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1.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1515270

ABSTRACT

Introducción: Las urgencias psiquiátricas en la edad pediátrica constituyen un problema de salud pública. Objetivo: Describir las urgencias psiquiátricas y la conducta seguida, en el momento de su evaluación, en pacientes atendidos en consulta de urgencia. Métodos: Estudio observacional, descriptivo y transversal, en 340 pacientes examinados en el Hospital Pediátrico "Juan Manuel Márquez", de enero a abril de 2019. Se utilizó un instrumento validado en estudios anteriores y se realizó entrevista a pacientes y familiares. El procesamiento y análisis de los datos se realizó con el SPSS 21 y estadígrafos descriptivos. Para la comparación de frecuencias observadas y esperadas de una variable se empleó la prueba binomial, y la Ji-cuadrada, con una probabilidad de 0,5 %. Resultados: El 53,8 % de los pacientes declararon entre 15 y 19 años; 50,3 % varones. El 61,2 % presentaban antecedentes patológicos psiquiátricos y 40,3 % procedía de medios familiares problemáticos. Entre los principales motivos de consulta destacaron la conducta suicida y el consumo de sustancias psicoactivas. El 25 % de los pacientes requirió hospitalización, el resto se derivó a la atención ambulatoria. En más de 60 % se utilizaron psicofármacos. Conclusiones: Predominaron en el estudio los adolescentes, masculinos, con antecedentes patológicos personales de enfermedad psiquiátrica, procedentes de medios familiares conflictivos, con diagnóstico de trastornos del comportamiento, conducta suicida, trastornos afectivos, psicosis y trastornos adictivos; entre estos últimos, se diagnosticó la patología dual. Solo la cuarta parte requirió hospitalización y en la mayoría se usaron psicofármacos.


Introduction: Psychiatric emergencies in pediatric age constitute a public health problem. Objective: To describe the psychiatric emergencies and the behavior followed, at the time of their evaluation, in patients attended in an emergency consultation. Methods: Observational, descriptive and cross-sectional study in 340 patients examined at "Juan Manuel Márquez" Pediatric Hospital, from January to April 2019. An instrument validated in previous studies was used and interviews were conducted with patients and relatives. Data processing and analysis was performed with SPSS 21 and descriptive statistics were used. For the comparison of observed and expected frequencies of a variable, the binomial test and the Chi-square, with a probability of 0.5% were used. Results: 53.8% of patients were between 15 and 19 years old, and 50.3 % were male. 61.2 % had a psychiatric pathological history and 40.3% came from problematic family environments. Among the main reasons for consultation were suicidal behaviour and the consumption of psychoactive substances. 25% of patients required hospitalization, the rest were referred to outpatient care. Psychotropic drugs were used in more than 60%. Conclusions: In the study predominated adolescents, males, with a personal pathological history of psychiatric illness, from conflictive family environments, diagnosed with behavioral disorders, suicidal behavior, affective disorders, psychosis and addictive disorders; among the latter, dual pathology was diagnosed. Only a quarter required hospitalization and most used psychotropic drugs.

2.
Pediatr Diabetes ; 23(7): 976-981, 2022 11.
Article in English | MEDLINE | ID: mdl-35689539

ABSTRACT

The Dominican Republic has no recent data on type 1 diabetes (T1D) incidence in children. Therefore, a study was undertaken to determine this in persons aged <15 years (y). Data were collected on all new T1D diagnoses between 2010-2019 from the four institutions caring for children with T1D. Diagnosis was made according to standard criteria. No secondary ascertainment source was available. The trend and the effect of age and sex of T1D incidence was analyzed using Poisson regression. A total of 1224 new cases of T1D were diagnosed <15 y; mean ± standard deviation (range) 122 ± 12 (96-135) cases per year. Age at T1D diagnosis was 8.8 ± 3.7 y, with a significant female preponderance (n = 708, 57.8%, p < 0.001). When examined per 5-y age group, cases were consistently highest in 10-14 y, and lowest in 0-4 y in all study years. Mean crude T1D annual incidence was 4.3 (95% CI 3.5-5.1) per 100,000 population. There was no significant difference between incidence across the country's three departments (regions): Southeast (4.4 [3.4-5.7]/100,000 population), North (4.1 [2.9-5.6]), and Southwest (3.9 [2.4-5.9]). Mean standardized annual incidence was 4.1 (4.1-4.2) per 100,000 population, with no significant trend of increase over the study period. The incidence of T1D in children aged <15 y is relatively low in Dominican Republic, but consistent with the limited data from other countries in the region. However, the incidence is eight times higher than the previous estimate during 1995-1999. Ongoing surveillance is warranted.


