los 24 meses de lactancia materna recomendada por la OMS. Las causas de la interrupción de la lactancia más frecuente fue la medicación (36,4%), seguida de sensación de falta de leche (27,3%) y de que el niño se quedaba con hambre (18,2%). CONCLUSIONES: La medicación representó la mayor causa de destete involuntario, siendo medicamentos compatibles con la lactancia en más de la mitad de los casos reportados. El farmacéutico, profesional con mayor conocimiento de fuentes de información sobre medicamentos, podría haber contribuido en estos casos para la preservación de la lactancia


INTRODUCTION: Who recommends that during the first six months of life, infants should be fed exclusively with breast milk. From that moment, they should receive adequate and safe complementary foods, without abandoning breastfeeding at least until two years of age. Pharmacological treatment is one of the reasons for abandoning breastfeeding despite the fact that most current medications are compatible with breastfeeding. OBJECTIVE: To determine the causes of the interruption of breastfeeding in women participants of two national virtual platforms. METHOD: Observational, descriptive study using a virtual survey of 33 women who have suspended breastfeeding from April 2015 to April 2017, participants of two virtual breastfeeding and maternity support platforms in Paraguay. Sampling not probabilistic for convenience. RESULTS: The average age of 28 ± 4.2 years, mostly university, residents in the Central department.30.3% of weaning was detected before 6 months, and only 9.0% reached 24 months of breastfeeding recommended by WHO. The causes of the most frequent interruption of breastfeeding were medication (36.4%), followed by a feeling of lack of milk (27.3%) and that the child was left hungry (18.2%). CONCLUSIONS: The medication represented the major cause of involuntary weaning, being compatible with breastfeeding drugs in more than half of the cases reported. The pharmacist, a professional with greater knowledge of information sources on medications, could have contributed in these cases to the preservation of breastfeeding


Assuntos
Humanos , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Adulto Jovem , Adulto , Uso de Medicamentos/estatística & dados numéricos , Aleitamento Materno/estatística & dados numéricos , Fatores Socioeconômicos , Estudos Transversais , Fatores de Tempo , Paraguai
9.
Allergol. immunopatol ; 48(3): 223-231, mayo-jun. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-192023

RESUMO

OBJECTIVES: To analyze the incidence of wheezing in the first six years of life; the prevalence of asthma at six years of age; and the associated risk factors, in a population from Valencia, Spain. METHODS: A prospective longitudinal study was made of a cohort of 636 newborn infants, with follow-up of the clinical records and the completion of questionnaires up to the age of six years. RESULTS: The prevalence of asthma at six years of age was 12.8%. Up until that age, 63% of the study population had experienced at least one episode of wheezing, and 35% had suffered recurrent wheezing (three or more episodes). Admission due to wheezing was associated to school asthma. The following risk factors were identified: atopic dermatitis (OR: 2.1; 95%CI: 1.2-3.5), the presence of at least one episode of wheezing in the first year (OR: 1.8; 95%CI: 1.1-2.9), prematurity (OR: 2.5; 95%CI: 1.2-5.1), and a family history of asthma (OR: 2.2; 95%CI: 1.2-4.1). CONCLUSIONS: The prevalence of asthma at six years of age in our population is similar to that described in other longitudinal studies. An important increase is observed in the cumulative incidence of wheezing and of recurrent wheezing up to three years of age, followed by stabilization. The most relevant risk factors for developing asthma at six years were atopic dermatitis, wheezing during the first year, prematurity, and a family history of asthma. Full-term pregnancy and the minimization of respiratory infections at an early age could reduce the prevalence of asthma at six years of age in our population


No disponible


Assuntos
Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Lactente , Asma/epidemiologia , Sons Respiratórios/diagnóstico , Estudos de Coortes , Fatores de Risco , Estudos Longitudinais , Espanha/epidemiologia , Estudos Prospectivos , Inquéritos e Questionários , Dermatite Atópica/epidemiologia , Modelos Logísticos , Análise Multivariada
10.
Allergol. immunopatol ; 48(3): 232-236, mayo-jun. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-192024

