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2.
Emerg Med Clin North Am ; 37(3): 365-379, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31262409

RESUMO

Acute ischemic stroke (AIS) is a medical emergency that requires prompt recognition and streamlined work-up to ensure that time-dependent therapies are initiated to achieve the best outcomes. This article discusses frequently missed AIS in the emergency department, the role of various imagining modalities in the work-up of AIS, updates on the use of intravenous thrombolytics and endovascular therapy for AIS, pearls on supportive care management of AIS, and prehospital and hospital process improvements to shorten door-to-needle time.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/terapia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Algoritmos , Glicemia/análise , Encéfalo/diagnóstico por imagem , Tomada de Decisão Clínica , Ensaios Clínicos como Assunto , Medicina de Emergência , Procedimentos Endovasculares , Febre/prevenção & controle , Fibrinolíticos/uso terapêutico , Humanos , Hipertensão/terapia , Oxigenoterapia , Transferência de Pacientes , Telemedicina , Tenecteplase/uso terapêutico , Trombectomia , Terapia Trombolítica , Tempo para o Tratamento , Ativador de Plasminogênio Tecidual/uso terapêutico
3.
PLoS Med ; 16(6): e1002830, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31199792

RESUMO

BACKGROUND: Although there is mounting evidence demonstrating beneficial effects of community health workers (CHWs), few studies have examined the impact of CHW programs focused on preventing infectious diseases in children through behavior changes. We assessed the preventive effects of community health volunteers (CHVs), who receive no financial incentive, on child diarrhea and fever prevalence in Ghana. METHODS AND FINDINGS: We conducted a cluster-randomized controlled trial in 40 communities in the Volta Region, Ghana. Twenty communities were randomly allocated to the intervention arm, and 20 to the control arm, using a computer-generated block randomization list. In the intervention arm, CHVs were deployed in their own community with the key task of conducting home visits for health education and community mobilization. The primary outcomes of the trial were diarrhea and fever prevalence at 6 and 12 months among under-5 children based on caregivers' recall. Secondary outcomes included oral rehydration treatment and rapid diagnostic testing for malaria among under-5 children, and family planning practices of caregivers. Generalized estimating equations (GEEs) with a log link and exchangeable correlation matrix were used to determine the relative risk (RR) and 95% confidence intervals (CIs) for diarrhea, fever, and secondary outcomes adjusted for clustering and stratification. Between April 18 and May 4, 2015, 1,956 children were recruited and followed up until September 20, 2016. At 6 and 12 months post-randomization, 1,660 (85%) and 1,609 (82%) participants, respectively, had outcomes assessed. CHVs' home visits had no statistically significant effect on diarrhea or fever prevalence at either time point. After a follow-up of 12 months, the prevalence of diarrhea and fever was 7.0% (55/784) and 18.4% (144/784), respectively, in the control communities and 4.5% (37/825) and 14.7% (121/825), respectively, in the intervention communities (12-month RR adjusted for clustering and stratification: diarrhea, RR 0.73, 95% CI 0.37-1.45, p = 0.37; fever, RR 0.76, 95% CI 0.51-1.14, p = 0.20). However, the following were observed: improved hand hygiene practices, increased utilization of insecticide-treated bed nets, and greater participation in community outreach programs (p-values < 0.05) in the intervention group. In a post hoc subgroup analysis, the prevalence of diarrhea and fever at 6 months was 3.2% (2/62) and 17.7% (11/62), respectively, in the intervention communities with ≥70% coverage and a ≥30-minute visit duration, and 14.4% (116/806) and 30.2% (243/806) in the control communities (RR adjusted for clustering, stratification, baseline prevalence, and covariates: diarrhea, RR 0.23, 95% CI 0.09-0.60, p = 0.003; fever, RR 0.69, 95% CI 0.52-0.92, p = 0.01). The main limitations were the following: We were unable to investigate the longer-term effects of CHVs; the trial may have been underpowered to detect small to moderate effects due to the large decline in diarrheal and fever prevalence in both the intervention and control group; and caregivers' practices were based on self-report, and the possibility of caregivers providing socially desirable responses cannot be excluded. CONCLUSIONS: We found no effect of CHVs' home visits on the prevalence of child diarrhea or fever. However, CHV programs with high community coverage and regular household contacts of effective duration may reduce childhood infectious disease prevalence. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Registry, ISRCTN49236178.