Subject(s)
Diabetes Mellitus, Type 1 , Child , Child, Preschool , Diabetes Mellitus, Type 1/epidemiology , Dominican Republic/epidemiology , Female , Humans , Incidence
3.
Pediatr Diabetes ; 23(2): 173-182, 2022 03.
Article in English | MEDLINE | ID: mdl-34779087

ABSTRACT

OBJECTIVE: To assess the efficacy and safety of DPP-4 inhibition with sitagliptin in youth with type 2 diabetes (T2D). STUDY DESIGN: This was a 54-week, double-blind, randomized, controlled clinical trial evaluating the safety and efficacy of DPP-4 inhibition with sitagliptin 100 mg once daily as initial oral therapy in youth with T2D. The 190 participants, aged 10-17 years, had HbA1c 6.5%-10% (7.0%-10% if on insulin). All were negative for pancreatic autoantibodies and overweight/obese at screening or diagnosis. The trial was placebo controlled for the first 20 weeks, after which metformin replaced placebo. The primary efficacy endpoint was change from baseline in HbA1c at Week 20. RESULTS: Treatment groups were well balanced at baseline (mean ± SD HbA1c = 7.5% ± 1.0, BMI percentile = 97.1% ± 6.8, age = 14.0 years ± 2.0 [57.4% <15], 60.5% female). At Week 20, least squares mean changes from baseline in HbA1c were -0.01% (sitagliptin) and 0.18% (placebo); between-group difference (95% CI) = -0.19% (-0.68, 0.30), p = 0.448. At Week 54, the changes in HbA1c were 0.45% (sitagliptin) and -0.11 (placebo/metformin). There were no notable between-group differences in the adverse event profiles through Week 54. CONCLUSIONS: DPP-4 inhibition with sitagliptin did not provide significant improvement in glycemic control. In this study, sitagliptin was generally well tolerated with a safety profile similar to that reported in adults. (ClinicalTrials.gov: NCT01485614; EudraCT: 2011-002528-42).


Subject(s)
Diabetes Mellitus, Type 2/drug therapy , Patient Safety/standards , Sitagliptin Phosphate/pharmacology , Administration, Oral , Adolescent , Blood Glucose/analysis , Child , Diabetes Mellitus, Type 2/physiopathology , Double-Blind Method , Drug Therapy, Combination/methods , Drug Therapy, Combination/statistics & numerical data , Female , Glycated Hemoglobin/analysis , Humans , Hypoglycemic Agents/pharmacology , Hypoglycemic Agents/therapeutic use , Male , Metformin/pharmacology , Metformin/therapeutic use , Patient Safety/statistics & numerical data , Sitagliptin Phosphate/therapeutic use , Treatment Outcome
4.
Pediatr Diabetes ; 23(2): 183-193, 2022 03.
Article in English | MEDLINE | ID: mdl-34779103

