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1.
Arch. argent. pediatr ; 117(2): 115-120, abr. 2019. graf, tab
Artigo em Espanhol | LILACS-Express | ID: biblio-1001167

RESUMO

El anticuerpo monoclonal anti-IgE omalizumab está indicado para tratamiento del asma grave. Estudio longitudinal (pre-posintervención), observacional y analítico con el objetivo de evaluar la evolución clínica y funcional de pacientes con asma grave no controlada, 16 semanas antes y después del tratamiento. En los 17 casos, se controló el asma (p= 0,00001). Se redujeron en un 48,5 % las exacerbaciones (p= 0,009) y en un 100 % las crisis graves (p= 0,001). Dieciséis pacientes (el 94 %) tuvieron exacerbaciones pretratamiento y 10 (el 59 %), luego del omalizumab (p= 0,005). No hubo hospitalizaciones (p= 0,007). Se redujo en un 20 % la dosis de corticoides inhalados (0,002) y el número de casos con corticoides orales continuos (p= 0,01); disminuyó el uso de salbutamol (p= 0,001) y de corticoides orales (p= 0,003). No se modificó la función pulmonar. Dos casos presentaron reacciones adversas leves. El omalizumab permitió un adecuado control de la enfermedad en pacientes con asma grave.


Omalizumab, an anti-IgE monoclonal antibody, is indicated for the treatment of severe asthma. A longitudinal (pre-/post-intervention), observational, analytical study was conducted to assess the clinical and functional course of patients with uncontrolled severe asthma, 16 weeks before and after treatment. Asthma was controlled in 17 cases (p = 0.00001). Exacerbations were reduced by 48.5 % (p = 0.009) and severe crises, by 100 % (p = 0.001). Before omalizumab treatment, 16 patients (94 %) had exacerbations, whereas 10 (59 %) had them after treatment (p = 0.005). None of the patients was hospitalized (p = 0.007). The dose of inhaled corticosteroids was reduced by 20 % (0.002); the number of patients using continuous oral corticosteroids (p = 0.01), salbutamol (p = 0.001), and oral corticosteroids (p=0.003) also decreased. Pulmonary function was not affected. Two patients had mild adverse reactions. Omalizumab achieved an adequate asthma control in patients with severe asthma.

2.
Arch Argent Pediatr ; 117(2): e115-e120, 2019 04 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30869489

RESUMO

Omalizumab, an anti-IgE monoclonal antibody, is indicated for the treatment of severe asthma. A longitudinal (pre-/post-intervention), observational, analytical study was conducted to assess the clinical and functional course of patients with uncontrolled severe asthma, 16 weeks before and after treatment. Asthma was controlled in 17 cases (p = 0.00001). Exacerbations were reduced by 48.5 % (p = 0.009) and severe crises, by 100 % (p = 0.001). Before omalizumab treatment, 16 patients (94 %) had exacerbations, whereas 10 (59 %) had them after treatment (p = 0.005). None of the patients was hospitalized (p = 0.007). The dose of inhaled corticosteroids was reduced by 20 % (0.002); the number of patients using continuous oral corticosteroids (p = 0.01), salbutamol (p = 0.001), and oral corticosteroids (p=0.003) also decreased. Pulmonary function was not affected. Two patients had mild adverse reactions. Omalizumab achieved an adequate asthma control in patients with severe asthma.