Assuntos
Serviços de Saúde Comunitária/normas , Agentes Comunitários de Saúde/normas , Diarreia/epidemiologia , Febre/epidemiologia , Visita Domiciliar , Adulto , Criança , Pré-Escolar , Análise por Conglomerados , Serviços de Saúde Comunitária/métodos , Diarreia/prevenção & controle , Feminino , Febre/prevenção & controle , Seguimentos , Gana/epidemiologia , Humanos , Masculino
4.
Pediatr Blood Cancer ; 66(9): e27816, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31157521

RESUMO

BACKGROUND: Hydroxyurea (HU) increases fetal hemoglobin (HgbF) and ameliorates sickle cell disease (SCD) symptoms. Studies have demonstrated the safety and efficacy of HU in infants and children. Initiation of HU in infancy for children with SCD needs to be implemented in community practice. PROCEDURE: Starting in 2011, the Pediatric Sickle Cell Program of Northern Virginia initiated HU in infants with SCD. A prospective longitudinal database tracked the clinical course and outcomes. RESULTS: Twenty-four children with HgbSS who started HU by age 1 were continuously followed for a total of 95 person-years. Age at the time of analysis ranged from 2 to 7 years. Average hemoglobin at 6-month intervals ranged from 9.5 + 1.9 to 10.7 + 0.8 g/dL, and average HgbF ranged from 27.8 + 5.0% to 34.1 + 6.6%. Twenty-seven hospitalizations occurred (0.28/person-year), all before age 3, including 19 (70%) for fever or infection, five (19%) for splenic sequestration, and one (4%) for pain in an infant prior to starting HU. The treat-and-release emergency department visits totaled 68 (0.72/person-year), including 62 visits (91%) for fever, infection, or viral illness, and two visits (3%) for pain/dactylitis in infants before HU initiation. Splenic sequestration accounted for all five transfusions. No pain episodes requiring medical attention were documented after HU initiation. No complicated acute chest syndrome, no abnormal or conditional transcranial Doppler ultrasound, and no overt strokes occurred. CONCLUSION: Implementation of HU in infancy for patients with SCD in community practice is feasible and is highly effective in preventing disease complications.


Assuntos
Anemia Falciforme , Transfusão de Sangue , Hospitalização , Hidroxiureia/administração & dosagem , Anemia Falciforme/sangue , Anemia Falciforme/terapia , Criança , Pré-Escolar , Feminino , Hemoglobina Fetal/metabolismo , Febre/sangue , Febre/prevenção & controle , Seguimentos , Hemoglobina Falciforme/metabolismo , Humanos , Lactente , Estudos Longitudinais , Masculino , Estudos Prospectivos , Viroses/sangue , Viroses/prevenção & controle
6.
Rev Gaucha Enferm ; 40(spe): e20180218, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30970103

RESUMO

OBJECTIVE: To describe the thermoregulation protocol implementation for newborns (NB). METHODS: An experimental report, conducted at a neonatal unit in Salvador, Bahia, from January 2016 to January 2017. The Plan, Do, Check, Action cycle guided the construction, implementation and applicability of the protocol. RESULTS: Implementation of the protocol that allowed the reduction of adverse events due to thermal instability during surgical procedures and introduction of new technologies. CONCLUSION: The protocol could improve and strengthen the care practices related to safe surgery in newborns.


Assuntos
Protocolos Clínicos , Febre/prevenção & controle , Hipotermia/prevenção & controle , Complicações Intraoperatórias/prevenção & controle , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Operatórios , Humanos , Recém-Nascido , Guias de Prática Clínica como Assunto
7.
Autoimmun Rev ; 18(6): 615-620, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30959218

RESUMO

BACKGROUND: Febrile neutropenia is generally recognised as a complication of myelosuppressive chemotherapy. Recombinant human granulocyte colony stimulating factor (G-CSF) is commonly used as a primary or secondary prophylaxis to reduce the degree and duration of neutropenia in patients at risk of developing chemotherapy-induced neutropenic fever and infectious complications. G-CSF is known to decrease mortality and increase the possibility of maintaining adequate chemotherapy dose intensity and density, which is essential in curable malignancies. Common side effects are generally mild. However, potentially fatal adverse events have also been reported. CASE PRESENTATION: Herein, we summarise previously reported and report two new independent cases of G-CSF-induced aortitis, both in patients treated with chemotherapy for breast cancer. The two cases, identified only a few months apart, share several common characteristics including type of cancer, gender, age, chemotherapy, G-CSF treatment regimen, and time span from G-CSF initiation to aortitis manifestation. The two cases were both diagnosed by CT scan and successfully treated with corticosteroids along with discontinuation of G-CSF. CONCLUSION: This case report highlights that although aortitis is a rare adverse event of G-CSF treatment, it should be considered in cases of unexplained fever and/or clinical and laboratory findings that do not respond to antibiotics.


