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Hemophagocytic lymphohistiocytosis (HLH) is a rare genetic hyperinflammatory syndrome that occurs early in life. Macrophage activation syndrome (MAS) usually refers to a secondary form of HLH associated with autoimmunity, although there are other causes of secondary HLH, such as infections and malignancy. In this article, we reviewed the concepts, epidemiology, clinical and laboratory features, diagnosis, differential diagnosis, prognosis, and treatment of HLH and MAS. We also reviewed the presence of MAS in the most common autoimmune diseases that affect children. Both are severe diseases that require prompt diagnosis and treatment to avoid morbidity and mortality.
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Enfermedades Autoinmunes , Linfohistiocitosis Hemofagocítica , Síndrome de Activación Macrofágica , Niño , Humanos , Síndrome de Activación Macrofágica/diagnóstico , Síndrome de Activación Macrofágica/etiología , Linfohistiocitosis Hemofagocítica/diagnóstico , Linfohistiocitosis Hemofagocítica/complicaciones , Enfermedades Autoinmunes/complicaciones , Diagnóstico DiferencialRESUMEN
Endovascular therapy (EVT) is a highly effective stroke treatment, but trials validating this intervention did not include patients with posterior cerebral artery (PCA) occlusion. The aim of this systematic review with meta-analysis was to assess the efficacy and safety of EVT for acute PCA occlusion. PubMed, Scopus, ISI, and CENTRAL were searched for studies assessing EVT in adult patients with PCA occlusion. Outcomes of interest were recanalization, symptomatic intracerebral haemorrhage (sICH), mortality, functional independence, and excellent functional outcome at 90 days. Frequencies and odds ratios (ORs) were pooled using random effect models and heterogeneity was measured using the I2 statistic and explored by means of meta-regression. Fifteen studies were included, all observational. Recanalization rates were high [81%, 95% CI (73-88%)] and sICH rates low [2%, 95% CI (1-4%)]. Heterogeneity was high for recanalization (I2 = 80%) but not for sICH, and not accounted for by any of the moderators tested. Compared to best medical treatment, EVT was associated with higher chances of sICH [OR = 2.04, 95% CI (1.12-3.71)] and no effect in functional independence [OR = 0.98, 95% CI (0.63-1.54)], with a tendency to higher chances of excellent functional outcome [OR = 1.29, 95% CI (0.90-1.86)] and mortality [OR = 1.56, 95% CI (0.84-2.90)]. EVT for acute PCA occlusion is technically feasible but associated with higher chance of sICH. There is no evidence to support this treatment to achieve higher rates of functional independence, but other gains that can impact patients' quality of life cannot be excluded. More studies are required with robust design, better patient selection, and comprehensive outcome evaluation.
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Procedimientos Endovasculares , Humanos , Procedimientos Endovasculares/métodos , Infarto de la Arteria Cerebral Posterior/terapia , Infarto de la Arteria Cerebral Posterior/fisiopatologíaRESUMEN
Perinatal hypoxia-ischemia represents a significant risk to CNS development, leading to high mortality rates, diverse damages, and persistent neurological deficits. Despite advances in neonatal medicine in recent decades, the incidence of HIE remains substantial. Motor deficits can manifest early, while cognitive impairments may be diagnosed later, emphasizing the need for extended follow-up. This review aims to explore potential candidates for therapeutic interventions for hypoxic-ischemic encephalopathy (HIE), with a focus on cognitive deficits. We searched randomized clinical trials (RCT) that tested drug treatments for HIE and evaluated cognitive outcomes. The results included studies on erythropoietin, melatonin, magnesium sulfate, topiramate, and a combination of vitamin C and ibuprofen. Although there are several indications of the efficacy of these drugs among animal models, considering neuroprotective properties, the RCTs failed to provide complete effectiveness in the context of cognitive impairments derived from HIE. More robust RCTs are still needed to advance our knowledge and to establish standardized treatments for HIE.
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The total mixed ration (TMR) is currently a widespread method to feed dairy cows. It is a mixture of raw fodder and concentrate feed that can be contaminated by several mycotoxins. The main aim of this paper was to provide a critical review on TMR mycotoxin occurrence and its usefulness to monitor and control them on-farm. Aflatoxins, zearalenone, deoxynivalenol, T-2 toxin and fumonisins (regulated mycotoxins) are the most prevalent mycotoxins evaluated in TMR. Nonetheless, several emerging mycotoxins represent a health risk at the animal level regarding their prevalence and level in TMR. Even when measured at low levels, the co-occurrence of mycotoxins is frequent and synergistic effects on animal health are still underevaluated. Similar to the animal feed industry, on-farm plans monitoring mycotoxin feed contamination can be developed as a herd health management program. The estimated daily intake of mycotoxins should be implemented, but thresholds for each mycotoxin are not currently defined in dairy farms.
