ABSTRACT
Resumen: El aflojamiento de los implantes, la falla catastrófica de la interfaz hueso-tornillo, la migración de material y la pérdida de estabilidad de los componentes del ensamble de la fijación constituyen una seria complicación en la cirugía de columna de adultos. La contribución de la biomecánica se basa en la medición experimental y la simulación de las fijaciones transpediculares de columna. La trayectoria de inserción cortical mostró un incremento en la resistencia de la interfase tornillo-hueso respecto a la inserción pedicular tanto para fuerzas de tracción axiales al tornillo como en distribución de esfuerzos en la vértebra. Los tornillos de doble rosca tuvieron una resistencia similar a los pediculares estándar. Los tornillos de rosca parcial de cuatro filetes mostraron mejor resistencia a la fatiga en cuanto a mayor carga de rotura y número de ciclos para la falla. Los tornillos aumentados, ya sea con cemento o hidroxiapatita mejoraron también la resistencia a la fatiga en vértebras osteoporóticas. Las simulaciones de segmentos rígidos confirmaron la presencia de esfuerzos superiores en los discos intervertebrales que provocan el daño de los segmentos adyacentes. La parte posterior de las vértebras puede estar sometida a mayores esfuerzos, fundamentalmente en la superficie de la interfaz hueso-tornillo, por lo que son más susceptibles a la falla en esta región.
Abstract: Implant loosening, catastrophic failure of the bone-screw interface, material migration, and loss of stability of the fixation component assembly constitute a serious complication in adult spinal surgery. The contribution of biomechanics is based on experimental measurement and simulation of transpedicular spinal fixations. The cortical insertion trajectory showed an increase in the resistance of the screw-bone interface with respect to the pedicle insertion trajectory, both for axial traction forces to the screw and for stress distribution in the vertebra. The double-threaded screws and standard pedicle screws had similar strength. Partially threaded screws with four-thread showed better resistance to fatigue in terms of a higher failure load and number of cycles to fail. Cement or hydroxyapatite augmented screws with also showed a better fatigue resistance in osteoporotic vertebrae. Rigid segment simulations confirmed the presence of higher stresses on the intervertebral discs causing damage to adjacent segments. The posterior body of the vertebra may be subjected to high stresses, in the bone-screw interface, being this bone region more susceptible to failure.
ABSTRACT
Abstract Vernonanthura polyanthes, popularly known as assa-peixe, is a medicinal plant that has been widely used by Brazilian Cerrado population for treatment of diseases without a detailed evaluation of their effectiveness, toxicity, and proper dosage. Thus, more studies investigating the safety of V. polyanthes aqueous extract before the use are needed. The purpose of this study was to evaluate the toxicity, cytotoxicity and genotoxicity of V. polyanthes leaves aqueous extract using the Artemia salina and Allium cepa assays. For the A. salina assay, three groups of 10 larvae were exposed to V. polyanthes leaves aqueous extract at the concentrations of 5, 10, 20, 40, and 80 mg/ml. For the A. cepa assay, 5 onion bulbs were exposed to V. polyanthes leaves aqueous extract at 10, 20, and 40 mg/ml, and then submitted to macroscopic and microscopic analysis. As result it was identified a toxicity and cytotoxicity of V. polyanthes dependent on the extract concentration. The A. salina assay suggests that the concentration of 24 mg/ml of the V. polyanthes extract is able to kill 50% of naupllis; while the A. cepa assay suggests that V. polyanthes leaves aqueous extract is toxic at concentrations higher than 20 mg/ml; however the cytotoxic effect in A. cepa root cells was observed at 40 mg/ml of the extract. It is important to say that the V. polyanthes leaves aqueous extract concentration commonly used in popular medicine is 20 mg/ml. Thus, the popular concentration used is very close to toxicity limit in A. salina model (24 mg/ml) and is the concentration which showed toxic effect in A. cepa root cells (20 mg/ml). No genotoxic activity of V. polyantes leaves aqueous extract was observed in the conditions used in this study. Because of the antiproliferative action and no genotoxic activity, V. polyanthes leaves aqueous extract may present compounds with potential use for human medicine. However more detailed studies need to be performed to confirm this potential.
Resumo Vernonanthura polyanthes, popularmente conhecida como assa-peixe, é uma planta medicinal amplamente utilizada pela população brasileira do Cerrado para o tratamento doenças, sem uma avaliação detalhada de sua eficácia, toxicidade e dosagem adequada. Dessa forma, são necessários estudos para investigar a segurança do uso do extrato aquoso de V. polyanthes. O objetivo deste estudo foi avaliar a toxicidade, citotoxicidade e genotoxicidade do extrato aquoso de folhas de V. polyanthes utilizando os ensaios de Artemia salina e Allium cepa. Para o ensaio de A. salina, três grupos de 10 larvas foram expostos ao extrato aquoso de folhas de V. polyanthes nas concentrações de 5, 10, 20, 40 e 80 mg/ml. Para o ensaio de A. cepa, 5 bulbos de cebola foram expostas ao extrato aquoso de folhas de V. polyanthes nas concentrações de 10, 20 e 40 mg/ml, e então submetidos a análise macroscópica e microscópica. O ensaio de A. salina sugere que a concentração de 24 mg/ml do extrato de V. polyanthes é capaz de matar 50% dos náuplios; enquanto o ensaio de A. cepa sugere que o extrato aquoso das folhas de V. polyanthes é tóxico em concentrações superiores a 20 mg/ml. O efeito citotóxico nas células da raiz de A. cepa foi observado apenas na concentração de 40 mg/ml. É importante dizer que a concentração de extrato aquoso de folhas de V. polyanthes comumente usada na medicina popular é de 20 mg/ml. Assim, a concentração popular utilizada está muito próxima do limite de toxicidade no modelo de A. salina (24 mg/ml) e é a mesma concentração que apresentou efeito tóxico nas células da raiz de A. cepa (20 mg/ml). Não foi observada atividade genotóxica do extrato aquoso de folhas de V. polyantes nas condições utilizadas neste trabalho. Por causa da ação antiproliferativa e ausência de atividade genotóxica, o extrato aquoso de folhas de V. polyanthes pode ser uma boa fonte natural de compostos antitumorais e pode apresentar potencial para uso na medicina. No entanto, estudos mais detalhados precisam ser realizados para confirmar esse potencial.
