ABSTRACT
Non-Alcoholic Fatty Liver disease (NAFLD) can lead to Non Alcoholic steatohepatitis (NASH), cirrhosis, and liver cancer. The treatment for NAFLD involves modification of caloric intake and physical activity. NAFLD has a pro-oxidant nature; therefore, it is logical to suppose that the antioxidant methionine can be used as a treatment for this disease. Aim. This study aimed to evaluate the effect of high-methionine dietary therapy on patients with NAFLD. Materials and methods. A randomized clinical study was conducted over three months. In this study, 121 NAFLD patients participated, and the age of the participants was ≥ 20 years (experimental group included 56 and control group 65), all of whom were randomized and matched by sex, recluted from the ISSSTE hospital in Xalapa, Mexico. The patients were instructed to consume food to cover the recommended methionine daily doses, and the daily amount consumed was calculated. Methionine effect was measured as NAFLD regression and quality of life improvement. Results. Nutritional therapy induced NAFLD regression and diminished central fat accumulation, blood pressure, and the fatty liver index. Some parameters, such as liver enzymes, did not changed. The quality of life of patients improved after treatment. Conclusions. In this study, we show a hepatoprotective effect induced only in three months of chances in the diet, thus, a longer diet may generate more relevant benefits in the resistant parameters of our study(AU)
La enfermedad del hígado graso no alcohólico (NAFLD) puede conducir a la esteatohepatitis no alcohólica (NASH), la cirrosis y el cáncer de hígado. El tratamiento para NAFLD es la modificación de la ingesta calórica y la actividad física. Debido a que NAFLD tiene una naturaleza pro-oxidante; es lógico suponer que el antioxidante metionina puede utilizarse en el tratamiento de esta enfermedad. Objetivo. el presente trabajo evaluó el papel de la terapia nutricional con alimentos ricos en metioninaen pacientes con NAFLD. Materiales y Métodos. Se realizó un ensayo clínico aleatorizado durante tres meses. Participaron en el estudio 121 pacientes con NAFLD con edad ≥ 20 años (56 en el grupo experimental y 65 en el control), todos aleatorizados y pareados por sexo, reclutados de la Clínica Hospital ISSTE en la ciudad de Xalapa, México, en el año 2015. Se instruyó a los pacientes en consumir los alimentos hasta completar la dosis diaria recomendada de metioninay se calculó la cantidad diaria consumida. Su efecto se midió como la regresión de NAFLD y la mejora de la calidad de vida. Resultados. La terapia nutricional retrocedió NAFLD; disminuyó la acumulación de grasa central, la presión arterial y el índice de hígado graso. Algunos parámetros, como las enzimas de la función hepática, no se modificaron con el tratamiento. Otro parámetro fue la mejora de la calidad de vida de los pacientes tratados. Conclusiones. En este trabajo mostramos un impacto hepatoprotector producido con tan solo tres meses de cambios en la dieta, por lo que una dieta más prolongada podría generar beneficios aún más significativos en los parámetros resistentes en nuestro protocolo(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Feeding Behavior , Non-alcoholic Fatty Liver Disease , Liver Cirrhosis , Energy Intake , Exercise , Diet , MethionineABSTRACT
Resumen Introducción: El comportamiento suicida hace referencia a las diversas conductas para dejar de vivir es un fenómeno multifactorial ampliamente estudiado en población urbana, sin embargo, la población campesina, especialmente agricultores y trabajadores agrícolas están entre los grupos de alto riesgo. Objetivo: Evaluar las relaciones entre el riesgo suicida y las estrategias de afrontamiento al estrés en una muestra de 76 campesinos entre los 18 y 79 años del municipio de El Santuario, Colombia, durante la emergencia sanitaria por Covid-19. Método: Para este estudio se utilizó un diseño descriptivo correlacional de corte transversal y se emplearon como instrumentos la Escala de Evaluación de Riesgo Suicida -ERS- y la Escala de Estilos y Estrategias de Afrontamiento (EEEAE). Resultados: Los resultados encontrados en la Escala ERS no indicaron niveles clínicos de riesgo suicida. Y respecto a la EEEAE casi siempre los participantes usaban las estrategias de Reevaluación positiva, Apoyo social, Desconexión cognitiva y Resolver el problema. Hubo correlaciones negativas entre todas las dimensiones de la escala ERS con EEEAE, menos entre las dimensiones Depresión/Desesperanza y Aislamiento/Soporte social (ERS) con la Desconexión cognitiva (EEEAE) y especialmente la estrategia de Reevaluación Positiva tuvo un peso significativo sobre riesgo suicida. Conclusiones: La Reevaluación Positiva es una estrategia de afrontamiento que puede proteger la salud mental ante situaciones de estrés asociados con el riesgo suicida de la población campesina, los agricultores y trabajadores agrícolas.