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ABSTRACT Objective: To evaluate autoinflammatory diseases (AID) according to age at diagnosis and sex, and response to therapy in a large population. Methods: This is a cross-sectional observational study of a Latin American registry using a designed web system for data storage, collected between 2015 and 2018. Any altered findings during follow-up were recorded. The forms were translated into Portuguese and Spanish, including demographic, clinical, laboratory, genetic and treatment characteristics. Results: We included 152 patients, 51.3% male and 75% Caucasian. The median age at disease onset was 2.1 years (0-15.6 years) and median age at diagnosis 6.9 years (0-21.9 years); 111 (73%) were children (0-9 years old), and 41 (27%) were adolescents and young adults (AYA) (10-21 years old). Periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome (PFAPA) occurred in 46/152 (30%), chronic non-bacterial osteomyelitis (CNO) in 32/152 (21%), and familial Mediterranean fever (FMF) in 24/152 (15.7%). PFAPA was significantly higher in young children than in AYA (38.7% vs. 7.3%, p<0.001), while CNO were lower (13.5% vs. 41.5%, p<0.001). The frequency of females was significantly higher in CNO (28.4% vs. 14.1%, p=0.031) and lower in FMF (8.1% vs. 23.1%, p=0.011). The most used drugs were glucocorticoids, non-steroidal anti-inflammatory drugs (NSAID), and colchicine. Glucocorticoids and colchicine treatment were used in all AID with good to moderate response. However, cryopyrin-associated periodic syndromes (CAPS) seemed unresponsive to glucocorticoids. NSAIDs and methotrexate were the main medications used to treat CNO. Conclusions: Differences among AID patients were observed in the LA population regarding sex and age at disease diagnosis.
RESUMO Objetivo: Avaliar as doenças autoinflamatórias (DAI) de acordo com sexo e idade no momento do diagnóstico e a resposta terapêutica em uma grande população. Métodos: Este é um estudo observacional transversal de um registro latino-americano que usou um sistema de dados coletados entre 2015 e 2018. Quaisquer achados alterados ao longo do acompanhamento foram registrados. Os formulários foram traduzidos para os idiomas português e espanhol, incluindo características demográficas, clínicas, laboratoriais, genéticas e de tratamento. Resultados: Incluímos 152 pacientes, sendo 51,3% do sexo masculino e 75% da raça branca. A média de idade de início da doença foi de 2,1 anos (0-15,6 anos) e a média de idade de diagnóstico 6,9 anos (0-21,9 anos); 111 (73%) eram crianças (0-9 anos) e 41 (27%) adolescentes/adultos jovens (10-21 anos). A síndrome de febre periódica, estomatite aftosa, faringite e adenite (PFAPA) ocorreu em 46/152 (30%), osteomielite não bacteriana crônica (CNO) em 32/152 (21%) e febre familiar do Mediterrâneo (FMF) em 24/152 (15,7%). A PFAPA foi significativamente maior em crianças pequenas (38,7 vs. 7,3%, p<0,001), e a CNO, em adolescentes/adultos jovens (13,5 vs. 41,5%, p<0,001). A frequência do sexo feminino foi significativamente maior na CNO (28,4 vs. 14,1%, p=0,031) e menor na FMF (8,1 vs. 23,1%, p=0,011). Os medicamentos mais utilizados foram glicocorticoides, anti-inflamatórios não esteroidais (AINE) e colchicina. O tratamento com glicocorticoides e colchicina foi usado em todas as DAI com resposta boa a moderada. No entanto, as síndromes periódicas associadas à criopirina (CAPS) pareciam não responder aos glicocorticoides. AINE e metotrexato foram os principais medicamentos utilizados no tratamento da CNO. Conclusões: Diferenças de pacientes com DAI foram observadas na população latino-americana em pacientes agrupados por sexo e idade ao diagnóstico da doença.
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Abstract Hemophagocytic lymphohistiocytosis (HLH) is a rare genetic hyperinflammatory syndrome that occurs early in life. Macrophage activation syndrome (MAS) usually refers to a secondary form of HLH associated with autoimmunity, although there are other causes of secondary HLH, such as infections and malignancy. In this article, we reviewed the concepts, epidemiology, clinical and laboratory features, diagnosis, differential diagnosis, prognosis, and treatment of HLH and MAS. We also reviewed the presence of MAS in the most common autoimmune diseases that affect children. Both are severe diseases that require prompt diagnosis and treatment to avoid morbidity and mortality.
