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1.
BMC Geriatr ; 19(1): 245, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481016

RESUMO

BACKGROUND: The percentage of older adults with hearing loss who stop using their hearing aids and the variables associated with this phenomenon have not been systematically investigated in South America. This problem is relevant to the region since countries such as Colombia, Brazil and Chile have public programmes that provide hearing aids to older adults. The aims of this study were to determine the percentage of older adults fitted with a hearing aid at a public hospital in Chile who subsequently stop using it and the auditory and socio-demographic variables associated with the hazard of discontinuing hearing aid use. METHODS: A group that included 355 older adults who had been fitted with a hearing aid was studied retrospectively. In a structured interview, participants were asked about socio-demographic variables and answered part of the Chilean National Survey on Health, evaluating self-perceived hearing loss and responding to questions about discontinuation of hearing aid use and their satisfaction with the device. Survival models were applied to determine the hazard of stopping hearing aid use in relation to the variables of interest. RESULTS: The rate of discontinuation of hearing aid use reached 21.7%. Older adults stopped using their hearing aids mainly during the first 5-6 months post-fitting, and then this number steadily increased. The income fifth quintile was 2.56 times less likely to stop using the hearing aid compared to the first. Those who self-reported that they could not hear correctly without the hearing aid were 2.62 times less likely to stop using it compared to those who reported normal hearing. The group that was very dissatisfied with the hearing aid was 20.86 times more likely to discontinue use than those who reported satisfaction with the device. CONCLUSIONS: Socio-demographic variables such as economic income and auditory factors such as self-perceived hearing loss and satisfaction with the device were significantly associated with the hazard of stopping hearing aid use. Self-perceived hearing loss should be considered part of the candidacy criteria for hearing aids in older adults in Chile and other (developing) countries.

2.
Infectio ; 23(3): 271-304, July-Sept. 2019. tab
Artigo em Inglês | LILACS-Express | ID: biblio-1002162

RESUMO

Abstract Invasive Candidiasis (IC) and candidemia (as its most frequent manifestation) have become the main cause of opportunistic mycosis at hospital settings. This study, made by members of the Colombian Association of Infectious Diseases (ACIN), was aimed at providing a set of recommendations for the management, follow-up and prevention of IC / candidemia and mucous membrane candida infection in adult, pediatric and neonatal patients in a hospital setting, including the hemato-oncological and critical care units. All the data obtained through an exhaustive search were reviewed and analyzed in a comprehensive manner by all the members of the group, and the recommendations issued are being made after a careful review of the scientific literature available and the consensus of all specialists involved; the emergence of Candida Spp. problem is highlighted and a correct orientation to health professionals regarding the management of patients with candidiasis is provided in a rational and practical way, emphasizing patient evaluation, diagnostic strategies, prophylaxis, empirical treatment, directed treatment and preventative therapy.


Resumen La Candidiasis Invasora (CI) y la candidemia, como su manifestación más frecuente, se ha convertido en la principal causa de micosis oportunista a nivel hospitalario. Este manuscrito realizado por miembros de la Asociación Colombiana de Infectología (ACIN), tuvo como objetivo proporcionar un conjunto de recomendaciones para manejo, seguimiento y prevención de la CI/candidemia y de la infección candidiásica de mucosas, en población adulta, pediátrica y neonatal, en un entorno hospitalario, incluyendo las unidades hemato-oncológicas y unidades de cuidado crítico. Todos los datos obtenidos mediante una búsqueda exhaustiva, fueron revisados y analizados de manera amplia por todos los miembros del grupo, y las recomendaciones emitidas se elaboraron luego de la evaluación de la literatura científica disponible, y el consenso de todos los especialistas involucrados, reconociendo el problema de la emergencia de las infecciones por Candida Spp. y brindando una correcta orientación a los profesionales de la salud sobre el manejo de pacientes con enfermedad candidiásica, de una forma racional y práctica, enfatizando en la evaluación del paciente, estrategias de diagnóstico, profilaxis, tratamiento empírico, tratamiento dirigido y terapia preventiva.

