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1.
Pediatr Dermatol ; 2019 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-31755135

RESUMO

BACKGROUND: Acute hemorrhagic edema of young children is a benign skin-limited vasculitis mainly affecting children 2 to 24 months of age, which is often considered the infantile variant of immunoglobulin A vasculitis (Henoch-Schönlein purpura). In most cases, the diagnosis is made on a clinical basis without a skin biopsy. METHODS: A systematic review of the literature was performed to examine the reported prevalence of vascular immune deposits in skin biopsies of patients with acute hemorrhagic edema of young children. RESULTS: Testing for vascular immune deposits was performed in 75 cases (64 boys and 11 girls aged from 3.5 to 72, median 11 months) published between 1970 and 2018. Vessel wall deposition of complement C3 was seen in 40 cases. Immunoglobulin M (N = 24), immunoglobulin A (N = 21), immunoglobulin G (N = 13), and immunoglobulin E (N = 3) were less frequently detected. Gender, age, clinical features, and disease duration were not statistically different in cases with and without vessel wall deposition of immunoglobulin A. CONCLUSION: Immune deposits in skin vessels, most frequently complement C3, are common in subjects with acute hemorrhagic edema of young children, providing furhter evidence that acute hemorrhagic edema, immunoglobulin A vasculitis, and pauci-immune vasculitides are different entities.

3.
Am J Hum Genet ; 104(6): 1210-1222, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31079897

RESUMO

We delineate a KMT2E-related neurodevelopmental disorder on the basis of 38 individuals in 36 families. This study includes 31 distinct heterozygous variants in KMT2E (28 ascertained from Matchmaker Exchange and three previously reported), and four individuals with chromosome 7q22.2-22.23 microdeletions encompassing KMT2E (one previously reported). Almost all variants occurred de novo, and most were truncating. Most affected individuals with protein-truncating variants presented with mild intellectual disability. One-quarter of individuals met criteria for autism. Additional common features include macrocephaly, hypotonia, functional gastrointestinal abnormalities, and a subtle facial gestalt. Epilepsy was present in about one-fifth of individuals with truncating variants and was responsive to treatment with anti-epileptic medications in almost all. More than 70% of the individuals were male, and expressivity was variable by sex; epilepsy was more common in females and autism more common in males. The four individuals with microdeletions encompassing KMT2E generally presented similarly to those with truncating variants, but the degree of developmental delay was greater. The group of four individuals with missense variants in KMT2E presented with the most severe developmental delays. Epilepsy was present in all individuals with missense variants, often manifesting as treatment-resistant infantile epileptic encephalopathy. Microcephaly was also common in this group. Haploinsufficiency versus gain-of-function or dominant-negative effects specific to these missense variants in KMT2E might explain this divergence in phenotype, but requires independent validation. Disruptive variants in KMT2E are an under-recognized cause of neurodevelopmental abnormalities.

4.
Fish Physiol Biochem ; 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30276578

RESUMO

The study of the toxic effect of carbofuran and multiwalled carbon nanotubes (MWCNTs) on Astyanax ribeirae metabolism is of paramount importance due to the increasing use of this pesticide in agriculture and in the production of nanotubes within the material industry. This study aimed to evaluate the effects of carbofuran, MWCNT, and the combination of these compounds on specific oxygen consumption and excretion of ammonia in A. ribeirae. Therefore, 65 fish were divided into three groups of treatments at varying concentrations: carbofuran (0.01, 0.05, 0.1, and 0.5 mg/L), MWCNT (0.1, 0.25, 0.5, and 1.0 mg/L), and 0.5 mg/L of MWCNT added to carbofuran concentrations (0.01, 0.05, 0.1, and 0.5 mg/L). The average specific oxygen consumption in the groups exposed to carbofuran, compared to the control, increased 73.49% at the 0.01 mg/L concentration and decreased 63.86% and 91.57% with treatments of 0.1 and 0.5 mg/L, respectively. For groups exposed to the MWCNT, there was an 83.91% drop with the 1.0 mg/L treatment, and the carbofuran + MWCNT groups recorded a decrease of 71.09%, 92.77%, and 93.98% at concentrations of 0.05, 0.1, and 0.5 mg/L, respectively. In relation to specific ammonia excretion, in groups exposed to carbofuran compared to the control, there was an increase of 134.37% and 200% with the 0.1 and 0.5 mg/L treatments, respectively. The group exposed to carbofuran + MWCNT experienced a decrease of 60% and 80% with treatments of 0.1 mg/L carbofuran + 0.5 mg/L MWCNT and 0.5 mg/L carbofuran + 0.5 mg/L MWCNT, respectively. Therefore, it was concluded that carbofuran + MWCNT interact, increasing the effects in Astyanax sp.