Assuntos
Aortite/induzido quimicamente , Fator Estimulador de Colônias de Granulócitos/efeitos adversos , Idoso , Antineoplásicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Feminino , Febre/induzido quimicamente , Febre/prevenção & controle , Humanos , Pessoa de Meia-Idade , Neutropenia/induzido quimicamente , Neutropenia/prevenção & controle
8.
Evid. actual. práct. ambul ; 22(1): e001077, abr. 2019. tab.
Artigo em Espanhol | LILACS | ID: biblio-1015125

RESUMO

La bronquiolitis es una infección respiratoria aguda baja de causa viral, de aparición invernal, que es común en bebés de 0a 12 meses de edad. Conduce a que las vías respiratorias pequeñas se inflamen y se llenen de desechos, obstruyéndose.El bebé tiene una tos fuerte, secreción nasal, generalmente fiebre y puede presentar sibilancias dificultad respiratoria ydesaturación de oxígeno. Tras la presentación de un caso en la guardia se generó una controversia científica sobre lautilidad de los broncodilatadores en pacientes con bronquiolitis. Luego de realizar una búsqueda bibliográfica y seleccionarla evidencia más reciente y de mejor calidad, se concluye que la evidencia no apoya el uso de broncodilatadores enpacientes con bronquiolitis.(AU)


Bronchiolitis is a low acute respiratory lower respiratory tract infection of viral origin, winter appearance, which is commonin babies from 0 to 12 months of age. It causes the small airways in the lungs to become inflamed and fill with debris. Theinfant has a harsh cough, runny nose, usually fever and may have wheezing, respiratory distress and oxygen desaturation.After the presentation of a case in the emergency department, a scientific controversy was generated about the usefulnessof bronchodilators in patients with bronchiolitis. After conducting a literature search and selecting the most recent and bestquality evidence, it is concluded that evidence does not support the use of bronchodilators in patients with bronchioliTIS.(AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Broncodilatadores/administração & dosagem , Bronquiolite/tratamento farmacológico , Epinefrina/administração & dosagem , Albuterol/administração & dosagem , Infecções Respiratórias/tratamento farmacológico , Broncodilatadores/efeitos adversos , Broncodilatadores/uso terapêutico , Bronquiolite/diagnóstico , Epinefrina/efeitos adversos , Sons Respiratórios/diagnóstico , Tosse/prevenção & controle , Albuterol/efeitos adversos , Albuterol/uso terapêutico , Febre/prevenção & controle
9.
Chem Biol Interact ; 305: 134-147, 2019 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-30922767

RESUMO

Methiopropamine (MPA) is structurally categorized as a thiophene ring-based methamphetamine (MA) derivative. Although abusive potential of MPA was recognized, little is known about the neurotoxic potential of MPA up to now. We investigated whether MPA induces dopaminergic neurotoxicity, and whether MPA activates a specific dopamine receptor. Here, we observed that treatment with MPA resulted in dopaminergic neurotoxicity in a dose-dependent manner. MPA treatment potentiated oxidative parameters (i.e., increases in the level of reactive oxygen species, 4-hydroxynonenal, and protein carbonyl), M1 phenotype-related microglial activity, and pro-apoptotic property (i.e., increases in Bax- and cleaved caspase-3-expressions, while a decrease in Bcl-2-expression). Moreover, treatment with MPA resulted in significant impairments in dopaminergic parameters [i.e., changes in dopamine level, dopamine turnover rate, tyrosine hydroxylase (TH) levels, dopamine transporter (DAT) expression, and vesicular monoamine transporter-2 (VMAT-2) expression], and in behavioral deficits. Both dopamine D1 receptor antagonist SCH23390 and D2 receptor antagonist sulpiride protected from these neurotoxic consequences. Therefore, our results suggest that dopamine D1 and D2 receptors simultaneously mediate MPA-induced dopaminergic neurodegeneration in mice via oxidative burdens, microgliosis, and pro-apoptosis.


Assuntos
Metanfetamina/toxicidade , Estresse Oxidativo/efeitos dos fármacos , Receptores de Dopamina D1/metabolismo , Receptores de Dopamina D2/metabolismo , Animais , Proteínas Reguladoras de Apoptose/genética , Proteínas Reguladoras de Apoptose/metabolismo , Benzazepinas/farmacologia , Benzazepinas/uso terapêutico , Diferenciação Celular/efeitos dos fármacos , Corpo Estriado/efeitos dos fármacos , Corpo Estriado/metabolismo , Dopamina/metabolismo , Antagonistas dos Receptores de Dopamina D2/farmacologia , Antagonistas dos Receptores de Dopamina D2/uso terapêutico , Febre/prevenção & controle , Locomoção/efeitos dos fármacos , Masculino , Metanfetamina/síntese química , Metanfetamina/química , Camundongos , Camundongos Endogâmicos ICR , Microglia/citologia , Microglia/efeitos dos fármacos , Microglia/metabolismo , Espécies Reativas de Oxigênio/análise , Espécies Reativas de Oxigênio/metabolismo , Receptores de Dopamina D1/antagonistas & inibidores , Receptores de Dopamina D2/química , Sulpirida/farmacologia , Sulpirida/uso terapêutico , Tirosina 3-Mono-Oxigenase/metabolismo
10.
Urol Int ; 102(4): 462-467, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30917379