RESUMO

BACKGROUND: China and Spain are world leaders in the consumption of edible bulbs (garlic and onion), but there are few references to their capacity to cause allergic symptoms. The target was to study allergic sensitization and clinical symptoms associated with garlic and onion consumption in a large sample of allergic patients. METHODS: An observational cross-sectional study was conducted, testing garlic and onion extracts in 8109 patients of all ages seen by our allergy clinic in 2018. Forty-four aeroallergens and foods were tested, including garlic and onion, with prick test and determination of specific IgE. Oral provocation and contact tests were performed if a delayed reaction was suspected. Western Blot was performed in the serum of patients positive to garlic and onion. RESULTS: We conducted 356,798 skin tests and 4254 specific IgE determinations. Of the 8109 patients tested, 2508 (30.92%) presented with symptoms associated with food intake and, in these patients, food hypersensitivity was detected by skin test, positive specific IgE or provocation in 924 patients, and was caused by garlic or onions in 27, indicating a prevalence of 2.92%. Immunodetection showed an association between the symptoms and a specific LTP to these bulbs, without cross-reactivity with other LTPs in the Mediterranean diet (peach, wheat). CONCLUSIONS: Allergic hypersensitivity to garlic and onions should not be underestimated and, given their high consumption, should be included in the diagnostic food allergy battery


No disponible


Assuntos
Humanos , Masculino , Feminino , Lactente , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Hipersensibilidade Alimentar/diagnóstico , Alho/imunologia , Imunoglobulina E/sangue , Cebolas/imunologia , Hipersensibilidade Alimentar/imunologia , Testes Cutâneos , Teste de Radioalergoadsorção , Estudos Transversais , Western Blotting
11.
Allergol. immunopatol ; 48(3): 244-250, mayo-jun. 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-192026

RESUMO

INTRODUCTION AND OBJECTIVES: Eosinophilic esophagitis (EoE) is frequently miss-diagnosed or overlooked for several years because of the invasiveness of investigations and the non-specificity of symptoms in childhood. Due to the lack of specific recommendations in children, its management remains very heterogeneous, especially concerning allergy testing. The aim of this study is to analyze our population and practices, in comparison with the literature, with a focus on allergic management, to harmonize and optimize our practice. MATERIAL AND METHODS: We included all children with a diagnosis of EoE at the Hospital Femme Mere Enfant, Bron, France. Data were collected via retrospective chart review. RESULTS: 108 patients were included with an average age of 9.5 years. Average delay before diagnosis was 6.65 years. Symptoms varied with age, with a predominance of vomiting (60% of patients), feeding difficulties (72%) and growth difficulties (24%) in children < 5 years, whereas older children often presented with feeding blockage (64%) and dysphagia (61%). Cough was frequent in our cohort (18.5%), especially in children < 10 years (38.5% between three and five years). The allergic background was frequent (70.3%) and 80% of our patients benefited from allergy testing. Allergy testing was particularly useful to guide therapy as elimination diet represented an effective treatment in 60% of our patients CONCLUSIONS: Allergy testing has to be harmonized to include major allergens (egg, milk, peanut, fish, wheat, and soy), including prick and patch tests. Allergy-testing based diet seemed to be the best compromise between efficiency and constraints, especially in mono-sensitized patients


No disponible


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Esofagite Eosinofílica/imunologia , Esofagite Eosinofílica/diagnóstico , Técnicas Imunológicas , Estudos Retrospectivos , Hipersensibilidade/diagnóstico , Esofagite Eosinofílica/complicações , Hipersensibilidade Alimentar/diagnóstico , Rinite Alérgica/diagnóstico , Dermatite Atópica/diagnóstico , Endoscopia , Imunoglobulina E/análise , Testes Cutâneos
12.
Allergol. immunopatol ; 48(3): 259-264, mayo-jun. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-192028