Subject(s)
Humans , Animals , Plant Extracts/toxicity , Asteraceae , Brazil , Plant Leaves , OnionsABSTRACT
El soporte ventilatorio no invasivo es una herramienta que ha demostrado mejorar la sobrevida de pacientes con falla muscular de la bomba respiratoria y el manejo de enfermedades pulmonares crónicas, incluso la ventilación no invasiva nocturna ha servido de puente hacia el trasplante pulmonar. Se presenta el caso de una adolescente de 14 años con enfermedad pulmonar crónica hipoxémica severa y falla ventilatoria secundaria, que requirió ventilación prolongada y traqueostomía en espera de trasplante pulmonar. Luego de reevaluar indemnidad de la vía aérea fue decanulada a soporte ventilatorio no invasivo, con uso alternado de mascarilla nasal nocturna y pieza bucal diurna, permitiendo descanso muscular respiratorio eficiente, y mejoría de flujo de tos con técnicas de apilamiento de aire. Este plan permitió una decanulación segura y realizar soporte continuo ventilatorio no invasivo con un programa de rehabilitación cardiorrespiratorio. Generalmente, el soporte ventilatorio no invasivo se utiliza en trastornos primarios de la bomba respiratoria. En este caso, se indicó para enfermedad pulmonar crónica hipoxémica, mostrando claros beneficios con oxigenación adecuada, buen rendimiento cardiovascular con mejor tolerancia al ejercicio y entrenamiento en el escenario de preparación al trasplante pulmonar.
Noninvasive Ventilatory Support has demonstrated to improve survival of patients with ventilatory pump muscle failure and nocturnal noninvasive ventilation is useful in chronic lung disease, even bridging to lung transplant. We present a 14 years old girl with severe hypoxemic chronic lung disease and secondary ventilatory failure, who required continuous long-term ventilation and underwent a tracheostomy waiting for lung transplant. After reevaluated the airway patency the patient was decannulated to Noninvasive Ventilation Support, alternating nocturnal nasal mask with diurnal mouth piece in order to provide efficient respiratory muscle rest, made air stacking and improved cough flow. This plan allows safe decannulation to continuous Noninvasive Ventilatory Support tailoring a rehabilitation cardiorespiratory program. Usually, Noninvasive Ventilation Support is prescribed for primary respiratory pump muscles failure, but in this case, it was applied for a hypoxemic chronic lung disease. Clear benefits were observed leading to appropriate oxygenation, good cardiovascular performance with better tolerance to exercise for training in the preparatory scenario of a lung transplant.
Subject(s)
Humans , Female , Adolescent , Respiratory Insufficiency/therapy , Lung Transplantation , Device Removal/methods , Noninvasive Ventilation/methods , Respiratory Insufficiency/diagnostic imaging , Preoperative Care/methods , Tracheostomy , Radiography, Thoracic , Ventilator Weaning , Tomography, X-Ray Computed , Chronic Disease , HypoxiaABSTRACT
Duchenne muscular dystrophy (DMD) is one of the most common neuromuscular diseases. Its evolution with well-defined stages related to motor and functional alterations, allows easily establishing relationships with respiratory function through a simple laboratory assessment including vital capacity (VC) measurements as well as peak cough flows. Without any treatment with respiratory rehabilitation, the main cause of morbidity and mortality is ventilatory failure, secondary to respiratory pump muscles weakness and inefficient cough. The VC plateau is reached during the non-ambulatory stages, generally after 13 years old. Respiratory rehabilitation protocols, including air stacking techniques, manual and mechanical assisted coughing and non-invasive ventilatory support, can effectively addressed the VC decline as well as the decrease in peak cough flows, despite advancing to stages with practically non-existent lung capacity. Non-invasive ventilatory support may be applied after 19 years old, initially at night and then extending it during the day. In this way, survival is prolonged, with good quality of life, avoiding ventilatory failure, endotracheal intubation and tracheostomy. This article proposes staggered interventions for respiratory rehabilitation based on the functional stages expected in the patient with DMD who has lost ambulation.
La distrofia muscular de Duchenne (DMD) es una de las enfermedades neuromusculares más frecuentes. Su curso evolutivo con etapas de declinación en la funcionalidad motora bien definidas, permite fácilmente establecer relaciones con la función respiratoria a través de un laboratorio de evaluación sencilla, básicamente de la capacidad vital (CV) y la capacidad tusígena. Sin intervenciones en rehabilitación respiratoria, la principal causa de morbimortalidad es la insuficiencia ventilatoria secundaria a debilidad de músculos de la bomba respiratoria e ineficiencia de la tos. En las etapas no ambulantes, se alcanza la meseta de la CV, generalmente después de los 13 años, su declinación junto con la disminución de la capacidad tusígena puede ser enfrentada efectivamente con la utilización de protocolos de rehabilitación respiratoria. Estos deben considerar la restitución de la CV con técnicas de insuflación activa o apilamiento de aire, tos asistida manual y mecánica, más soporte ventilatorio no invasivo, inicialmente nocturno después de los 19 años y luego diurno, pese a avanzar a etapas con capacidad pulmonar prácticamente inexistente. De esta manera, se prolonga la sobrevida, con buena calidad de vida, evitando el fallo ventilatorio, eventos de intubación endotraqueal y traqueostomía. Este artículo, hace propuestas escalonadas de intervención en rehabilitación respiratoria basadas en las etapas funcionales esperables en el paciente con DMD que ha perdido la capacidad de marcha.
