Implementación y evaluación de un programa de gestión de calidad para el monitoreo de glucómetros en un hospital universitario / Implementation and evaluation of a management program quality for monitoring glucometers in a hospital academic

Introducción: El uso de dispositivos portátiles para controlar la glucemia se ha extendido en los últimos años a las entidades hospitalarias, porque proporcionan un resultado rápido al realizarse al lado de la cama del paciente (point-of-care testing). Objetivo: Describir el proceso y los resultados de la implementación de un programa de gestión de calidad para el control de glucómetros hospitalarios. Materiales y Métodos: Se presenta la implementación de un programa de gestión de calidad para evaluar 50 glucómetros pertenecientes a siete áreas críticas del Hospital Italiano de Buenos Aires (Unidad Coronaria, Terapia Intensiva de Adultos y Pediátrica, Terapia Intermedia, Central de Emergencias de Adultos y Pediátrica, Unidad de Cuidados Intensivos Neonatológicos), desde el 1 de enero de 2014 hasta la actualidad, basado en tres estrategias: control diario, análisis mensual (precisión y exactitud) y control de muestras paralelas. Resultados: Luego de instaurar este programa y analizar los datos de los primeros 17 meses, se requirió un recambio total de 292 glucómetros: 150 debido al control de calidad diario, 119 por el análisis mensual y 23 por el control de muestras paralelas. Esto implicó retirar 17/50 glucómetros por mes. Conclusiones: Si bien estos dispositivos son útiles por su rápida respuesta, el 34,6% debió ser reemplazado por no haber superado alguno de los requisitos planteados en las estrategias de evaluación. La peor performance fue en los niveles de hipoglucemia, situación de interés para la rápida toma de decisiones. Es importante destacar la necesidad de aplicación de un plan de calidad para glucómetros sobre la base de un diseño propio y a medida de la institución para garantizar la seguridad del paciente.(AU)

Introduction: The use of portable devices for glycemic control has been extended in recent years to hospital entities, because they provide a rapid result when they are performed at or near the patient's bedside (point of care testing). Objective: To describe the process and results of the implementation of a quality management program to control of hospital glucometers. Materials and Methods: We present the implementation of a quality management program to evaluate 50 glucometers belonging to seven critical areas of Hospital Italiano de Buenos Aires (Coronary Unit, Adult and Pediatric Intensive Care Unit, Intermediate Therapy, Adult and Pediatric Emergency Center, Unit of Neonatal Intensive Care), from January 1, 2014 to the present, based on three strategies: Daily Control, Monthly Analysis and Control of Parallel Samples. Results: After implementing this program and analyzing the first 17 months, the substitution of 292 glucometers was required: 150 due to daily quality control, 119 per monthly analysis and 23 due to control parallel samples. This involved withdrawing 17/50 glucometers monthly. Conclusions: Although these devices are useful because of their rapid response, 34.6% had to be replaced because they exceeded the requirements presented in the evaluation strategies. The worst performance was in levels of hypoglycemia, a situation of interest for rapid decision-making. It is important to emphasize the need to apply a quality plan for glucometers based on an own design and suitable for the institution to guarantee the safety of the patient.(AU)

Diseño y simulación de un filtro de células de tipo linfocitos T en un sistema de microfluidos / Design and Simulation of a T-Type Lymphocyte Cells Filter on a Microfluidic System / Desenho e simulação de um filtro de células de tipo linfócitos T em um sistema de microfluidos

Este trabajo consistió en diseñar y validar, mediante simulación experimental por computadora, un sistema de filtraje de linfocitos T en un sistema basado en microfluidos para detección del virus del VIH. Materiales y métodos: se utilizó la herramienta de simulación AutoDesk® Inventor, con la cual se realizó el diseño del sistema de microfluídica. El sistema de filtraje se probó haciendo una simulación por computadora en la herramienta de simulación AutoDesk® Simulation cfd (computational fluid dynamics software) en la cual diferentes partículas con varios diámetros (5 µm, 10 µm, 15 µm) fluían por el sistema a probar. Resultados y conclusiones: los resultados demostraron que el sistema de filtraje permitió el paso de las partículas esperadas, sin embargo, se observó que permitió el paso de partículas más grandes que las deseadas, por lo cual hay que seguir trabajando en el perfeccionamiento del sistema. La eficiencia del sistema de filtraje fue de un 33,33 %.