5.
Neuromuscul Disord ; 28(5): 443-449, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29653699

RESUMO

Acute benign calf myositis is a rare infection-associated syndrome presenting with calf pain that occurs in epidemics or sporadically. Epidemic cases are usually associated with influenza virus type B. Sporadic cases, however, might be associated with a large number of microorganisms. Furthermore, during an outbreak there is a great alertness that promotes earlier diagnosis. In contrast, there is likely a lower awareness regarding the sporadic form, compromising early and correct diagnosis. In order to characterize the sporadic form of acute calf myositis and increase the knowledge of this condition, we systematically reviewed the literature reporting sporadic cases. We identified 72 reports, including 451 patients, 325 males and 126 females. Sporadic acute benign calf myositis affected subjects ≤18 years of age (N = 450; 99%), who followed a prodromal flu-like illness (N = 411; 91%), presented with pain and tenderness affecting only the calves for ≤1½ weeks (N = 441; 99%) and was never complicated by kidney involvement. The creatine kinase ratio was ≥10 in 310 (70%) out of 444 cases. Microbiological studies identified an infectious trigger in 181 cases, mostly influenza virus (type B more frequently than type A), Dengue, Ebstein-Barr or Parainfluenza virus and Mycoplasma pneumoniae. Sporadic acute benign calf myositis is a self-limited condition that can usually be diagnosed on a clinical basis. Unlike the epidemic form, many cases are due to microorganisms other than influenza virus B or A.

6.
J Clin Rheumatol ; 22(2): 80-1, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26906300

RESUMO

Little attention has been so far paid to familial cases of Henoch-Schönlein syndrome. We performed a search of the Medical Subject Headings terms (Henoch or Schönlein OR anaphylactoid purpura OR IgA nephropathy OR Berger nephropathy) AND (family OR familial). We identified no more than 19 reports including 47 families with a total of 100 affected cases: their ages ranged from 1.3 to 51 years (median, 11 years), with a male-to-female ratio of 1.4. Familial cases developed simultaneously in 45% and nonsimultaneously in 55% of the families. Age, male-to-female ratio, and clinical findings were not statistically different in cases with simultaneous and nonsimultaneous familial occurrence of Henoch-Schönlein syndrome. Henoch-Schönlein syndrome occurs almost always sporadically. Age at presentation, male-to-female ratio, and findings are similar in familial (both simultaneously and nonsimultaneously occurring) and sporadic Henoch-Schönlein cases.


Assuntos
Púrpura de Schoenlein-Henoch/epidemiologia , Púrpura de Schoenlein-Henoch/genética , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Adulto Jovem
7.
Eur J Pediatr ; 175(4): 557-61, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26608931

RESUMO

UNLABELLED: Acute hemorrhagic edema of young children is a rare leukocytoclastic vasculitis that has been reported exclusively in small retrospective cases series, case reports, or quizzes. Considering that retrospective experience deserves confirmation in at least one observational prospective study, we present our experience with 16 children (12 boys and 4 girls, 5-28 months of age) affected by acute hemorrhagic edema. The patients were in good general conditions and with a low-grade or even absent fever. They presented with non-itching red to purpuric targetoid lesions not changing location within hours, with non-pitting and sometimes tender indurative swelling, and without mucous membrane involvement or scratch marks. Signs for articular, abdominal, or kidney involvement were absent. Antinuclear or antineutrophil cytoplasmic autoantibodies were never detected. The cases were managed symptomatically as outpatients and fully resolved within 4 weeks or less. No recurrence or familiarity was noted. CONCLUSION: This is the first prospective evaluation of hemorrhagic edema. Our findings emphasize its distinctive tetrad: a well-appearing child; targetoid lesions that do not change location within hours; non-pitting, sometimes tender edema; complete resolution without recurrence. What is known • Acute hemorrhagic edema of young children is considered a benign vasculitis. • There have been ≈100 cases reported in small retrospective case series. What is new • The first prospective evaluation of this condition emphasizes its features: febrile prodrome; well-appearing child; targetoid lesions not changing location within hours; non-pitting, sometimes tender indurative edema; absent extracutaneous involvement; resolution within 3 weeks. • Antineutrophil cytoplasmic autoantibodies do not play a pathogenic role.