RESUMO

BACKGROUND: The management of febrile urinary tract infection (fUTI) in patients with vesicoureteral reflux (VUR) is crucial to prevent renal scarring. Continuous antibiotic prophylaxis (CAP) is the most widely used initial treatment for VUR. However, the optimal duration of CAP is still unclear. We aimed to clarify an appropriate patient population and the optimal timing to discontinue CAP. METHODS: We reviewed the records of 247 patients with primary VUR between January 2000 and December 2015. Seventy-two patients who discontinued CAP despite persistent VUR were enrolled. Kaplan-Meier method and Cox proportional hazard model was used in statistical analysis. RESULTS: Following the discontinuation of CAP, fUTI developed in 25 patients after a median of 9 months (range 0-81). VUR resolved spontaneously in 9 out of 47 patients without recurrence during follow-up. Multivariate analysis showed bilateral VUR and duration of CAP of less than 1 year after the last fUTI were significant risk factors for recurrence. CONCLUSION: Among the risk factors examined, patients administered CAP for less than 1 year after the last fUTI and those with bilateral VUR had significantly more frequent recurrence. Our study suggests that the administration of CAP for more than 1 year after the last fUTI is beneficial in avoiding recurrent fUTI.


Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Febre/tratamento farmacológico , Febre/prevenção & controle , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/prevenção & controle , Refluxo Vesicoureteral/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Esquema de Medicação , Feminino , Febre/complicações , Humanos , Lactente , Estimativa de Kaplan-Meier , Rim/patologia , Masculino , Análise Multivariada , Modelos de Riscos Proporcionais , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Prevenção Secundária , Infecções Urinárias/complicações , Refluxo Vesicoureteral/complicações
11.
Cochrane Database Syst Rev ; 2: CD001532, 2019 02 20.
Artigo em Inglês | MEDLINE | ID: mdl-30784039

RESUMO

BACKGROUND: Vesicoureteric reflux (VUR) results in urine passing retrograde up the ureter. Urinary tract infections (UTI) associated with VUR have been considered a cause of permanent renal parenchymal damage in children with VUR. Management has been directed at preventing UTI by antibiotic prophylaxis and/or surgical correction of VUR. This is an update of a review first published in 2004 and updated in 2007 and 2011. OBJECTIVES: The aim of this review was to evaluate the available evidence for both benefits and harms of the currently available treatment options for primary VUR: operative, non-operative or no intervention. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Specialised Register to 3 May 2018 through contact with the Information Specialist using search terms relevant to this review. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE, and EMBASE; handsearching conference proceedings, and searching the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA: RCTs in any language comparing any treatment of VUR and any combination of therapies. DATA COLLECTION AND ANALYSIS: Two authors independently determined study eligibility, assessed quality and extracted data. Dichotomous outcomes were expressed as risk ratios (RR) with 95% confidence intervals (CI) and continuous data as mean differences (MD) with 95% CI. Data were pooled using the random effects model. MAIN RESULTS: Thirty four studies involving 4001 children were included. Interventions included; long-term low-dose antibiotics, surgical reimplantation of ureters, endoscopic injection treatment, probiotics, cranberry products, circumcision, and oxybutynin. Interventions were used alone and in combinations. The quality of conduct and reporting of these studies was variable, with many studies omitting crucial methodological information used to assess the risk of bias. Only four of the 34 studies were considered at low risk of bias across all fields of study quality. The majority of studies had many areas of uncertainty in the risk of bias fields, reflecting missing detail rather than stated poor design.Low-dose antibiotic prophylaxis compared to no treatment/placebo may make little or no difference to the risk of repeat symptomatic UTI (9 studies, 1667 children: RR 0.77, 95% CI 0.54 to 1.09; low certainty evidence) and febrile UTI (RR 0.83, 95% CI 0.56 to 1.21; low certainty evidence) at one to two years. At one to three years, antibiotic prophylaxis made little or no difference to the risk of new or progressive renal damage on DMSA scan (8 studies, 1503 children: RR 0.73, 95% CI 0.33 to 1.61; low certainty evidence). Adverse events were reported in four studies with little or no difference between treatment groups (1056 children: RR 0.94, 95% CI 0.81 to 1.08; ), but antibiotics increased the likelihood of bacterial drug resistance threefold (187 UTIs: RR 2.97, 95% CI 1.54 to 5.74; moderate certainty evidence).Seven studies compared long-term antibiotic prophylaxis alone with surgical reimplantation of ureters plus antibiotics, but only two reported the outcome febrile UTI (429 children). Surgery plus antibiotic treatment may reduce the risk of repeat febrile UTI by 57% (RR 0.43, 95% CI 0.27 to 0.70; moderate certainty evidence). There was little or no difference in the risk of new kidney defects detected using intravenous pyelogram at 4 to 5 years (4 studies, 572 children, RR 1.09, 95% CI 0.79 to 1.49; moderate certainty evidence)Four studies compared endoscopic injection with antibiotics alone and three reported the outcome febrile UTI. This analysis showed little or no difference in the risk of febrile UTI with endoscopic injection compared to antibiotics (RR 0.74, 95% CI 0.31 to 1.78; low certainty evidence). Four studies involving 425 children compared two different materials for endoscopic injection under the ureters (polydimethylsiloxane (Macroplastique) versus dextranomer/hyaluronic acid polymer (Deflux), glutaraldehyde cross-linked (GAX) collagen (GAX) 35 versus GAX 65 and Deflux versus polyacrylate polyalcohol copolymer (VANTRIS)) but only one study (255 children, low certainty evidence) had the outcome of febrile UTI and it reported no difference between the materials. All four studies reported rates of resolution of VUR, and the two studies comparing Macroplastique with Deflux showed that Macroplastique was probably superior to dextranomer/hyaluronic acid polymer (3 months: RR 0.50, 95% CI 0.33 to 0.78; 12 months: RR 0.54 95% CI 0.35 to 0.83; low certainty evidence)Two studies compared probiotic treatment with antibiotics and showed little or no difference in risk of repeat symptomatic UTI (RR 0.82 95% CI 0.56 to 1.21; low certainty evidence)Single studies compared circumcision with antibiotics, cranberry products with no treatment, oxybutynin with placebo, two different surgical techniques and endoscopic injection with no treatment. AUTHORS' CONCLUSIONS: Compared with no treatment, the use of long-term, low-dose antibiotics may make little or no difference to the number of repeat symptomatic and febrile UTIs in children with VUR (low certainty evidence). Considerable variation in the study designs and subsequent findings prevented drawing firm conclusions on efficacy of antibiotic treatment.The added benefit of surgical or endoscopic correction of VUR over antibiotic treatment alone remains unclear since few studies comparing the same treatment and with relevant clinical outcomes were available for analysis.


