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1.
Pediatr Emerg Care ; 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31058761

RESUMO

OBJECTIVE: Guidelines adherence in emergency departments (EDs) relies partly on the availability of resources to improve sepsis care and outcomes. Our objective was to assess the management of pediatric septic shock (PSS) in Latin America's EDs and to determine the impact of treatment coordinated by a pediatric emergency specialist (PEMS) versus nonpediatric emergency specialists (NPEMS) on guidelines adherence. METHODS: Prospective, descriptive, and multicenter study using an electronic survey administered to PEMS and NPEMS who treat PSS in EDs in 14 Latin American countries. RESULTS: We distributed 2164 surveys with a response rate of 41.5%, of which 22.5% were PEMS. Overall American College of Critical Care Medicine reported guidelines adherence was as follows: vascular access obtained in 5 minutes, 76%; fluid infusion technique, 60%; administering 40 to 60 mL/kg within 30 minutes, 32%; inotropic infusion by peripheral route, 61%; dopamine or epinephrine in cold shock, 80%; norepinephrine in warm shock, 57%; and antibiotics within 60 minutes, 82%. Between PEMS and NPEMS, the following differences were found: vascular access in 5 minutes, 87.1% versus 72.7% (P < 0.01); fluid infusion technique, 72.3% versus 55.9% (P < 0.01); administering 40 to 60 mL/kg within 30 minutes, 42% versus 29% (P < 0.01); inotropic infusion by peripheral route, 75.7% versus 56.3% (P < 0.01); dopamine or epinephrine in cold shock, 87.1% versus 77.3% (P < 0.05); norepinephrine in warm shock, 67.8% versus 54% (P < 0.01); and antibiotic administration within first 60 minutes, 90.1% versus 79.3% (P < 0.01), respectively. Good adherence criteria were followed by 24%. The main referred barrier for sepsis care was a failure in its recognition, including the lack of triage tools. CONCLUSIONS: In some Latin American countries, there is variability in self-reported adherence to the evidence-based recommendations for the treatment of PSS during the first hour. The coordination by PEMS support greater adherence to these recommendations.

2.
New Phytol ; 223(1): 475-486, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30762231

RESUMO

Soil fertility influences plant community structure, yet few studies have focused on how this influence is affected by the type of mycorrhizal association formed by tree species within local communities. We examined the relationship of aboveground biomass (AGB) and diversity of adult trees with soil fertility (nitrogen, phosphorus, organic matter, etc.) in the context of different spatial distributions of arbuscular mycorrhizal (AM) and ectomycorrhizal (EM) trees in a temperate forest in Northeast China. Diversity showed a positive trend along the soil fertility gradient driven mostly by a positive relationship between AM tree abundance and soil fertility. By contrast, the AGB showed a negative trend along the soil fertility gradient driven mostly by a negative relationship between EM tree AGB and soil fertility. Furthermore, the opposite trend in the AGB and tree species diversity along the soil fertility gradient led to an overall negative diversity-biomass relationship at the 50-m scale but not the 20-m scale. These results suggest that tree mycorrhizal associations play a critical role in driving forest community structure along soil fertility gradients and highlight the importance of tree mycorrhizal associations in influencing how the diversity-ecosystem function (e.g. biomass) relationships change with soil fertility.

3.
New Phytol ; 222(4): 1936-1950, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30689219

RESUMO

The biological and functional diversity of ectomycorrhizal (ECM) associations remain largely unknown in South America. In Patagonia, the ECM tree Nothofagus pumilio forms monospecific forests along mountain slopes without confounding effects of vegetation on plant-fungi interactions. To determine how fungal diversity and function are linked to elevation, we characterized fungal communities, edaphic variables, and eight extracellular enzyme activities along six elevation transects in Tierra del Fuego (Argentina and Chile). We also tested whether pairing ITS1 rDNA Illumina sequences generated taxonomic biases related to sequence length. Fungal community shifts across elevations were mediated primarily by soil pH with the most species-rich fungal families occurring mostly within a narrow pH range. By contrast, enzyme activities were minimally influenced by elevation but correlated with soil factors, especially total soil carbon. The activity of leucine aminopeptidase was positively correlated with ECM fungal richness and abundance, and acid phosphatase was correlated with nonECM fungal abundance. Several fungal lineages were undetected when using exclusively paired or unpaired forward ITS1 sequences, and these taxonomic biases need reconsideration for future studies. Our results suggest that soil fungi in N. pumilio forests are functionally similar across elevations and that these diverse communities help to maintain nutrient mobilization across the elevation gradient.