This work consisted in designing and validating, by experimental computational simulation, a T-Lymphocites filtering system based on microfluidics for hiv virus detection. Material and methods: It was used AutoDesk® Inventor simulation tool was used with which the microfluidic system design was performed. The filter system was tested by a computer simulation in the AutoDesk® Simulation cfd (computational fluid dynamics software, simulation tool in which different particles with different diameters (5 µm, 10 µm, 15 µm) flow through the system to test. Results and conclusions: Results showed that this system allowed to pass the expected particles, however, it also was observed that it allows bigger particles than desired, for this reason it is necessary to keep on working on system perfectioning. Filtering system efficiency was of a 33.33 %.

Este trabalho consistiu em desenhar e validar, mediante simulação experimental por computador, um sistema de filtragem de linfócitos T em um sistema baseado em microfluidos para detecção do vírus do VIH. Materiais e metodos: utilizou-se a ferramenta de simulação AutoDesk® Inventor, com a qual se realizou o desenho do sistema de microfluídica. O sistema de filtragem provou-se fazendo uma simulação por computador na ferramenta de simulação AutoDesk® Simulation CFD (computational fluid dynamics software) na qual diferentes partículas com vários diâmetros (5 µm, 10 µm, 15 µm) fluíam pelo sistema a provar. Resultados e conclusaos: Os resultados demonstraram que o sistema de filtragem permitiu a passagem das partículas esperadas, no entanto, se observou que permitiu a passagem de partículas mais grandes que as desejadas, pelo qual deve-se seguir trabalhando no aperfeiçoamento do sistema. A eficiência do sistema de filtragem foi de 33,33 %.

Reflexiones en torno a la adherencia a tratamiento de las personas en situación de enfermedad / Reflections about treatment adherence to treatment of people living in illness

La relación profesional- paciente es muy importante para promover una buena adherencia. Sin embargo los pacientes admiten que con relativa frecuencia, abandonan la medicación, la dieta, la práctica de ejercicios, o cualquier otra intervención terapéutica. Esto afecta a largo plazo la calidad de vida. El éxito del tratamiento depende de ambos: médico/ terapeuta y paciente. Para una sólida adherencia, el tratante requiere de competencias técnicas y de herramientas y habilidades comunicacionales...

The relationship with the patient is very important in order to promote good adherence. Nevertheless, patients admit that it's getting more common to stop taking pills, maintaining diets and exercise, or another medical/ therapeutic interventions. This affects the quality of life in the long term. The success of the treatment depends on both the doctor/therapist, and patient. For solid adherence the specialists require technical competence and communicational skills and abilities...

Conductas autolesivas no suicidas en la práctica clínica: Primera parte: conceptualización y diagnóstico / Non suicidal self injuries in clinical practice

Self-injurious acts are understood as transnosologic behaviors, which by their vital risk and psychopathological complexity require a specific medical diagnosis and treatment. Their management should be known by psychiatrists and other medical specialties. There are varied reasons that can trigger these maladaptive behaviors which are coming from the specific difficulties arising from the patient's mental state. It is essential to identify the presence of triggering or concomitant psychiatric disorders for the appropriate guiding of clinical management...

Las conductas autoagresivas pueden comprenderse como comportamientos transnosológicos que, por su riesgo vital y complejidad psicopatológica, requieren de un diagnóstico y manejo médico específicos. Este manejo debe ser conocido tanto por el médico psiquiatra como por facultativos de otras especialidades. Existen variadas motivaciones que pueden desencadenar conductas autolesivas, las que tienen su origen en dificultades específicas relacionadas con el estado mental del paciente. Resulta imperativo identificar la presencia de patologías psiquiátricas desencadenantes, o concomitantes, para orientar el apropiado manejo clínico...