Assuntos
Edema/diagnóstico , Vasculite Leucocitoclástica Cutânea/diagnóstico , Doença Aguda , Anticorpos Anticitoplasma de Neutrófilos/sangue , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos
10.
Int J Pharm ; 468(1-2): 196-8, 2014 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-24746411

RESUMO

Trials with pulverized brand-name antihypertensive drugs suggest that, from the perspective of taste acceptability, crushed candesartan, chlortalidon, hydrochlorothiazide, lercanidipine and lisinopril should be preferred to pulverized amlodipine, atenolol, bisoprolol, enalapril, irbesartan, losartan, ramipril, telmisartan and valsartan. Brand-name antihypertensive drugs and the corresponding generic medicines have never been compared with respect to their taste acceptability. We therefore investigated among healthy health care workers the taste acceptability of a pulverized 1 mg-test dose of the brand-name and two generics containing either the dihydropyridine calcium-channel blocker amlodipine (Norvasc(®), Amlodipin-Mepha(®) and Amlodipin Pfizer(®)) or the angiotensin receptor antagonist candesartan (Atacand(®), Cansartan-Mepha(®) and Pemzek(®)). For this purpose, a smiley-face scale depicting four degrees of pleasure was used. Between November and December 2013, the taste test was performed among 19 nurses (15 female and 4 male subjects) and 12 physicians (5 female and 7 male subjects) aged between 25 and 49 years. Pulverized brand-names and generics containing either amlodipine or candesartan did not differ with respect to their taste acceptability.


Assuntos
Anlodipino/administração & dosagem , Bloqueadores do Receptor Tipo 1 de Angiotensina II/administração & dosagem , Anti-Hipertensivos/administração & dosagem , Benzimidazóis/administração & dosagem , Bloqueadores dos Canais de Cálcio/administração & dosagem , Medicamentos Genéricos/farmacologia , Satisfação do Paciente , Percepção Gustatória/efeitos dos fármacos , Tetrazóis/administração & dosagem , Adulto , Química Farmacêutica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego
11.
Neuromuscul Disord ; 24(4): 342-6, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24530048

RESUMO

Acute benign myalgia cruris is characterized by transient bilateral calf pain that leads to difficulty walking. A regional outbreak of influenza virus B-associated myalgia cruris was observed during the seasonal influenza outbreak observed in Switzerland from week 1 to 13 of 2013. We performed a prospective case finding among the Swiss-Italian pediatric emergency units and pediatricians. A review of the literature was also performed. The diagnosis of myalgia cruris was made in 49 Swiss-Italian children aged 3.0-14 years (♂:♀=1.7). Flu-like symptoms were resolving when bilateral calf pain began that remitted over ⩽ 7days. The creatine kinase-level, assessed in 28 patients, was elevated in 25. Nose swabs were positive for influenza virus B in 13 out of 14 cases. The blood cell count, measured in 41 cases, disclosed leucopenia in 12 and thrombocytopenia in 3. The review of the literature found 10 outbreaks of ⩾ 10 cases of influenza virus B-associated myalgia cruris, which included a total of 203 patients with a mean age of 7.3 years and a ♂:♀ ratio of 2.0. In conclusion influenza virus B caused a large Swiss-Italian outbreak of myalgia cruris. Our outbreak and the literature indicate that influenza virus B-associated myalgia cruris affects preschool- and school-aged children, primarily boys.