Assuntos
Infecções Urinárias/prevenção & controle , Refluxo Vesicoureteral/terapia , Resinas Acrílicas/uso terapêutico , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Criança , Colágeno/uso terapêutico , Dextranos/uso terapêutico , Dimetilpolisiloxanos/uso terapêutico , Feminino , Febre/etiologia , Febre/prevenção & controle , Humanos , Ácido Hialurônico/uso terapêutico , Rim/anormalidades , Masculino , Probióticos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Reimplante , Ureter/cirurgia , Infecções Urinárias/complicações , Refluxo Vesicoureteral/complicações
12.
J Pediatr Nurs ; 45: e89-e94, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30738633

RESUMO

PURPOSE: The characteristics of postoperative fever after cleft repair surgery in children are unknown. Thus, the purpose of this study was to determine the incidence of and risk factors for postoperative fever. DESIGN AND METHODS: We retrospectively assessed 328 children who underwent cleft surgery at our hospital between March 2016 and April 2017 and were followed up for at least 3 days postoperatively. Fever was defined as a body temperature ≥38.0 °C. RESULTS: Seventy-one percent (n = 233) of patients developed fever within 72 h postoperatively, and most cases of postoperative fever were benign. Patients most frequently developed fever within 24 h postoperatively, and the occurrence of fever significantly decreased between 24 and 72 h postoperatively (p < 0.001). The incidence of fever with temperatures between 38.0 °C and 39.0 °C was higher than that of fever with temperatures ≥39.0 °C (p < 0.001). The mean duration of an episode of fever was 4 h. The type of surgery, method of anesthesia, and duration of anesthesia and surgery were found to be correlated with postoperative fever after cleft surgery. CONCLUSIONS: Most cases of postoperative fever after cleft surgery were benign occurrences. Postoperative fever after cleft repair surgery was characterized by a low grade, an early onset and a short duration in children. The method of anesthesia, duration of surgery and duration of anesthesia were risk factors for postoperative fever. PRACTICE IMPLICATIONS: Our results could help healthcare providers to gain increased knowledge of the risk factors for fever and when and how to treat postoperative fever.


Assuntos
Anestesia/efeitos adversos , Fissura Palatina/cirurgia , Febre/etiologia , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/etiologia , Anestesia/métodos , Criança , Pré-Escolar , Feminino , Febre/prevenção & controle , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Fatores de Risco
13.
Intensive Care Med ; 45(4): 468-476, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30741326

RESUMO

PURPOSE: One potential way to protect patients from the physiological demands that are a consequence of fever is to aim to prevent fever and to treat it assiduously when it occurs. Our primary hypothesis was that more active fever management would increase survival among patient subgroups with limited physiological reserves such as older patients, patients with higher illness acuity, and those requiring organ support. METHODS: We conducted an individual-level patient data meta-analysis of randomised controlled trials to compare the outcomes of ICU patients who received more active fever management with the outcomes of patients who received less active fever management. The primary outcome variable of interest was the unadjusted time to death after randomisation. RESULTS: Of 1413 trial participants, 707 were assigned to more active fever management and 706 were assigned to less active fever management. There was no statistically significant heterogeneity in the effect of more active compared with less active fever management on survival in any of the pre-specified subgroups that were chosen to identify patients with limited physiological reserves. Overall, more active fever management did not result in a statistically significant difference in survival time compared with less active fever management [hazard ratio 0.91; (95% CI 0.75-1.10), P = 0.32]. CONCLUSIONS: Our findings do not support the hypothesis that more active fever management increases survival compared with less active fever management overall or in patients with limited physiological reserves.