Assuntos
Micorrizas/fisiologia , Solo/química , Sequência de Bases , Biodiversidade , Chile , DNA Ribossômico/genética , Meio Ambiente , Geografia
4.
New Phytol ; 220(4): 1076-1091, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29689121

RESUMO

Contents Summary 1076 I. Introduction 1076 II. Historical overview 1077 III. Identities and distributions of tropical ectomycorrhizal plants 1077 IV. Dominance of tropical forests by ECM trees 1078 V. Biogeography of tropical ECM fungi 1081 VI. Beta diversity patterns in tropical ECM fungal communities 1082 VII. Conclusions and future research 1086 Acknowledgements 1087 References 1087 SUMMARY: Ectomycorrhizal (ECM) associations were historically considered rare or absent from tropical ecosystems. Although most tropical forests are dominated by arbuscular mycorrhizal (AM) trees, ECM associations are widespread and found in all tropical regions. Here, we highlight emerging patterns of ECM biogeography, diversity and ecosystem functions, identify knowledge gaps, and offer direction for future research. At the continental and regional scales, tropical ECM systems are highly diverse and vary widely in ECM plant and fungal abundance, diversity, composition and phylogenetic affinities. We found strong regional differences among the dominant host plant families, suggesting that biogeographical factors strongly influence tropical ECM symbioses. Both ECM plants and fungi also exhibit strong turnover along altitudinal and soil fertility gradients, suggesting niche differentiation among taxa. Ectomycorrhizal fungi are often more abundant and diverse in sites with nutrient-poor soils, suggesting that ECM associations can optimize plant nutrition and may contribute to the maintenance of tropical monodominant forests. More research is needed to elucidate the diversity patterns of ECM fungi and plants in the tropics and to clarify the role of this symbiosis in nutrient and carbon cycling.


Assuntos
Biodiversidade , Micorrizas/fisiologia , Filogeografia , Clima Tropical , Florestas
5.
Dev Med Child Neurol ; 60(11): 1117-1122, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29655223

RESUMO

AIM: To estimate the strengths of association between clinical features and migraine or arterial ischaemic stroke (AIS) in children presenting to the emergency department. METHOD: Eighty-four children with migraine, prospectively recruited from 2009 to 2010, were compared with 55 children with AIS, prospectively/retrospectively recruited from 2003 to 2010. Odds ratios were calculated via logistic regression to measure associations between clinical features and process-of-care factors, and migraine and AIS. RESULTS: Median age was 13 years 5 months (interquartile range 12y 11mo-13y 10mo) for migraine and 5 years (interquartile range 3y 7mo-8y) for patients with AIS. All cases of AIS and 30% of migraine cases underwent neuroimaging. Over 40% of children with migraine had vomiting, numbness, or visual disturbance; other symptoms were uncommon. Fifty-five per cent had no signs on physician assessment. Weakness or speech disturbance were common in patients with AIS. Significant clinical features associated with increased odds of AIS included sudden symptom onset, weakness, seizures, speech disturbance, and ataxia, and signs of face, arm, or leg weakness, inability to walk, dysarthria, dysphasia, and altered consciousness (p<0.05). Significant features associated with decreased odds of AIS included older age, vomiting, visual, sensory, other symptoms, and absent focal signs on assessment (p<0.05). INTERPRETATION: Presenting features can discriminate childhood AIS from migraine. These differences inform decisions about urgency and type of neuroimaging in children presenting to the emergency department with brain attack symptoms. WHAT THE PAPER ADDS: Weakness, seizures, ataxia, speech, or walking difficulties are more frequent in arterial ischaemic stroke (AIS). Vomiting, visual, or sensory disturbance and absent focal signs are more frequent in migraine. Identifying features of AIS and migraine guides neuroimaging in children with brain attack symptoms.