3.
Arch. argent. pediatr ; 116(2): 105-111, abr. 2018. ilus, tab
Artigo em Espanhol | LILACS-Express | ID: biblio-887455

RESUMO

Introducción. El asma grave representa 5-7% del total de asmáticos. La OMS propuso un protocolo de seguimiento para categorizarlos como asma grave resistente al tratamiento (AGRT) o asma grave de difícil control (AGDC). Objetivo. Analizar las características clínicas, funcionales y terapéuticas de pacientes con AGRT o AGDC. Métodos. Estudio transversal, observacional y analítico para evaluar el diagnóstico, grado de control (clínico y funcional), comorbilidades, adherencia al tratamiento, técnica inhalatoria y factores ambientales en pacientes con asma grave. Resultados. Se incluyeron 69 pacientes: AGRT (n= 33) y AGDC (n= 36). El 100% del grupo con AGRT fue hospitalizado previamente por asma vs. 87,8% del grupo con AGDC (p= 0,03). El 63% del grupo AGRT requirió cuidados intensivos (UCI)), 82%, asistencia ventilatoria y uno fue traqueostomizado. En el AGDC, 54% requirió internación en la UCI , y 33%, asistencia ventilatoria (p= 0,03). La espirometría basal fue normal en el AGDC; se observó incapacidad ventilatoria obstructiva leve en el AGRT (p= 0,009). En el AGDC, hubo menor cumplimiento del tratamiento (p= 0,01). Se requirieron dosis mayores de corticoides inhalados en AGRT (p= 0,0001). Omalizumab fue indicado en AGRT (p= 0,0001). A los 6 meses de seguimiento, más del 75% de los niños en ambos grupos presentó asma controlada. Conclusiones. Se observó significativa falta de adherencia al tratamiento en el grupo AGDC. Se redujeron las dosis de tratamiento en este grupo. Se logró controlar la enfermedad en un alto porcentaje de niños con AGRT y AGDC.


Introduction. Severe asthma accounts for 5-7% of all asthma cases. The World Health Organization proposed a follow-up protocol to classify cases into severe, treatment-resistant asthma (STRA) or severe, difficult-to-control asthma (SDCA). Objective. To analyze the clinical, functional, and therapeutic characteristics of patients with STRA or SDCA. Methods. Cross-sectional, observational, and analytical study to assess the diagnosis, the extent of control (clinical and functional), comorbidities, treatment adherence, inhalation technique, and environmental factors in patients with severe asthma. Results. A total of 69 patients were included: STRA (n= 33) and SDCA (n= 36). In the group with STRA, 100% of patients had been previously hospitalized due to asthma compared to 87.8% in the group with SDCA (p= 0.03). In the group with STRA, 63% required admission to the intensive care unit (ICU); 82%, ventilatory support; and 1 patient, tracheostomy. In the group with SDCA, 54% required admission to the ICU; and 33%, ventilatory support (p= 0.03). The baseline spirometry was normal in the SDCA group; a mild obstructive ventilatory defect was observed in the STRA group (p= 0.009). In the SDCA group, treatment adherence was lower (p= 0.01). Higher inhaled corticosteroid doses were required in the STRA group (p= 0.0001). Omalizumab was indicated in the case of STRA (p= 0.0001). After 6 months of follow-up, more than 75% of children in both groups achieved asthma control. Conclusions. A significant lack of treatment adherence was observed in the SDCA group. In this group, treatment doses were reduced. Asthma was controlled in a high percentage of children with STRA and SDCA.

4.
Arch Argent Pediatr ; 116(2): 105-111, 2018 Apr 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29557596

RESUMO

INTRODUCTION: Severe asthma accounts for 5-7% of all asthma cases. The World Health Organization proposed a follow-up protocol to classify cases into severe, treatment-resistant asthma (STRA) or severe, difficult-to-control asthma (SDCA). OBJECTIVE: To analyze the clinical, functional, and therapeutic characteristics of patients with STRA or SDCA. METHODS: Cross-sectional, observational, and analytical study to assess the diagnosis, the extent of control (clinical and functional), comorbidities, treatment adherence, inhalation technique, and environmental factors in patients with severe asthma. RESULTS: A total of 69 patients were included: STRA (n= 33) and SDCA (n= 36). In the group with STRA, 100% of patients had been previously hospitalized due to asthma compared to 87.8% in the group with SDCA (p= 0.03). In the group with STRA, 63% required admission to the intensive care unit (ICU); 82%, ventilatory support; and 1 patient, tracheostomy. In the group with SDCA, 54% required admission to the ICU; and 33%, ventilatory support (p= 0.03).The baseline spirometry was normal in the SDCA group; a mild obstructive ventilatory defect was observed in the STRA group (p= 0.009).In the SDCA group, treatment adherence was lower (p= 0.01). Higher inhaled corticosteroid doses were required in the STRA group (p= 0.0001). Omalizumab was indicated in the case of STRA (p= 0.0001). After 6 months of follow-up, more than 75% of children in both groups achieved asthma control. CONCLUSIONS: A significant lack of treatment adherence was observed in the SDCA group. In this group, treatment doses were reduced. Asthma was controlled in a high percentage of children with STRA and SDCA.