Subject(s)
Humans , Respiratory Therapy/methods , Muscular Dystrophy, Duchenne/rehabilitation , Scoliosis/rehabilitation , Vital Capacity , Noninvasive VentilationABSTRACT
Spinal Muscular Atrophy (SMA) is a disease of the anterior horn of the spinal cord, which causes muscle weakness that leads to a progressive decrease in vital capacity and diminished cough flows. Respiratory morbidity and mortality are a function of the degree of respiratory and bulbar-innervated muscle. The former can be quantitated by the sequential evaluation of vital capacity to determine the lifetime maximum (plateau) and its subsequent rate of decline, progressing to ventilatory failure. SMA types 1 and 2 benefit from non-invasive respiratory care in early childhood and school age, improving quality and life expectancy. This document synthesizes these recommendations with special reference to interventions guided by stages that include air stacking, assisted cough protocols, preparation for spinal arthrodesis and non-invasive ventilatory support, even in those patients with loss of respiratory autonomy, minimizing the risk tracheostomy. Failure to consider these recommendations in the regular assessment of patients reduces the offer of timely treatments.
La Atrofia Muscular Espinal (AME) es una enfermedad genética del asta anterior de la medula espinal, que cursa con debilidad muscular progresiva. La intensidad y precocidad de la debilidad muscular presenta diferentes grados de afectación de los grupos musculares respiratorios, determinando la meseta en la capacidad vital y progresión a la insuficiencia ventilatoria, como también el compromiso de los músculos inervados bulbares. Los AME tipo 1 y 2, se benefician con cuidados respiratorios no invasivos en la infancia temprana y edad escolar, mejorando la calidad y esperanza de vida. Este documento sintetiza dichas recomendaciones, con especial referencia a intervenciones guiadas por etapas, que incluyan apilamiento de aire, protocolos de tos asistida, preparación para la artrodesis de columna y soporte ventilatorio no invasivo, incluso en aquellos pacientes con pérdida de la autonomía respiratoria, minimizando el riesgo de traqueostomía. La no consideración de estas recomendaciones en la valoración regular de los pacientes resta la oferta de tratamientos oportunos.
Subject(s)
Humans , Respiratory Therapy/methods , Muscular Atrophy, Spinal/therapy , Muscular Atrophy, Spinal/physiopathology , Vital Capacity/physiology , Noninvasive VentilationSubject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/therapy , Pneumonia, Viral/etiology , Algorithms , Coronavirus Infections/etiology , Systemic Inflammatory Response Syndrome/etiology , Risk Assessment , Clinical Laboratory Techniques , Early Diagnosis , Clinical Decision-MakingABSTRACT
The CoVID-19 pandemic has impacted in a lesser extent and intensity to patients younger than 15 years. The role of different imaging studies of lung involvement has been extensively addressed, from the first cases of severe pneumonia and respiratory distress syndrome in adults. There are fewer reports of the comparative usefulness of conventional radiology, ultrasound, and computed axial tomography in children. Of those, ground glass opacities, crazy paving pattern and surrounding halo consolidation are the most characteristic. Even though none of them allows diagnostic confirmation, their correct interpretation helps in decision flows. Computed axial tomography is more accurate for defining the type and extent of lung parenchymal involvement. The role of the ultrasound in early stages in the emergency department is clearer in adults than in children, in whom there is a good correlation with chest tomography. This article addresses the different radiological patterns, their pathophysiological representation and differential diagnoses, in order to alert pediatricians of their interpretation, as well as the potential role of imaging diagnoses most frequently used in children with low acute respiratory infection.
La pandemia CoVID-19 ha impactado en una proporción e intensidad menor a los pacientes menores de 15 años. El rol de los diferentes estudios por imágenes del compromiso pulmonar ha sido extensamente abordado, desde los primeros casos de neumonías graves y síndrome de distrés respiratorio en adultos. En niños existen menos reportes de la utilidad de la radiología convencional, ecografía y tomografía axial computarizada. Sin embargo, los patrones más característicos observados en adultos se repiten en los niños. De ellos, el vidrio esmerilado, el patrón en empedrado y la consolidación con halo circundante son los más característicos. Aun cuando ninguno de ellos permite confirmación diagnóstica, su correcta interpretación ayuda en los flujos de decisiones. La tomografía axial computarizada es más certera para la definición de tipo y extensión del compromiso parenquimatoso pulmonar. El rol en los estadios tempranos en el servicio de urgencia de la ecografía es más claro en adultos que en niños, donde existe buena correlación con la tomografía de tórax. Este artículo aborda los diferentes patrones radiológicos, su representación fisiopatológica y diagnósticos diferenciales, con el objeto de apoyar a los pediatras en su interpretación, como también reconocer el rol de las técnicas de imágenes diagnósticas más frecuentemente utilizadas en niños con infección respiratoria aguda baja.