Assuntos
Isquemia Encefálica/diagnóstico , Transtornos de Enxaqueca/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Adolescente , Encéfalo/diagnóstico por imagem , Isquemia Encefálica/terapia , Criança , Pré-Escolar , Diagnóstico Diferencial , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Transtornos de Enxaqueca/terapia , Neuroimagem , Estudos Prospectivos , Estudos Retrospectivos , Acidente Vascular Cerebral/terapia
6.
Pediatr Emerg Care ; 34(8): 552-557, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27749807

RESUMO

OBJECTIVES: The aim was to describe clinical presentation, management, and outcomes of stroke in a tertiary emergency department (ED) of a developing country. METHODOLOGY: Retrospective case series of patients aged 1 month to 18 years presenting to an ED with radiological confirmed acute stroke during a 7-year period were studied. RESULTS: Ninety-five patients were identified. Twenty-five patients were excluded because of incomplete records (8) or not presenting via ED (17). Thirty-four (48.5%) were diagnosed with hemorrhagic stroke (HS), 30 (42.8%) with arterial ischemic stroke (AIS), and 6 (8.5%) with sinus venous thrombosis (SVT). Mean age was 5.3 years, and 55.3% were male. The median time from onset of symptoms to ED presentation was 24 hours (mean, 55 hours; interquartile range [IQR], 14-72) for AIS, 24 hours (mean, 46.9 hours; IQR, 9-48) for HS, and 120 hours (mean,112 hours; IQR, 72-168) for SVT. Congenital cardiac disease was the most common risk factor (9%). For AIS, the most common symptoms were focal numbness 56.6% (95% confidence interval [CI], 37.8%-75.4%), focal weakness 56.6% (95% CI, 37.8%-75.4%), and seizures 50% (95% CI, 31%-68.8%). For HS, the most common symptoms were headache 64.7% (95% CI, 47.7%-81.6%), vomiting 79.4 (95% CI, 65-93.7), and altered mental status 64.7% (95% CI, 47.7-81.6). Computed tomography scan was done in 100% of the patients and magnetic resonance imaging in 54%. Twenty-five (36%) patients were admitted to intensive care unit and required intubation. Long-term deficit was identified in 24 (36%) patients based on medium-term follow-up. CONCLUSIONS: The spectrum of stroke in a developing country was similar to published series from developed countries in terms of final diagnosis, risk factors, and delay to ED presentation, neuroimaging, and long-term neurodeficits. No tropical diseases were identified as risk factors.


Assuntos
Acidente Vascular Cerebral/diagnóstico , Adolescente , Criança , Pré-Escolar , Costa Rica , Países em Desenvolvimento , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/terapia , Centros de Atenção Terciária/estatística & dados numéricos
7.
Pediatr Crit Care Med ; 19(3): e152-e156, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29252866

RESUMO

OBJECTIVES: To develop a Latin American Consensus about Pediatric Cardiopulmonary Resuscitation. To clarify, reinforce, and adapt some specific recommendations for pediatric patients and to stimulate the implementation of these recommendations in clinical practice. DESIGN: Expert consensus recommendations with Delphi methodology. SETTING: Latin American countries. SUBJECTS: Experts in pediatric cardiopulmonary resuscitation from 19 Latin American countries. INTERVENTIONS: Delphi methodology for expert consensus. MEASUREMENTS AND MAIN RESULTS: The goal was to reach consensus with all the participating experts for every recommendation. An agreement of at least 80% of the participating experts had to exist in order to deliver a recommendation. Two Delphi voting rounds were sent out electronically. The experts were asked to score between 1 and 9 their level of agreement for each recommendation. The score was then classified into three groups: strong agreement (score 7-9), moderate agreement (score 4-6), and disagreement (score 1-3). Nineteen experts from 19 countries participated in both voting rounds and in the whole process of drafting the recommendations. Sixteen recommendations about organization of cardiopulmonary resuscitation, prevention, basic resuscitation, advanced resuscitation, and postresuscitation measures were approved. Ten of them had a consensus of 100%. Four of them were agreed by all the participants except one (94.7% consensus). One recommendation was agreed by all except two experts (89.4%), and finally, one was agreed by all except three experts (84.2%). All the recommendations reached a level of agreement. CONCLUSIONS: This consensus adapts 16 international recommendations to Latin America in order to improve the practice of cardiopulmonary resuscitation in children. Studies should be conducted to analyze the effectiveness of the implementation of these recommendations.