3.
Int Orthod ; 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31451344

RESUMO

OBJECTIVE: Non-syndromic cleft lip/palate (NSCL/P) has a multifactorial and polygenic aetiology. The role of genetics in its occurrence has not been fully clarified. The present meta-analysis aimed to evaluate the association of betaine-homocysteine S-methyltransferase (BHMT) polymorphisms (rs3797546 and rs3733890) with the risk of NSCL/P. MATERIALS AND METHODS: PubMed/Medline, Scopus, Cochrane Library, and Web of Science databases were systematically searched for articles published up until December 2018 with no language restriction. Quality evaluation of each study was performed by the Newcastle-Ottawa Scale (NOS). The crude odds ratio (OR) and 95% confidence interval (CI) were calculated for each study by RevMan 5.3 software, and a funnel plot analysis was performed by the CMA 2.0 software using the Egger's and Begg's tests. RESULTS: Review of the four selected studies revealed that the CC genotype of rs3797546 polymorphism significantly increased the risk of NSCL/P. No association was noted between NSCL/P risk and rs3733890 polymorphism except in Chinese (elevated risk of NSCL/P) and Polish (decreased risk of NSCL/P) populations. CONCLUSIONS: According to the present meta-analysis, rs3733890 polymorphism does not play a role in susceptibility to NSCL/P; whereas, rs3797546 polymorphism may play a role in susceptibility to NSCL/P. Future studies are required to examine the association between BHMT polymorphisms and the NSCL/P risk in different ethnicities with a larger sample size.

4.
Artigo em Inglês | MEDLINE | ID: mdl-31387249

RESUMO

Background: Non-syndromic cleft lip/palate (NSCL/P) has an etiology, including both genetic and environmental factors. Herein, we evaluated the association of rs13041247 and rs11696257 v-maf musculoaponeurotic fibrosarcoma oncogene homolog B (MAFB) polymorphisms with the risk of NSCL/P in a meta-analysis. Methods: The PubMed/Medline, Scopus, Cochrane Library, Web of Science, and HuGE Navigator databases were systematically searched to retrieve relevant articles published up to January 2019. The Newcastle-Ottawa scale was applied for quality evaluation of retrieved articles. The 95% confidence interval (CI) and crude odds ratio (OR) were calculated for each study using the Review Manager 5.3 software to show the association between MAFB polymorphisms and risk of NSCL/P. The comprehensive meta-analysis 2.0 software was used to calculate the publication bias. In addition, sensitivity analysis was carried out to show the stability of results. Results: Of 102 articles retrieved from the databases, 10 articles were analyzed in this meta-analysis. Ten articles, including eleven studies reporting rs13041247 MAFB polymorphism, included 3082 NSCL/P patients and 4104 controls. Three studies that reported rs11696257 MAFB polymorphism involved 845 NSCL/P patients and 927 controls. The rs11696257 MAFB polymorphism was not associated with the risk of NSCL/P, but the CC and TC genotypes of rs13041247 polymorphism were associated with the risk of NSCL/P. Nevertheless, the C allele and CC and TC genotypes were associated with a significant decline in the risk of NSCL/P in population-based studies. Conclusions: The results of this meta-analysis demonstrated that the risk of NSCL/P was related to rs13041247 polymorphism, not rs11696257 MAFB polymorphism. Well-designed studies are required to assess the interaction of MAFB and other genes with environmental factors in different ethnic groups.

5.
Dig Dis Sci ; 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31392473

RESUMO

BACKGROUND AND AIMS: Nodular gastropathy (NG) is an inflammatory condition of the gastric mucosa characterized by the endoscopic detection of multiple millimeter protrusions. A strong association between NG and Helicobacter pylori and a possible role of NG as a risk factor for undifferentiated gastric cancer have been described. The aim of this study was to characterize the pathogenic and inflammatory profile of patients with NG. METHODS: Adult patients referred for upper gastrointestinal endoscopy were prospectively enrolled in this study. H. pylori infection status was determined by rapid urease test. Biopsies were stained with hematoxylin-eosin. Sydney and OLGA scores were used to assess gastritis characteristics and gastric cancer risk. PCR analysis was performed to determine bacterial load and virulence factors CagA (and its EPIYA motifs) and VacA alleles. Finally, gastric mucosa cytokine gene expression (IL-8, IL-1ß, and TNF-α) was determined by real-time RT-PCR. RESULTS: Forty-eight patients, mean age of 36 years, were recruited. All NG patients were infected by H. pylori. OLGA score was similar in both groups (NG patients and non-NG patients). NG patients had higher bacterial load in the gastric corpus (p = 0.01) and significantly less pro-inflammatory cytokine levels than non-NG infected patients (p = 0.01). CONCLUSIONS: In our study, NG is not associated with preneoplastic lesions. An increase in bacterial load without a concomitant increase in mucosal inflammatory cytokine responses in H. pylori-infected subjects with NG may represent a general dampening of immune responses or an additional mechanism of H. pylori active immune evasion.