Pain pressure threshold algometry of the abdominal wall in healthy women

The objective of this study was to determine the inter- and intra-examiner reliability of pain pressure threshold algometry at various points of the abdominal wall of healthy women. Twenty-one healthy women in menacme with a mean age of 28 ± 5.4 years (range: 19-39 years) were included. All volunteers had regular menstrual cycles (27-33 days) and were right-handed and, to the best of our knowledge, none were taking medications at the time of testing. Women with a diagnosis of depression, anxiety or other mood disturbances were excluded. Women with previous abdominal surgery, any pain condition or any evidence of inflammation, hypertension, smoking, alcoholism, or inflammatory disease were also excluded. Pain perception thresholds were assessed with a pressure algometer with digital traction and compression and a measuring capacity for 5 kg. All points were localized by palpation and marked with a felt-tipped pen and each individual was evaluated over a period of 2 days in two consecutive sessions, each session consisting of a set of 14 point measurements repeated twice by two examiners in random sequence. There was no statistically significant difference in the mean pain threshold obtained by the two examiners on 2 diferent days (examiner A: P = 1.00; examiner B: P = 0.75; Wilcoxon matched pairs test). There was excellent/good agreement between examiners for all days and all points. Our results have established baseline values to which future researchers will be able to refer. They show that pressure algometry is a reliable measure for pain perception in the abdominal wall of healthy women.

Estrés post–traumático: interferencia y ajuste ocupacional / Post traumatic stress disorder: adaptive occupational response

La incorporación del marco teórico de la ciencia ocupacional en el abordaje de los conflictos emergentes que se presentan al desarrollo profesional del Terapeuta Ocupacional en el área de la psiquiatría y salud mental, brinda el fundamento para diagnosticar, evaluar, y restablecer las situaciones disfuncionales en que ven involucradas las personas. El estudio presentado describe las interferencias ocupacionales como consecuencia de un estrés post – traumático, en mujeres que han sufrido un asalto en la vía publica. Se recuerda el evento, sucedido con anterioridad entre 3 y 6 meses, se analizan las acciones que ocasionan mayor impacto y se reflexiona sobre la directa proporcionalidad entre retomar las ocupaciones y la recuperación de la seguridad.

The inclusion of Occupational Science as a theory to address new conflicts found in the course of professional development of occupational therapists in the area of mental health and psychiatry gives the foundation for diagnosis, evaluation, and recovery from dysfunctional circumstances in which people feel involved. This study describes the negative impact that Post Traumatic Stress Disorder had on occupational lives of women who were assaulted in public streets. These events are described after three to six month they took place. An analysis of the actions that produced more impact and a reflection about the direct relationship between engaging again in occupations and confidence recovery are highlighted in this paper.

Decrease of intestinal tumors induced by 1,2-dimethylhydrazine in rats fed with cow milk and buffalo milk

Epidemiological studies in human beings and experimental studies in laboratory animals suggest that milk and dairy products can inhibit effects on the development of some kinds of tumors. Cow milk contains sphingomyelin, butyric acid, conjugated linoleic acid, calcium, vitamin A, carotene and vitamin D. All of these components are known to inhibit the process of carcinogenesis. Our objective was to determine the effect of cow milk and water buffalo milk on the development of colon neoplasias in an experimental model of carcinogenesis in rats induced with 1,2-dimethylhydrazine (DMH). Three-month-old Wistar male rats with an average body weight of 180 g were given a nutritionally adequate diet and drinking water adlivitum, cow milk or water buffalo milk. The milk diets were provided two weeks before the first DMH treatment and their administration was continued during the 10 weeks of DMH treatment. Milk administration finished two weeks after the last DMH doses treatment. Four months after the last carcinogen injection, all surviving animals were sacrificed and examined for intestinal tumors. The number, size, and location of the tumors were recorded and gross pathology was described. Small tumors (< 2.5 mm) were examined by Scanning Electron Microscopy (SEM). Significantly fewer tumors were observed in both groups treated with DMH and supplemented with milk, than in the group treated with DMH without milk administration.

Análisis genético en pacientes con cáncer colorrectal / Microsatellite instability among patients with colorectal cancer

Background: In patients with colorectal carcinoma, insertions or deletions of short sequences of DNA, a phenomenon called microsatellite instability, are observed. Aim: To look for microsatellite instability and mutations of MLH1 and MSH2 gene mutations in patients with colorectal carcinoma. Material and Methods: Ten patients with sporadic colorectal carcinoma and 31 patients fulfilling criteria for hereditary nonpolyposis colon cancer (HNPCC), aged 9 to 70 years, were studied. Microsatellite instability was studied in samples of tumor and peripheral blood mononuclear cell DNA. Six markers were amplified by polymerase chain reaction and capillary electrophoresis. In samples with microsatellite instability, mutations of MLH1 and MSH2 genes were studied by direct sequencing. Results: Thirty four percent of patients had microsatellite instability and among these, 76 percent had a high degree of instability. BAT40 marker had the higher frequency of instability. No mutations for MLH1 and MSH2 genes were observed. However a new polymorphism, C399T, was identified in exon 3 of MSH2 gene. This polymorphism was observed both in patients with sporadic colorectal carcinoma and patients with HNPCC. Conclusions: There is a high frequency of microsatellite instability among patients with colorectal cancer. A new polymorphism, not previously reported, was identified in MSH2 gene.