Assuntos
Reanimação Cardiopulmonar/métodos , Cuidados Críticos/métodos , Consenso , Técnica Delfos , Humanos , América Latina , Guias de Prática Clínica como Assunto , Sociedades Médicas
8.
Stroke ; 48(5): 1198-1202, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28336681

RESUMO

BACKGROUND AND PURPOSE: Access to acute stroke interventions in the emergency department (ED) relies on correct clinical diagnosis. Our aims were to determine the accuracy and reliability of pediatric ED physician diagnosis of childhood stroke and other conditions presenting with brain attack symptoms. METHODS: Prospective study of consecutive children aged 1 month to 18 years presenting to the ED from June 2009 to December 2010 with focal neurological deficits. Accuracy (sensitivity, specificity, and receiver operator characteristic curves [ROCs]) and interrater agreement (κ) were determined, between ED physician diagnoses, as recorded in the electronic hospital administrative software system, and final neurological diagnosis, after completion of diagnostic work-up. RESULTS: Two-hundred eighty-seven children with 301 consecutive presentations were recruited. The most common final brain attack diagnoses included migraine in 84 children, first seizure in 48, Bell's palsy in 29, stroke in 21, and conversion disorders in 18 children. Sensitivity of ED physician stroke diagnosis was 62%, and specificity was 98% (ROC, 0.8). Inter-rater agreement for ED physician and final stroke diagnosis was substantial (κ=0.61). ED physician diagnostic accuracy and reliability was highest for Bell's palsy (ROC=0.98; κ=0.96), and lowest for central nervous system demyelination (ROC=0.5; κ=-0.01) and cerebellitis (ROC=0.50; κ=0.50). CONCLUSIONS: ED physician diagnostic accuracy and reliability varies considerably across disorders presenting with brain attack symptoms. Clinical recognition tools are required to assist pediatric ED physicians with diagnosis of stroke and other serious neurological disorders.


Assuntos
Encefalopatias/diagnóstico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Acidente Vascular Cerebral/diagnóstico , Adolescente , Paralisia de Bell/diagnóstico , Ataxia Cerebelar/diagnóstico , Criança , Pré-Escolar , Transtorno Conversivo/diagnóstico , Doenças Desmielinizantes/diagnóstico , Feminino , Humanos , Lactente , Masculino , Transtornos de Enxaqueca/diagnóstico , Pediatria/estatística & dados numéricos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
9.
Stroke ; 47(10): 2476-81, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27601378

RESUMO

BACKGROUND AND PURPOSE: Clinical identification of stroke in the pediatric emergency department is critical for improving access to hyperacute therapies. We identified key clinical features associated with childhood stroke or transient ischemic attack compared with mimics. METHODS: Two hundred and eighty consecutive children presenting to the emergency department with mimics, prospectively recruited over 18 months from 2009 to 2010, were compared with 102 children with stroke or transient ischemic attack, prospectively/retrospectively recruited from 2003 to 2010. RESULTS: Cerebrovascular diagnoses included arterial ischemic stroke (55), hemorrhagic stroke (37), and transient ischemic attack (10). Mimic diagnoses included migraine (84), seizures (46), Bell's palsy (29), and conversion disorders (18). Being well in the week before presentation (odds ratio [OR] 5.76, 95% confidence interval [CI] 2.25-14.79), face weakness (OR 2.94, 95% CI 1.19-7.28), arm weakness (OR 8.66, 95% CI, 2.50-30.02), and inability to walk (OR 3.38, 95% CI 1.54-7.42) were independently associated with increased odds of stroke diagnosis. Other symptoms were independently associated with decreased odds of stroke diagnosis (OR 0.28, 95% CI 0.10-0.77). Associations were not observed between seizures or loss of consciousness. Factors associated with stroke differed by arterial and hemorrhagic subtypes. CONCLUSIONS: Being well in the week before presentation, inability to walk, face and arm weakness are associated with increased odds of stroke. The lack of positive or negative association between stroke and seizures or loss of consciousness is an important difference to adults. Pediatric stroke pathways and bedside tools need to factor in differences between children and adults and between stroke subtypes.