6.
World Neurosurg ; 130: 512-515, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31279922

RESUMO

BACKGROUND: Hemangiomas are benign blood vessels tumors that represent less than 1% of all the bone neoplasms. Calvarial hemangiomas are mainly solitary lesions commonly located in the frontal and parietal bone; however, they may occur in any skull region. These tumors increase in size over a period of months to years before they start showing their first symptoms such as headache, bone deformity, and pathological fractures. Differential diagnosis with osteosarcoma should be considered. Surgical resection with a safety margin is a standard treatment of the cranial hemangioma. Furthermore, radiotherapy has proven to stop the tumor's growth but not its size. CASE DESCRIPTION: We treated an 11-year-old male who had a rare case of a capillary hemangioma located in the clivus bone. The patient underwent 2 endoscopic endonasal resection because of tumor recurrence. Surgical safety margins are highly recommended, but this procedure could not be performed because of the tumor's location. After the second relapse, the oncology team decided to initiate radiotherapy. At 6-month follow-up, the tumor reduced its size and remained unchanged. CONCLUSIONS: Surgical safety margins are highly important to prevent recurrence in this type of bone tumors. Skull base hemangiomas are a big challenge when you want to achieve these safety margins. We believe that a combined treatment of surgery and radiotherapy should be considered as the main treatment.

7.
Arch Argent Pediatr ; 117(4): 216-223, 2019 Aug 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31339263

RESUMO

INTRODUCTION: Severe acute respiratory tract infection (ARTI) is a very common cause of hospitalization in pediatrics; respiratory syncytial virus (RSV) is the major etiologic agent. Accurately defining the burden of RSV life-threatening disease (LTD) and its risk factors is a challenge. OBJECTIVES: To know the impact of RSV in children hospitalized due to ARTI and describe the risk factors for LTD. MATERIALS AND METHODS: Prospective study in children < 2 years old hospitalized due to ARTI during 2012-2013 at Hospital de Niños "R. Gutiérrez." LTD was defined as requiring non-invasive ventilation and/or mechanical ventilation. RESULTS: 622 studied children, 372 were RSV(+) (59.8 %). Annual rate of hospitalization due to RSV in infants < 1 year old: 956 (95 % CI: 858-1062)/10 000hospitalizations. RSV caused 56/78 (71.8 %) cases of LTD; 42 (75 %) were previously healthy subjects; 32 (76.2 %) were < 6 months old. In the multivariate analysis, RSV was a risk factor for LTD (adjusted odds ratio [aOR]: 2.04; 95 % CI: 1.15-3.63; p = 0.014). A differential effect by sex was identified in RSV(+) patients: over-crowding was a risk factor for LTD in males (aOR: 2.36; 95 % CI: 1.07-5.21; p = 0.033); breastfeeding was a significant protective factor in females (aOR: 0.342; 95 % CI: 0.13-0.91; p = 0.032). CONCLUSIONS: RSV caused more than half of ARTI cases and mostly affected previously healthy patients < 1 year old. Males living in overcrowding conditions and females who were not breastfed were at the greatest risk for LTD.

8.
BMC Public Health ; 19(1): 675, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151392

RESUMO

BACKGROUND: Animal data suggest that jet fuels such as JP-8 are associated with hearing deficits when combined with noise and that the effect is more pronounced than with noise exposure alone. Some studies suggest peripheral dysfunction while others suggest central auditory dysfunction. Human data are limited in this regard. The aim of this study was to investigate the possible chronic adverse effects of JP-8 combined with noise exposure on the peripheral and central auditory systems in humans. METHODS: Fifty-seven participants who were current personnel from the Royal Australian Air Force were selected. Based on their levels of exposure to jet fuels, participants were divided into three exposure groups (low, moderate, high). Groups were also categorised based on their noise exposure levels (low, moderate, high). All participants were evaluated by tympanometry, pure-tone audiometry (1-12 kHz), distortion product otoacoustic emissions (DPOAEs), auditory brainstem response (ABR), words-in-noise, compressed speech, dichotic digit test, pitch pattern sequence test, duration pattern sequence test and adaptive test of temporal resolution. All auditory tests were carried out after the participants were away from the Air Force base for a minimum of two weeks, thus two weeks without jet fuel and noise exposure. RESULTS: Jet fuel exposure was significantly associated with hearing thresholds at 4 and 8 kHz; average hearing thresholds across frequencies in the better ear; DPOAEs at 2.8, 4 and 6 kHz; ABR wave V latency in the right ear; compressed speech and words-in-noise. Further analyses revealed that participants with low exposure level to jet fuels showed significantly better results for the aforementioned procedures than participants with moderate and high exposure levels. All results were controlled for the covariates of age and noise exposure levels. CONCLUSIONS: The results suggest that jet fuel exposure, when combined with noise exposure, has an adverse effect on audibility in humans. Taking all the test results into consideration, jet fuel exposure combined with noise exposure specifically seems to affect the peripheral hearing system in humans.