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Lowering the storage temperature is an effective method to extend the postharvest and shelf life of fruits. Nevertheless, this technique often leads to physiological disorders, commonly known as chilling injuries. Apples and pears are susceptible to chilling injuries, among which superficial scald is the most economically relevant. Superficial scald is due to necrotic lesions of the first layers of hypodermis manifested through skin browning. In peaches and nectarines, chilling injuries are characterized by internal symptoms, such as mealiness. Fruits with these aesthetic or compositional/structural defects are not suitable for fresh consumption. Genetic variation is a key factor in determining fruit susceptibility to chilling injuries; however, physiological, or technical aspects such as harvest maturity and storage conditions also play a role. Multi-omics approaches have been used to provide an integrated explanation of chilling injury development. Metabolomics in pome fruits specifically targets the identification of ethylene, phenols, lipids, and oxidation products. Genomics and transcriptomics have revealed interesting connections with metabolomic datasets, pinpointing specific genes linked to cold stress, wax synthesis, farnesene metabolism, and the metabolic pathways of ascorbate and glutathione. When applied to Prunus species, these cutting-edge approaches have uncovered that the development of mealiness symptoms is linked to ethylene signaling, cell wall synthesis, lipid metabolism, cold stress genes, and increased DNA methylation levels. Emphasizing the findings from multi-omics studies, this review reports how the integration of omics datasets can provide new insights into understanding of chilling injury development. This new information is essential for successfully creating more resilient fruit varieties and developing novel postharvest strategies.
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Para compreender melhor a percepção de desgoverno e o sentimento de desamparo que se alastraram no Brasil sob a Covid-19, este artigo examina dois momentos históricos relativos à interface peste-desamparo, das perspectivas psicanalítica e política. O primeiro momento trata do entrelaçamento entre vida e obra de Freud e culmina com sua experiência com a pandemia da gripe espanhola, em 1920; o segundo, trabalha a forma pela qual estamos lidando com o advento da pandemia do coronavírus, desde março de 2020, que — até o momento em que escrevo este artigo (janeiro de 2022) — matou mais de 600 mil brasileiros e trouxe o luto para mais de cinco milhões de famílias no mundo. A hipótese deste trabalho assevera que o sentimento de desamparo que estamos vivenciando desvela o negacionismo e o desgoverno que, inclusive, põem em xeque o estado democrático de direito no país.
Resumos To better understand the widespread perception of misgovernment and helplessness in Brazil during the COVID-19 pandemic, this article examines two historic moments referring to the interface between plague and helplessness, from the psychoanalytic and political perspectives. Firstly, it addresses the intertwining between Freud's life and work, culminating with his experience during the Spanish flu pandemic, in 1920. Secondly, it analyses the measures put in place to combat the coronavirus pandemic, since March 2020, which — until the moment I am writing this article (January 2022) — killed more than 600,000 Brazilians and left more than five million families around the world in mourning. This paper asserts that the feeling of helplessness unveils a state of denialism and misgovernment, which calls into question the Brazilian rule of law.
Pour mieux comprendre la perception répandue de la mauvaise administartion et de l'impuissance au Brésil pendant la pandémie de Covid-19, cet article examine deux moments historiques liés à l'interface peste-impuissance, du point de vue psychanalytique et politique. Premièrement, il traite de l'imbrication entre la vie et l'œuvre de Freud, qui culmine avec son expérience pendant la pandémie de grippe espagnole en 1920. Deuxièmement, il analyse les mesures misen en place pour combattre la pandémie du coronavirus, depuis mars 2020, qui — jusqu'au moment de la rédaction de cet article (janvier 2022) — a fait plus de 600 000 victimes brésiliennes et endeuillé plus de cinq millions de familles dans le monde. Cet essai affirme que le sentiment d'impuissance dévoile un état de négationnisme et de mauvaise gouvernance, qui remet en question l'État de droit et la démocratie au Brésil.
Para comprender mejor la percepción del desgobierno y del sentimiento de desamparo en Brasil durante la crisis del Covid-19, este artículo examina dos momentos históricos relacionados con la interfaz peste-desamparo, desde un punto de vista psicoanalítico y político. El primer momento trata del entrelazamiento entre la vida y la obra de Freud y culmina con su experiencia con la pandemia de gripe española en 1920. El segundo momento se refiere a la forma en que estamos lidiando con el advenimiento de la pandemia de Coronavirus desde marzo de 2020 que, al momento de redactar este artículo (enero de 2022), ha causado más de 600.000 víctimas brasileñas y dejado más de cinco millones de familias en todo el mundo. Este ensayo se basa en el supuesto de que el sentimiento de desamparo que experimentamos se debe a la negación del Covid y al desgobierno. Además, estas dos razones han representado una amenaza para el estado de derecho y la democracia en Brasil.