Assuntos
Paralisia de Bell/diagnóstico , Isquemia Encefálica/diagnóstico , Transtorno Conversivo/diagnóstico , Hemorragias Intracranianas/diagnóstico , Transtornos de Enxaqueca/diagnóstico , Convulsões/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Adolescente , Criança , Pré-Escolar , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Recém-Nascido , Ataque Isquêmico Transitório/diagnóstico , Masculino , Exame Físico
10.
Case Rep Pediatr ; 2016: 8097105, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27247819

RESUMO

Hydropneumothorax is an uncommon presentation of a complicated pneumonia, and very few cases in the pediatric population have been reported. This is a case of a 5-month-old patient who presented to the emergency department (ED) with a three-day history of fever, diarrhea, and respiratory distress. His initial assessment suggested a lower respiratory tract infection and because of his respiratory distress and hypoxia a chest X-ray was performed. Other clinical information and radiologic studies will be discussed further, but his chest X-ray suggested a right-sided hydropneumothorax secondary to a complicated pneumonia. He completed 12 days of IV antibiotic treatment and required a chest tube for drainage. Patient was discharged home with a full recovery.

11.
Ecol Lett ; 19(4): 383-92, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26833573

RESUMO

Tropical forests are renowned for their high diversity, yet in many sites a single tree species accounts for the majority of the individuals in a stand. An explanation for these monodominant forests remains elusive, but may be linked to mycorrhizal symbioses. We tested three hypotheses by which ectomycorrhizas might facilitate the dominance of the tree, Oreomunnea mexicana, in montane tropical forest in Panama. We tested whether access to ectomycorrhizal networks improved growth and survival of seedlings, evaluated whether ectomycorrhizal fungi promote seedling growth via positive plant-soil feedback, and measured whether Oreomunnea reduced inorganic nitrogen availability. We found no evidence that Oreomunnea benefits from ectomycorrhizal networks or plant-soil feedback. However, we found three-fold higher soil nitrate and ammonium concentrations outside than inside Oreomunnea-dominated forest and a correlation between soil nitrate and Oreomunnea abundance in plots. Ectomycorrhizal effects on nitrogen cycling might therefore provide an explanation for the monodominance of ectomycorrhizal tree species worldwide.


Assuntos
Biodiversidade , Florestas , Micorrizas/fisiologia , Ciclo do Nitrogênio/fisiologia , Nitrogênio/metabolismo , Árvores/microbiologia , Panamá , Microbiologia do Solo , Clima Tropical
12.
Mycorrhiza ; 26(1): 1-17, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25940407

RESUMO

Neotropical montane forests are often dominated by ectomycorrhizal (EM) tree species, yet the diversity of their EM fungal communities remains poorly explored. In lower montane forests in western Panama, the EM tree species Oreomunnea mexicana (Juglandaceae) forms locally dense populations in forest otherwise characterized by trees that form arbuscular mycorrhizal (AM) associations. The objective of this study was to compare the composition of EM fungal communities associated with Oreomunnea adults, saplings, and seedlings across sites differing in soil fertility and the amount and seasonality of rainfall. Analysis of fungal nrITS DNA (nuclear ribosomal internal transcribed spacers) revealed 115 EM fungi taxa from 234 EM root tips collected from adults, saplings, and seedlings in four sites. EM fungal communities were equally species-rich and diverse across Oreomunnea developmental stages and sites, regardless of soil conditions or rainfall patterns. However, ordination analysis revealed high compositional turnover between low and high fertility/rainfall sites located ca. 6 km apart. The EM fungal community was dominated by Russula (ca. 36 taxa). Cortinarius, represented by 14 species and previously reported to extract nitrogen from organic sources under low nitrogen availability, was found only in low fertility/high rainfall sites. Phylogenetic diversity analyses of Russula revealed greater evolutionary distance among taxa found on sites with contrasting fertility and rainfall than was expected by chance, suggesting that environmental differences among sites may be important in structuring EM fungal communities. More research is needed to evaluate whether EM fungal taxa associated with Oreomunnea form mycorrhizal networks that might account for local dominance of this tree species in otherwise diverse forest communities.