Assuntos
Perda Auditiva/epidemiologia , Hidrocarbonetos/efeitos adversos , Militares/estatística & dados numéricos , Ruído/efeitos adversos , Adulto , Austrália/epidemiologia , Feminino , Testes Auditivos , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
9.
Mol Cell Neurosci ; 98: 82-96, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31200100

RESUMO

The olfactory tubercle (OT) is located in the ventral-medial region of the brain where it receives primary input from olfactory bulb (OB) projection neurons and processes olfactory behaviors related to motivation, hedonics of smell and sexual encounters. The OT is part of the dopamine reward system that shares characteristics with the striatum. Together with the nucleus accumbens, the OT has been referred to as the "ventral striatum". However, despite its functional importance little is known about the embryonic development of the OT and the phenotypic properties of the OT cells. Here, using thymidine analogs, we establish that mouse OT neurogenesis occurs predominantly between E11-E15 in a lateral-to-medial gradient. Then, using a piggyBac multicolor technique we characterized the migratory route of OT neuroblasts from their embryonic point of origin. Following neurogenesis in the ventral lateral ganglionic eminence (vLGE), neuroblasts destined for the OT followed a dorsal-ventral pathway we named "ventral migratory course" (VMC). Upon reaching the nascent OT, neurons established a prototypical laminar distribution that was determined, in part, by the progenitor cell of origin. A phenotypic analysis of OT neuroblasts using a single-color piggyBac technique, showed that OT shared the molecular specification of striatal neurons. In addition to primary afferent input from the OB, the OT also receives a robust dopaminergic input from ventral tegmentum (Ikemoto, 2007). We used tyrosine hydroxylase (TH) expression as a proxy for dopaminergic innervation and showed that TH onset occurs at E13 and progressively increased until postnatal stages following an 'inside-out' pattern. Postnatally, we established the myelination in the OT occurring between P7 and P14, as shown with CNPase staining, and we characterized the cellular phenotypes populating the OT by immunohistochemistry. Collectively, this work provides the first detailed analysis of the developmental and maturation processes occurring in mouse OT, and demonstrates the striatal nature of the OT as part of the ventral striatum (vST).

10.
Rev. chil. infectol ; 36(3): 371-375, jun. 2019. tab, graf
Artigo em Espanhol | LILACS-Express | ID: biblio-1013795

RESUMO

Resumen Introducción: La piomiositis es la infección del músculo esquelético, entidad poco frecuente en pediatría. Objetivo: Describir las características de 21 niños con piomiositis. Métodos: Estudio prospectivo-analítico de niños ingresados con diagnóstico de piomiositis entre mayo de 2016 y abril de 2017 en el Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina. Resultados: Tasa de hospitalización de 21,5/10.000 admisiones (IC 95% 4,65- 71,43). La mediana de edad fue de 5,4 años (rango 1,25-11,6). El 90,4% presentaba algún factor predisponente. La localización más frecuente fue en miembros inferiores. La proteína C reactiva (PCR) estuvo elevada en todos los pacientes, con una media de 124 mg/L (DS 96), siendo significativamente más elevada en los pacientes que tuvieron hemocultivos positivos 206 (DS 101) vs 98 (DS 81), (p = 0,02). Se obtuvo rescate microbiológico en 17 pacientes (80,9%): Staphylococcus aureus resistente a meticilina (SARM) (n: 15) y Streptococcus pyogenes (n: 2). Se presentó con bacteriemia 23,8% de los pacientes. El 81% requirió drenaje quirúrgico. Conclusión: Staphylococcus aureus RM adquirido en la comunidad (SARMAC) es el patógeno predominante. En la selección del tratamiento empírico adecuado debería tenerse en cuenta: el patrón de resistencia local y el valor de PCR.


Background: Pyomyositis is the infection of skeletal muscle, a rare pathology in children. Aim To describe the characteristics of pyomyositis in pediatric patients. Methods: Prospective analytical study of hospitalized children diagnosed with pyomyositis from May 2016 to April 2017 at the Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina. Results: Twenty-one patients with pyomyositis were identified. Annual rate: 21.5/10,000 admissions (95% CI 4.65-71.43). The median age was 5.4 years (range 1.25-11.6). The lower limbs were the most affected site. C-reactive protein (CRP) was elevated in all patients, with a mean of 124 mg/L (SD 96), being significantly higher in patients with bacteremia: 206 (DS 101) vs 98 (DS 81), p = 0.02. Bacterial cultures were positive in 17/21 (80.9%): 15 methicillin-resistant Staphylococcus aureus (MRSA), and 2 Streptococcus pyogenes. Blood cultures were positive in 5 (23.8%). Conclusion: MRSA-community acquired is the predominant pathogen in our setting. In the selection of the appropriate empirical treatment, the local resistance pattern and the CRP value should be taken into account.