Subject(s)
Humans , Male , Infant, Newborn , Child , Pneumonia, Viral/diagnostic imaging , Coronavirus Infections/diagnostic imaging , Betacoronavirus , Radiography, Thoracic , Tomography, X-Ray Computed , Ultrasonography , PandemicsABSTRACT
Noninvasive ventilatory support (NIVS) combined with mechanical cough assist (MI-E) is an effective tool to treat patients with acute ventilatory failure due to neuromuscular disorders (NMD). Airway respiratory infection could be lethal or with risk of endotraqueal intubation, especially when vital capacity (VC) is less than 15 ml/k. We report 2 obese adolescents, aged 11 and 14 years old, with myasthenic crisis (MC) and Duchenne muscular dystrophy (DMD). The last one with a severe cifoescoliosis treated with nocturnal noninvasive ventilation at home. MC girl has been treated with pyridostigmine, prednisolone and mycophenolate. They were admitted for thymectomy and spinal surgery arthrodesis respectively. After admission they developed airway respiratory infection triggering by Methaneumovirus and were treated with oxygen therapy, non-invasive ventilation with low-pressure support and EV immunoglobulin for the MC girl. After 48 h both patients developed severe respiratory failure, Sa/FiO2 < 200, atelectasis of lower lobes and difficulty to swallow, a peak cough flow (PFT)
El soporte ventilatorio no invasivo (SVNI) y la rehabilitación respiratoria con apilamiento de aire más tos asistida manual o mecánica, son efectivas para tratar la insuficiencia ventilatoria aguda en pacientes con enfermedades neuromusculares (ENM) y deterioro progresivo de la bomba respiratoria. Las agudizaciones gatilladas por infecciones respiratorias causan insuficiencia ventilatoria aguda potencialmente mortal y con alto riesgo de intubación, en especial cuando la capacidad vital (CV) es < de 15ml/k. Se reportan 2 adolescentes obesos con ENM de 11 y 14 años con miastenia gravis y distrofia muscular de Duchenne (DMD) con asistencia ventilatoria no invasiva nocturna con baja presión de soporte (AVNI), ingresados para timectomía y artrodesis de columna respectivamente. Una vez ingresados evolucionan con insuficiencia ventilatoria aguda secundaria a una infección respiratoria por Metaneumovirus. Inicialmente fueron manejados con oxigenoterapia, AVNI y gamaglobulina endovenosa en el caso de la paciente con crisis miasténica (CM). A las 48h presentan dificultad respiratoria severa, Sa/FiO2 < 200, atelectasias bibasales y disfagia, CV de 800ml (11ml/k) en el paciente con CM y de 200 ml (2,5ml/k) en el paciente con DMD y un pico flujo tosido (PFT) < 100 l/m. Se cambia a SVNI con equipo Trilogy® y BipapA40®, en modalidad S/T (espontáneo/tiempo) y AVAPS (volumen promedio asegurado en presión de soporte) con altos parámetros ventilatorios; suspendiendo rápidamente la oxigenoterapia, al combinar tos mecánicamente asistida con in-exsufflator (MI-E) en forma intensiva. Ambos pacientes presentan mejoría clínica sostenida, de la CV, PFT y pico flujo exuflado máximo con MI-E (PFE-MI-E). El SVNI más la aplicación sistemática del MI-E hasta lograr SaO2 de al menos 95% con oxígeno ambiental evita la intubación endotraqueal en ENM, a diferencia del agravamiento producido por AVNI y oxigenoterapia con criterios clásicos.
Subject(s)
Humans , Male , Female , Child , Adolescent , Respiratory Insufficiency/complications , Respiratory Insufficiency/therapy , Noninvasive Ventilation/methods , Clinical Evolution , Neuromuscular Diseases/complications , Obesity/complicationsABSTRACT
RESUMEN Este artículo presenta la vida y obra de Guillermo Rawson, uno de los padres del sanitarismo nacional. Se reseñan su formación médica, su paso por la política y, finalmente, su labor como docente e investigador de la Salud Pública en Argentina.
ABSTRACT This article presents the life and work of Guillermo Rawson, one of the fathers of national public health care. It reviews his medical training, his time in politics and, finally, his work as a teacher and researcher of Public Health in Argentina.
ABSTRACT
Patients hospitalized for acute asthma treated with a pre-established algorithm could decrease hospital stay and critical bed (PICU) requirement. The objective of this article was to implement and evaluate the impact of a pre-established algorithm to treat children hospitalized for acute asthma. It is a cross-sectional and comparative study, with a prospective sample for convenience, of asthmatic children between 5 and 15 years admitted during 2017 without response to the first line of treatment in the emergency department. Patients with cardiorespiratory comorbidities and with direct admission to PICU were excluded. An algorithm was applied for 2 hours and its effectiveness was evaluated by a clinical score (PAS: English Pediatric Asthma Score). 55 patients were admitted, mean age 8.02 years, 41.8% female. The PAS decreased from 8 to 5 points at the end of the algorithm (p <0.001). When comparing the results obtained with the group treated the previous year, without algorithm application in 51 patients with similar demographic characteristics, a shorter hospitalization was observed (0.6 days versus 0.95 days (p <0.0368)). The algorithm in acute asthma unified treatment criteria and times in its application. A rapid decrease in clinical score and a shorter hospital stay were observed.