5.
Buenos Aires; Médica Panamericana; 2018. 180 p. ilus.
Monografia em Espanhol | LILACS | ID: biblio-882735

RESUMO

La patología respiratoria presenta un gran desafío para las instituciones de salud, por su frecuencia, su complejidad diagnóstica y terapéutica y la carga que representa en costos económicos y vitales. Estos conceptos se extienden a todos los grupos etarios y sus características han ido cambiando a lo largo del tiempo ante los avances producidos en las inmunizaciones, los métodos diagnósticos y los tratamientos. Aún así, las infecciones respiratorias bajas son todavía la causa más frecuente de consulta, internación, morbilidad crónica, discapacidad y mortalidad en pediatría. Este nuevo volumen aborda esta temática especial y entre sus características se destacan: El estudio de las patologías más frecuentes en los diferentes ámbitos de atención pero en particular en el primer nivel, con una exposición centrada en los aspectos que facilitan el diagnóstico rápido y el tratamiento adecuado, con el menor uso de recursos y con pautas que fijan la derivación oportuna hacia el especialista o hacia una institución de mayor complejidad. El desarrollo de importantes temas, como la patología obstructiva de la vía aérea superior, su estudio diagnóstico y sus formas recurrentes; bronquiolitis; las intercurrencias respiratorias en pacientes con condiciones clínicas especiales; y la supuración pleuropulmonar. La inclusión, en todos los capítulos, de casos clínicos con su evolución y desenlace, textos destacados con los principales conceptos y puntos claves para recordar. Una obra sólida y práctica, que transmite la experiencia de los profesionales de una institución del prestigio internacional del Hospital dePediatría Prof. Dr. Juan P. Garrahan, dedicada a todos los pediatras, dondequiera que trabajen al servicio de la salud de los niños.


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Obstrução das Vias Respiratórias , Argentina , Asma , Bronquiolite , Hemoptise , Laringe/anormalidades , Doenças Neuromusculares , Oxigenoterapia , Derrame Pleural , Doença Pulmonar Obstrutiva Crônica , Testes de Função Respiratória , Sons Respiratórios , Infecções Respiratórias , Traqueostomia
6.
Respirology ; 22(1): 187-191, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27511212

RESUMO

BACKGROUND AND OBJECTIVE: Pneumonectomy (PNE) is a procedure infrequently performed in children. A high morbidity/mortality rate associated with PNE has been described. Few series have been published in the last 15 years. Risk factors associated with morbidity/mortality after PNE were evaluated. Indications, course, survival and complications of PNE in children were also analized. METHODS: In a case series of 51 children who underwent PNE, death within 30 days of surgery, pneumonia, empyema, sepsis, adult respiratory distress syndrome, bronchopleural fistula, bleeding, pneumothorax and post-PNE syndrome were considered major morbidities. Scoliosis, wound infection and atelectasis were considered minor morbidities. RESULTS: Median age at PNE was 7.4 years; 45% were males. Indications of pneumonectomy were postinfectious bronchiectasis (61%), tumours (17%), pulmonary malformations (17%), aspiration syndrome (14%), cystic fibrosis (6%), immunodeficiency (4%) and trauma (2%). Mortality rate was 4% at 1 month. Major and minor morbidities were present in 23% and 27% of patients, respectively. Risk factors for development of morbidities after PNE were age ≤ 3 years (OR: 16.7; 95% CI: 2.4-117) and the need for mechanical ventilation for at least 4 days (OR: 8; 95% CI: 1.5-43.6). CONCLUSION: Children are at high risk of death, major and minor morbidities following PNE. Caution is recommended for this group of patients.