11.
Arch Esp Urol ; 72(4): 422-428, 2019 May.
Artigo em Espanhol | MEDLINE | ID: mdl-31070139

RESUMO

OBJECTIVE: The incidence of simple renal cysts is very high, especially in elderly people. However, malignant transformation of a simple renal cyst is exceptional. Likewise, the treatment to be carried out, in these rare cases, is controversial, with respect to opting for radical renal surgery. METHODS: We present the case of a patient with a solid nodule in a large cyst. Complete removal of the cyst was performed by transperitoneal laparoscopic technique. The histopathological study of the surgical piece revealed the existence of a cyst with clear renal cell carcinoma with nucleolar grade 2. The clinical evolution has been satisfactory, performing a minimally invasive surgery (laparoscopic cyst excision). DISCUSSION: Although it is considered that surgical treatment of choice is radical surgery in these cases, we believe that nephron sparing surgery may represent a therapeutic option, taking into account the young age of our patient. A histogenetic hypothesis is discussed to explain the appearance of a clear cell tumor in a simple renal cyst. CONCLUSION: The development of a renal cell carcinoma in simple renal cysts is a very infrequent pathology.Laparoscopic total cystectomy is a minimally invasive therapeutic option for the treatment of renal cell carcinoma originating in a simple renal cyst, although it is of an important size. We establish the hypothesis of migration of the cells of the renal collecting tubes into the cyst wall to explain the malignant transformation of the renal simple cyst.


Assuntos
Carcinoma de Células Renais , Doenças Renais Císticas , Neoplasias Renais , Laparoscopia , Idoso , Carcinoma de Células Renais/cirurgia , Humanos , Rim , Doenças Renais Císticas/cirurgia
12.
Rev Chilena Infectol ; 36(1): 83-90, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31095207

RESUMO

Given that the last notified case of poliomyelitis due to wild poliovirus type 2 was in 1999, in 2012, the Strategic Advisory Group of Experts on Immunization (SAGE) of the World Health Organization (WHO) recommended the withdrawal of the type 2 component of oral polio vaccine (OPV) and the introduction of a bivalent OPV (bOPV) in all countries by 2016. WHO recommended also that the withdrawal should be preceded by the introduction of at least one dose of inactivated poliovirus vaccine (IPV) in routine immunization schedules. The introduction of IPV prior to the change of the bOPV in 2016 to trivalent OPV (tOPV) was based on the concept of ensuring that a substantial proportion of the population would be protected against type 2 polio after the removal of the type 2 OPV. However, the world's two producers of IPV (Bilthoven Biologicals and Sanofi) have faced problems in the production of this vaccine and therefore reported a reduction of the global supply of IPV. In response to the potential shortage of IPV, at a meeting held on March 10 2017, the SAGE and Technical Advisory Group (TAG) of the Pan American Health Organization (PAHO) urged the countries in the Latin American region to replace the routine administration of the full doses of inactivated polio vaccine (IPV-C) in the immunization schedule (administered by intramuscular route), administering a fraction of the full dose in two intradermal shots (IPV-f). The possibility of this strategy was analyzed by opinion leaders convened by the Paraguayan Society of Pediatrics with the support of the Latin American Society of Pediatric Infectious Diseases (SLIPE) and Latin American Association of Pediatrics (ALAPE). This document presents the results of the discussion.

13.
Biomolecules ; 9(3)2019 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-30884918

RESUMO

Oral mucosal lesions have many etiologies, including viral or bacterial infections, local trauma or irritation, systemic disorders, and even excessive alcohol and tobacco consumption. Folk knowledge on medicinal plants and phytochemicals in the treatment of oral mucosal lesions has gained special attention among the scientific community. Thus, this review aims to provide a brief overview on the traditional knowledge of plants in the treatment of oral mucosal lesions. This review was carried out consulting reports between 2008 and 2018 of PubMed (Medline), Web of Science, Embase, Scopus, Cochrane Database, Science Direct, and Google Scholar. The chosen keywords were plant, phytochemical, oral mucosa, leukoplakia, oral lichen planus and oral health. A special emphasis was given to certain plants (e.g., chamomile, Aloe vera, green tea, and coffea) and plant-derived bioactives (e.g., curcumin, lycopene) with anti-oral mucosal lesion activity. Finally, preclinical (in vitro and in vivo) and clinical studies examining both the safety and efficacy of medicinal plants and their derived phytochemicals were also carefully addressed.