Los pacientes hospitalizados por asma agudo tratados con un algoritmo preestablecido, podrían disminuir la estancia hospitalaria y requerimiento de cama crítica (UCIP). El objetivo de este trabajo fue el de implementar y evaluar el impacto de un algoritmo preestablecido para tratar a niños hospitalizados por asma aguda. Es un estudio transversal y comparativo, con una muestra prospectiva por conveniencia, de niños asmáticos entre 5 y 15 años ingresados durante el 2017 sin respuesta a la primera línea de tratamiento en el servicio de urgencia. Se excluyeron pacientes con comorbilidades cardiorespiratorias y con ingreso directo a UCIP. Se aplicó un algoritmo durante 2 horas evaluando su efectividad mediante puntaje clínico (PAS, por su sigla en inglés Pediatric Asthma Score). Ingresaron 55 pacientes, edad media 8,02 años, 41,8% sexo femenino. El PAS disminuyó de 8 a 5 puntos al finalizar algoritmo (p <0,001). Al comparar los resultados obtenidos con el grupo tratado el año anterior, sin aplicación de algoritmo en 51 pacientes con similares características demográficas, se observó una hospitalización más breve (0,6 días versus 0,95 días (p < 0,0368)). El algoritmo en asma aguda unificó criterios de tratamiento y los tiempos en su aplicación. Se observó una rápida disminución del puntaje clínico y menor estancia hospitalaria.
Subject(s)
Asthma/therapy , Algorithms , Child, Hospitalized , Acute Disease , Outcome Assessment, Health CareABSTRACT
Neonatal asphyxia occurs due to reduction in oxygen supply to vital organs in the newborn. Rapid restoration of oxygen to the lungs after a long period of asphyxia can cause lung injury and decline of respiratory function, which result from the activity of molecules that induce vascular changes in the lung such as nitric oxide (NO) and vascular endothelial growth factors (VEGF). In this study, we evaluated the pulmonary and vascular morphometry of rats submitted to the model of neonatal asphyxia and mechanical ventilation, their expression of pulmonary VEGF, VEGF receptors (VEGFR-1/VEGFR-2), and endothelial NO synthase (eNOS). Neonate Sprague-Dawley rats (CEUA #043/2011) were divided into four groups (n=8 each): control (C), control submitted to ventilation (CV), hypoxia (H), and hypoxia submitted to ventilation (HV). The fetuses were harvested at 21.5 days of gestation. The morphometric variables measured were body weight (BW), total lung weight (TLW), left lung weight (LLW), and TLW/BW ratio. Pulmonary vascular measurements, VEGFR-1, VEGFR-2, VEGF, and eNOS immunohistochemistry were performed. The morphometric analysis showed decreased TLW and TLW/BW ratio in HV compared to C and H (P<0.005). Immunohistochemistry showed increased VEGFR-2/VEGF and decreased VEGFR-1 expression in H (P<0.05) and lower eNOS expression in H and HV. Median wall thickness was increased in H, and the expression of VEGFR-1, VEGFR-2, VEGF, and eNOS was altered, especially in neonates undergoing H and HV. These data suggested the occurrence of arteriolar wall changes mediated by NO and VEGF signaling in neonatal hypoxia.
Subject(s)
Animals , Asphyxia Neonatorum/therapy , Respiration, Artificial/adverse effects , Vascular Endothelial Growth Factor Receptor-1/analysis , Vascular Endothelial Growth Factor Receptor-2/analysis , Vascular Endothelial Growth Factor A/analysis , Nitric Oxide Synthase Type III/analysis , Lung/pathology , Arterioles/pathology , Reference Values , Asphyxia Neonatorum/physiopathology , Asphyxia Neonatorum/pathology , Respiration, Artificial/methods , Immunohistochemistry , Rats, Sprague-Dawley , Disease Models, Animal , Lung/physiopathology , Lung/blood supplyABSTRACT
Pediatric acute asthma should be considered like an indicator of poor control of this disease of high prevalence. In acute refractory asthma there is no response to initial treatment with bronchodilators and corticosteroids. Although any asthmatic exacerbation in children and adolescents can progress to severe respiratory failure, poor response to first-line treatment is less frequent. In Chile pediatric asthma has government financial protection Despite widespread clinical guidelines, exacerbations remain a high health burden due to direct and indirect costs and are associated with school attendance and poor quality of life. A stepwise approach of asthma should consider written action plans that ensure the patient and his family early recognition of a crisis, a stepwise treatment in a pre-established time line and the continuity of medical actions from emergency unit to hospital care units. The objectives are to reduce morbimortality, health´s expenses and opportunity for educational actions. This article reviews some treatment options for children and adolescents who present with moderate and severe acute asthma in the emergency unit and are admitted to intermediate units. The focus is the initial management of the first 120 minutes of acute respiratory failure. We propose an algorithm that includes pharmacological management and respiratory care with high flow oxygen therapy and noninvasive ventilation assistance
El asma agudo en pediatría se debe entender como un indicador de mal control de esta enfermedad de alta prevalencia mundial. El asma agudo refractario es aquel que no responde en forma inicial al tratamiento combinado con broncodilatadores y corticoides. Pese a que cualquier exacerbación asmática en los niños y adolescentes puede progresar a una insuficiencia respiratoria grave, la mala respuesta al tratamiento de primera línea es menos frecuente. A pesar de contar con guías clínicas y en Chile ser el asma una garantía en salud, las agudizaciones representan alta carga sanitaria vinculadas con inasistencia escolar y mala calidad de vida. El manejo del asma, incluyendo planes de acción escritos destinados al reconocimiento precoz de una crisis, el tratamiento por etapas en una línea de tiempo preestablecida según objetivos y la continuidad necesaria desde el servicio de urgencia a los cuidados en la internación, fundamentalmente en cuidados intermedios, tiene como objetivos disminuir la morbimortalidad, reducir los gastos en salud y realizar acciones educativas. Este articulo revisa algunas alternativas de tratamiento escalonado para niños y adolescentes que se presenten con asma agudo moderado y severo en los servicios de urgencia y son ingresado en unidades de intermedio, enfocado en el manejo inicial de los primeros 120 minutos de la insuficiencia respiratoria aguda. Se propone un algoritmo que incluye el manejo farmacológico y la terapia respiratoria con oxigenoterapia de alto flujo y asistencia ventilatoria no invasiva