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ABSTRACT Objective: To evaluate the importance attributed to tonsillitis by guardians and their level of knowledge about the disease, correlating their management with their schooling and socioeconomic profiles. Methods: A quantitative, descriptive and observational cross-sectional study involving students aged 5 to 17 years from state-owned and private schools. A questionnaire was applied on management of tonsillitis and knowledge about rheumatic fever, addressing demographic and socioeconomic data. Results: A total of 323 students were included, predominantly females (61.3%), from state-owned schools (77.1%), with a mean age of 9.7±0.3 years. Among the guardians, 48.6% completed high school. Among the students 75.2% had at least one episode of odynophagia in the previous 12 months. Considering the previous 2 years, 89.8% reported this symptom. There was no collection of bacteriological specimens in 67.8%, and in 83% if taking into account only the last episode, despite the search for medical care in most cases (92.6%). The use of anti-inflammatory drugs was very frequent (43.0% "always" and 42.4% "sometimes"). Among the guardians, 81.7% denied being aware of the relation between rheumatic fever and inappropriate treatment of odynophagia; 85.8% said they wished they had received more information. Conclusion: Although it is quite common in schoolchildren, tonsillitis is neglected by many guardians and health professionals, and the ignorance of its relation with rheumatic fever is practically universal, which may contribute to its high prevalence.
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Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Estudiantes , Tonsilitis/epidemiología , Instituciones Académicas , Brasil/epidemiología , Estudios TransversalesRESUMEN
RESUMO Objetivo: Descrever o perfil epidemiológico das vítimas assistidas pela Viatura Médica de Emergência e Reanimação em paragem cardiorrespiratória e refletir se tinham critérios para utilizar a oxigenação por membrana extracorpórea. Métodos: Estudo retrospectivo, de coorte, descritivo e exploratório. A colheita de dados foi efetuada durante o mês de janeiro de 2018, na região Norte de Portugal, por meio da consulta à base de registos da Viatura Médica de Emergência e Reanimação sobre assistências prestadas no período de 2012 a 2016. Foi elaborada uma grelha de observação suportada pelo instrumento utilizado para a colheita de dados do registo nacional de paragem cardiorrespiratória pré-hospitalar. Resultados: Após aplicar critérios de inclusão, a amostra foi composta por 36 vítimas. Verificou-se que a oxigenação por membrana extracorpórea poderia ter sido aplicada a 24 vítimas no período balizado da colheita de dados, o que resultaria em várias possibilidades de transplantação e/ou sobrevivência, quer da própria vítima quer de outras vidas. Conclusão: A Viatura Médica de Emergência e Reanimação tem potencial para ser incluída na rede oxigenação por membrana extracorpórea da área em estudo.
ABSTRACT Objective: To describe the epidemiological profile of victims of cardiac arrest assisted using a nontransporting emergency medical service vehicle and to determine whether these patients met the criteria for the use of extracorporeal membrane oxygenation. Methods: This study employed a retrospective, cohort, descriptive, and exploratory design. Data were collected in January 2018 in northern Portugal by consulting the records of nontransporting emergency medical service vehicles that provided assistance between 2012 and 2016. An observation grid was prepared that was supported by the instrument used for collecting data from the national registry of out-ofhospital cardiac arrests. Results: After applying the inclusion criteria, the sample consisted of 36 victims. Extracorporeal membrane oxygenation could have been applied to 24 victims during the period analyzed, which might have increased the odds for transplantation, survival, or both, for either the victim or other individuals. Conclusion: Nontransporting emergency medical service vehicles have the potential for inclusion in the extracorporeal membrane oxygenation network of the study area.
