ABSTRACT
Resumen El síndrome de Guillain-Barré (SGB) es una enfermedad inmunológica del nervio periférico y las raíces nerviosas, poco frecuente, potencialmente mortal y que suele desencadenarse por infecciones. La incidencia del SGB puede aumentar durante el brote de enfermedades infecciosas, tal como se observó en las epidemias del virus Zika en la Polinesia Francesa en 2013 y en América Latina en 2015. El diagnóstico y el manejo clínico del SGB pueden ser complicados ya que su presentación y el curso de la enfermedad son heterogéneos, y actualmente no se cuenta con guías clínicas internacionales. Para respaldar a los médicos, especialmente en el contexto de un brote de una enfermedad infecciosa, hemos desarrollado una guía clínica aplicable en todo el mundo para el diagnóstico y el tratamiento del SGB. La guía se basa en literatura actualizada y el consenso de expertos, y tiene una estructura de diez pasos para facilitar su uso en la práctica clínica. Inicialmente, brindamos una introducción a los criterios de diagnóstico, variantes clínicas y diagnósticos diferenciales del SGB. Los diez pasos luego abordan el reconocimiento y el diagnóstico temprano del SGB, la admisión a la unidad de cuidados intensivos, indicación y selección de tratamiento, seguimiento y tratamiento de la progresión de la enfermedad, predicción del curso clínico, resultados y tratamiento de complicaciones y secuelas.
Abstract Guillain-Barré syndrome (GBS) is a rare, but potentially fatal, immune-mediated disease of the peripheral nerves and nerve roots that is usually triggered by infections. The incidence of GBS can therefore increase during outbreaks of infectious diseases, as was seen during the Zika virus epidemics in 2013 in French Polynesia and in 2015 in Latin America. Diagnosis and management of GBS can be complicated as its clinical presentation and disease course are heterogeneous, and no international clinical guidelines are currently available. To support clinicians, especially in the context of an outbreak, we have developed a globally applicable guideline for the diagnosis and management of GBS. The guideline is based on current literature and expert consensus, and has a ten-step structure to facilitate its use in clinical practice. We first provide an introduction to the diag nostic criteria, clinical variants and differential diagnoses of GBS. The ten steps then cover early recognition and diagnosis of GBS, admission to the intensive care unit, treatment indication and selection, monitoring and treatment of disease progression, prediction of clinical course and outcome, and management of complications and sequelae.
Subject(s)
Humans , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/therapy , Guillain-Barre Syndrome/epidemiology , Zika Virus Infection/diagnosis , Zika Virus Infection/therapy , Zika Virus Infection/epidemiology , Incidence , Disease Outbreaks , Zika VirusABSTRACT
Los problemas médicos gastrointestinales, nutricionales, metabólicos, endocrinológicos y de microbiota en los pacientes pediátricos con diagnóstico de trastorno del espectro autista (TEA) son parte de los problemas médicos concomitantes al diagnóstico. La prevalencia alcanza a más del 91 % en el caso de los problemas gastrointestinales, hasta el 89 % para los nutricionales y metabólicos, más del 50 % de disfunción tiroidea y hasta el 100 % para los relacionados con la microbiota.Es urgente actualizar la práctica médica para incluir la evaluación, testeo, diagnóstico y tratamiento de estos problemas médicos concomitantes al diagnóstico de TEA en la población pediátrica, adolescente y adulta. El tratamiento riguroso de dichos problemas genera cambios positivos en la calidad de vida y en la sintomatología bajo la cual el TEA se diagnostica en muchos casos. Debe basarse en evidencia científica de alta calidad, con control y cuidado médico adecuado
Gastrointestinal, nutritional, metabolic, endocrine, and microbiota medical problems in pediatric patients diagnosed with autism spectrum disorder (ASD) are some of the coexisting medical conditions in ASD diagnosis. Their prevalence reaches more than 91 % for gastrointestinal problems, up to 89 % for nutritional and metabolic disorders, more than 50 % for thyroid dysfunction, and up to 100 % for microbiota-related conditions.There is an urgency for medical practice to be updated and to include the assessment, testing, diagnosis, and treatment of these coexisting medical conditions in ASD diagnosis in the pediatric, adolescent, and adult population. A strict management of such conditions results in positive changes in the quality of life and symptoms based on which ASD is diagnosed many times. It should be based on high-quality scientific evidence with an adequate medical care and control
Subject(s)
Humans , Child, Preschool , Child , Adolescent , Endocrine System Diseases/metabolism , Microbiota , Autism Spectrum Disorder/microbiology , Gastrointestinal Diseases/metabolism , Concurrent Symptoms , Nutritional Status , Autism Spectrum Disorder/complications , Autism Spectrum Disorder/diet therapy , Autism Spectrum Disorder/metabolism , Gastrointestinal Diseases/complications , Gastrointestinal Diseases/diet therapyABSTRACT
Hérnias são umas das afecções que mais acometem os pequenos e grandes animais, podendo ter origem traumática ou não. Estas afecções, geralmente, necessitam de um reparo cirúrgico o mais rápido possível, devido ao fato de suas consequências poderem levar o animal ao óbito. Alguns estudos têm avaliado o comportamento da túnica albugínea como biomaterial de enxertia para reforço de parede abdominal, obtendo resultados favoráveis. O presente trabalho tem como objetivo avaliar o comportamento do enxerto de túnica albugínea ovina na parede abdominal de ratos. Foram selecionados 30 ratos da raça Wistar, os quais foram divididos em 2 grupos de 15 animais, sendo um grupo controle (C), um grupo teste (TA), onde os animais receberam reforço de parede abdominal com túnica albugínea ovina. Cada grupo foi dividido em três subgrupos contendo cinco animais, que foram submetidos à eutanásia nos dias 7, 21 e 42. O material coletado foi submetido a análises macroscópicas e histopatológicas a fim de afirmar a aplicabilidade do material e propor a utilização da túnica albugínea heteróloga como material de enxertia para a reconstrução da parede abdominal. Nos animais do grupo TA observou-se maior infiltrado inflamatório, neovascularização, deposição de colágeno e fibrose do que nos animais do grupo controle, concluindo assim que a túnica albugínea ovina é um biomaterial que funciona como substrato e promove uma precocidade da cicatrização de parede abdominal de ratos.
Hernias are one of the infections that most affect small and large animals, and may have traumatic origin or not. These conditions usually require a surgical repair as soon as possible, due to the fact that its consequences can lead the animal to death. Some studies have evaluated the behavior of the Tunica albuginea as a biomaterial for grafting abdominal wall reinforcement, obtaining favorable results. This study aims to evaluate the ovine Tunica albuginea graft behavior in the abdominal wall of rats. We selected 30 Wistar rats, which were divided into 2 groups of 15 rats, with a control group (C) and a test group (TA) where the rats received abdominal wall reinforcement with ovine Tunica albuginea. Each group was divided into three subgroups with five rats that were sacrificed on days 7, 21 and 42. The collected material was submitted to macroscopic and histopathological analysis to affirm the suitability of the material and propose the use of heterologous Tunica albuginea as grafting material for the reconstruction of the abdominal wall. In the TA group there was a higher inflammatory infiltration, neovascularization and collagen deposition and fibrosis than in group control, thus concluding that the ovine Tunica albuginea is a biomaterial that acts as substrate and promotes precocity of the abdominal wall healing of rats.