Assuntos
Florestas , Juglandaceae/microbiologia , Micorrizas/classificação , Micorrizas/genética , Sequência de Bases , Biodiversidade , DNA Fúngico/genética , Variação Genética , Meristema/microbiologia , Micorrizas/isolamento & purificação , Panamá , Filogenia , Raízes de Plantas/microbiologia , Plântula/microbiologia , Análise de Sequência de DNA , Solo/química , Microbiologia do Solo , Árvores/microbiologia , Clima Tropical
13.
Neurology ; 82(16): 1434-40, 2014 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-24658929

RESUMO

OBJECTIVES: To determine symptoms, signs, and etiology of brain attacks in children presenting to the emergency department (ED) as a first step for developing a pediatric brain attack pathway. METHODS: Prospective observational study of children aged 1 month to 18 years with brain attacks (defined as apparently abrupt-onset focal brain dysfunction) and ongoing symptoms or signs on arrival to the ED. Exclusion criteria included epilepsy, hydrocephalus, head trauma, and isolated headache. Etiology was determined after review of clinical data, neuroimaging, and other investigations. A random-effects meta-analysis of similar adult studies was compared with the current study. RESULTS: There were 287 children (46% male) with 301 presentations over 17 months. Thirty-five percent arrived by ambulance. Median symptom duration before arrival was 6 hours (interquartile range 2-28 hours). Median time from triage to medical assessment was 22 minutes (interquartile range 6-55 minutes). Common symptoms included headache (56%), vomiting (36%), focal weakness (35%), numbness (24%), visual disturbance (23%), seizures (21%), and altered consciousness (21%). Common signs included focal weakness (31%), numbness (13%), ataxia (10%), or speech disturbance (8%). Neuroimaging included CT imaging (30%), which was abnormal in 27%, and MRI (31%), which was abnormal in 62%. The most common diagnoses included migraine (28%), seizures (15%), Bell palsy (10%), stroke (7%), and conversion disorders (6%). Relative proportions of conditions in children significantly differed from adults for stroke, migraine, seizures, and conversion disorders. CONCLUSIONS: Brain attack etiologies differ from adults, with stroke being the fourth most common diagnosis. These findings will inform development of ED clinical pathways for pediatric brain attacks.


Assuntos
Acidente Vascular Cerebral/diagnóstico , Adolescente , Adulto , Encéfalo/patologia , Criança , Pré-Escolar , Procedimentos Clínicos , Diagnóstico Diferencial , Diagnóstico Precoce , Serviço Hospitalar de Emergência , Feminino , Hospitais Pediátricos , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Exame Neurológico , Estudos Prospectivos , Acidente Vascular Cerebral/etiologia , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X , Vitória
14.
Pediatr Infect Dis J ; 33(1): 104-6, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23989105

RESUMO

Few reports of infective endocarditis in Latin American children have been published. We describe the epidemiology of infective endocarditis at the only pediatric tertiary hospital in Costa Rica. Methicillin-resistant Staphylococcus aureus rate was isolated in 44% of cases. The case fatality rate was 23%.


Assuntos
Endocardite Bacteriana/epidemiologia , Adolescente , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Costa Rica/epidemiologia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos
15.
Case Rep Pediatr ; 2013: 373712, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23607028

RESUMO

Necrotizing fasciitis is a serious soft tissue infection rarely occurring in children after blunt trauma. Due to its high morbidity and mortality rates, a high index of suspicion is necessary for prompt diagnosis and treatment. We describe a 6-year-old Costa Rican girl who died secondary to multiple complications following a posttraumatic necrotizing fasciitis.

16.
BMC Pediatr ; 11: 93, 2011 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-22014183

RESUMO

BACKGROUND: Stroke recognition tools have been shown to improve diagnostic accuracy in adults. Development of a similar tool in children is needed to reduce lag time to diagnosis. A critical first step is to determine whether adult stoke scales can be applied in childhood stroke.Our objective was to assess the applicability of adult stroke scales in childhood arterial ischemic stroke (AIS) METHODS: Children aged 1 month to < 18 years with radiologically confirmed acute AIS who presented to a tertiary emergency department (ED) (2003 to 2008) were identified retrospectively. Signs, symptoms, risk factors and initial management were extracted. Two adult stroke recognition tools; ROSIER (Recognition of Stroke in the Emergency Room) and FAST (Face Arm Speech Test) scales were applied retrospectively to all patients to determine test sensitivity. RESULTS: 47 children with AIS were identified. 34 had anterior, 12 had posterior and 1 child had anterior and posterior circulation infarcts. Median age was 9 years and 51% were male. Median time from symptom onset to ED presentation was 21 hours but one third of children presented within 6 hours. The most common presenting stroke symptoms were arm (63%), face (62%), leg weakness (57%), speech disturbance (46%) and headache (46%). The most common signs were arm (61%), face (70%) or leg weakness (57%) and dysarthria (34%). 36 (78%) of children had at least one positive variable on FAST and 38 (81%) had a positive score of ≥1 on the ROSIER scale. Positive scores were less likely in children with posterior circulation stroke. CONCLUSION: The presenting features of pediatric stroke appear similar to adult strokes. Two adult stroke recognition tools have fair to good sensitivity in radiologically confirmed childhood AIS but require further development and modification. Specificity of the tools also needs to be determined in a prospective cohort of children with stroke and non-stroke brain attacks.