Menstrual cycle worsening of epileptic seizures in women with symptomatic focal epilepsy

INTRODUCTION: Hormonal fluctuation is responsible for worsening of epileptic seizures during the menstrual cycle. OBJECTIVE: To identify irregularities in the menstrual cycles of women with mesial temporal lobe epilepsy (MTLE) and extratemporal focal epilepsy (ETFE) and correlate the frequency of seizures during the menstrual cycles. METHOD: We evaluated prospectively women in the menacme with MTLE and ETFE. Calendars were provided for these patients, and they were asked to mark their seizure frequency according to the menses. Calendars were reviewed in each routine medical appointment. RESULTS: Thirty-nine patients with MTLE and 14 with ETFE were evaluated. We registered 211 cycles in the patients with MTLE and 49 in those with ETFE. Irregular menstrual cycles were found in 28 (28/39, 71.7%) patients with MTLE and 6 (6/14, 42.8%) with ETFE (p=0.052). Premenstrual seizure worsening was observed in 46 (21.8%) patients with MTLE and 9 (18.3%) with ETFE (p=0.596). Menstrual worsening was observed in 47 (22.2%) patients with MTLE and 15 (30.6%) with ETFE (p=0.217). Ovulatory worsening was observed in 36 (17%) patients with MTLE and 13 (26.5%) with ETFE (p=0,126). Catamenial worsening was observed in 58 (27.4%) of the patients with MTLE and in 17 (34.7%) of the patients with ETFE (p=0.315). CONCLUSION: There was no difference between the group of patients with MTLE and ETFE regarding the frequency of irregular cycles and seizure worsening during the premenstrual, menstrual, catamenial or ovulatory periods.

INTRODUÇÃO: Admite-se que a flutuação hormonal seja a responsável para a piora de crises epilépticas no período catamenial. OBJETIVO: Identificar irregularidades nos ciclos menstruais de mulheres com epilepsia de lobo temporal mesial (ELTM) e epilepsia focal extratemporal (EFET); e relacionar a frequencia de crises durante o ciclo menstrual. MÉTODO: Avaliamos mulheres na menacme, que apresentem quadro clínico laboratorial compatível com ELTM e EFET. Foram fornecidos calendários para estas pacientes e instruídas para preenchimento correto da menstruação e das crises epilépticas e serão revistos em cada consulta médica rotineira. RESULTADOS: Foram avaliadas 39 pacientes com ELTM e 14 com EFET. Registramos 211 ciclos nas pacientes com ELTM e 49 nas com EFET. Ciclos menstruais irregulares foram apresentados por 28 (71,7%) pacientes com ELTM e 14 (42,8%) com EFEP (p=0,052). Piora pré-menstrual foi observada em 46 (21,8%) pacientes com ELTM e 9 (18,3%) com EFET (p=0,596). Piora menstrual foi observada em 47 (22,2%) pacientes com ELTM e 15 (30,6%) com EFET (p=0,217). Piora ovulatória foi observada em 36 (17%) pacientes com ELTM e 13 (26,5%) com EFET (p=0,126). Piora catamenial foi observada em 58 (27,4%) das pacientes com ELTM e em 17 (34,7%) das pacientes com EFET (p=0,315). CONCLUSÃO: Não houve diferença entre os grupos de pacientes com ELTM e EFET quanto à freqüência de ciclos irregulares e piora das crises nos períodos pré-menstrual, menstrual, catamenial ou ovulatório.