Subject(s)
Humans , Respiratory Insufficiency/therapy , Asthma/complications , Asthma/therapy , Respiratory Insufficiency/etiology , Asthma/diagnosis , Severity of Illness Index , Nebulizers and Vaporizers , Bronchodilator Agents/therapeutic use , Prednisone/therapeutic use , Noninvasive VentilationABSTRACT
Abstract Vernonanthura polyanthes, popularly known as assa-peixe, is a medicinal plant that has been widely used by Brazilian Cerrado population for treatment of diseases without a detailed evaluation of their effectiveness, toxicity, and proper dosage. Thus, more studies investigating the safety of V. polyanthes aqueous extract before the use are needed. The purpose of this study was to evaluate the toxicity, cytotoxicity and genotoxicity of V. polyanthes leaves aqueous extract using the Artemia salina and Allium cepa assays. For the A. salina assay, three groups of 10 larvae were exposed to V. polyanthes leaves aqueous extract at the concentrations of 5, 10, 20, 40, and 80 mg/ml. For the A. cepa assay, 5 onion bulbs were exposed to V. polyanthes leaves aqueous extract at 10, 20, and 40 mg/ml, and then submitted to macroscopic and microscopic analysis. As result it was identified a toxicity and cytotoxicity of V. polyanthes dependent on the extract concentration. The A. salina assay suggests that the concentration of 24 mg/ml of the V. polyanthes extract is able to kill 50% of naupllis; while the A. cepa assay suggests that V. polyanthes leaves aqueous extract is toxic at concentrations higher than 20 mg/ml; however the cytotoxic effect in A. cepa root cells was observed at 40 mg/ml of the extract. It is important to say that the V. polyanthes leaves aqueous extract concentration commonly used in popular medicine is 20 mg/ml. Thus, the popular concentration used is very close to toxicity limit in A. salina model (24 mg/ml) and is the concentration which showed toxic effect in A. cepa root cells (20 mg/ml). No genotoxic activity of V. polyantes leaves aqueous extract was observed in the conditions used in this study. Because of the antiproliferative action and no genotoxic activity, V. polyanthes leaves aqueous extract may present compounds with potential use for human medicine. However more detailed studies need to be performed to confirm this potential.
Resumo Vernonanthura polyanthes, popularmente conhecida como assa-peixe, é uma planta medicinal amplamente utilizada pela população brasileira do Cerrado para o tratamento doenças, sem uma avaliação detalhada de sua eficácia, toxicidade e dosagem adequada. Dessa forma, são necessários estudos para investigar a segurança do uso do extrato aquoso de V. polyanthes. O objetivo deste estudo foi avaliar a toxicidade, citotoxicidade e genotoxicidade do extrato aquoso de folhas de V. polyanthes utilizando os ensaios de Artemia salina e Allium cepa. Para o ensaio de A. salina, três grupos de 10 larvas foram expostos ao extrato aquoso de folhas de V. polyanthes nas concentrações de 5, 10, 20, 40 e 80 mg/ml. Para o ensaio de A. cepa, 5 bulbos de cebola foram expostas ao extrato aquoso de folhas de V. polyanthes nas concentrações de 10, 20 e 40 mg/ml, e então submetidos a análise macroscópica e microscópica. O ensaio de A. salina sugere que a concentração de 24 mg/ml do extrato de V. polyanthes é capaz de matar 50% dos náuplios; enquanto o ensaio de A. cepa sugere que o extrato aquoso das folhas de V. polyanthes é tóxico em concentrações superiores a 20 mg/ml. O efeito citotóxico nas células da raiz de A. cepa foi observado apenas na concentração de 40 mg/ml. É importante dizer que a concentração de extrato aquoso de folhas de V. polyanthes comumente usada na medicina popular é de 20 mg/ml. Assim, a concentração popular utilizada está muito próxima do limite de toxicidade no modelo de A. salina (24 mg/ml) e é a mesma concentração que apresentou efeito tóxico nas células da raiz de A. cepa (20 mg/ml). Não foi observada atividade genotóxica do extrato aquoso de folhas de V. polyantes nas condições utilizadas neste trabalho. Por causa da ação antiproliferativa e ausência de atividade genotóxica, o extrato aquoso de folhas de V. polyanthes pode ser uma boa fonte natural de compostos antitumorais e pode apresentar potencial para uso na medicina. No entanto, estudos mais detalhados precisam ser realizados para confirmar esse potencial.
ABSTRACT
Gallbladder duplication is a rare congenital anomaly and, like other biliary malformations, is associated with an increased risk of complications in the laparoscopic cholecystectomy We present a case of a woman consulting in the emergency department for clinical symptoms compatible with acute cholecystitis. An abdominal ultrasound is performed confirming the clinical suspicions, observing the typical findings. Pathological dilatation of the extrahepatic biliary tract is also confirmed, therefore she is evaluated with MR cholangiography, which also confirms signs compatible with acute cholecystitis; the presence of a cystic formation of saccular morphology in an intrahepatic location was identified, with the same structure as the gallbladder, but smaller in size and with a duct of its own that drained into the common hepatic duct independently to the cystic duct of the inflamed vesicle.