Assuntos
Estado Terminal/terapia , Febre/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Adulto , Febre/fisiopatologia , Febre/prevenção & controle , Humanos
14.
Complement Ther Med ; 42: 429-437, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30670279

RESUMO

INTRODUCTION: It is believed that tubulointerstitial inflammation plays a role in the formation of renal scarring secondary to acute pyelonephritis (APN). Vitamin A is an anti-inflammatory agent that is involved in the re-epithelialization of damaged mucosal surfaces. OBJECTIVE: The aim of this study was to evaluate the efficacy of vitamin A supplementation in combination with antibiotics for improving urinary tract infections (UTIs) symptoms and preventing renal scarring in girls with APN. STUDY DESIGN: This randomized, double-blind, placebo-controlled clinical trial was conducted on 90 girls aged 2 to 12 years old between 2015 and 2017. Patients with UTIs and first episode of APN diagnosed based on 99 mTc-DMSA scintigraphy (uptake defect) were assessed for eligibility. Patients were randomly divided into two groups that either received 10 days of oral vitamin A (intervention group) or 10 days of placebo (control group) in addition to antibiotics during the acute phase of infection. The clinical response was considered as the primary outcome [duration (positive days) of UTI symptoms during trial treatment period] and secondary outcomes (no change, improving and or worsening of 99 mTc-DMSA scan results 6 months after treatment from baseline). P < 0.05 was considered to be statistically significant. RESULTS: Seventy-four patients (vitamin A group: 36 patients, placebo: 38 patients) were included in the analysis. The mean age was 5.25 ± 1 year old. Three patients (7.89%) in the placebo group and 2 patients (5.55%) in the vitamin A group had vesicoureteral reflux (VUR) (p = 0.114). Duration of fever (vitamin A group: 1.8 days, placebo: 3.1 days, p = 0.0026), urinary frequency (1.3 days vs. 2.8 days, p = 0.003) and poor feeding (2.3 days vs. 4.2 days, p = 0.005) were significantly lower in the vitamin A group. Following the second 99 mTc-DMSA scan, worsening of lesions was observed among 8 (22.2%) and 17 (44.7%) patients in the vitamin A and placebo groups, respectively (p = 0.003). 63.8% (23 patients) of the vitamin A group and 21% (8 patients) of placebo group showed lesion improving in the photopenic region. (P < 0.0001) There was no evidence of vitamin A intolerance. DISCUSSION: Our results show the efficacy of vitamin A supplementation on reducing renal scarring secondary to APN and on fever, urinary frequency and poor feeding duration in girls with APN. CONCLUSION: Vitamin A supplementation is effective for improving the clinical symptoms of UTI and reducing renal injury and scarring following APN in girls with first APN. However, larger randomized clinical trials (RCTs) with longer follow up are needed to confirm these effects.


Assuntos
Cicatriz/prevenção & controle , Suplementos Nutricionais , Rim/efeitos dos fármacos , Pielonefrite/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico , Vitamina A/uso terapêutico , Vitaminas/uso terapêutico , Doença Aguda , Criança , Pré-Escolar , Cicatriz/etiologia , Método Duplo-Cego , Comportamento Alimentar/efeitos dos fármacos , Feminino , Febre/prevenção & controle , Humanos , Lactente , Rim/patologia , Pielonefrite/complicações , Resultado do Tratamento , Infecções Urinárias/complicações , Micção/efeitos dos fármacos , Vitamina A/farmacologia , Vitaminas/farmacologia
15.
J Knee Surg ; 32(2): 171-179, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29514368

RESUMO

Low doses of corticosteroids have been proved to be effective in decreasing the inflammatory cytokines and relieving the pain. However, the optimal dosage of corticosteroids in total knee arthroplasty (TKA) is undetermined. A total of 103 patients were randomly divided into three groups. Group A containing 32 patients received normal saline. Group B including 36 patients used two doses of 100 mg hydrocortisone, given 2 hours before and 8 hours after surgery. Group C involving 35 patients received four doses of 100 mg hydrocortisone, 8 hours apart.The level of interleukin 6 (IL-6) and C-reactive protein (CRP) were lower in group C than those in group A when detected at 12, 24, and 48 hours after operation and even lower than that in group B at 24 and 48 hours (p < 0.05, all). The visual analog scale (VAS) pain scores were significantly reduced by using two doses of hydrocortisone at the first 12 hours compared with group A (p > 0.05), but it did not show statistic difference 24 hours later (p > 0.05). For comparison, patients with multiple doses achieved continuously better outcomes on pain management than the blank control group within postoperative 36 hours at rest and at 24 hours with activity. In addition, patients using multiple doses of hydrocortisone achieved fewer occurrences of nausea and vomiting, fever, and sleeplessness, better knee function recovery, better patient satisfaction, and shorter length of hospital stays (p < 0.05, all).Multiple dose of hydrocortisone was benefit to the pain management and early rehabilitation in TKA and may be recommended to the clinical practice.