Osteogénesis comparativa de los cartílagos secundarios de la clavícula y placas epifisiarias de los huesos largos / Comparative osteogenesis of the clavicle secondary cartilages and epiphyseal cartilages of long bones

La clavícula es un hueso formado por osificación membranosa, es decir no se preforma de cartílago. Sin embargo desarrolla cartílagos secundarios como centros de crecimiento, los cuales presentan diferencias morfológicas y funcionales con los cartílagos de crecimiento de los huesos largos. Estos últimos son cartílagos primarios derivados del modelo cartilaginoso original. Se realizó un estudio histológico e inmunohistoquímico de los cartílagos secundarios de la clavícula y de los cartílagos de crecimiento del fémur y húmero, en fetos humanos, entre las 12 y 40 semanas de gestación y en ratones entre 15 días de gestación y 20 días de edad. Se utilizaron las siguientes tinciones: hematoxilina-eosina-azul Alcián, tricrómico de Masson y rojo de picrosirius. En la técnica inmunohistoquímica de inmunoperoxidasa se utilizaron como anticuerpos primarios vimentina, PCNA y BMP. Los cartílagos claviculares son cartílagos hialinos cubiertos por una delgada capa de tejido mesenquimático. En su superficie se distinguen varias capas: superficial de tejido conectivo, proliferativa formada por células mesenquimáticas, madurativa con condrocitos hipertróficos y una zona de osificación con condrocitos en regresión y trabéculas óseas en formación. El anticuerpo anti PCNA mostró inmunotinción positiva en la capa proliferativa en todas las etapas estudiadas y el anticuerpo anti BMP se expresó intensamente en las células de las zonas de osificación. La técnica de picrosirius mostró colágeno tipo I en las capas superficiales. En los cartílagos claviculares la proliferación ocurre en el mesénquima de la capa proliferativa, en cambio, en los huesos largos la actividad mitótica ocurre en la zona de cartílago hiperplásico. En los cartílagos claviculares existe colágeno tipo I, a diferencia del cartílago de crecimiento epifisiario donde sólo existe colágeno tipo II. Los cartílagos secundarios de la clavícula presentan importantes diferencias morfológicas y funcionales en el crecimiento con los cartílagos primarios de los huesos largos.

Discrepancies between clinical diagnoses and autopsy findings

Autopsy examination is considered to be an essential element for medical auditing and teaching. Despite the significant progress in diagnostic procedures, autopsy has not always confirmed the clinical diagnosis. In the present study, we compared the diagnosis recorded on medical charts with reports of 96 autopsies performed at the University Teaching Hospital of the Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil, between 1975 and 1982, and of 156 autopsies performed at the same institution between 1992 and 1996. The clinical diagnosis of the basic cause of death was confirmed at autopsy in 77 percent of cases. The percent confirmation fell to 60 percent when the immediate terminal cause of death was considered, and in 25 percent of cases, the terminal cause was only diagnosed at autopsy. The discrepancies between clinical and autopsy diagnosis were even larger for secondary diagnoses: 50 percent of them were not suspected upon clinical diagnosis. Among them, we emphasize the diagnosis of venous thromboses (83 percent), pulmonary embolisms (80 percent), bronchopneumonias (46 percent) and neoplasias (38 percent). Iatrogenic injuries were very frequent, and approximately 90 percent of them were not described in clinical reports. Our results suggest that highly sensitive and specific diagnostic tests are necessary but cannot substitute the clinical practice for the elaboration of correct diagnoses

Effects of high molybdenum intake on 1.2 - dimethylhydrazine-induced intestinal tumors in rats

Wistar male rats, 3 months of age were given ad-libitum a nutritionally adequate diet and demineralized drinking water. The Molybdenum (Mo) and Tungsten (W) were provided in the drinking water at 200 ppm concentration. Intestinal tumors were induced by 1,2-dimethylhydrazine (DMH) given subcutaneously as 16 weekly doses at 20 mg/kg body weight. Mo in the form of (NH4)6 Mo7O24 4H2O or W in the form of (Na2WO4) were provided in the drinking water two months before the first DMH treatment and were continued during 4 months more until the last DMH treatment. Three months after the last carcinogen injection, all animals were sacrificed and examined for intestinal tumors. The number, size and location of the tumors were recorded and the pathology was examined. The addition of Mo to the drinking water induced an increase of hepatic Mo content. At the end of the second month, the hepatic content of Mo was 5.61 ppm, compared with control and W groups (2.18 and 0.96 ppm, respectively). A significantly lower incidence of tumors was observed in the Mo group (47), compared with the control group given DMH alone (105) and W group (113). On the other hand, the Mo group showed a significant decrease in the numbers of multiple tumors per rat.