La duplicación de la vesícula biliar es una anomalía del desarrollo poco frecuente, y al igual que otras malformaciones de la vía biliar, se asocia a un mayor riesgo de complicaciones en la colecis-tectomía laparoscópica. Se presenta un caso de una mujer que consulta en el servicio de urgencia por cuadro clínico compatible con colecistitis aguda. Se realiza una ecografía abdominal que confirma la presunción clínica, observándose los hallazgos típicos. Se constata además dilatación patológica de la vía biliar extrahepática, por lo que se evalúa con colangiorresonancia, que además de confirmar los signos compatibles con la colecistitis aguda, se identificó la presencia de una formación quística de morfología sacular en situación intrahepática, de igual morfología que la vesícula biliar, pero de menor tamaño y con un conducto propio que drenaba al conducto hepático común en forma independiente al conducto cístico de la vesícula inflamada.
Subject(s)
Humans , Female , Aged , Cholangiography/methods , Gallbladder/abnormalities , Gallbladder/diagnostic imaging , Cholelithiasis/etiology , Magnetic Resonance ImagingABSTRACT
Este trabalho teve por objetivo identificar as plantas medicinais de uso popular e o perfil socioeconômico de seus usuários em área urbana de Ouro Preto, MG. O levantamento utilizou entrevistas semiestruturadas e amostragem aleatória, perfazendo 10% das residências. O grau de conhecimento sobre plantas medicinais foi medido pelo número de espécies citadas. Analisou-se a relação entre o saber popular sobre as plantas medicinais e características socioeconômicas dos entrevistados (renda, escolaridade, sexo, idade e forma de aquisição do conhecimento). Foram questionadas 6.713 pessoas, onde mais de 90% usam plantas medicinais para se tratarem. Identificou-se 342 espécies, reunidas em 94 famílias. Para cada espécie foram referidos os nomes populares, hábito, procedência, uso medicinal, parte usada, e forma de preparo. As principais moléstias tratadas com plantas foram: diarreia, insônia, gripe, hidropisia, distúrbios hepáticos, renais e do trato respiratório. Há um grande número de espécies nativas utilizadas. Dentre as exóticas, a maioria é de origem europeia. O uso místico de espécies, embora presente na cultura popular do município, foi pouco citado. Algumas espécies identificadas figuram na lista das espécies ameaçadas de extinção. O grau de conhecimento sobre plantas medicinais pela população de Ouro Preto independe, tanto do nível econômico, como da escolaridade ou do sexo. A idade e a forma de aquisição do conhecimento influenciam no saber popular das ervas medicinais. As pessoas com maior saber popular sobre as plantas adquiriram esses conhecimentos principalmente pelo costume familiar, por livros, ou por outras pessoas. Pessoas mais jovens conhecem menos espécies medicinais que as mais idosas, sugerindo risco de perda desse conhecimento tradicional. A grande riqueza de plantas citadas neste trabalho denota a importância de estudos etnobotânicos no resgate do conhecimento tradicional em áreas urbanas, tanto pelo seu valor histórico-cultural, como pela importância científica.
This work aimed to identify the medicinal plants of popular use and the socioeconomic profile of the users in the urban area of Ouro Preto, state of Minas Gerais, Brazil. The survey was carried out with random sampling and semi-structured interviews, amounting to 10% of households. The degree of knowledge about medicinal plants was measured by the number of species mentioned. The relationship between the popular knowledge about medicinal plants and the socioeconomic characteristics of the users (income, education, gender, age and type of knowledge acquisition) was also studied. In this survey, 6,713 inhabitants were questioned, of whom more than 90% use medicinal plants. A total of 342 species grouped in 94 families were identified. The popular names, growth habit, habitat, medicinal uses, part used and method of preparation are listed for each identified species. The main ailments treated with plants were diarrhea, insomnia, flu, dropsy and liver, renal and respiratory tract disorders. There is a large number of native species. Among the exotic ones, most are of European origin. The spiritual use of species, although present in the popular culture of the city, was negligible. Some species figure on the Brazilian red lists. It was noted that knowledge of medicinal plants by the population of Ouro Preto, in species richness, is not related to income, class, educational level and gender. The age and manner of acquisition of empirical knowledge about medicinal plants are associated with the number of species listed. Persons with greater popular knowledge about medicinal plants acquired information through family tradition, books and from other persons. Younger persons know fewer medicinal plants than the older ones, what suggests a loss of this traditional knowledge. The richness of the plants mentioned in this paper demonstrates the importance of ethnobotanical studies in the rescue of traditional knowledge in urban areas, for its scientific, historical and cultural values.