Assuntos
Pneumonectomia , Pneumonia , Pneumotórax , Complicações Pós-Operatórias , Respiração Artificial , Sepse , Argentina/epidemiologia , Criança , Feminino , Humanos , Masculino , Mortalidade , Avaliação de Processos e Resultados (Cuidados de Saúde) , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Pneumonectomia/mortalidade , Pneumonia/diagnóstico , Pneumonia/epidemiologia , Pneumonia/etiologia , Pneumotórax/diagnóstico , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Respiração Artificial/efeitos adversos , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Sepse/diagnóstico , Sepse/epidemiologia , Sepse/etiologia , Resultado do Tratamento
7.
Pediatr Surg Int ; 32(5): 451-7, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26971789

RESUMO

PURPOSE: Primary lung tumors are rare during childhood and encompass a wide variety of histological types. Each has a different biology and a different therapeutic approach. The aim of this article is to review the experience of a pediatric referral center with this kind of tumors during the last 24 years. METHODS: A retrospective chart review was performed for patients with diagnosis of primary lung tumor between the years 1990-2014. The variables analyzed were age, sex, course of the disease, symptoms, localization, surgery, histology and outcome. RESULTS: Between 1990 and 2014, 38 patients with primary lung tumors were treated at our institution. Age at presentation was 6.6 ± 5.2 years (r 0.91-16.58) and the female:male relationship was 1.37. Inflammatory myofibroblastic lung tumor (n = 13), carcinoid tumor (n = 6) and pleuropulmonary blastoma (n = 6) were the most frequent histological types. Persistent radiographic abnormality was the most frequent presenting sign (34 %). Global mortality was 15.8 % varying according to histology. CONCLUSION: Although the diagnosis of primary lung tumor is rare, the persistence of a radiographic abnormality in spite of adequate treatment for inflammatory processes forces us to evaluate further. The age of the patient is an important factor in the decision of the diagnostic work-up.


Assuntos
Neoplasias Pulmonares/diagnóstico , Adolescente , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/cirurgia , Masculino , Neoplasias de Tecido Muscular/diagnóstico , Neoplasias de Tecido Muscular/cirurgia , Blastoma Pulmonar/diagnóstico , Blastoma Pulmonar/cirurgia , Encaminhamento e Consulta , Estudos Retrospectivos
8.
Respirology ; 20(6): 982-6, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25939617

RESUMO

BACKGROUND AND OBJECTIVE: Post-infectious bronchiolitis obliterans (PIBO) is a severe disorder following acute lower pulmonary infection in young children, especially caused by adenovirus. Mannose-binding lectin (MBL) deficiency arising from polymorphisms in the coding and non-coding region on the MBL2 gene has been associated with more frequent and severe respiratory infections. Our aim was to evaluate the influence of MBL variants in the susceptibility and evolution of children with PIBO. METHODS: One hundred eleven children with PIBO diagnosis were studied. The coding A, B, D and X promoter variants of MBL2 gene were assessed by PCR-RFLP. B and D alleles were pooled as O. The combined genotypes A/A and YA/O were grouped as sufficient MBL (sMBL), and O/O and XA/O as insufficient MBL (iMBL) groups. To evaluate the frequency of MBL2 polymorphisms in the general population, we studied DNA samples from 127 healthy donors from the blood bank of the hospital (control group). RESULTS: iMBL variants were significantly more frequent in PIBO children compared with controls (21.6% vs 10.2%, P = 0.01). PIBO patients with iMBL required intensive care unit (P = 0.001) and mechanical assistance at the moment of viral injury (P = 0.001) more frequently than those with sMBL. CONCLUSIONS: Insufficiency of MBL was more common in PIBO children than in healthy controls. This genetic condition was significantly associated with more severe initial disease, illustrating the relevance of innate immune defence factors prior to the maturation of the adaptative immune system.