Assuntos
Aloe/química , Camomila/química , Café/química , Curcumina/farmacologia , Licopeno/farmacologia , Mucosa Bucal/efeitos dos fármacos , Extratos Vegetais/farmacologia , Chá/química , Curcumina/química , Humanos , Licopeno/química , Mucosa Bucal/patologia , Extratos Vegetais/química , Extratos Vegetais/isolamento & purificação
14.
Arch Oral Biol ; 101: 8-12, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30851692

RESUMO

OBJECTIVE: Natural compounds such as epigallocatechin-3-gallate (EGCG) have previously shown chemotherapeutic properties with few side-effects. In our study, we evaluated the effects of combining EGCG with 5-fluorouracil (5-FU) and radiotherapy on oral squamous cell cancer. We evaluated whether the combination of lower doses of 5-FU with EGCG could be equally or more effective than the use of higher doses of 5-FU alone. METHODS: Cell viability, migration and cell cycles were assayed in oral cancer cell lines treated with 5-FU, 5-FU + EGCG and radiation (0, 2.5 and 5 Gy). RESULTS: This study found that the combination of EGCG with 5-FU reduced cell viability and migration distance compared to control samples and the same dose of 5-FU alone. Addition of EGCG increased the number of cells in the G2/M phase, while 5-FU arrested the cell cycle in phase S. Moreover, cell exposure to 5 Gy radiation decreased the effects of combining with EGCG. CONCLUSIONS: In summary, the combination of EGCG and 5-FU reduced both cell viability and migration as well as altered the cell cycle to a greater extent than 5-FU alone.

15.
Arch. argent. pediatr ; 117(1): 12-18, feb. 2019. graf, tab
Artigo em Espanhol | LILACS-Express | ID: biblio-983771

RESUMO

Introducción. En Argentina, se estiman 400 000 casos anuales de varicela. Dado el subregistro de casos existentes, la carga de enfermedad real se desconoce. Objetivo. Evaluar la carga de enfermedad por varicela antes de la introducción de la vacuna al Calendario Nacional. Materiales y métodos. Estudio retrospectivo, analítico, observacional, realizado en tres centros asistenciales del país. Revisión de los registros de consultas ambulatorias a los Servicios de Urgencias y de las historias clínicas de las internaciones por varicela en pacientes < 18 años. Período: 1/2011-12/2013. Resultados. Fueron asistidas un total de 382782 consultas ambulatorias; 3367 (0,88 %) correspondieron a consultas por varicela; el 57,6 %, < 4 años. Requirieron internación 164 (4,9 %) con una tasa de hospitalización global de 65,3/10000 hospitalizados/año (IC 95 %: 55,4-76,5); tasa de hospitalización en niños sanos: 57,2/10 000 (IC 95 %: 67,7-48,0); mediana de edad: 31,5 meses. Las causas de internación más frecuentes fueron infecciones de piel y/o partes blandas (61,1 %) y respiratorias (10,1 %). El 54,3 % recibió tratamiento con aciclovir, y el 73,1 %, con antibióticos. Presentaron bacteriemia 5/67 (7,5 %), todas por cocos Gram(+) y en inmunocompetentes. De los 19 pacientes inmunocomprometidos, el 36,8 % tuvo complicaciones (5 infecciones de piel y/o partes blandas y 2 neumonías). La mediana de días de internación fue 4, significativamente más prolongada en pacientes inmunocomprometidos. Un paciente requirió cuidados intensivos. No hubo fallecidos. Conclusión. La carga de enfermedad registrada fue significativa, con impacto considerable en pacientes sin patología de base.