RESUMO

The clinical history is of importance in the investigation of allergic diseases but does have limitations. Many allergic conditions will be over-diagnosed if anamnesis alone is used for diagnostic criteria. Serum total immunoglobulin E (TIgE) quantification, as well as panels containing allergens prevalent in the studied population, may serve as screening tests and facilitate the diagnosis of allergic disease or its exclusion. We assessed the positivity of two versions of these tests, Phadiatop Europe® (PhEU) and Phadiatop Infant® (PhInf), as well as total IgE (TigE) values in patients with a medical diagnosis of allergic disease and non-allergic individuals. METHODS: A cross-sectional study performed in eleven Brazilian pediatric allergy centers with patients divided into groups according to the primary condition and a group of assessed control subjects. They were submitted to TIgE measurement and screening tests (PhEu and PhInf). RESULTS: TIgE mean serum levels were significantly higher among allergic patients, especially those with asthma/rhinitis or atopic dermatitis. The positivity of the screening tests, considering the total population, was 63.8% for PhEU and 72.6% for PhInf. These increased when we evaluated only the allergic subjects. The concordance index of the two tests was Kappa = 0.7 and higher among those of greater age. CONCLUSIONS: In the assessed population, there were significantly higher levels among those with positive screening tests and PhInf showed better performance in the identification of sensitized individuals, regardless of age. This is the first study to evaluate Phadiatop and Phadiatop Infant in the same population


No disponible


Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Testes Hematológicos/métodos , Hipersensibilidade/diagnóstico , Imunoglobulina E/sangue , Técnicas Imunológicas/métodos , Hipersensibilidade/imunologia , Brasil , Estudos Transversais , Alérgenos/imunologia , Dermatite Atópica/imunologia , Asma/imunologia , Rinite Alérgica/imunologia , Sensibilidade e Especificidade
13.
Allergol. immunopatol ; 48(3): 265-269, mayo-jun. 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-192029

RESUMO

INTRODUCTION AND OBJECTIVES: A high rate of cross-reactivity has been reported between the specific proteins of hen's egg with proteins of various avian eggs by quantitative immunoelectrophoretic techniques. The aim of this study was to assess the clinical cross-reactivity of different birds' eggs in children with hen's egg allergy based on skin prick test results. MATERIAL AND METHODS: This cross-sectional study enrolled 52 infants with hen's egg allergy and 52 healthy infants with no history of food allergy from October 2018 to April 2019. Skin prick tests were performed in both patient and control groups with fresh extract of white and yolk related to pigeon, duck, goose, turkey, quail, and partridge. RESULTS: Fifty (96.1%) children with hen's egg allergy showed positive sensitization to at least one of the avian eggs. The most frequent positive skin tests were related to quail's white (36 = 69.2%) followed by duck's white (34 = 65.5%), and sensitization was the least frequent in pigeon's yolk (23 = 44.2%). Skin tests of the control group were negative to all the tested extracts. CONCLUSIÓN: Because of fewer sensitizations to some avian eggs, further research should clarify starting oral immunotherapy with the yolk of goose and pigeon in children with hen's egg allergy


No disponible


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Proteínas do Ovo/imunologia , Hipersensibilidade Alimentar/imunologia , Hipersensibilidade a Ovo/imunologia , Apresentação Cruzada/imunologia , Alérgenos/análise , Hipersensibilidade a Ovo/diagnóstico , Testes Cutâneos/métodos , Estudos Transversais , Imunoterapia/métodos , Inquéritos e Questionários
14.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(3): 151-154, mayo-jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-192419

RESUMO

El papiloma del plexo coroideo es un tumor poco frecuente del sistema nervioso central, que representa menos del 1% de todas las neoplasias intracraneales. Las ubicaciones habituales son el ventrículo lateral en bebés y niños y el cuarto ventrículo en adultos. El tercer ventrículo es una localización inhabitual, con pocos casos recogidos en la bibliografía. Describimos el caso de un niño de 3 meses que ingresó en nuestro centro con signos de aumento de la presión intracraneal. Los estudios de neuroimagen mostraron una lesión en el tercer ventrículo, con hidrocefalia asociada. Al paciente se le extirpó completamente el tumor mediante abordaje transfrontal y cirugía de derivación ventriculoperitoneal. El curso postoperatorio del niño transcurrió sin incidentes y la imagen de resonancia magnética de seguimiento no reveló tumor residual. La histopatología de la lesión resecada confirmó el diagnóstico de papiloma del plexo coroideo. Discutimos las características clínicas, radiológicas e histológicas de este tipo infrecuente de tumores