Abstract Introduction: Suicidal behavior refers to the various behaviors to stop living, it is a multifactorial phenomenon widely studied in the urban population, however, the rural population, especially farmers and agricultural workers, are among the high-risk groups. Objective: Evaluate the relationships between suicidal risk and stress coping strategies in a sample of 76 peasants between 18 and 79 years of age from the municipality of El Santuario, Colombia during the Covid-19 health emergency. Method: For this study, a cross-sectional correlational descriptive design was used. The Suicide Risk Assessment Scale -SRAS- and the Coping Styles and Strategies Scale were used as measurement instruments (CSSS). Results: The results found in the SRAS Scale did not indicate clinical levels of suicidal risk. And regarding the EEEAE, the participants almost always used the strategies of Positive Reappraisal, Social Support, Cognitive Disconnection and Problem-Solving skills. There were negative correlations between all the dimensions of the SRAS scale with CSSS, less between the dimensions Depression/Hopelessness and Isolation/social support (SRAS) with Cognitive Disconnection (CSSS) and especially the Positive Reappraisal had a significant weight on suicidal risk. Conclusions: Positive Reappraisal is a coping strategy that can protect mental health in situations of stress associated with suicidal risk of the rural population, farmers, and agricultural workers.
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Antecedentes La carga de enfermedad y el tratamiento de la psoriasis han sido bien caracterizados en los países desarrollados, pero los estudios epidemiológicos realizados en America Latina son escasos. Objetivos Describir las características sociodemográficas, clínicas y económicas de la psoriasis en pacientes pediátricos y adultos de Colombia. Métodos Este fue un estudio observacional transversal que incluyó pacientes recolectados en consultorios privados de dermatología, instituciones prestadoras de salud y hospitales de siete ciudades de Colombia. Se incluyeron datos relacionados con la distribución de la enfermedad, peso, altura, índice de masa corporal, medición de la cintura/cadera, severidad de la enfermedad, tratamiento, antecedentes de comorbilidades y costos directos para el paciente o la familia. Se realizó un análisis de regresión logística múltiple para evaluar las asociaciones entre la severidad de la psoriasis y las variables sociodemográficas y clínicas. Resultados Se incluyeron 203 pacientes (43.8% mujeres y 56.2% hombres) con un rango de edad entre 7 a 89 años. El subtipo principal fue la psoriasis vulgar y la edad media de diagnóstico fue de 37,1 años. Las comorbilidades más frecuentes fueron la obesidad, la hipertensión arterial, la artritis psoriásica, la dislipidemia y la diabetes. Las mujeres tuvieron un mayor riesgo de presentar artritis psoriásica. El índice de masa corporal y la hipertensión se asociaron significativamente con la severidad de la psoriasis, mientras que ser mujer y no obeso se relacionó con un menor riesgo, respectivamente. Un tercio de los pacientes tenía antecedentes familiares de psoriasis y trastornos del sueño. Cuarenta y uno por ciento de los participantes no tenían ingresos o tenían ingresos inferiores a 224 dólares estadounidenses por mes y >20% de sus ingresos los gastaron en la enfermedad. Conclusiones Este estudio muestra un gran impacto de la psoriasis en los pacientes afectados y contribuye a comprender la carga de la psoriasis en América Latina aportando datos científicos sólidos a la comunidad dermatológica y a las autoridades sanitarias colombianas con respecto a los estándares de atención médica. También crea conciencia sobre la carga económica de la enfermedad y también enfatiza la necesidad de un seguimiento estrecho de los pacientes con psoriasis para prevenir, identificar y manejar sus comorbilidades.