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Humanos , Masculino , Femenino , Adulto , Oxigenación por Membrana Extracorpórea , Paro Cardíaco/terapia , Estudios Retrospectivos , Estudios de Cohortes , Tratamiento de Urgencia , Paro Cardíaco/epidemiología , Persona de Mediana EdadRESUMEN
Abstract Background: To date there are no specific classification criteria for childhood-onset systemic lupus erythematosus (cSLE). This study aims to compare the performance among the American College of Rheumatology (ACR) 1997, the Systemic Lupus International Collaborating Clinics criteria (SLICC) and the new European League Against Rheumatism (EULAR)/ACR criteria, in a cSLE cohort. Methods: We conducted a medical chart review study of cSLE cases and controls with defined rheumatic diseases, both ANA positive, to establish each ACR1997, SLICC and EULAR/ACR criterion fulfilled, at first visit and 1-year-follow-up. Results: Study population included 122 cSLE cases and 89 controls. At first visit, SLICC criteria had higher sensitivity than ACR 1997 (89.3% versus 70.5%, p < 0.001), but similar specificity (80.9% versus 83.2%, p = 0.791), however performance was not statistically different at 1-year-follow-up. SLICC better scored in specificity compared to EULAR/ACR score ≥ 10 at first visit (80.9% versus 67.4%, p = 0.008) and at 1-year (76.4% versus 58.4%, p = 0.001), although sensitivities were similar. EULAR/ACR criteria score ≥ 10 exhibited higher sensitivity than ACR 1997 (87.7% versus 70.5%, p < 0.001) at first visit, but comparable at 1-year, whereas specificity was lower at first visit (67.4% versus 83.2%, p = 0.004) and 1-year (58.4% versus 76.4%, p = 0.002). A EULAR/ACR score ≥ 13 against a score ≥ 10, resulted in higher specificity, positive predictive value, and cut-off point accuracy. Compared to SLICC, a EULAR/ACR score ≥ 13 resulted in lower sensitivity at first visit (76.2% versus 89.3%, p < 0.001) and 1-year (91% versus 97.5%, p = 0.008), but similar specificities at both assessments. When compared to ACR 1997, a EULAR/ACR total score ≥ 13, resulted in no differences in sensitivity and specificity at both observation periods. Conclusions: In this cSLE population, SLICC criteria better scored at first visit and 1-year-follow-up. The adoption of a EULAR/ACR total score ≥ 13 in this study, against the initially proposed ≥10 score, was most appropriate to classify cSLE. Further studies are necessary to address if SLICC criteria might allow fulfillment of cSLE classification earlier in disease course and may be more inclusive of cSLE subjects for clinical studies.
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Animales , Humanos , Encéfalo/metabolismo , Preparaciones Farmacéuticas/metabolismo , Barrera Hematoencefálica/metabolismo , Distribución Tisular/fisiología , Modelos Teóricos , Aracnoides/efectos de los fármacos , Aracnoides/metabolismo , Transporte Biológico/efectos de los fármacos , Transporte Biológico/fisiología , Encéfalo/efectos de los fármacos , Preparaciones Farmacéuticas/administración & dosificación , Barrera Hematoencefálica/efectos de los fármacos , Distribución Tisular/efectos de los fármacos , Líquido Extracelular/efectos de los fármacos , Líquido Extracelular/metabolismoRESUMEN
OBJETIVE to create a reduced version of the QASCI, which is structurally equivalent to the long one and meets the criteria of reliability and validity. METHOD Through secondary data from previous studies, the participants were divided into two samples, one for the development of reduced version and the second for study of the factorial validity. Participants responded to QASCI, the SF 36, the ADHS and demographic questions. RESULTS A reduced version of 14 items showed adequate psychometric properties of validity and internal consistency, adapted to a heptadimensional structure that assesses positive and negative aspects of care. CONCLUSION Confirmatory factor analysis revealed a good fit with the advocated theoretical model. .
OBJETIVO Crear una versión reducida del Cuestionario de Evaluación de la Sobrecarga del Cuidador Informal (CESCI) que sea estructuralmente equivalente y que reúna criterios de fidelidad y validez. MÉTODO Mediante datos secundarios a estudios anteriores se constituyeron dos muestras, la primera para el desarrollo de la versión reducida y la segunda para estudiar la validez factorial. Los participantes respondieron al CESCI, el SF 36, la HAD y a preguntas sociodemográficas. RESULTADOS La versión reducida de 14 ítems demostró adecuadas propiedades psicométricas de validez y consistencia interna adaptadas a una estructura heptadimensional que evalúa los aspectos negativos y positivos del cuidar. CONCLUSIÓN El análisis factorial confirmatorio reveló un buen ajuste al modelo teórico preconizado. .
OBJETIVO Criar uma versão reduzida do Questionário de Avaliação da Sobrecarga do Cuidador Informal (QASCI), que seja estruturalmente equivalente e que reúna critérios de fidelidade e validade. MÉTODO Através de dados secundários a estudos anteriores constituíram-se duas amostras, uma para o desenvolvimento da versão reduzida e a segunda para estudar a validade fatorial. Os participantes responderam ao QASCI, ao SF 36, à EADH e a perguntas sociodemográficas. RESULTADOS A versão reduzida de 14 itens mostrou adequadas propriedades psicométricas de validade e consistência interna adaptada a uma estrutura heptadimensional que avalia aspetos negativos e positivos do cuidar. CONCLUSÃO A análise fatorial confirmatória revelou um bom ajustamento ao modelo teórico preconizado. .