Assuntos
Artroplastia do Joelho/reabilitação , Glucocorticoides/administração & dosagem , Hidrocortisona/administração & dosagem , Dor Pós-Operatória/prevenção & controle , Proteína C-Reativa/análise , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Febre/prevenção & controle , Humanos , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Náusea e Vômito Pós-Operatórios/prevenção & controle , Distúrbios do Início e da Manutenção do Sono/prevenção & controle , Escala Visual Analógica
16.
Dev Psychobiol ; 61(1): 96-106, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30338516

RESUMO

This study investigated the effect of inflammation and MgSO4 pretreatment on behaviors caused by hyperthermia (HT) and the effect of these interventions on PTZ-induced seizure a week later. In this experimental study, rat pups experienced inflammation on postnatal day 10 (P10). On P18-19, the pups received either saline or MgSO4 then subjected to hyperthermia. On P25-26, PTZ-induced seizure was initiated in the rats. Neonatal inflammation increased the susceptibility to HT-induced seizure. Inflammation and HT increased the susceptibility to PTZ-induced seizure. Pretreatment with MgSO4 before hyperthermia decreased the susceptibility to both HT- and PTZ-induced seizure. Furthermore, calcium and magnesium blood levels significantly decreased compared to control rats. It can be concluded that neonatal inflammation potentiates while pretreatment with MgSO4 attenuates HT-induced seizures. Also, neonatal inflammation and HT potentiate PTZ-induced seizure initiated one week later.


Assuntos
Anticonvulsivantes/farmacologia , Febre/complicações , Febre/prevenção & controle , Inflamação/complicações , Sulfato de Magnésio/farmacologia , Convulsões/etiologia , Convulsões/prevenção & controle , Animais , Animais Recém-Nascidos , Anticonvulsivantes/administração & dosagem , Feminino , Sulfato de Magnésio/administração & dosagem , Masculino , Ratos
17.
J Gynecol Obstet Hum Reprod ; 48(1): 65-68, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30447348

RESUMO

PURPOSE: To evaluate the efficacy of preoperative vaginal cleansing using povidone-iodine solution 10% on rates of post cesarean section (CS) infectious morbidities (endometritis, febrile morbidity and wound infection). METHODS: This prospective randomized trial was conducted among 226 pregnant women scheduled for term elective CS. Patients were equally divided into two groups by simple randomization method. The study group had preoperative vaginal cleansing using povidone-iodine solution 10% for about 1 min, while the control group did not. All cases received the prophylactic antibiotics and the usual abdominal scrub. Adverse post CS infectious morbidities such as endometritis, febrile morbidity and wound infection were observed at the time of hospital discharge and weekly for 6 weeks postpartum. RESULTS: Both groups were matched regarding the baseline patients' characteristics. Overall, post-CS infectious morbidity was significantly reduced from 20.7% in the control group to 7.5% in the intervention group. Marked significant reduction was seen in the incidence of endometritis (11.8% in the control group versus 2.8% in the intervention group). However, maternal fever and wound infection showed no significant difference between both groups. CONCLUSION: Vaginal cleansing with povidone-iodine solution 10% prior to elective CS appears to be effective in reducing rates of post-CS infectious morbidity mainly endometritis.


Assuntos
Anti-Infecciosos Locais/uso terapêutico , Cesárea/métodos , Desinfecção/métodos , Endometrite/prevenção & controle , Febre/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Povidona-Iodo/uso terapêutico , Cuidados Pré-Operatórios/métodos , Vagina , Administração Intravaginal , Adulto , Cesárea/estatística & dados numéricos , Desinfecção/estatística & dados numéricos , Endometrite/epidemiologia , Feminino , Febre/epidemiologia , Humanos , Complicações Pós-Operatórias/epidemiologia , Gravidez , Cuidados Pré-Operatórios/estatística & dados numéricos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle
18.
Rev. gaúch. enferm ; 40(spe): e20180218, 2019. tab, graf
Artigo em Português | LILACS | ID: biblio-1004110

RESUMO

Resumo OBJETIVO Descrever a implantação do protocolo de termorregulação para procedimentos cirúrgicos em recém-nascido (RN). MÉTODOS Relato de experiência, realizado em uma unidade neonatal em Salvador-BA, no período de janeiro de 2016 a janeiro 2017. O ciclo Plan, Do, Check, Action norteou a construção, a implantação e a aplicabilidade do protocolo. RESULTADOS Implantação do protocolo que possibilitou a redução de eventos adversos por instabilidade térmica durante procedimentos cirúrgicos e introdução de novas tecnologias. CONCLUSÃO O protocolo possibilitou a melhoria e o fortalecimento das práticas assistenciais relacionadas com a cirurgia segura em RN.