Background Although psoriasis burden and treatment have been well characterized in developed countries, there are scarce in-depth epidemiological studies in Latin American countries. Objectives To describe the sociodemographic and clinical features and the economic burden of psoriasis among children and adult patients from Colombia. Methods This cross-sectional study included patients from dermatology private practice offices, health provider institutions and hospitals in seven Colombian cities. We collected data on disease distribution, weight, height, body mass index, waist-hip ratio, disease severity, therapy, personal history of comorbidities, and direct costs. Multiple logistic regression analyses were conducted to assess the associations between severity scales and sociodemographic and clinical variables. Results Two-hundred-three patients (43.8% women, 56.2% men) with an age range between 7 to 89 years old were included. The main subtype was psoriasis vulgaris and mean age of diagnosis was 37.1 years. The most common comorbidities were obesity, hypertension, psoriatic arthritis, dyslipidemia and diabetes. Women had a significant increased odds of presenting with psoriatic arthritis. Body-mass-index and hypertension were significantly associated with a higher psoriasis severity, whereas being female and non-obese was associated with a lower risk. A third of the patients had a family history of psoriasis and sleeping disorders. Forty-one percent of participants either had no income or had an income below 224 US dollars per month and >20% of their income was spent on their disease. Conclusions This study is supported by robust scientific data and contributes to understanding the burden of psoriasis in Latin America. This study adds well-supported data through an in-depth clinical and economical characterization of Colombian children and adult patients with psoriasis and shows the high impact and burden of the disease on patients and their families.
ABSTRACT
Antecedentes. La violencia hacia el adulto mayor es un problema social que ocurre dentro de la familia y que, por miedo, no es denunciado. Esto dificulta el trabajo del personal multiprofesional de salud para la detección, denuncia y prevención de estos casos. Objetivo. Identificar la prevalencia, los tipos de violencia intrafamiliar, su asociación con variables sociodemográficas y la presencia de síntomas depresivos en el adulto mayor que vive en la comunidad de estudio. Materiales y métodos. Estudio cuantitativo, descriptivo y transversal con 369 adultos mayores en el distrito de Breña, Lima (Perú). Se utilizaron el Canadian Task Force on the Periodic Health Examination y la Escala de Depresión Geriátrica como instrumentos de datos sociodemográficos. Para el análisis de los datos se aplicó estadística descriptiva y regresión logística. Resultados. Predominó el sexo femenino, el adulto mayor más joven, el estado civil casado y la conformación familiar por el cónyuge. La prevalencia de violencia intrafamiliar fue 79.7% y de síntomas depresivos 48.2%. Prevaleció la violencia financiera. En la regresión se verificó que aquel que no trabaja tiene mayor chance de sufrir violencia. Entre más años de estudio, disminuye el riesgo de sufrir violencia. Asimismo, aquel que no presenta síntomas depresivos no sufre violencia. Conclusiones. Se verificó que el adulto mayor necesita de atención permanente. El personal de salud debe reconocer síntomas y señales en el adulto mayor que sufre violencia y que presenta síntomas depresivos; debe ofrecer información sobre la importancia de denunciar estos casos para favorecer un envejecimiento saludable y con calidad.
Background. Violence against the elderly is a social problem that occurs within the family and is not reported because of fear. This hinders the work of health multi-professional staff for the detection, reporting and prevention of such cases. Objective. To identify the prevalence, types of domestic violence, its association with socio-demographic variables and depressive symptoms in the elderly living in the community studied. Materials and methods. A quantitative, descriptive, cross-sectional study was carried out with 369 elderly in the district of Breña, Lima (Peru). The Canadian Task Force on the Periodic Health Examination and the Geriatric Depression Scale were used as socio-demographic instruments. For data analysis, descriptive statistics and logistic regression were applied. Results. Female sex, younger elderly, married marital status and family formation by the married were predominant. The prevalence of domestic violence was 79.7% and 48.2% for depressive symptoms. Financial violence was prevalent. During the regression, it was verified that whoever that does not work has a greater chance of suffering violence. The more the years of schooling, the lower the risk of violence. Also, the ones who have depressive symptoms don't suffer violence. Conclusions. It was observed that the elderly need lifelong care. The health staff must recognize signs and symptoms in the elderly suffering violence and presenting depressive symptoms; the health staff must provide information on the importance of reporting cases to promote a healthy and qualitative aging.