Assuntos
Surtos de Doenças , Influenza Humana/epidemiologia , Influenza Humana/fisiopatologia , Influenzavirus B , Mialgia/epidemiologia , Mialgia/fisiopatologia , Criança , Pré-Escolar , Feminino , Humanos , Itália/epidemiologia , Masculino , Transtornos dos Movimentos/epidemiologia , Transtornos dos Movimentos/fisiopatologia , Suíça/epidemiologia
12.
Pediatr Nephrol ; 29(2): 235-9, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24061644

RESUMO

BACKGROUND: Little information is available on ureteral or vesical involvement in Henoch-Schönlein syndrome. To determine the features of this condition we performed a formal analysis of peer-reviewed scientific literature on this topic. METHODS: The US National Library of Medicine database was used as the data source. All articles published as full-length articles or letters were collected. Reports published in languages other than English, French, German, Italian or Spanish were not considered. RESULTS: We analyzed 32 reports describing 35 cases (24 male and 11 female subjects aged between 3.5 and 63, median 7.0 years) with ureteral (n = 30), vesical (n = 4), or both ureteral and vesical involvement (n = 1). The presentation included colicky abdominal pain, macroscopic hematuria (sometimes containing blood clots), urinary tract infection or urinary retention. The diagnosis of ureteral involvement was often fortuitous. Patients with vesical involvement were managed conservatively. However, the majority of those with ureteral involvement were managed surgically. CONCLUSIONS: Ureteral or vesical involvement is unusual and likely underappreciated in Henoch-Schönlein syndrome. Improved recognition and wider appreciation of this involvement can help to avoid associated morbidity. Management must be individualized for each patient. A multidisciplinary approach may be of value in planning medical treatment, surgical intervention, and follow-up.


Assuntos
Púrpura de Schoenlein-Henoch/complicações , Doenças Ureterais/etiologia , Doenças da Bexiga Urinária/etiologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome , Doenças Ureterais/epidemiologia , Doenças da Bexiga Urinária/epidemiologia , Adulto Jovem
13.
Am J Med Genet A ; 164A(2): 346-52, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24376213

RESUMO

Frontonasal dysplasia (FND) is a genetically heterogeneous malformation spectrum with marked hypertelorism, broad nasal tip and bifid nose. Only a small number of genes have been associated with FND phenotypes until now, the first gene being EFNB1, related to craniofrontonasal syndrome (CFNS) with craniosynostosis in addition, and more recently the aristaless-like homeobox genes ALX3, ALX4, and ALX1, which have been related with distinct phenotypes named FND1, FND2, and FND3 respectively. We here report on a female patient presenting with severe FND features along with partial alopecia, hypogonadism and intellectual disability. While molecular investigations did not reveal mutations in any of the known genes, ALX4, ALX3, ALX1 and EFNB1, comparative genomic hybridization (array CGH) techniques showed a large heterozygous de novo deletion at 11p11.12p12, encompassing the ALX4 gene. Deletions in this region have been described in patients with Potocki-Shaffer syndrome (PSS), characterized by biparietal foramina, multiple exostoses, and intellectual disability. Although the patient reported herein manifests some overlapping features of FND and PPS, it is likely that the observed phenotype maybe due to a second unidentified mutation in the ALX4 gene. The phenotype will be discussed in view of the deleted region encompassing the ALX4 gene.


Assuntos
Transtornos Cromossômicos/genética , Anormalidades Craniofaciais/genética , Proteínas de Ligação a DNA/genética , Exostose Múltipla Hereditária/genética , Face/anormalidades , Fenótipo , Deleção de Sequência , Fatores de Transcrição/genética , Deleção Cromossômica , Transtornos Cromossômicos/diagnóstico , Cromossomos Humanos Par 11/genética , Hibridização Genômica Comparativa , Anormalidades Craniofaciais/diagnóstico , Éxons , Exostose Múltipla Hereditária/diagnóstico , Ossos Faciais/anormalidades , Facies , Feminino , Heterozigoto , Humanos , Imagem Tridimensional/métodos , Polimorfismo de Nucleotídeo Único , Adulto Jovem
15.
Mundo saúde (Impr.) ; 38(1): 105-115, dez. 2013. mapas, tab, graf
Artigo em Português | LILACS | ID: lil-756225

