Consenso colombiano de la enfermedad inflamatoria intestinal pediátrica

está disponible en el texto completo

Introduction: Pediatric ulcerative colitis (CUP), pediatric Crohn's disease (PCD), and pediatric inflammatory bowel disease not classifiable (PIDNCID) have clinical and psychosocial particularities that differentiate them from those of adults and may condition different therapeutic approaches due to possible nutritional, growth and developmental repercussions, representing a challenge for the pediatrician and gastroenterologist. Objective: Develop expert consensus evidence-based recommendations for the timely and safe diagnosis and treatment of Pediatric Inflammatory Bowel Disease (PID) in children under 18 years of age for professionals caring for these patients and healthcare payers. Methodology: Through a panel of experts from the Colombian College of Pediatric Gastroenterology, Hepatology and Nutrition (COLGAHNP) and a multidisciplinary group, 35 questions were asked regarding the clinical picture, diagnosis, and treatment of PID. Through a critical review and analysis of the literature with particular emphasis on the main clinical practice guidelines (CPGs), randomized clinical trials (RCTs), and meta-analyses of the last ten years, from which the experts made 77 recommendations that responded to each of the research questions with their respective practical points. Subsequently, each of the statements was voted on within the developer group, including the statements that achieved > 80%. Results: All statements scored > 80%. PID has greater extension, severity, and evolution towards stenosis, perianal disease, extraintestinal manifestations, and growth retardation compared to adult patients, so its management should be performed by multidisciplinary groups led by pediatric gastroenterologists and prepare them for a transition to adulthood. Porto's criteria allow a practical classification of PID. In CPE, we should use the Paris classification and perform ileocolonoscopy and esophagogastroduodenoscopy, since 50% have upper involvement, using the SES-CD (UCEIS/Mayo in CUP) and taking multiple biopsies. Initial labs should include inflammatory markers and fecal calprotectin and rule out intestinal infections. Treatment, induction, and maintenance of PID should be individualized and decided according to risk stratification. Follow-up should use PCDAI and PUCAI for the last 48 hours. Immunologists and geneticists should evaluate patients with early and infantile PID. Conclusion: A consensus guideline is provided with evidence-based recommendations on timely and safe diagnosis and treatments in patients with ILD.

Imunoglobulina endovenosa em pacientes pediátricos e adultos em unidades de terapia intensiva com síndrome de resposta inflamatória sistêmica grave e/ou síndrome de disfunção de múltiplos órgãos / Intravenous immunoglobulin in pediatric and adult patients in intensive care units with systemic inflammatory response syndrome and/or multiple organ dysfunction syndrome

A literatura revela benefícios, em termos de sobrevivência, relacionados ao uso da imunoglobulina endovenosa em adultos com sepse hospitalizados em unidades de terapia intensiva, em comparação com pacientes tratados com placebo, ou com os que não sofreram intervenção. Em nossa prática clínica, alguns pacientes com sepse e/ou com síndrome de disfunção de múltiplos órgãos apresentam níveis de imunoglobulinas dentro das faixas utilizadas para interpretação do estado imunológico de indivíduos saudáveis. Desconhecemos se pacientes em estado crítico devido a infecção e inflamação poderiam ter a função das imunoglobulinas diminuída, a despeito de ter níveis de imunoglobulinas dentro da faixa de normalidade. O objetivo do presente artigo foi utilizar as informações dos resultados sobre segurança e eficácia publicados na literatura para intervenção com imunoglobulina humana endovenosa (IGIV), sobretudo em adultos com sepse e internados em unidades de terapia intensiva, numa tentativa de extrapolar os resultados para pacientes pediátricos com sepse e/ou com síndrome de disfunção de múltiplos órgãos, dando suporte ao seu uso durante as primeiras 12 e 24 horas em unidade de terapia intensiva pediátrica como coadjuvante, imunomodulador e anti-inflamatório, juntamente com a intervenção de rotina, em crianças com níveis "fisiologicamente normais" e/ou limítrofes baixos de IgG. Foram consultados os bancos de dados PubMed, MEDLINE e Cochrane de 1995 a 2011, com os seguintes termos: sepse, síndrome de disfunção orgânica múltipla, adultos, população pediátrica, unidade de terapia intensiva, e intervenção ou tratamento com imunoglobulina humana endovenosa.

The literature has described survival benefits associated with the use of intravenous immunoglobulin in adult patients admitted to intensive care units as compared to patients receiving placebo or no intervention. In our clinical practice, some patients with sepsis and/or multiple organ dysfunction syndrome show immunoglobulin levels within the normal ranges used to describe the immune status of healthy patients. It remains to be known whether a critically ill patient due to infection and inflammation could have an impaired immunoglobulin function despite showing normal immunoglobulin levels. The objective of this study was to review data on the safety and effectiveness of the use of intravenous immunoglobulin therapy in adult patients with sepsis admitted to intensive care units, in an attempt to extrapolate results to pediatric patients with sepsis and/or multiple organ dysfunction syndrome. The review focused on data supporting the use of intravenous immunoglobulin in the first 12-24 hours in the pediatric intensive care unit as an adjuvant, immunomodulatory, and anti-inflammatory agent, in addition to the routine intervention in children with “physiologically normal” or borderline low IgG levels. The PubMed, MEDLINE, and Cochrane databases were searched for articles published between 1995 and 2011, using the terms sepsis, multiple organ dysfunction syndrome, adult, pediatric population, intensive care unit, and intervention or treatment with human intravenous immunoglobulin.