ABSTRACT
Introdução: A incidência de defeitos do tubo neural é de cerca de 1/1000 nascimentos. Na mielomenngocele, o tratamento intra-uterino utilizando a técnica neurocirúrgica clássica, apresenta melhor prognóstico neurológico, do que o tratamento pós natal, mas está associado a complicações maternas e fetais. Novas técnicas de correção estão sendo estudadas para diminuir a morbidade materna e fetal. Objetivo: Comparar os efeitos sobre a medula de duas técnicas cirúrgicas de correção intra-uterina de um defeito semelhante à mielomeningocele , em fetos de ovelha. Métodos: Em 15 fetos foi criado um defeito semelhante à mielomeningocele (laminectomia e excisão de dura-máter) no 90° dia de gestação. O tipo de correção foi randomizado. No grupo 1, o defeito foi corrigido usando a técnica neurocirúrgica clássica, com a sutura de três camadas (dura-máter, músculo e pele), realizada por um neurocirurgião. No grupo 2, um especialista em Medicina Fetal, utilizou uma técnica simplificada, colocando um fragmento de celulose Biosintética sobre a medula e suturando apenas a pele sobre a celulose. Próximo ao termo da gestação (132° dias), os fetos foram sacrificados para análise anatomopatológica. Resultados: Ocorreram 1 morte materna, 3 casos de trabalho de parto precoce e 4 tardios. Um total de 10 casos foram viáveis para avaliação anatomopatológica 10 casos, 6 no grupo 1 e 4 no grupo 2. No grupo 1, todos os casos mostraram aderência da medula à cicatriz (meningoadesão) e perda da arquitetura medular por destruição do funículo posterior e 5 de 6 casos apresentaram perda da visualização da substância cinzenta. No grupo 2, observamos em todos os casos, a formação de uma neoduramater, separando o tecido nervoso do músculo adjacente, sendo que o funículo posterior e a substância cinzenta estavam preservados. Conclusão: A técnica simplificada foi superior à técnica neurocirúrgica, com maior preservação da medula e evitando as aderências do tecido nervoso. Nossos...
Introduction: The incidence of neural tube defects is about 1/1000 births. In myelomeninocele, the intrauterine treatment with the classical neurosurgical technique suggest better neurological prognosis for the fetus, than postnatal treatment, but it is associated with maternal and fetal complications. New correction techniques are being studied to decrease maternal and fetal morbidity. Objective: To compare the effects on the medulla of two surgical techniques for intrauterine correction of myelomeningocele-like defect in sheep. Methods: In 15 pregnant sheep a myelomeningocele -like defect (laminectomy and dural excision) was created in the lumbar region in 90o day gestation. The type of correction was randomized. In group 1 the defect was corrected using the classic neurosurgical technique of three layers suture (dura-mater, muscle and skin closure) performed by a neurosurgeon. In group 2, a fetal medicine specialist used a biosynthetic cellulose patch to protect the medulla and only the skin was sutured above it. Near term (132o day gestation) fetuses were sacrificed for pathological analysis. Results: One maternal death occurred, early preterm labour, and late preterm labour occurred in 3 and 4 cases, respectively. A total of 10 cases were available for pathological analysis, 6 in group 1 and 4 in group 2. In group 1, all the cases showed a adherence of the medulla to the scar (meningoneural adhesion) and a destruction of the normal architecture of nervous tissue, whithout view of posterior funiculus and in 5 of 6 cases without view of grey matter. In group 2, in all the cases were observed a formation of an organized tissue involving the cellulose patch, a neoduramater, separating the nervous tissue of adjacent muscle, preserving the posterior funicullus and grey matter. Conclusion: The simplified new technique was better than the classical neurosurgical technique. It preserved the nervous tissued and avoided the adherence of the medulla to the scar....