Introduction. In Argentina, an estimated 400 000 varicella cases occur annually. Given the under-recording of existing cases, the actual burden of disease is unknown. Objective. To assess the burden of varicella before the introduction of the varicella vaccine in the national immunization schedule. Materials and methods. Retrospective, analytical, observational study carried out in three hospitals of Argentina. Review of medical records from outpatient visits to the Emergency Department and from patients younger than 18 years hospitalized for varicella. Period: 1/2011-12/2013. Results. A total of 382 782 outpatients were seen; 3367(0.88%) corresponded to visits due to varicella; 57.6 % were < 4 years old. A total of 164 (4.9 %) patients required hospitalization, with an overall hospitalization rate of 65.3/10 000 hospitalized patients/year (95 % confidence interval -#91;CI-#93;: 55.4-76.5); hospitalization rate in healthy children: 57.2/10 000 (95 % CI: 67.7-48.0); median age: 31.5 months. The most common causes of hospitalization were skin and/or soft tissue infections (61.1 %) and respiratory infections (10.1 %). Also, 54.3 % were treated with acyclovir and 73.1 %, with antibiotics. Bacteremia developed in 5/67 patients (7.5 %), all cases were caused by Gram-positive cocci and occurred in immunocompetent patients. Out of 19 immunocompromised patients, 36.8 % had complications (5 skin and/or soft tissue infection and 2 pneumonia cases). The median length of stay was 4 days, which is significantly more prolonged in immunocompromised patients. One patient required intensive care. No patient died. Conclusion. The burden of disease was significant, with a considerable impact in patients without an underlying disease.

16.
Arch. argent. pediatr ; 117(1): 63-67, feb. 2019. ilus, graf, tab
Artigo em Espanhol | LILACS-Express | ID: biblio-983783

RESUMO

El dengue es la arbovirosis humana que más morbimortalidad ocasiona mundialmente. Durante 2016, se registró, en la Ciudad de Buenos Aires, Argentina, la mayor epidemia de esta enfermedad. Objetivo: describir las características clínicas y hematológicas en una población pediátrica. Métodos: estudio de corte transversal que incluyó a pacientes atendidos del 18-1-16 al 15-4-16 en el Hospital de Niños "Dr. Ricardo Gutiérrez". Resultados: se registraron 156 casos, 82 confirmados por virología; 130 (83 %), autóctonos. Las manifestaciones clínicas más frecuentes fueron fiebre, cefalea y dolor retroocular. Las alteraciones del laboratorio significativas fueron leucopenia, plaquetopenia y aumento de transaminasas. Se internaron 35 pacientes (23 %), 25 (16 %) con signos de alarma. No se presentó ningún caso de dengue grave. Conclusiones: el reconocimiento oportuno de los signos de alarma y el control hematológico resultan fundamentales para detectar a los niños en riesgo y ofrecerles tratamiento de soporte en forma precoz.


Dengue is the human arbovirus with the highest morbidity and mortality in the world. The largest outbreak of dengue in Buenos Aires, Argentina, occurred during 2016. Objective: To describe clinical and hematological features in children with confirmed dengue infection. Methods: Cross sectional study that included children attended since January 18th to April 15th 2016 at Hospital de Niños "Dr. Ricardo Gutiérrez". Results: among 156 registered cases, 82 confirmed cases by virology test; 130 (83 %) autochthonous cases. The most frequent clinical manifestations were fever, headache and retro-ocular pain. Laboratory abnormalities were leukopenia, thrombocytopenia and increased liver enzymes. Thirty-five children were hospitalized (23 %), 25 (16 %) with warning signs. In our study, no cases of severe dengue occurred. Conclusions: early recognition of warning signs and hematological monitoring is essential in order to detect patients at risk and offer them adequate early treatment.

17.
Postgrad Med J ; 95(1120): 96-101, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30787196

RESUMO

Clinical rotations are an essential part of Internal Medicine (IM) residency programmes, where curricular objectives are carried out. To our knowledge, there are no validated instruments to assess IM clinical rotations. Our objective was to develop an instrument for residents to assess the quality of clinical rotations in an IM residency programme, and to test the psychometric properties of the instrument. A mixed methodology was used, including qualitative and quantitative phases. Items were proposed by a group of experts based on previously identified residency needs, followed by a quantitative phase to generate consensus among educators and residents to define which items would be included in the instrument (Delphi panel). After generating the instrument, psychometric tests were performed to assess construct validity (factor analysis) and reliability (Raykov's reliability coefficient). We obtained a 15-item instrument after two Delphi rounds: Internal Medicine Program Instrument 15-items (IMPRINT-15). Sixty-two residents answered 428 surveys using a Likert scale during 7 months (response rate 98.9%). The median score was 4.3 (IQR 3.9-4.7) (scale from 1 to 5). The factor analysis showed two domains in the clinical rotation assessment: (1) teaching and care activities; (2) evaluation and feedback. The instrument is reliable with Raykov's reliability coefficient of 0.86. Also, Raykov's reliability coefficient for the domains were 0.89 and 0.83, respectively. The IMPRINT-15 instrument is a bi-dimensional, valid and reliable questionnaire to evaluate the perceived quality by residents of the IM clinical rotations. Also, it constitutes the first validated instrument in this field worldwide.