Choroid plexus papilloma is an uncommon tumour of the central nervous system, accounting for less than 1% of all intracranial neoplasm. The usual locations are the lateral ventricle in infants and children and the fourth ventricle in adults. The third ventricle is a rare location, with few cases reported in the literature. We describe the case of a 3-month-old boy who was admitted to our centre with signs of raised intracranial pressure. Neuroimaging studies showed a third ventricular mass with associated hydrocephalus. The patient underwent complete tumour removal through a transfrontal approach and ventriculo-peritoneal shunt surgery. Postoperative course of the child was uneventful and follow-up magnetic resonance imaging revealed no residual tumour. Histopathology of the resected lesion confirmed the diagnosis of choroid plexus papilloma. We discuss the clinical, radiological and histological features of this infrequent type of tumours


Assuntos
Humanos , Masculino , Lactente , Papiloma do Plexo Corióideo/diagnóstico por imagem , Papiloma do Plexo Corióideo/cirurgia , Terceiro Ventrículo/cirurgia , Neuroendoscopia/métodos , Terceiro Ventrículo/patologia , Derivação Ventriculoperitoneal/métodos , Ultrassonografia , Cérebro/diagnóstico por imagem , Cérebro/patologia
15.
Acta otorrinolaringol. esp ; 71(3): 154-159, mayo-jun. 2020. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-192630

RESUMO

BACKGROUND: Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of nasal obstruction in neonates with respiratory distress manifestations. Diagnosis is made with craniofacial computed tomography, prompt and precise treatment creates good outcomes in these patients. AIM: To present our experience in diagnosis and management considerations with this rare pathology and a case series of our surgically managed patients. METHODS: A retrospective, analytical study of CNPAS patients surgically managed over a period of seven years. Evaluation and follow up was reviewed. RESULTS: Thirteen patients were evaluated; pyriform aperture mean width was 5.5mm. Of these patients, 31% also had Congenital Midnasal Stenosis. Medical treatment failed for all the patients and they required surgical enlargement of the pyriform aperture. No complications were seen and all patients improved in symptoms and development. CONCLUSIONS: Congenital nasal obstruction can be fatal in new-borns, CNPAS is a rare differential diagnosis that must be completely evaluated, properly treated with conservative management and if it fails, with well-planned and executed surgery. Follow-up shows high rates of success


ANTECEDENTES: a estenosis congénita de la apertura piriforme nasal (CNPAS, por sus siglas en inglés) es una causa poco frecuente de obstrucción nasal en los recién nacidos, con manifestaciones de dificultad respiratoria. El diagnóstico se realiza por tomografía computarizada cráneo-facial. Se requiere un tratamiento rápido y preciso para mejorar los resultados en estos pacientes. OBJETIVOS: Presentar nuestra experiencia en el diagnóstico y las consideraciones del tratamiento de esta enfermedad. Se evalúa una serie de casos de pacientes tratados quirúrgicamente. MÉTODOS: Estudio retrospectivo y analítico de pacientes con CNPAS tratados quirúrgicamente en un período de 7 años. Revisión de la evaluación y seguimiento. RESULTADOS: Se evaluaron 13 pacientes; la anchura media de la apertura piriforme fue de 5,5mm. El 31% de los pacientes también tenían estenosis nasal media congénita. Todos los pacientes fallaron al tratamiento médico y requirieron agrandamiento quirúrgico de la apertura piriforme. No se observaron complicaciones en los pacientes, mejorando los síntomas y el desarrollo. CONCLUSIONES: La obstrucción nasal congénita puede ser letal en los recién nacidos, siendo la CNPAS un diagnóstico diferencial poco frecuente que debe evaluarse por completo, y tratarse adecuadamente de manera conservadora; en caso de fallo, debe realizarse cirugía bien planificada y ejecutada. El seguimiento muestra altas tasas de éxito