RESUMO

O nitrogênio possui um papel-chave em sistemas aquáticos, especialmente nos ambientes de transição entre águas marinhase doces como os estuários. Assim sendo, muitos organismos, como as ostras, podem ser afetados pelo aumentoda concentração em determinadas épocas, limitando assim seu cultivo. O objetivo deste estudo foi avaliar aspectos daqualidade da água das áreas utilizadas para o cultivo da ostra do mangue Crassostrea spp. em Cananeia (SP, Brasil) e desua adequabilidade para o cultivo dos moluscos com relação às concentrações de nitrogênio amoniacal, nitrito e nitrato.O nitrogênio amoniacal variou de 0,8 a 3,2 μmol/L, o nitrito, de 0,1 a 3,2 μmol/L, e o nitrato, de 0,1 a 1,9 μmol/L. Ao analisaresses dados em todas as estações, verificou-se que o nitrogênio amoniacal, o nitrito e o nitrato foram estatisticamentediferentes entre as marés de quadratura e alta de sizígia. Como não houve diferença entre as estações que fazem a engordadas ostras e a estação Agrossolar (controle), concluiu-se que a atividade no estuário de Cananeia não causa incrementosignificativo nas concentrações de amônia, nitrito e nitrato. As concentrações registradas em Cananeia são similares àsobservadas para outras regiões tropicais e subtropicais estuarinas do mundo.


Nitrogen plays a key role in aquatic systems, especially in environments which are influenced both by marine and freshwater,such as estuaries. The aim of this study was to evaluate aspects of water quality of Crassostrea spp. aquaculture sites inCananeia (SP, Brazil) and adequacy thereof for the cultivation of mollusks in relation to concentrations of total ammoniacalnitrogen, nitrite and nitrate. Variations in concentrations of total ammoniacal nitrogen were 0.8 to 3.2 μmol/L, nitrite 0.1to 3.2 μmol/L, and nitrate from 0.1 to 1.9 μmol/L. Analyzing these data in all seasons together, we found that average totalammoniacal nitrogen and nitrite levels were significantly different for the tides and neap tide. These concentrations recordedat Cananeia are similar to those observed for other estuarine tropical and subtropical regions of the world.


Assuntos
Animais , Amônia , Crassostrea , Nitratos , Nitrito Redutases
17.
Am J Med Genet A ; 161A(11): 2909-19, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24124034

RESUMO

We report on the clinical and molecular characterization of eight patients, one male and seven females, with clinical diagnosis of Cornelia de Lange syndrome (CdLS), who were found to carry distinct mutations of the SMC1A gene. Five of the eight mutations are novel, with two involving amino acid residues previously described as altered in a different way. The other three have been reported each in a single case. Comparison of pairs of individuals with the same mutation indicates only partial overlap of their clinical phenotypes. The following novel missense mutations, all affecting highly conserved amino acid residues, were found: p.R398G in the N-terminal coiled-coil domain, p.V651M in the C-terminal coiled-coil/hinge junction, p.R693G in the C-terminal coiled-coil, and p.N1166T and p.L1189F in the C-terminal ABC cassette. The latter is localized in the H-loop, and represents the first mutation involving a functional motif of SMC1A protein. The effect of the mutations on SMC1A protein function has been predicted using four bioinformatic tools. All mutations except p.V651M were scored as pathogenic by three or four of the tools. p.V651M was found in the only male individual of our cohort, who presented with the most severe phenotype. This raises the issue of gender effect when addressing mutation-phenotype correlation for genes such as SMC1A, which incompletely escapes X-inactivation. Our clinical and molecular findings expand the total number of characterized SMC1A-mutated patients (from 44 to 52) and the restricted repertoire of SMC1A mutations (from 29 to 34), contributing to the molecular and clinical signature of SMC1A-based CdLS.