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Humanos , Cuidadores , Costo de Enfermedad , Encuestas y Cuestionarios , Cuidadores/psicología , PsicometríaRESUMEN
Os autores relatam um caso clínico sobre Síndrome SAPHO, na faixa etária pediátrica, com enfoque dermatológico. Essa entidade deve ser considerada, nos pacientes que tenham dor na parede torácica anterior ou outros sintomas musculoesqueléticos, acompanhados por lesões dermatológicas, como pustulose palmoplantar e acne fulminans. As manifestações cutâneas específicas, diagnóstico e o tratamento utilizado serão apresentados.
The authors report a case of SAPHO Syndrome, in pediatric age, with a dermatological focus. This entity should be considered in patients who have pain in the anterior chest wall or other musculoskeletal symptoms, accompanied by palmoplantar pustulosis and acne fulminans. The specific cutaneous manifestations, diagnosis and the treatment will be presented.
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Niño , Humanos , Lactante , Masculino , Síndrome de Hiperostosis Adquirido/patología , Síndrome de Hiperostosis Adquirido/terapia , Enfermedad Crónica , Diagnóstico DiferencialRESUMEN
Distúrbios do aparelho respiratório nas doenças reumáticas que acometem a faixa etária pediátrica não são raros e podem apresentar características clínicas diferentes quando comparados ao quadro clínico de adultos. Este artigo de revisão procura mostrar as principais manifestações do aparelho respiratório, com ênfase no acometimento pulmonar, nas principais doenças reumáticas da infância e adolescência.
Respiratory tract disorders in the juvenile rheumatic diseases are not infrequent and can have different clinical features when compared with those in the adult diseases. The purpose of this review article is to show the main manifestations of the respiratory tract, with an emphasis on lung involvement, in the most frequent juvenile rheumatic diseases.
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Humanos , Enfermedades Reumáticas , Enfermedades Reumáticas/complicaciones , Enfermedades Reumáticas/diagnóstico , Enfermedades Reumáticas/tratamiento farmacológicoRESUMEN
OBJETIVOS: Descrever uma população de crianças com diagnóstico de doença de Kawasaki (DK) atendida em centros de reumatologia pediátrica do Rio de Janeiro. Analisar o período de atraso no diagnóstico e início do tratamento, devido à dificuldade de distinguir DK de outras doenças febris comuns da infância; e o impacto deste atraso na frequência de sequelas coronarianas. MÉTODOS: Os dados analisados incluíram: nome, sexo, idade, data do inicio dos sintomas e da admissão no serviço especializado, sintomatologia, evolução clínica, uso de Imunoglobulina Endovenosa (IGEV) e complicações coronarianas. RESULTADOS: Dos 125 casos estudados, 63 por cento eram meninos. 40 por cento tinham menos de 2 anos no momento do diagnóstico. O intervalo médio entre o inicio dos sintomas e o diagnóstico de DK foi de 12 dias (duração média da febre = 14 dias). Dos casos estudados, 22,4 por cento receberam o diagnostico de DK antes do atendimento em serviço especializado; nos demais, as hipóteses diagnosticas iniciais incluíam: infecções bacterianas (60 por cento), virais (12 por cento), outras doenças reumatológicas (4 por cento) e reações adversas à vacinação (1,6 por cento). Em 85.6 por cento dos casos registrou-se o tratamento realizado, sendo administrada IGEV em 46,7 por cento, e a partir do 10º dia em 21,5 por cento dos casos. Dos 20 pacientes apresentando sequelas coronarianas, 9 tiveram diagnóstico tardio, incluindo 3 iniciando tratamento após o 10º dia e 6 sem tratamento. Não encontramos associação significativa entre a frequência de sequelas coronarianas e: sexo; idade; critérios clínicos; tratamento com IGEV antes ou depois do 10º dia de doença. CONCLUSÕES: O diagnóstico de DK pode ser atrasado pela dificuldade em diferenciá-lo de outras doenças febris da infância.