Assuntos
Bronquiolite Obliterante/epidemiologia , Lectina de Ligação a Manose/deficiência , Erros Inatos do Metabolismo/epidemiologia , Adolescente , Argentina/epidemiologia , Bronquiolite Obliterante/etiologia , Criança , Pré-Escolar , Suscetibilidade a Doenças , Feminino , Frequência do Gene , Variação Genética , Genótipo , Humanos , Lactente , Masculino , Lectina de Ligação a Manose/genética , Erros Inatos do Metabolismo/genética , Polimorfismo Genético , Infecções Respiratórias/complicações
9.
Buenos Aires; Fundación Garrahan; 2015. 188 p. ilus.
Monografia em Espanhol | LILACS | ID: biblio-882569

RESUMO

A 27 años del nacimiento del Hospital Garrahan, sentimos la necesidad de ponernos en contacto con todos los pediatras para compartir con ellos las estrategias de atención del niño y su familia utilizadas en nuestra institución, destacar la importancia del trabajo interdisciplinario y colaboración permanente. En este volumen desarrollamos el tema del niño que fue prematuro, ya que estos pacientes presentan al pediatra desafíos específicos y novedosos. Si bien la prematurez es la principal causa de mortalidad infantil, la sobrevida de los prematuros ha aumentado significativamente en los últimos años, y por lo tanto estos niños acceden al cuidado pediátrico con creciente frecuencia y vulnerabilidad. Algunos de ellos pueden sufrir secuelas de distinto grado y en diferentes aspectos de su desarrollo, crecimiento o función respiratoria. Dado que el rol del pediatra es fundamental en el diagnóstico, la prevención y el tratamiento de posibles secuelas, el reconocimiento de sus necesidades especiales y cuidado centrado en la familia, el profesional encontrará aquí aspectos epidemiológicos, de identificación y prevención de riesgos, comunicación con la familia, oportunidades de interconsultas y abordaje de la discapacidad mediante el análisis de casos clínicos.


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Argentina , Displasia Broncopulmonar , Seguimentos , Nutrição do Lactente , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Transtornos do Neurodesenvolvimento , Equipe de Assistência ao Paciente , Alta do Paciente , Nascimento Prematuro/epidemiologia , Doenças Respiratórias
10.
Neumol. pediátr. (En línea) ; 9(3): 88-94, sept. 2014. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-773885

RESUMO

Congenital lung malformations (CLM) comprise a heterogeneous group of lung diseases. They vary widely in their clinical presentation and severity, depending on the degree of lung involvement and their location in the thoracic cavity. They can manifest at any age and can be the source of significant morbidity and mortality in infants and children. Patients with CLM can present respiratory symptoms at birth or can remain asymptomatic for long periods. There has been an increase in early diagnosis of CLM attributable to the routine use of prenatal ultrasound. Management of these lesions depends on the type of malformation and symptoms. Treatment of asymptomatic patients is controversial, because the prognosis of these diseases is unpredictable. Because of the risk of complications, most authors recommend resection of the lesion at the time of diagnosis. This review describes the principal CLM, their diagnosis, and the controversies regarding treatment.


Las malformaciones pulmonares congénitas (MPC) constituyen un grupo heterogéneo de enfermedades. Varían en su presentación clínica y gravedad en función al grado de afectación pulmonar y a su ubicación en tórax. Se pueden manifestar a cualquier edad y pueden condicionar morbilidad y mortalidad significativa en lactantes y niños. Los pacientes pueden presentar síntomas respiratorios desde el nacimiento o permanecer asintomáticos durante largos períodos. Se ha observado un aumento en el diagnóstico precoz de las MPC atribuible al uso rutinario de la ecografía prenatal. El manejo de estas lesiones depende del tipo de malformación y de los síntomas. El tratamiento de pacientes asintomáticos es controvertido debido a que el pronóstico de estas enfermedades es desconocido. La mayoría de los autores recomiendan la resección de la lesión en el momento del diagnóstico debido al riesgo de complicaciones. Esta revisión describe las principales malformaciones congénitas del pulmón, su diagnóstico y las estrategias de tratamiento.