ABSTRACT

OBJECTIVE: To assess the efficacy and safety of sitagliptin in youth with type 2 diabetes (T2D) inadequately controlled with metformin ± insulin. STUDY DESIGN: Data were pooled from two 54-week, double-blind, randomized, placebo-controlled studies of sitagliptin 100 mg daily or placebo added onto treatment of 10- to 17-year-old youth with T2D and inadequate glycemic control on metformin ± insulin. Participants (N = 220 randomized and treated) had HbA1c 6.5%-10% (7.0%-10% if on insulin), were overweight/obese at screening or diagnosis and negative for pancreatic autoantibodies. The primary endpoint was change from baseline in HbA1c at Week 20. RESULTS: Treatment groups were well balanced at baseline (mean HbA1c = 8.0%, BMI = 30.9 kg/m2 , age = 14.4 years [44.5% <15], 65.9% female). The dose of background metformin was >1500 mg/day for 71.8% of participants; 15.0% of participants were on insulin therapy. At Week 20, LS mean changes from baseline (95% CI) in HbA1c for sitagliptin/metformin and placebo/metformin were -0.58% (-0.94, -0.22) and -0.09% (-0.43, 0.26), respectively; difference = -0.49% (-0.90, -0.09), p = 0.018; at Week 54 the LS mean (95% CI) changes were 0.35% (-0.48, 1.19) and 0.73% (-0.08, 1.54), respectively. No meaningful differences between the adverse event profiles of the treatment groups emerged through Week 54. CONCLUSIONS: These results do not suggest that addition of sitagliptin to metformin provides durable improvement in glycemic control in youth with T2D. In this study, sitagliptin was generally well tolerated with a safety profile similar to that reported in adults. (ClinicalTrials.gov: NCT01472367, NCT01760447; EudraCT: 2011-002529-23/2014-003583-20, 2012-004035-23).


Subject(s)
Diabetes Mellitus, Type 2/drug therapy , Patient Safety/standards , Sitagliptin Phosphate/pharmacology , Administration, Oral , Adolescent , Blood Glucose/analysis , Child , Diabetes Mellitus, Type 2/physiopathology , Double-Blind Method , Drug Therapy, Combination/methods , Drug Therapy, Combination/statistics & numerical data , Female , Glycated Hemoglobin/analysis , Humans , Hypoglycemic Agents/pharmacology , Hypoglycemic Agents/therapeutic use , Male , Metformin/pharmacology , Metformin/therapeutic use , Patient Safety/statistics & numerical data , Sitagliptin Phosphate/therapeutic use , Treatment Outcome
5.
Arch. venez. pueric. pediatr ; 77(2): 87-92, jun. 2014. ilus, tab
Article in Spanish | LILACS | ID: lil-740257

ABSTRACT

Los términos deshidratación y depleción de volumen se suelen utilizar indistintamente, pero se refieren a diferentes condiciones fisiológicas que resultan del tipo de pérdida de fluidos. La rehidratación oral es el método de elección para el tratamiento de las deshidrataciones leves y moderadas debidas a la diarrea. Sin embargo, se presentan situaciones clínicas en las cuales la hidratación endovenosa (EV) está formalmente indicada. La deshidratación es la complicación más frecuente y grave de las diarreas en los niños. Los siguientes son los objetivos que se deben tener presente: corregir el déficit de volumen, los trastornos de osmolaridad (sodio), el desequilibrio ácido-base, los iones específicos (K, Na, Ca) y aportar calorías. Establecer un acceso vascular es vital para la administración de líquidos al paciente con compromiso circulatorio. El lugar predilecto es aquel que permita el acceso vascular más sencillo. En caso de no lograr un acceso venoso periférico rápido, se considera que la vía intraósea es la mejor alternativa para obtener un acceso vascular, debido a la facilidad, rapidez y seguridad de la técnica. La guía ecográfica debe utilizarse siempre que sea posible para facilitar la visualización directa al colocar los accesos venosos.


The terms of dehydration and volume depletion are often used interchangeably, but they relate to different physiological conditions resulting from various types of fluid loss. Oral rehydratation is the method of choice for the treatment of mild to moderate dehydration due to diarrhea. However, there are clinical situations in which intravenous hydration is formally recommended. Dehydration is the most common and serious complication of diarrhea in children. The following are the objectives that must be present: correction of volume deficit, osmolality disorders, acid-base imbalance, specific ions (K, Na, Ca) alterations, and provide calories. To establish a vascular access is vital to the administration of fluids to patients with circulatory compromise. The favorite place is the one that allows easy vascular access. In case of failure to achieve a fast peripheral venous access, the intraosseous route is the best alternative for vascular access, due to the ease, speed and safety of the technique. Ultrasound guidance should be used whenever possible to facilitate direct visualization by placing venous access.