Assuntos
Medicina Interna/educação , Internato e Residência , Satisfação no Emprego , Médicos/psicologia , Inquéritos e Questionários , Adulto , Técnica Delfos , Retroalimentação , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Psicometria , Reprodutibilidade dos Testes
18.
Rev. chil. infectol ; 36(1): 83-90, feb. 2019. tab
Artigo em Inglês | LILACS-Express | ID: biblio-1003656

RESUMO

Abstract Given that the last notified case of poliomyelitis due to wild poliovirus type 2 was in 1999, in 2012, the Strategic Advisory Group of Experts on Immunization (SAGE) of the World Health Organization (WHO) recommended the withdrawal of the type 2 component of oral polio vaccine (OPV) and the introduction of a bivalent OPV (bOPV) in all countries by 2016. WHO recommended also that the withdrawal should be preceded by the introduction of at least one dose of inactivated poliovirus vaccine (IPV) in routine immunization schedules. The introduction of IPV prior to the change of the bOPV in 2016 to trivalent OPV (tOPV) was based on the concept of ensuring that a substantial proportion of the population would be protected against type 2 polio after the removal of the type 2 OPV. However, the world's two producers of IPV (Bilthoven Biologicals and Sanofi) have faced problems in the production of this vaccine and therefore reported a reduction of the global supply of IPV. In response to the potential shortage of IPV, at a meeting held on March 10 2017, the SAGE and Technical Advisory Group (TAG) of the Pan American Health Organization (PAHO) urged the countries in the Latin American region to replace the routine administration of the full doses of inactivated polio vaccine (IPV-C) in the immunization schedule (administered by intramuscular route), administering a fraction of the full dose in two intradermal shots (IPV-f). The possibility of this strategy was analyzed by opinion leaders convened by the Paraguayan Society of Pediatrics with the support of the Latin American Society of Pediatric Infectious Diseases (SLIPE) and Latin American Association of Pediatrics (ALAPE). This document presents the results of the discussion.

19.
Emerg Infect Dis ; 25(3): 573-576, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30602120

RESUMO

After a 2014 outbreak of severe respiratory illness caused by enterovirus D68 in the United States, sporadic cases of acute flaccid myelitis have been reported worldwide. We describe a cluster of acute flaccid myelitis cases in Argentina in 2016, adding data to the evidence of association between enterovirus D68 and this polio-like illness.


Assuntos
Enterovirus Humano D , Infecções por Enterovirus/epidemiologia , Mielite/epidemiologia , Mielite/virologia , Fatores Etários , Argentina/epidemiologia , Proteínas do Capsídeo/genética , Pré-Escolar , Infecções por Enterovirus/história , Infecções por Enterovirus/terapia , Infecções por Enterovirus/virologia , Feminino , História do Século XXI , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Lactente , Masculino , Mielite/história , Mielite/terapia , Filogenia , Carga Viral
20.
Arch Argent Pediatr ; 117(1): 12-18, 2019 02 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30652441

RESUMO

INTRODUCTION: In Argentina, an estimated 400 000 varicella cases occur annually. Given the under-recording of existing cases, the actual burden of disease is unknown. OBJECTIVE: To assess the burden of varicella before the introduction of the varicella vaccine in the national immunization schedule. MATERIALS AND METHODS: Retrospective, analytical, observational study carried out in three hospitals of Argentina. Review of medical records from outpatient visits to the Emergency Department and from patients younger than 18 years hospitalized for varicella. Period: 1/2011-12/2013. RESULTS: A total of 382 782 outpatients were seen; 3367(0.88%) corresponded to visits due to varicella; 57.6 % were < 4 years old. A total of 164 (4.9 %) patients required hospitalization, with an overall hospitalization rate of 65.3/10 000 hospitalized patients/year (95 % confidence interval |#91;CI|#93;: 55.4-76.5); hospitalization rate in healthy children: 57.2/10 000 (95 % CI: 67.7-48.0); median age: 31.5 months. The most common causes of hospitalization were skin and/or soft tissue infections (61.1 %) and respiratory infections (10.1 %). Also, 54.3 % were treated with acyclovir and 73.1 %, with antibiotics. Bacteremia developed in 5/67 patients (7.5 %), all cases were caused by Gram-positive cocci and occurred in immunocompetent patients. Out of 19 immunocompromised patients, 36.8 % had complications (5 skin and/or soft tissue infection and 2 pneumonia cases). The median length of stay was 4 days, which is significantly more prolonged in immunocompromised patients. One patient required intensive care. No patient died. CONCLUSION: The burden of disease was significant, with a considerable impact in patients without an underlying disease.

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