Subject(s)
Animals , Male , Female , Fetal Therapies , Fetoscopy , Meningomyelocele , Sheep , Spinal DysraphismABSTRACT
Se presenta el caso clínico de una paciente que debutó con hipertensión arterial (HTA) grado II realizándose los estudios sistematizados correspondientes para descartar patologías secundarias. Dentro de los estudios de primera línea en la valoración merece destacarse la ecografía Doppler renal por la información que ella aporta, orientado al diagnóstico de estenosis de la arteria renal. La identificación de una HTA de origen renovascular supone el hallazgo de una de las causas reversibles de hipertensión. Dentro de esta etiología la más frecuente es la displasia fibromuscular (DFM) que mejora con la corrección de la estenosis mediante técnicas quirúrgicas o percutáneas con angioplastia con balón o stent. El objetivo es presentar un caso clínico para mostrar la complejidad del proceso diagnóstico y la importancia que tiene la sospecha clínica para la corrección oportuna de este tipo de HTA reversible...
Subject(s)
Humans , Adolescent , Female , Fibromuscular Dysplasia/complications , Fibromuscular Dysplasia/diagnosis , Fibromuscular Dysplasia/therapy , Hypertension, Renovascular/etiology , Renal Artery Obstruction/therapy , Echocardiography, Doppler , Physical ExaminationABSTRACT
OBJECTIVE: To compare the classical neurosurgical technique with a new simplified technique for prenatal repair of a myelomeningocelelike defect in sheep. METHODS: A myelomeningocele-like defect (laminectomy and dural excision) was created in the lumbar region on day 90 of gestation in 9 pregnant sheep. Correction technique was randomized. In Group 1 the defect was corrected using the classic neurosurgical technique of three-layer suture (dura mater, muscle and skin closure) performed by a neurosurgeon. In Group 2, a fetal medicine specialist used a biosynthetic cellulose patch to protect the spinal cord and only the skin was sutured above it. Near term (day 132 of gestation) fetuses were sacrificed for pathological analysis. RESULTS: There were two miscarriages and one maternal death. In total, six cases were available for pathological analysis, three in each group. In Group 1, there were adherence of the spinal cord to the scar (meningo-neural adhesion) and spinal cord architecture loss with posterior funiculus destruction and no visualization of grey matter. In Group 2, we observed in all cases formation of a neo-dura mater, separating the nervous tissue from adjacent muscles, and preserving the posterior funiculus and grey matter. CONCLUSION: The new simplified technique was better than the classic neurosurgical technique. It preserved the nervous tissue and prevented the adherence of the spinal cord to the scar. This suggests the current technique used for the correction of spina bifida in humans may need to be reassessed.
OBJETIVO: Comparar a técnica neurocirúrgica clássica a uma nova técnica simplificada, para correção de mielomeningocele, em fetos de ovelhas. MÉTODOS: Em 9 fetos, foi criado um defeito semelhante à mielomeningocele (laminectomia e excisão de dura-máter) no 90º dia de gestação. O tipo de correção foi randomizado. No Grupo 1, o defeito foi corrigido usando a técnica neurocirúrgica clássica, com a sutura de três camadas (dura-máter, músculo e pele), realizada por um neurocirurgião. No Grupo 2, um especialista em Medicina Fetal utilizou a técnica simplificada, colocando um fragmento de celulose biossintética sobre a medula e suturando apenas da pele sobre a celulose. Próximo ao termo da gestação (132 dias), os fetos foram sacrificados para análise anatomopatológica. RESULTADOS: Ocorreram dois casos de aborto e uma morte materna, restando seis casos para avaliação - três em cada grupo. No Grupo 1, todos os casos mostraram aderência da medula à cicatriz (meningoadesão) e perda da arquitetura medular, com destruição do funículo posterior e perda da visualização da substância cinzenta. No Grupo 2, observou-se, em todos os casos, a formação de uma neodura-máter, separando o tecido nervoso do músculo adjacente, sendo que o funículo posterior e a substância cinzenta estavam preservados. CONCLUSÃO: A técnica simplificada foi superior à neurocirúrgica, com maior preservação da medula e evitando as aderências do tecido nervoso. Os presentes achados sugerem que a técnica utilizada atualmente na correção de mielomeningocele em fetos humanos deva ser reavaliada.