Resumen OBJETIVO Describir la implementación del protocolo de termorregulación para procedimientos quirúrgicos en recién nacido (RN). MÉTODOS Relato de experiencia, realizado en una unidad neonatal en Salvador-BA, en el período de enero de 2016 a enero de 2017. El ciclo Plan, Do, Check, Action orientó la construcción, la implementación y la aplicabilidad del protocolo. RESULTADOS Se pudo implementar el protocolo que permitió reducir eventos adversos por inestabilidad térmica durante procedimientos quirúrgicos y se introdujo nuevas tecnologías. CONCLUSIÓN El protocolo permitió una mejora y un fortalecimiento de las prácticas asistenciales, relacionadas con la cirugía segura en RN.


Abstract OBJECTIVE To describe the thermoregulation protocol implementation for newborns (NB). METHODS An experimental report, conducted at a neonatal unit in Salvador, Bahia, from January 2016 to January 2017. The Plan, Do, Check, Action cycle guided the construction, implementation and applicability of the protocol. RESULTS Implementation of the protocol that allowed the reduction of adverse events due to thermal instability during surgical procedures and introduction of new technologies. CONCLUSION The protocol could improve and strengthen the care practices related to safe surgery in newborns.


Assuntos
Humanos , Recém-Nascido , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Operatórios , Protocolos Clínicos , Assistência Perioperatória/métodos , Febre/prevenção & controle , Hipotermia/prevenção & controle , Complicações Intraoperatórias/prevenção & controle , Guias de Prática Clínica como Assunto
19.
Malar J ; 17(1): 406, 2018 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-30390652

RESUMO

BACKGROUND: As malaria is among the leading public health problems globally, early diagnosis and treatment of cases is one of the key interventions for its control and elimination. Nevertheless, little is known about early treatment-seeking behaviour for malaria of people in Ethiopia. This study was conducted to investigate early treatment-seeking behaviour and associated factors among febrile patients in Dera district, one of the malaria hotspot districts in Ethiopia. METHODS: An institution-based, cross-sectional study was conducted among malaria-suspected febrile patients in Dera district, Amhara Regional State, Ethiopia from September to December 2017. The study used the lottery method to select sample health facilities, and participant allocation to facilities was done in proportion to client flow to the respective health facilities. Data were collected by interview. Thus, binary logistic regression model was fitted to the data. Crude and adjusted odds ratios with the respective confidence intervals and p-values were computed. An explanatory variable with a p-value ≤ 0.05 was considered statistically significant. SPSS version 20 was used for the analysis. RESULTS: A total of 680 respondents completed the study with a response rate of 96.6%. The study revealed that 356 (52.4%) participants sought treatment within 24 h of fever onset, and patients who: knew the advantage of sleeping under nets [AOR 95% CI 2.8 (1.70-4.60)]; knew mosquito breeding sites [AOR 95% CI 1.9 (1.10-3.30)]; had good, overall knowledge about malaria [AOR 95% CI 2.7 (1.56-4.76)]; had previous history of malaria [AOR 95% CI 3.26 (1.64-6.49)]; were at a distance of < 6 km from a health centre [AOR 95% CI 2.5 (1.72-3.60)]; and, had family size < 5 [AOR 95% CI 2.1 (1.43-3.20)], were more likely to seek treatment within 24 hof fever onset. CONCLUSION: A low proportion of malaria-suspected patients sought treatment within 24 h of fever onset compared to the national target. Awareness about the advantage of sleeping under nets, knowledge about mosquito breeding sites and malaria itself, previous history of malaria, distance from the health centres, and family size were found to be predictors of early treatment-seeking behaviour for malaria. Strengthening strategies tailored to increasing awareness for communities about malaria prevention methods and early treatment-seeking behaviour is essential.


Assuntos
Febre/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Malária/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Etiópia , Feminino , Febre/prevenção & controle , Humanos , Malária/prevenção & controle , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
Eur J Haematol ; 101(6): 721-727, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30107054

RESUMO

Antibiotics are frequently administered for prophylaxis of fever in neutropenic children with cancer. This strategy is mainly derived from adults' data, and various pediatric studies evidenced the effectiveness of antibiotics (eg, fluoroquinolones) in the prevention of febrile neutropenia. However, only two pediatric randomized, double-blind, placebo-controlled trials have been performed, with a total of 262 leukemic children enrolled, and no other one was ever powered for analyzing effectiveness over other infectious complications. In an era of increasing antibiotic resistance, the widespread use of antibiotic prophylaxis in neutropenic leukemic children needs to be strongly supported.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Infecções Bacterianas/etiologia , Infecções Bacterianas/prevenção & controle , Leucemia Mieloide Aguda/complicações , Neutropenia/complicações , Neutropenia/etiologia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Criança , Febre/etiologia , Febre/prevenção & controle , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Leucemia Mieloide Aguda/terapia , Pediatria
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