6.
J Clin Invest ; 124(7): 2935-46, 2014 Jul.
Article in English | MEDLINE | ID: mdl-24865431

ABSTRACT

Acute exposure to particulate matter (PM) air pollution causes thrombotic cardiovascular events, leading to increased mortality rates; however, the link between PM and cardiovascular dysfunction is not completely understood. We have previously shown that the release of IL-6 from alveolar macrophages is required for a prothrombotic state and acceleration of thrombosis following exposure to PM. Here, we determined that PM exposure results in the systemic release of catecholamines, which engage the ß2-adrenergic receptor (ß2AR) on murine alveolar macrophages and augment the release of IL-6. In mice, ß2AR signaling promoted the development of a prothrombotic state that was sufficient to accelerate arterial thrombosis. In primary human alveolar macrophages, administration of a ß2AR agonist augmented IL-6 release, while the addition of a beta blocker inhibited PM-induced IL-6 release. Genetic loss or pharmacologic inhibition of the ß2AR on murine alveolar macrophages attenuated PM-induced IL-6 release and prothrombotic state. Furthermore, exogenous ß2AR agonist therapy further augmented these responses in alveolar macrophages through generation of mitochondrial ROS and subsequent increase of adenylyl cyclase activity. Together, these results link the activation of the sympathetic nervous system by ß2AR signaling with metabolism, lung inflammation, and an enhanced susceptibility to thrombotic cardiovascular events.


Subject(s)
Adrenergic beta-2 Receptor Agonists/administration & dosage , Adrenergic beta-2 Receptor Agonists/adverse effects , Interleukin-6/biosynthesis , Particulate Matter/administration & dosage , Particulate Matter/adverse effects , Thrombosis/etiology , Adenylyl Cyclases/biosynthesis , Animals , Antithrombin III/biosynthesis , Bronchoalveolar Lavage Fluid/chemistry , Catecholamines/biosynthesis , Colforsin/administration & dosage , Humans , Macrophages, Alveolar/drug effects , Macrophages, Alveolar/physiology , Male , Mice , Mice, Knockout , Peptide Hydrolases/biosynthesis , Propranolol/administration & dosage , Propranolol/adverse effects , Reactive Oxygen Species/metabolism , Receptors, Adrenergic, beta/deficiency , Receptors, Adrenergic, beta/genetics , Receptors, Adrenergic, beta-1/deficiency , Receptors, Adrenergic, beta-1/genetics
7.
Clin Pulm Med ; 19(6): 282-288, 2012 Nov.
Article in English | MEDLINE | ID: mdl-23293508

ABSTRACT

Malignant pleural mesothelioma (MPM) can be a challenging diagnosis for clinicians to make as it is often difficult to distinguish from benign asbestos pleural effusions and metastatic carcinomas. In this review, we present a case of MPM and discuss clinical manifestations, traditional diagnostic techniques, and the role of cytopathologic immunostains and serum biomarkers in the diagnosis of MPM.

8.
Arch. venez. pueric. pediatr ; 73(4): 52-59, dic. 2010. ilus, graf
Article in Spanish | LILACS | ID: lil-659158

ABSTRACT

En el tratamiento de la meningitis, la administración de potentes antibióticos produce la lisis bacteriana y la liberación de sus componentes, lo cual estimula la cascada inflamatoria. Este hecho explica el deterioro neurológico que se evidencia en ocasiones después de iniciados los antimicrobianos. La letalidad de la meningitis bacteriana en niños se encuentra entre un 4 y 10%, y el pronóstico varía dependiendo de múltiples factores: edad, presencia de comorbilidad, patógeno responsable y grado de severidad y compromiso al momento de la admisión. Se ha propuesto que la administración de un tratamiento coadyuvante temprano (uso de esteroides y/o glicerol) que disminuya la respuesta inflamatoria, pueda evitar estas complicaciones y mejorar el pronóstico. Las complicaciones agudas son frecuentes y todas deben manejarse en forma precoz, desde el ingreso en la sala de emergencia con la terapia usual, siguiendo los lineamientos establecidos en los protocolos de reanimación, los cuales han demostrado mejorar la supervivencia de estos pacientes. La meta primordial del tratamiento es evitar o disminuir el daño secundario causado por eventuales problemas hemodinámicos, hipóxicos, hidroelectrolíticos, convulsiones, entre otros. Se contemplan las medidas de prevención o tratamiento, las cuales en muchos casos requieren de la monitorización permanente del paciente