Assuntos
Proteínas de Ciclo Celular/genética , Proteínas Cromossômicas não Histona/genética , Síndrome de Lange/diagnóstico , Síndrome de Lange/genética , Mutação , Fenótipo , Adolescente , Sequência de Aminoácidos , Criança , Pré-Escolar , Éxons , Facies , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Dados de Sequência Molecular , Alinhamento de Sequência
18.
Int J Pharm ; 457(1): 333-6, 2013 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-23906666

RESUMO

More and more data indicate the importance of palatability when selecting drugs for children. Since hypertension is uncommon in children, no child-friendly palatable formulations of these agents are currently available. As a consequence, in everyday practice available tablets are crushed and administered mixed with food or a sweet drink. We started investigating the issue of palatability of drugs among children in 2004 using smile-face scales. In the first trial we compared taste and smell acceptability of pulverized angiotensin receptor antagonists among nephropathic children and found that the score assigned to candesartan was significantly higher than that assigned to irbesartan, losartan, telmisartan and valsartan. In the second trial we compared the taste of pulverized amlodipine and lercanidipine among children and found that the score assigned to lercanidipine was significantly higher. Our third trial was performed using pulverized ß-adrenoceptor blockers, angiotensin-converting enzyme inhibitors, calcium-channel antagonists and diuretics among medical officers and pediatricians. The palatability scores assigned to chlorthalidone, hydrochlorothiazide and lisinopril were significantly higher to those assigned to atenolol, bisoprolol, enalapril and ramipril. In conclusion pulverized amlodipine, atenolol, bisoprolol, enalapril, irbesartan, losartan, ramipril, telmisartan and valsartan are poor tasting. From the child's perspective, lercanidipine, candesartan, chlorthalidone, hydrochlorothiazide and lisinopril are preferable.


Assuntos
Anti-Hipertensivos , Paladar , Antagonistas Adrenérgicos beta , Inibidores da Enzima Conversora de Angiotensina , Bloqueadores dos Canais de Cálcio , Criança , Diuréticos , Humanos , Odorantes
19.
Curr Hypertens Rep ; 15(5): 444-52, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23897423

RESUMO

There is growing concern about elevated blood pressure in children and adolescents, because of its association with the obesity epidemic. Moreover, cardiovascular function and blood pressure level are determined in childhood and track into adulthood. Primary hypertension in childhood is defined by persistent blood pressure values ≥ the 95th percentile and without a secondary cause. Preventable risk factors for elevated blood pressure in childhood are overweight, dietary habits, salt intake, sedentary lifestyle, poor sleep quality and passive smoking, whereas non-preventable risk factors include race, gender, genetic background, low birth weight, prematurity, and socioeconomic inequalities. Several different pathways are implicated in the development of primary hypertension, including obesity, insulin resistance, activation of the sympathetic nervous system, alterations in sodium homeostasis, renin-angiotensin system and altered vascular function. Prevention of adult cardiovascular disease should begin in childhood by regularly screening for high blood pressure, counseling for healthy lifestyle and avoiding preventable risk factors.


Assuntos
Hipertensão/etiologia , Pressão Sanguínea , Determinação da Pressão Arterial , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Criança , Humanos , Fatores de Risco , Sódio na Dieta/efeitos adversos
20.
Br J Clin Pharmacol ; 75(1): 236-43, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22533367

RESUMO

AIMS: In symptomatic fever management, there is often a gap between everyday clinical practice and current evidence. We were interested to see whether the three linguistic regions of Switzerland differ in the management of fever. METHODS: A close-ended questionnaire, sent to 900 Swiss paediatricians, was answered by 322 paediatricians. Two hundred and fourteen respondents were active in the German speaking, 78 in the French speaking and 30 in the Italian speaking region. RESULTS: Paediatricians from the French and Italian speaking regions identify a lower temperature threshold for initiating a treatment and more frequently reduce it for children with a history of febrile seizures. A reduced general appearance leads more frequently to a lower threshold for treatment in the German speaking than in the French and Italian speaking areas. Among 1.5 and 5-year-old children the preference for the rectal route is more pronounced in the German than in the French speaking region. French speaking respondents more frequently prescribe ibuprofen and an alternating regimen with two drugs than German speaking respondents. Finally, the stated occurrence of exaggerated fear of fever was higher in the German and Italian speaking regions. CONCLUSIONS: Switzerland offers the opportunity to compare three different regions with respect to management of febrile children. This inquiry shows regional differences in symptomatic fever management and in the perceived frequency of exaggerated fear of fever. The gap between available evidence and clinical practice is more pronounced in the French and in the Italian speaking regions than in the German speaking region.


Assuntos
Febre/tratamento farmacológico , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Internet , Linguagem , Masculino , Suíça
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