Aberrant crypt foci and colon cancer: comparison between a short- and medium-term bioassay for colon carcinogenesis using dimethylhydrazine in Wistar rats

Aberrant crypt foci (ACF) in the colon of carcinogen-treated rodents are considered to be the earliest hallmark of colon carcinogenesis. In the present study the relationship between a short-term (4 weeks) and medium-term (30 weeks) assay was assessed in a model of colon carcinogenesis induced by dimethylhydrazine (DMH) in the rat. Six-week-old male Wistar rats were given subcutaneous injections of DMH (40 mg/kg) twice a week for 2 weeks and killed at the end of the 4th or 30th week. ACF were scored for number, distribution pattern along the colon and crypt multiplicity in 0.1 percent methylene-blue whole-mount preparations. ACF were distinguished from normal crypts by their larger size and elliptical shape. The incidence, distribution and morphology of colon tumors were recorded. The majority of ACF were present in the middle and distal colon of DMH-treated rats and their number increased with time. By the 4th week, 91.5 percent ACF were composed of one or two crypts and 8.5 percent had three or more crypts, while by the 30th week 46.9 percent ACF had three or more crypts. Thus, a progression of ACF consisting of multiple crypts was observed from the 4th to the 30th week. Nine well-differentiated adenocarcinomas were found in 10 rats by the 30th week. Seven tumors were located in the distal colon and two in the middle colon. No tumor was found in the proximal colon. The present data indicate that induction of ACF by DMH in the short-term (4 weeks) assay was correlated with development of well-differentiated adenocarcinomas in the medium-term (30 weeks) assay

Ultrasonografía del manguito de los rotadores del hombro: evaluación post quirúrgica / Ultrasound of the rotator cuff tears of the shoulder: postsurgical evaluation

Se estudiaron con ultrasonografía 40 pacientes operados de manguito rotador, en forma dinámica para pesquisar las características del tendón operado y la estabilidad de la cicatriz. Del total de desgarros encontramos un 27,7 por ciento de rotura, porcentaje similar a series previamente publicadas. Se describen los hallazgos del tendón operado y se correlacionan en algunos de ellos con exploración artroscópica demostrándose una buena sensibilidad del método. Consideramos a la ultrasonografía una alternativa válida para la evaluación post-quirúrgica del manguito rotador

Correlación ultrasonografía versus artroscopía en rotura del manguito rotador / Correlation ultrasonography versus arthroscopy in rupture of the rotator cuff

El cuadro de hombro doloroso es una consulta clínica frecuente, se presenta como un síntoma inespecífico, que comprende diferentes causas por lo que su estudio por un método de imagen resulta de utilidad. La artrografía fue durante años el método de elección, pero es un método invasivo y solo útil en caso de desgarros totales o articulares. Actualmente ha sido reemplazada por métodos no invasivos como lo son la ultrasonografía y la resonancia magnética, esta última de alto costo y poco accesible aún en nuestro medio. Diversos estudios, con ultrasonografía, presentan valores diversos de sensibilidad especificidad y exactitud. Por este motivo decidimos evaluar su rendimiento en nuestra experiencia, comparando los hallazgos ultrasonográficos con los artroscópicos en 67 pacientes explorados con equipo de alta resolución. El análisis de los datos revela una sensibilidad de 88 por ciento, especificidad de 78 por ciento, valor predictivo negativo de 70 por ciento, valor predictivo positivo de 91,5 por ciento y exactitud de 85 por ciento lo que hace de la ultrasonografía un buen método de imagen para el estudio de rotura del manguito rotador, agregado ello a su fácil acceso y bajo costo

Doença cerebrovascular na infância: I. Manifestaçöes epilépticas / Cerebrovascular disease in children: I. Epileptic manifestaions

As crises epilépticas podem constituir complicação de doença cerebrovascular (DCV), e a sua prevalência, apresentação clínica, fatores de risco e evolução em crianças tem sido estudadas por poucos autores. Neste estudo, 39 crianças com diagnóstico de DCV foram avaliadas quanto à ocorrência de manifestações epilépticas. Vinte e quatro (61,5 por cento) apresentaram crises durante algum momento da doença (22 na fase aguda e 2 na tardia); 13 (54,2 por cento) apresentaram crises generalizadas, 7 (29,2 por cento) parciais, e 4 (16,6 por cento) secudariamente generalizadas. A prevalência de manifestação epiléptica em lactentes foi significativamente maior (p=0,0362) do que nas outras faixas etárias. A localização cortical da DCV mostrou determinar de modo estatisticamente significante (p=0,0101) a ocorrência de crises. Não houve relação significativa entre o tipo de insulto vascular (isquêmica ou hemorrágico) e a ocorrência de crises. Quatorze pacientes evoluíram sem crise após a fase aguda; os 2 pacientes previamente epilépticos tiveram suas crises controladas com droga anti-epiléptica (DAE); 3 evoluíram com epilepsia (1 controlado com DAE e 2 de difícil controle); 3 continuaram em acompanhamento ambulatorial e não houve tempo hábil para definir se o quadro evoluirá para epilepsia e em 2 ocorreu óbito na fase aguda.