During the treatment of meningitis, the administration of potent antibiotics produces bacterial lyses and the release of its components, which stimulate the inflammatory cascade. This explains the neurological deterioration that occurs occasionally after antibiotic therapy is initiated. The lethality of bacterial meningitis in children is 4 to 10% and its prognosis varies by multiple factors: age, co morbidity, responsible pathogen and severity and clinical compromise at the time of admission. It has been suggested that the administration of early adjuvant treatment (steroids and/or glycerol) reduces the inflammatory response, may prevent complications and improve the outcome. Acute complications are frequent and must be treated early after admission in the emergency room with standard therapy, following the guidelines set out in CPR protocols, which have been shown to improve survival in these patients. The primary goal of treatment is to prevent or reduce the secondary damage caused by hemodynamic, hypoxic, electrolyte disorders and seizures, among others. Preventive and therapeutic strategies are reviewed, which in many cases will require constant monitoring of the patient


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Meningitis, Bacterial/complications , Meningitis, Bacterial/therapy , Therapeutics/methods , Pediatrics , Statistics on Sequelae and Disability
10.
Cochabamba; s.n; dic. 2005. 104 p. mapas, tab, graf.
Thesis in Spanish | LIBOCS, LILACS, LIBOE | ID: biblio-1295958

ABSTRACT

La prevalencia de malnutricion en los niños menores de un año es de 42,6 por ciento, que incluye la desnutricion, sobrepeso y obesidad. La prevalencia de obesidad corresponde a 7,4 por ciento, el sobrepeso 18,5 por ciento y la desnutricion 16,8 por ciento. La pevalencia del estado nutricional segun el sexo, es la siguiente: Desnutricion en niños 17,8 por ciento y 15,3 por ciento en las niñas. Sobrepeso en niños 21.4 por ciento y 15,4 por ciento en niñas. La obesidad tiene mayor prevalencia en niñas de 11,5 por ciento y en los niños corresponde a 3,6 por ciento


Subject(s)
Bolivia , Nutritional Status , Infant Nutrition
11.
Rev. méd. domin ; 59(3): 194-6, sept.-dic. 1998. tab
Article in Spanish | LILACS | ID: lil-269280

ABSTRACT

Realizamos un estudio prospectivo en el Hospital Docente Universitario Dr. Darío Contreras en su Departamento de Anestesiología en Santo Domingo, Rep. Dom., en 20 pacientes, los cuales fueron sometido a cirugía de miembros superiores, bajo bloqueo de Plexo braquial con Lidocaína 1// 40Mls (400 mg) mas 100 mg de Tramadol, en el período junio-julio 1996. De los pacientes estudiados el grupo etáreo más frecuente fue de 15 a 25 años con un 45//, en relación con el diagnóstico el 35// fueron fractura de cúbito y radio, de acuerdo a los efectos secundarios fueron náuseas y sedación con 25// y una analgesia post-quirúrgica mayor de 70// correspondiente a 3-4 horas


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Tramadol/therapeutic use , Brachial Plexus/drug effects , Lidocaine/therapeutic use , Prospective Studies
12.
Arch. domin. pediatr ; 27(2): 39-41, mayo-ago. 1991. ilus
Article in Spanish | LILACS | ID: lil-131967

ABSTRACT

Con el objetivo de conocer la frecuencia de asociación de infección aguda por Leptospiras y Hepatitis Infecciosa Aguda (HIA) en niños, se estudiaran 50 niños de ambos sexos, menores de 15 años, con evidencias de HIA (hiperbilirrubinemia bifásica y transaminasas elevadas), a los cuales se les determinó Ac-IgM-leptospirosica mediante el método de UREASA-ELISA encontrando 5 casos positivos (10 por ciento ), tres de los cuales también estuvieron asociados a la presencia de Ac. IgM. HAV, de aquí que solo en 2 casos (4 por ciento ) pudo encontrarse una relación entre infección aguda por Leptospira y HIA, concluyendo que aunque la infección leptospirósica es frecuente no lo es dentro del contexto de las HIA