Assuntos
Humanos , Criança , Pneumopatias/congênito , Pneumopatias/diagnóstico , Pneumopatias/terapia
11.
Acta Paediatr ; 103(9): 913-21, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24832610

RESUMO

UNLABELLED: Postinfectious bronchiolitis obliterans (PIBO) is an infrequent chronic lung that causes irreversible obstruction and, or, obliteration of the smaller airways. This review particularly focuses on more than 30 studies from South America. CONCLUSION: The initial PIBO event occurs in the early years of life and is strongly associated with adenovirus infection and the need for mechanical ventilator support. Treatment requires a multidisciplinary strategy. Multicentre studies are needed to determine progression, optimal management and long-term follow-up.


Assuntos
Bronquiolite Obliterante/microbiologia , Bronquiolite Obliterante/diagnóstico , Bronquiolite Obliterante/epidemiologia , Bronquiolite Obliterante/terapia , Humanos , Testes de Função Respiratória , Fatores de Risco , América do Sul
15.
Ann Allergy Asthma Immunol ; 110(3): 156-60, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23548523

RESUMO

BACKGROUND: New evidence suggests that different ß(2)-adrenergic receptor (ß2AR) polymorphisms may influence asthma control in patients receiving long-acting ß(2)agonists (LABAs) as regular therapy. OBJECTIVES: To determine the influence of ß2AR polymorphisms on asthma exacerbations in children with severe asthma from Argentina receiving inhaled corticosteroid (ICS) and LABAs regularly. METHODS: Ninety-seven children with severe asthma were genotyped for polymorphisms of ß2AR at codons 16 and 27. The number of severe exacerbations, the time of first asthma exacerbation, and the number of hospitalizations during 12 months were assessed. Changes on pulmonary function from the beginning to the end of the study were also evaluated. RESULTS: The number of overall asthma exacerbations and the proportion of children with these events were similar among ß2AR genotypes at position 16 (Arg/Arg, Arg/Gly, and Gly/Gly) and at position 27 (Gln/Gln, Gln/Glu, and Glu/Glu). The time to first asthma exacerbation was similar among individuals carrying different ß2AR polymorphisms. No ß2AR genotype association was found in relation to the number of hospitalizations. Longitudinal analysis of forced expiratory volume in 1 second from baseline to the end of the study also showed no differences among ß2AR genotypes at position 16 or 27. No association was observed among the 3 most common haplotypes (Arg/Arg-Gln/Gln, Gly/Gly-Gln/Gln, and Gly/Gly-Glu/Glu) and the number of participants with asthmatic crisis or with the overall number of exacerbations. CONCLUSION: ß2AR polymorphisms were not associated with an increased risk of having asthma exacerbations or lung function decline in a population of Argentinian children with severe asthma receiving ICS and LABAs regularly.


Assuntos
Agonistas de Receptores Adrenérgicos beta 2/administração & dosagem , Albuterol/análogos & derivados , Asma/diagnóstico , Asma/genética , Receptores Adrenérgicos beta 2/genética , Adolescente , Albuterol/administração & dosagem , Argentina , Asma/tratamento farmacológico , Asma/epidemiologia , Criança , Análise Mutacional de DNA , Progressão da Doença , Feminino , Seguimentos , Estudos de Associação Genética , Genótipo , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Polimorfismo Genético , Receptores Adrenérgicos beta 2/metabolismo , Testes de Função Respiratória , Xinafoato de Salmeterol
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