OBJECTIVES: To describe a population of children diagnosed with Kawasaki's disease (KD) in pediatric rheumatology centers of Rio de Janeiro, Brazil, defining the magnitude of the delay period in diagnosing KD and initiating treatment due to confusion with common childhood febrile illnesses and the impact of this delay on the frequency of coronary sequels. METHODS: Data analysis from hospital records summarized in a dedicated form, including name, gender, age, date of first recorded clinical signs, date of admission to the specialty service, information about symptoms, clinical evolution, intravenous immunoglobulin (IVIG) use and coronary sequels. RESULTS: Of 125 patients, 63 percent were males. 40 percent were under 2 years at diagnosis. Average lapse between earliest signs and KD diagnosis was 12 days (mean fever duration, 14 d). Only 22.4 percent had a diagnosis of KD before entering the specialty service. For the remainder, initial hipotheses included: bacterial (60 percent) and viral infections (12 percent), rheumatological diseases (4 percent) and adverse vaccination reactions (1.6 percent). Hence, prevalent febrile illnesses of childhood were major confounding factors. For records (85.6 percent) mentioning treatment, 46.7 percent reported IVIG treatment, beginning after day 10 in 23 cases (21.5 percent). 20 patients (16 percent) presented coronary sequels, 9 of which were diagnosed late, including 3 given IVIG after day 10, and 6 given no IVIG. We found no significant association between the frequency of coronary sequels and: a) sex; b) age; c) clinical criteria; d) initiation of IVIG treatment (before or after day 10). CONCLUSIONS: Common febrile illnesses of childhood often confound the diagnosis of KD.
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Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Síndrome Mucocutáneo Linfonodular , Brasil , Diagnóstico Tardío , Instituciones de Salud , Síndrome Mucocutáneo Linfonodular/diagnóstico , Síndrome Mucocutáneo Linfonodular/tratamiento farmacológico , Estudios Retrospectivos , Salud UrbanaRESUMEN
Este artigo trata do suicídio de uma perspectiva sociológica e comparativa. Salienta as diferenças e similitudes das obras O suicídio. Estudo sociológico, de Émile Durkheim, e Peuchet: sobre o suicídio, de Karl Marx, para mostrar que, apesar de cada um desses autores assumirem um posição filosófica própria, o resultado de seus trabalhos é mais complementar do que antagônico: ambos buscam delimitar o campo da Sociologia como disciplina científica.
This article discusses suicide from a sociological an sociological and comparative perspective. It emphasizes differences and similarities of two books, namely, Suicide. A study in Sociology, by Emile Durkheim and Peuchet: On Suicide, by Karl Marx, The text shows that, although the above authors start off from different philosophical premises, their works are complementary, as the sociological field.
El presente artículo trata del suicidio desde una perspectiva sociológica y comparativa. Subraya las diferencias y similitudes de las obras El suicidio, estudio sociológico, de Émile Durkheim, e Peuchet: sobre el suicidio, de Karl Marx, para mostrar que, a pesar de que cada uno de ellos asumieran una posición filosófica propia, el resultado de sus trabajos es más complementario de lo que antagónico: ambos buscan delimitar el campo de la Sociología como disciplina científica.
Cet article traite du suicide d'un point de vue sociologique et comparatif. Il met en relief les différences et les similitudes entre le oeuvres Le suicide, une étude sociologique, d'Émile Durkheim et Peuchet: a propos du suicide, de Karl Marx pour montrer que, bien que chaque auteur défend une position philosophique propre, le résultat de leurs travaux sont plutôt complémentaires qu'antagonistes: ils cherchent tous deux à définir le champ de la sociologie comme discipline scientifique.
Asunto(s)
Humanos , Sociología , Suicidio/historiaRESUMEN
Este artigo trata do suicídio de uma perspectiva sociológica e comparativa. Salienta as diferenças e similitudes das obras O suicídio. Estudo sociológico, de Émile Durkheim, e Peuchet: sobre o suicídio, de Karl Marx, para mostrar que, apesar de cada um desses autores assumirem um posição filosófica própria, o resultado de seus trabalhos é mais complementar do que antagônico: ambos buscam delimitar o campo da Sociologia como disciplina científica.AU
This article discusses suicide from a sociological an sociological and comparative perspective. It emphasizes differences and similarities of two books, namely, Suicide. A study in Sociology, by Emile Durkheim and Peuchet: On Suicide, by Karl Marx, The text shows that, although the above authors start off from different philosophical premises, their works are complementary, as the sociological field.AU
El presente artículo trata del suicidio desde una perspectiva sociológica y comparativa. Subraya las diferencias y similitudes de las obras El suicidio, estudio sociológico, de Émile Durkheim, e Peuchet: sobre el suicidio, de Karl Marx, para mostrar que, a pesar de que cada uno de ellos asumieran una posición filosófica propia, el resultado de sus trabajos es más complementario de lo que antagónico: ambos buscan delimitar el campo de la Sociología como disciplina científica.AU
Asunto(s)
Humanos , Suicidio/historia , SociologíaRESUMEN
O presente estudo objetivou mensurar a intensidade de ruídos emitidos pelos equipamentos da UTI Neonatal. A pesquisa desenvolvida é descritiva na modalidade quantitativa, e os dados foram coletados por meio de medidor de pressão sonora. Os resultados revelam que 100 por cento possuem a intensidade de ruído acima do recomendado pela norma da ABNT a NBR 10152 de 35 a 45 dB. É uma dificuldade encontrada de controle da poluição sonora. Está nas normas da ABNT que regulamentam a comercialização de equipamentos médicos com intensidade de ruído elevada e não padronizados.