Subject(s)
Animals , Female , Pregnancy , Fetal Therapies , Fetoscopy/methods , Fetus/surgery , Meningomyelocele/surgery , Neurosurgical Procedures/methods , Disease Models, Animal , Dura Mater/cytology , Dura Mater/surgery , Inventions , Obstetric Labor, Premature , SheepABSTRACT
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Summary Introduction A meaningful doctor-patient relationship is a key factor in medical practice and in the art of curing. In the past, several institutions have recommended the addition of humanistic education among medical doctors not only for enhancing the doctor-patient relationship, but also for improving the quality of medical care. In fact, an empathic physician-patient relationship has been associated with better clinic outcomes. In spite of recommendations, medical empathy is still an unexplored research area in medical education for two reasons. One of these is that theoretical research on empathy is not easy because of a lack of clarity in its conceptualization. Another reason for the dearth of empirical research is the absence of a valid and reliable operational tool by which to measure empathy in patient care situations. A team from the Center for Research in Medical Education and Health Care at the Medical College of Thomas Jefferson University, developed the Jefferson Scale of Physician Empathy (JSPE). The English version factor structure is consistent with conceptual aspects of a multidimensional scale that measures the perspective taking, compassionate care and "standing in the patient's shoes" factors. The JSPE has shown satisfactory psychometric properties; construct, discriminant, and criterion validity has been confirmed among medical students with an internal consistency of 0.89. Empathy may vary among individuals depending on social, educational, and personal experiences, and it corresponds to an interpersonal ability and a clinical competence component. Hence, the availability of a valid and reliable instrument for measuring empathy among medical doctors is a critical issue. However, the instrument should be culturally adapted for the population of interest. Therefore, the present study was designed for evaluating the validity and reliability of the Spanish version of the JPES among Mexican medical students. Material and methods Subjects: 1022 medical students (mean age 21±2.7 years) from the School of Medicine at the Autonomous University of Nuevo Leon, in Monterrey, Mexico (494 women and 528 men). Instrument: The students' version of the JSPE was used to measure the orientation of medical students towards empathy in patient care situations. The JSPE consists of 20 items on a seven-point Likert scale (1=strongly disagree, 7= strongly agree). Procedures: The JSPE was translated into Spanish and back translated following the guidelines to adaptate psychological evaluation instruments. The questionnaire was answered by first (n=687), third (n=183) and fifth grade (n=152) medical students. They were assured of the strict confidentiality of the test and of the individual responses. Plan of analysis: Dimensionality of 20 items was assessed with factors analysis using the principal components extraction method and orthogonal rotation. Cronbach's alpha was calculated for evaluating the internal consistency. Results The exploratory factor analysis allowed the identification of three factors with eigen values greater or equal to one. All the items with coefficients greater than 0.30 of the first factor were positive and corresponded to the perspective taking domain. On the other hand, seven out of ten negative questions loaded to the second factor with coefficients greater than 0.40; all of them were related to compassionate care. Finally, there were other two questions with high loading on the third factor, which matched to "standing in the patient's shoes" domain. The internal consistency was 0.74. The mean of empathy scores was 110 and the standard deviation, 14. The observed range was 44-140 compared to the possible range of 20-140. The mean empathy score was higher for women than men (111.9 ±13.9 vs. 109.08± 14.1, p=.002). Age was not significantly correlated with empathy scores, even after controlling for sex (women: r=-0.01; men: r=0.02). Conclusions The results of study supported the validity of the JSPE among medical students in Mexico. The first factor (perspective taking) corresponded to the main component of empathy. The other two factors, compassionate care and "standing in the patient's shoes", were related to specific components of the doctor-patient relationship. The observed internal consistency was satisfactory for personality tests. The findings showed significantly higher empathy scores for women than men, suggesting that female doctors might render a different type of medical care. These findings are consistent with those reported for U.S.A. medical students. It has been informed that women are more receptive to emotional signs than men and that they devote more time and offer more preventive care to their patients. More scientific evidence is needed to explain these sex differences which represents different implications for the selection of medical training. Interpersonal relationships are especially critical between physicians and patients. Failures in understanding a patient's perspective may result in communication problems, which in turn contribute to the patient's dissatisfaction with care. As soon as the doctor understands what his/her patient thinks and feels, he/she can offer a better care. This is how empathy translates into the vehicle of a meaningful doctor-patient relationship. Finally, empathy measurement is meaningful because it constitutes the first step for examining permanence from the first years of the medical career up to specialty training years. It also allows for the analysis of the impact of educational strategies designed to improve empathy and achieve potential benefits not only for the doctors' professional development but also for their patients' health.