El arte de la medicina: entre lo místico y la ciencia / The art of medicine: between the mystical and science

La medicina como ciencia y arte se complementan en la práctica cotidiana. Cuando se entienda la propiedad “plástica” de sistemas como el inmunológico, se estará en capacidad de inclinarnos respetuosos y reverentes ante el concepto de la creación...

Medicine as a science and art it complement each other in everyday practice. When we comprehend the attribute of “plasticity” of the immune system, we will be able to incline with respectful and reverential when we think in the concept of Creation...

Alergia a anestésicos locales y generales y a otros medicamentos durante procedimientos quirúrgicos / Allergy to local and general anesthetics and to other drugs during surgical procedures

Las reacciones de choque e hipersensibilidad a los anestésicos locales y generales y a otros medicamentos utilizados durante los procedimientos quirúrgicos, continúan siendo un reto en la práctica clínica. Las reacciones de hipersensibilidad alérgica pueden variar en su presentación e intensidad, y pueden producir desde síntomas leves en la piel hasta la muerte.

Shock and hypersensitivity reactions to local and general anesthetics and to other drugs used during surgical procedures continue being a challenge in clinical practice. Allergic hypersensitivity can vary in presentation and intensity and might manifest itself from mild cutaneous symptoms to death.

Contaminação bacteriana e fúngica de canudos de refrigerantes e seus recipientes em lanchonetes de município do interior de São Paulo / Fungal and bacterial contamination of drinking straws and their containers in snack bars in a municipality of São Paulo state, Brazil

OBJETIVO: Avaliar o nível de contaminação bacteriana e fúngica de canudos de refrigerantes e seus recipientes em 30 lanchonetes do Município de Ibiúna (SP), correlacionando com as condições de higiene, processos e métodos de desinfecção destes estabelecimentos. MÉTODOS: Foram colhidas três amostras por estabelecimento nas embalagens fechadas, em recipientes e swab em toda a superfície de contato. Foi aplicado um questionário a fim de avaliar: a empresa fornecedora dos canudos, higienização, freqüência e desinfecção, e foram efetuadas inspeções sanitárias nos estabelecimentos. Para as análises microbiológicas foi utilizada a técnica de lavagem superficial e semeadura em meios, para contagem de bactérias mesófilas. As amostras turvas foram semeadas em meios de cultura para: Staphylococcus aureus, Bacillus cereus, Pseudomonas aeruginosa, Enterococcus, coliformes totais e/ou termotolerantes. RESULTADOS: Dentre os microorganismos isolados nas amostras dos canudos nos recipientes foi detectado Bacillus cereus em 36,6 por cento, Enterococo spp. em 3,3 por cento. O Bacillus cereus foi isolado em 46,6 por cento nos swabs dos recipientes, e em 13,3 por cento, Enterococos. Na análise de associação do nível de contaminação microbiana de canudos de refrigerantes e seus recipientes com as condições de higiene, os processos de higienização e a desinfecção dos estabelecimentos, não foi identifica significância estatística (p>0,05). CONCLUSÃO: O Bacillus cereus foi o microorganismo que prevaleceu nas embalagens íntegras dos canudos, nos seus recipientes e no swab das superfícies. Não foi comprovada a associação de fatores de risco de contaminação bacteriana e fúngica.

OBJECTIVE: The objective of this study was to evaluate the fungal and bacterial contamination level of drinking straws and their containers of thirty snack bars at the municipality of Ibiuna (SP, Brazil) and to correlate these data with conditions of hygiene and the processes and methods of disinfection of these establishments. METHODS: Three samples of closed packages, containers and contact surface swabs were collected in each establishment. A questionnaire was administered to identify the straws supplier, hygiene methods, frequency and disinfection. Sanitary inspections were also performed in these establishments. Microbiological analyses were done using the superficial washing technique and seeding plates to count mesophilic bacteria, mold and yeasts. Turbid samples were seeded in culture media for: Staphylococcus aureus, Bacillus cereus, Pseudomonas aeruginosa, Enterococcus, total and/or thermotolerant coliforms. RESULTS: Microorganisms isolated from samples of drinking straws were Bacillus cereus 36.6 percent, Enterococcus spp and Molds/yeasts 3.3 percent. Swabs of containers revealed 46.6 percent of Bacillus cereus and 13.3 percent of Enterococcus. Association analyses of the microbial contamination level of drinking straws and their containers with conditions of hygiene, hygiene processes and disinfection of the establishments did not show statistical significance (p>0.05). CONCLUSION: Bacillus cereus was the most prevalent microorganism in closed packages, containers and surface swabs. No statistical association of risk factors for bacterial or fungal contamination was found.

Asma, una patología de interés / Asthma, an important pathology

El asma bronquial se considera una enfermedad de interés en salud pública. Latinoamérica tiene una de las prevalencias mas elevadas del mundo; en Colombia se encontró una prevalencia global de 10,4/100. Por tanto es pertinente revisar su definición, epidemiología, clínica, factores de riesgo, diagnóstico, clasificación y tratamiento para realizar el mejor y más adecuado enfoque y seguimiento de los pacientes que la padecen.

Rinitis alérgica: un hecho / Allergic rhinitis: a fact

La rinitis alérgica es una enfermedad de alta prevalencia. En la población infantil, infortunadamente el diagnóstico se hace en forma tardía, alrededor de los seis años. En el presente artículo se intenta estimular al lector a buscar los signos clínicos más sensibles para su diagnóstico y tratamiento tempranos.