Dyskinesia induced by phenytoin

Phenytoin is an effective antiepileptic drug, although, if can be associated with many side effects, including dyskinesia. Objective: To describe the clinical characteristics of phenytoin induced dyskinesia. Methods: We investigated the occurrence of involuntary movements in patients followed at our adult and pediatric epilepsy clinics during the period of one year. Results: Three patients presented with phenytoin-induced dyskinesia: one adult with axial and orofacial dyskinesia, and two children with choreoathetosis. They did not have other signs of phenytoin intoxication and had complete recovery after phenytoin withdrawal. Conclusion: Phenytoin induced dyskinesia may occur during either chronic or initial treatment and with normal serum phenytoin levels. However, it occurs most often in patients on polytherapy, usually after increasing dosage and with toxic serum levels. Other signs of phenytoin intoxication may be present in these patients, but often the dyskinesia is the only side effect, which may delay the diagnosis and treatment. The clinical characteristics of the involunatary movements vary and may be focal or generalized, most often characterized by choreoathetosis and dyskinesias. These may last for hours, days or even years, but frequently disappear completely after phenytoin withdrawal.

El oftalmoscopio directo en la consulta pediátrica

Con la llegada del nuevo milenio el oftalmoscopio directo habrá cumplido 150 años de su creación. A pesar de ser una herramienta importante para el exámen de pacientes de cualquier edad, sigue siendo subutilizado por médicos generales y especialistas. Nuestro objetivo es dar a pediatras y médicos no oftalmólogos argumentos y claves para incluir rutinariamente la oftalmoscopia directa en el exámen inicial de sus pacientes

Atherosclerosis morphology and pathogenesis

Atherosclerosis is a very common and important disease being the most important cause of mortality in Brazil. Indeed, in 1995, 23.3 per cent of deaths, all ages, in our country, were the consequence of atherosclerosis. This percentage grows to 26.3 per cent for S. Paulo and 32.7 per cent for Rio Grande do Sul. Morphologically, there are 3 main types of lesion: fatty streaks, fibrous plaques, and complicated lesions. Fatty streaks are inocuous and occur early in life. In some persons, with age, they change into fibrous plaques that may lead to stenosis. They also may become complicated by erosion, calcification, hemorrhage and thrombosis. Atherosclerosis is initiated by endothelial functional alterations responsible for increase in permeability to macromolecules, adhesion, and migration of monocytes-macrophages and lymphocytes plus recruitment of platelets and smooth-muscle medial cells. Adhesion molecules, cytokines, growth factors, and free radicals are locally synthetized, favoring proliferation of extracellular matrix and progression of the lesion. Experimental, clinical, and epidemiological evidence point to the importance of lipids, mainly cholesterol-rich low-density lipoprotein (LDL), as one of the most important molecules involved in the genesis and progression of atheroclerosis. Patients with a genetic disorder of cholesterol metabolism (familial hyperlipidemia), caused by a decrease in the availability of receptors for LDL, develop severe atherosclerosis early in life. A series of other factors, such as age, diabetes melitus, diet, hypertension, lack of exercise, elevated hemocysteinemia, immunological disorders, and coagulation instability, are related to the progression of atherosclerosis. All of them are capable of altering the endothelium or increasing the offer of LDL. All the above-mentioned factors are systemic; but atherosclerosis lesions are focal, located at preferential sites such as the emergence of colaterals, bifurcations, and curvatures of arteries, all areas in which the laminar flow is disturbed. In these areas shear stress is diminished favoring the prolongation of permanence time of lipid particles, cells, cytokines, growth factors, etc., in the vicinity of the endothelium. Moreover, the endothelium has "sensors" that act as transducers of mechanical forces in biological response. Experimental data demonstrated that the number and quality of adhesion molecules, cytokines, and growth factors synthetized...