ABSTRACT
From January, 1984 to March, 1999, 31 children under 15 y old (ages 1-14 y, median 8 y) were admitted after being bitten by rattlesnakes (Crotalus durissus ssp). One patient was classified as "dry-bite", 3 as mild envenoming, 9 as moderate envenoming and 18 as severe envenoming. Most patients had neuromuscular manifestations, such as palpebral ptosis (27/31), myalgia (23/31) and weakness (20/31). Laboratory tests suggesting rhabdomyolysis included an increase in total blood creatine kinase (CK, 28/29) and lactate dehydrogenase (LDH, 25/25) levels and myoglobinuria (14/15). The main local signs and symptoms were slight edema (20/31) and erythema (19/31). Before antivenom (AV) administration, blood coagulation disorders were observed in 20/25 children that received AV only at our hospital (incoagulable blood in 17/25). AV early reactions were observed in 20 of these 25 cases (9/9 patients not pretreated and 11/16 patients pretreated with hydrocortisone and histamine H1 and H2 antagonists). There were no significant differences in the frequency of patients with AV early reactions between the groups that were and were not pretreated (Fisher's exact test, p = 0.12). Patients admitted less than and more than 6 h after the bite showed the same risk of developing severe envenoming (Fisher's exact test, p = 1). No children of the first group (< 6 h) showed severe complications whereas 3/6 children admitted more than 6 h post-bite developed acute renal failure. Patients bitten in the legs had a higher risk of developing severe envenoming (Fisher's exact test, p = 0.04). There was a significant association between both total CK and LDH blood enzyme levels and severity (p < 0.001 for CK and p < 0.001 for LDH; Mann-Whitney U test). No deaths were recorded
Subject(s)
Humans , Animals , Male , Female , Infant , Child, Preschool , Child , Adolescent , Crotalid Venoms , Snake Bites , Antivenins , Brazil , Prospective Studies , Snake BitesABSTRACT
From January, 1984 to March, 1999, 73 children under 15 y old (ages 1-14 y, median 9 y) were admitted after being bitten by snakes of the genus Bothrops. Twenty-six percent of the children were classified as mild envenoming, 50.7 percent as moderate envenoming and 20.6 percent as severe envenoming. Two patients (2.7 percent) showed no signs of envenoming. Most of the patients presented local manifestations, mainly edema (94.5 percent), pain (94.5 percent) ecchymosis (73.9 percent) and blisters (11 percent). Local and/or systemic bleeding was observed in 28.8 percent of the patients. Before antivenom (AV) administration, blood coagulation disorders were observed in 60.7 percent (incoagulable blood in 39.3 percent) of the 56 children that received AV only in our hospital. AV early reactions, most of which were considered mild, were observed in 44.6 percent of these cases (in 15/30 patients not pretreated and in 10/26 patients pretreated with hydrocortisone and histamine H1 and H2 antagonists). The main clinical complications observed were local infection (15.1 percent), compartment syndrome (4.1 percent), gangrene (1.4 percent) and acute renal failure (1.4 percent). No deaths were recorded. There were no significant differences with regard to severity of envenoming versus the frequency of blood coagulation disorders among the three categories of envenoming (p = 0.75) or in the frequency of patients with AV early reactions between the groups that were and were not pretreated (p = 0.55). The frequency of local infection was significantly greater in severe cases (p < 0.001). Patients admitted more than 6 h after the bite had a higher risk of developing severe envenoming (p = 0.04)
Subject(s)
Humans , Animals , Male , Female , Infant , Child, Preschool , Child , Adolescent , Bothrops , Snake Bites , Antivenins , Brazil , Crotalid Venoms , Prognosis , Prospective Studies , Snake Bites , Time FactorsABSTRACT
In studies carried out on the parasites infecting ostriches (Struthio camelus) in Spain, trophozoites of Retortamonas sp. have been found in the intestinal contents of 28 out of 146 slaughtered ostriches. The species infecting ostriches could not be determined from the morphological data available. However, these findings are important as they constitute the first report of the genus Retortamonas in birds