Asunto(s)
Humanos , Recién Nacido , Medición del Ruido , Ruido , Unidades de Cuidado Intensivo NeonatalRESUMEN
OBJETIVO: Avaliar a freqüência e a gravidade dos efeitos adversos durante a infusão de infliximabe. MATERIAL E MÉTODOS: Avaliação retrospectiva de prontuários de 58 pacientes acompanhados em cinco serviços de reumatologia pediátrica. Todos apresentavam doença refratária ou eram intolerantes ao uso de uma ou mais drogas modificadoras de doença e receberam uma ou mais infusões de infliximabe. A análise estatística foi descritiva, levando-se em conta a freqüência e o tipo dos efeitos adversos, assim como sua relação com o número de infusões, a dose de infliximabe e a indicação. RESULTADOS: A média da idade na época da introdução do infliximabe foi de 12 anos e 9 meses e a média do tempo de evolução da doença foi de 7 anos e 7 meses. A principal indicação da medicação foi artrite idiopática juvenil (43). Dos 58 pacientes avaliados, 25 (43,1 por cento) apresentaram efeitos adversos durante a infusão e em 17 (29,3 por cento), a medicação teve de ser suspensa. As reações que ocorreram foram: dispnéia (dez), náuseas e vômitos (oito), rash cutâneo (sete), choque anafilático (seis), rubor facial (cinco), angioedema (quatro), dor torácica (quatro), urticária e hipertensão, entre outras. A reação anafilática foi mais freqüente entre a quarta e a sexta infusão. CONCLUSÃO: A freqüência e a gravidade dos efeitos adversos ao infliximabe devem ser levadas em conta, não apenas por ocasião da sua indicação, mas principalmente por ocasião da escolha do local para a sua aplicação, que deve contar com estrutura para atendimento de urgência.
OBJECTIVE: To evaluate the frequency and the severity of the adverse reactions during the infusion of infliximab. METHODS: We performed a retrospective chart review of 58 patients, followed up at 5 paediatric rheumatology centers. All patients presented refractory disease or were intolerant to one or more disease modifying drugs and received one or more infliximab infusions. The data analysis was descriptive, considering the frequency and the kind of adverse reactions as well as the number of the infusions, the infliximab dose and the indication. RESULTS: The mean age at the onset of infliximab was 12 years and 9 months and the mean of the disease duration was 7 years and 7 months. The main indication of the drug was juvenile idiopathic arthritis (43). Twenty five out of 58 patients (43.1 percent) presented adverse reactions during the infusion and 17 (29,3 percent) had to withdraw the treatment. The reactions were: dyspnea (ten), nausea and vomiting (eight), rash (seven), anaphylaxis (six), flush (five), angioedema (four), chest pain (four) besides urticaria, hypertension, among others. The anaphylaxis was more frequent between the fourth and the sixth infusion. CONCLUSION: The frequency and the severity of adverse reactions to infliximab must be considered not only in relation to its indication, but mainly for the choice of the center to the drug infusion where emergency treatment may be performed.
Asunto(s)
Humanos , Niño , Enfermedades Autoinmunes , Pautas de la Práctica en Medicina , Factor de Necrosis Tumoral alfaRESUMEN
Este artigo tem como foco a dinâmica da relação entre os Poderes Executivo e Legislativo federais no processo decisório da política de saúde durante um período que se inicia com a posse de José Sarney na Presidência da República (1985) e vai até o término do primeiro mandato do presidente Fernando Henrique Cardoso (1998). Procura-se problematizar a tese da primazia do Executivo Federal no processo legislativo em detrimento da autonomia e da iniciativa do Congresso Nacional. Inicialmente, analisam-se a participação e o peso relativo do Executivo e do Legislativo federais na conformação da agenda decisória da política pública de saúde no Brasil. Em seguida, enfatiza-se o tema dos recursos políticos de que dispuseram os dois Poderes durante os processos de negociação e voltados para a aprovação da legislação na área da saúde no Congresso Nacional.