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Adolescent , Hepatitis A , Immunoglobulin M/blood , Leptospirosis
13.
Arch. domin. pediatr ; 25(3): 75-7, sept.-dic 1989. tab
Article in Spanish | LILACS | ID: lil-103886

ABSTRACT

Con el objetivo de conocer la frecuencia de asociacion de infección aguda por Leptospiras y Hepatitis Infecciosa Aguda (HIA) en niños, se estudiaron 50 niños de ambos sexos, menores de 15 años, con evidencias de HIA (Hiperbilirrubinemia bifásica y transaminass elevadas), a los cuales se les determinó AcIgM-leptospirósica mediante el método de UREASA ELISA encontrando 5 casos positivos (10%), tres de los cuales tambén estuvieron asociados a la presencia de AcIgm HAV, de aquí que solo en 2 casos (4%) pudo encontrarse una relación entre infección aguda por Lpetospiras y HIA, concluyendo que aunque la infección leptospirósica es frecuente así como su asociación a la enfermedad hepática, la enfermedad es infrecuente dentro del contexto de las hepatitis no A no B (4%)


Subject(s)
Infant , Child, Preschool , Child , Adolescent , Humans , Male , Female , Antibodies, Anti-Idiotypic/blood , Hepatitis A/complications , Hepatitis A/immunology , Immunoglobulin M/analysis , Leptospirosis/complications , Leptospirosis/immunology , Enzyme-Linked Immunosorbent Assay , Hepatovirus/immunology , Radioimmunoassay
14.
Rev. cuba. estomatol ; 25(1): 78-89, ene.-abr. 1988. tab
Article in Spanish | LILACS | ID: lil-74010

ABSTRACT

El presente trabajo tiene como antecedente un estudio preliminar realizado por los autores en 1981. El actual se ha llevado a cabo con una muestra de 200 personas en varias instituciones de salud del municipio Cotorro, en un periodo de 4 meses (julio-septiembre de 1985), los cuales manifestaron temor o miedo a la atención estomatológica. En la muestra estudiada encontramos las causas fundamentales que lo generan, así como los hábitos, patrones de comportamiento, estados de ánimo y datos generales de los entrevistados y su relación con dichas causas. Los resultados obtenidos se presentan en tablas y porcentajes para un mejor análisis y comprensión. Se brindan conclusiones y recomendaciones


Subject(s)
Adult , Middle Aged , Humans , Male , Female , Dental Care/psychology , Fear
15.
Rev. cuba. estomatol ; 25(1): 78-89, ene.-abr. 1988. tab
Article in Spanish | CUMED | ID: cum-1330

ABSTRACT

El presente trabajo tiene como antecedente un estudio preliminar realizado por los autores en 1981. El actual se ha llevado a cabo con una muestra de 200 personas en varias instituciones de salud del municipio Cotorro, en un periodo de 4 meses (julio-septiembre de 1985), los cuales manifestaron temor o miedo a la atención estomatológica. En la muestra estudiada encontramos las causas fundamentales que lo generan, así como los hábitos, patrones de comportamiento, estados de ánimo y datos generales de los entrevistados y su relación con dichas causas. Los resultados obtenidos se presentan en tablas y porcentajes para un mejor análisis y comprensión. Se brindan conclusiones y recomendaciones


Subject(s)
Adult , Middle Aged , Aged , Humans , Male , Female , Dental Care/psychology , Fear
16.
R¡o Piedras, P.R; U.P.R., Medical Sciences Campus, School of Medicine, Dept. of Microbiology and Medical Zoology; 1987. 138 p il, gr ficas, tablas.
Thesis | Puerto Rico | ID: por-12343

Subject(s)
Ultrasonics , Lymphocytes
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