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Osso Nasal/anormalidades , Constrição Patológica/diagnóstico , Obstrução Nasal/etiologia , Obstrução Nasal/cirurgia , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Constrição Patológica/cirurgia , Estudos Retrospectivos
16.
Acta otorrinolaringol. esp ; 71(3): 166-174, mayo-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-192632

RESUMO

INTRODUCCIÓN: La hipoacusia neurosensorial (HNS) es el déficit sensorial más prevalente en nuestro medio. La secuenciación genómica de nueva generación (NGS) permite obtener un diagnóstico etiológico en un alto porcentaje de pacientes. Nuestro estudio piloto muestra los resultados de la aplicación sistemática de la NGS en una Unidad de Hipoacusia Infantil, así como sus implicaciones en el manejo clínico de los pacientes y sus familiares. MATERIAL Y MÉTODO: Se incluyó a 27 pacientes diagnosticados de HNS entre 2014 y 2017 en los que se descartó una causa ambiental. El test genético consistió en un panel de genes analizados mediante NGS (panel OTOgenicsTM). Este panel ha sido diseñado para incluir genes asociados con hipoacusia neurosensorial o mixta, de inicio precoz o tardío, sindrómica y no sindrómica, independientemente de su patrón de herencia. RESULTADOS: Se obtuvo un diagnóstico genético en el 56% (15/27) de los pacientes (62% en el caso de las HNS bilaterales); 5/27 (19%) presentaron variantes patogénicas en el gen GJB2 y el resto variantes patogénicas o probablemente patogénicas en otros genes asociados con HNS aislada (PR2X2, TECTA y STRC), con HNS sindrómicas (CHD7, GATA3, COL4A5, MITF y SOX10) o con HNS sindrómicas y no sindrómicas (BSND, ACTG1 y CDH23). DISCUSIÓN: El diagnóstico etiológico de la HNS supone un desafío en la práctica clínica. Nuestra serie demuestra que es posible implementar el diagnóstico genético en la rutina asistencial y que esta información tiene implicaciones pronósticas y terapéuticas


INTRODUCTION: Sensorineural hearing loss (SNL) is the most prevalent sensory deficit in our environment. Next generation genomic sequencing (NGS) enables an aetiological diagnosis in a high percentage of patients. Our pilot study shows the results of the systematic application of NGS in a Childhood Hearing Loss Unit, as well as its implications for the clinical management of patients and their families. MATERIAL AND METHOD: We included 27 patients diagnosed with SNL between 2014 and 2017, in which an environmental cause was ruled out. The genetic test consisted of a panel of genes analyzed by NGS (OTOgenicsTM panel). This panel has been designed to include genes associated with sensorineural or mixed hearing loss, early onset or late, syndromic and non-syndromic, regardless of their inheritance pattern. RESULTS: A genetic diagnosis was obtained in 56% (15/27) of the patients (62% in the case of bilateral SNL). Of the patients, 5/27 (19%) presented pathogenic variants in the GJB2 gene and the rest pathogenic and / or probably pathogenic variants in other genes associated with isolated SNL (PR2X2, TECTA and STRC), with syndromic SNL (CHD7, GATA3, COL4A5, MITF and SOX10) or with syndromic and non-syndromic SNL (BSND, ACTG1 and CDH23). DISCUSSION: The aetiological diagnosis of SNL is a challenge in clinical practice. Our series demonstrates that it is possible to implement genetic diagnosis in the care routine and that this information has prognostic and therapeutic implications


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Perda Auditiva/diagnóstico , Perda Auditiva/genética , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Perda Auditiva/etiologia , DNA/genética , Variação Estrutural do Genoma/genética
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