Assuntos
Acidente Vascular Cerebral/diagnóstico , Adolescente , Adulto , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Exame Neurológico , Estudos Retrospectivos
17.
Pediatr Emerg Care ; 27(10): 966-74; quiz 975-7, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21975501

RESUMO

Stroke is a major cause of morbidity and mortality in children and long-term neurological deficits. Although cerebrovascular disorders occur less often in children than in adults, recognition of stroke in children has probably increased because of the widespread application of noninvasive diagnostic studies such as magnetic resonance imaging and computed tomography.Computed tomography (CT) should be the first imaging choice in the emergency setting when stroke is suspected. It will show the presence of hemorrhage (eg, bleeding from arteriovenous malformation). It is often normal within the first hours in arterial ischemic stroke. As in adults, magnetic resonance imaging is the neuroimaging modality to confirm the clinical diagnosis of ischemic stroke. In children, however, magnetic resonance imaging requires sedation and may not be as readily available as CT. Perfusion imaging demonstrates flow within the brain and can detect areas that are at risk of ischemia; however, further studies in the pediatric population need to be validated for this technique in children. Angiography detects arterial disease (eg, aneurysm); however, its use has been largely superseded by better magnetic resonance angiography, which is sensitive enough to visualize lesions in the proximal anterior cerebral artery, middle cerebral artery, and distal internal carotid artery (ICA). Magnetic resonance imaging using diffusion- weighted imaging is the most versatile and sensitive imaging technique for identifying ischemic lesions. In the future, we need to identify the pediatric patient presenting to the emergency department with an acute stroke and develop a pathway for the use of particular imaging techniques (eg, CT vs magnetic resonance imaging).


Assuntos
Imagem por Ressonância Magnética , Acidente Vascular Cerebral/diagnóstico , Tomografia Computadorizada por Raios X , Infarto Encefálico/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Angiografia Cerebral , Hemorragia Cerebral/diagnóstico por imagem , Circulação Cerebrovascular , Criança , Humanos , Neuroimagem , Fatores de Risco , Trombose dos Seios Intracranianos/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia
18.
Ann Emerg Med ; 58(2): 156-63, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21310508

RESUMO

STUDY OBJECTIVE: Little is known about the presenting features of acute ischemic and hemorrhagic stroke in children presenting to the emergency department (ED). Yet, initial clinical assessment is a key step in the management pathway of stroke. We describe the presentation in the ED of children with confirmed acute ischemic and hemorrhagic stroke subtypes. METHODS: We conducted a retrospective descriptive case series of consecutive patients aged 1 month to younger than 18 years and presenting to a single-center tertiary ED with radiologically confirmed acute ischemic stroke or hemorrhagic stroke during a 5-year period. Patients were identified by medical record search with International Classification of Diseases, 10th Revision codes for hemorrhagic stroke and through the hospital stroke registry for acute ischemic stroke. Signs, symptoms, and initial management were described. RESULTS: Fifty patients with acute ischemic stroke and 31 with hemorrhagic stroke were identified. Mean age was 8.7 years (SD 5.2), and 51% were male. Fifty-six percent were previously healthy. Median time from onset of symptoms to ED presentation was 21 hours (interquartile range 6 to 48 hours) for acute ischemic stroke and 12 hours (interquartile range 4 to 72 hours) for hemorrhagic stroke. Acute ischemic stroke presented with symptoms of focal limb weakness (64%; 95% confidence interval [CI] 49% to 77%), facial weakness (60%; 95% CI 45% to 73%), and speech disturbance (46%; 95% CI 31% to 60%). Few patients with acute ischemic stroke presented with vomiting and altered mental status. Most patients with acute ischemic stroke had a Glasgow Coma Scale (GCS) score of 14 or greater (86%; 95% CI 73% to 94%) and presented with at least 1 focal neurologic sign (88%; 95% CI 73% to 98%). Hemorrhagic stroke presented with headache (73%; 95% CI 54% to 87%), vomiting (58%; 95% CI 40% to 75%), and altered mental status (48%; 95% CI 30% to 67%). GCS score in hemorrhagic stroke was less than 14 in 38% and less than 8 in 19% (95% CI 7% to 37%). Less than one third of patients had focal limb weakness, facial weakness, or slurred speech. Nineteen percent of patients with hemorrhagic stroke were intubated in the ED and admitted to the ICU. None of the acute ischemic stroke patients were intubated in the ED, and 4% were admitted to the ICU. CONCLUSION: Diagnosis of stroke in children with acute ischemic stroke and hemorrhagic stroke was delayed. Acute ischemic stroke presented mainly with focal findings; hemorrhagic stroke, with headache, vomiting, and mental status change.


Assuntos
Isquemia Encefálica/diagnóstico , Hemorragia Cerebral/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Escala de Coma de Glasgow , Cefaleia/etiologia , Humanos , Lactente , Intubação Intratraqueal/estatística & dados numéricos , Masculino , Debilidade Muscular/etiologia , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Fatores de Tempo , Vômito/etiologia
19.
Aust Fam Physician ; 40(1-2): 35-8, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21301691

RESUMO

BACKGROUND: Asthma is the most common chronic disease of childhood and the leading cause of childhood morbidity from chronic disease. When uncontrolled, asthma can place significant limits on daily life, and is sometimes fatal. OBJECTIVE: This article describes the initial assessment and management of status asthmaticus in children. DISCUSSION: Status asthmaticus is a medical emergency in which asthma symptoms are refractory to initial bronchodilator therapy. Patients may report chest tightness, rapidly progressive shortness of breath, dry cough and wheezing. Typically, patients present a few days after the onset of a viral respiratory illness, following exposure to potent allergens or irritants, or after exercise in a cold environment, however, they can also present with sudden onset of symptoms with an unknown trigger. Early recognition and initiation of therapy is vital in preventing severe complications such as respiratory failure. Aggressive treatment with beta-agonists, anticholinergics and corticosteroids remains the gold standard for this condition.


Assuntos
Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Administração por Inalação , Adolescente , Corticosteroides/uso terapêutico , Asma/diagnóstico , Broncodilatadores/uso terapêutico , Criança , Pré-Escolar , Antagonistas Colinérgicos/uso terapêutico , Doença Crônica/tratamento farmacológico , Feminino , Humanos , Lactente , Masculino , Fatores de Risco
20.
Aust Fam Physician ; 39(5): 270-5, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20485711

RESUMO

BACKGROUND: Children present to general practitioners with a wide range of problems, but most of the time they are not particularly unwell. Children with a more serious illness often compensate very well initially, so there is a risk that their illness will be overlooked or underestimated. OBJECTIVE: To outline the early recognition and management of children who are seriously ill. DISCUSSION: The initial assessment of an unwell child includes the paediatric assessment triangle: appearance, breathing and circulation to skin; primary survey that focuses on basic life support, patient assessment and immediate management; secondary survey with a detailed history of the event and physical examination; and ongoing assessment. Medical practitioners and their clinic staff must be prepared to undertake initial emergency management of a seriously ill child, and they must have the equipment and supplies available to carry out that management effectively.


Assuntos
Doenças Cardiovasculares/diagnóstico , Doenças do Sistema Nervoso Central/diagnóstico , Estado Terminal/terapia , Medicina de Família e Comunidade/métodos , Doenças Respiratórias/diagnóstico , Doença Aguda , Austrália , Doenças Cardiovasculares/terapia , Doenças do Sistema Nervoso Central/terapia , Criança , Pré-Escolar , Técnicas de Laboratório Clínico , Diagnóstico Diferencial , Diagnóstico por Imagem/métodos , Emergências , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pediatria/normas , Pediatria/tendências , Exame Físico , Padrões de Prática Médica , Doenças Respiratórias/terapia , Medição de Risco , Resultado do Tratamento
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