Subject(s)
Humans , Male , Female , Plants, Medicinal/anatomy & histology , Social Class , Urban Area , Community Participation/statistics & numerical data , Ethnobotany/methodsABSTRACT
Além do valor como recurso terapêutico, plantas medicinais também possuem potencial para serem utilizadas como fonte de princípios ativos contra fitopatógenos. O objetivo deste trabalho foi avaliar o efeito de óleos essenciais das espécies medicinais Baccharis dracunculifolia (alecrim-do-campo), Schinus terebinthifolius (aroeirinha) e Porophyllum ruderale (arnica-brasileira) sobre o crescimento dos fungos fitopatogênicos Fusarium oxysporum f. sp. phaseoli (Fop), F. solani f. sp. phaseoli (Fsp), Sclerotinia sclerotiorum (Ss), S. minor (Sm), Rhizoctonia solani (Rs), Sclerotium rolfsii (Sr) e Macrophomina phaseolina (Mp). Avaliou-se em placas de Petri o crescimento radial desses fungos em meio batata-dextrose-ágar (BDA) com cinco concentrações (0, 250, 500, 1000 e 3000 mg L-1) dos óleos essenciais. Discos de micélio (5 mm de diâmetro) de cada fungo em crescimento foram transferidos para placas de Petri que foram mantidas a 23°C no escuro por 48 horas. O óleo essencial de alecrim-do-campo foi o mais eficiente na redução do crescimento micelial de todos os fungos, com inibição completa quando se utilizou a concentração de 3000 mg L-1. A redução de crescimento variou de 29% (Fs) a 80% (Rs) a 250 mg L-1 do óleo essencial de alecrim-do-campo; a 500 mg L-1, variou de 29% (Fs) a 98% (Sr); e a 1000 mg L-1, de 41% (Fs) a 100% (Sr). A redução do crescimento dos fungos pelo óleo de aroeirinha na concentração de 3000 mg L-1 variou de 27% (Fsp) a 74% (Rs). Nessa concentração, o óleo de arnica-brasileira reduziu o crecimento micelial de Ss em 72%, o de Rs em 80% e o de Mp em 82%, sem efeitos significativos sobre o crescimento micelial de Fsp e Fop. Conclui-se que os óleos essenciais de alecrim-do-campo, aroeirinha e arnica-brasileira possuem potencial para o controle dos fungos fitopatogênicos estudados, com destaque para o óleo de alecrim-do-campo.
In addition to their value as therapeutic resources, medicinal plants also have the potential to be used as a source of alternative compounds against plant pathogens. The objective of this study was to evaluate the effect of essential oils extracted from the medicinal species Baccharis dracunculifolia, Schinus terebinthifolius and Porophyllum ruderale on the growth of the fungal plant pathogens Fusarium oxysporum f. sp. phaseoli (Fop), F. solani f. sp. phaseoli (Fsp), Sclerotinia sclerotiorum (Ss), S. minor (Sm), Rhizoctonia solani (Rs), Sclerotium rolfsii (Sr) and Macrophomina phaseolina (Mp). The radial mycelial growth of the fungi was evaluated on potato dextrose agar (PDA) in Petri dishes with five concentrations (0, 250, 500, 1000 and 3000 μL L-1) of the essential oils. Mycelial discs (5 mm diameter) of the growing colonies of each fungus were transferred to Petri dishes, which were maintained at 23 °C in the dark for 48 hours. The essential oil of B. dracunculifolia was the most effective oil in the reduction of the mycelial growth of all fungi. It completely inhibited their growth at 3000 mg L-1. At 250 mg L-1, the growth reduction caused by the oil of B. dracunculifolia varied from 29% (Fs) to 80% (Rs); at 500 mg L-1, it varied from 29% (Fs) to 98% (Sr); and at 1000 mg L-1, it varied from 41% (Fs) to 100% (Sr). The reduction of the mycelial growth caused by the oil of S. terebinthifolius at 3000 mg L-1 varied from 27% (Fsp) to 74% (Rs). At this concentration, the oil of P. ruderale reduced the mycelial growth of Ss by 72%, of Rs by 80% and of Mp by 82%, without significant effects on the mycelial growth of Fsp and Fop. We conclude that the essential oils of B. dracunculifolia, S. terebinthifolius and P. ruderale have the potential to be used to control the plant pathogens tested, especially the oil of B. dracunculifolia.
Subject(s)
Oils, Volatile/analysis , Plants, Medicinal/classification , Arnica/anatomy & histology , Anacardiaceae/anatomy & histology , Vernonia/anatomy & histology , Fungi/classificationABSTRACT
Flexible bronchoscopy imposes new challenges as a diagnostic and therapeutic routine procedure in pediatric respiratory disease especially in complicated patients. The development of new equipment with smaller diameter and better resolution has contributed to perform therapeutic procedures together with rigid bronchoscopy, not only for foreign body extraction. The same is occurring with the use of diagnostic imaging methods and endobronchial ultrasound in order in order tu study central airway compression. Other challenges include determining whether the pediatric pulmonologist should be trained both in rigid and flexible endoscopy; if these procedures are more accurate and safe only in tertiary reference centers; specifying whether these technologies are cost effective compared with diagnostic imaging techniques and virtual bronchoscopy.
La broncoscopía flexible impone nuevos desafíos como herramienta diagnóstica y terapéutica de uso rutinario en pacientes pediátricos cada vez más complejos. El desarrollo de nuevas tecnologías con equipos de diámetro cada vez más pequeño y de mejor resolución, la realización de procedimientos terapéuticos combinados con broncoscopía rígida y la complementariedad con métodos de diagnóstico por imágenes y ultrasonografía endobronquial, están en pleno desarrollo. Otros desafíos son definir si el neumólogo pediatra debe tener entrenamiento en técnicas de broncoscopía flexible y rígida, verificar si la realización de estos procedimientos endoscópicos es más rigurosa y segura en unidades terciarias, precisar si estas tecnologías son costo efectivas en relación a métodos de diagnóstico por imágenes y cuantificar en que magnitud los resultados obtenidos, modifican la conducta a seguir con el paciente.
Subject(s)
Humans , Male , Female , Child, Preschool , Bronchoscopy , Lung Diseases/diagnosisABSTRACT
En adultos, se ha demostrado que la metformina favorece la reducción de peso y previene el desarrollo de Diabetes Mellitus tipo 2 (DM2). Sin embargo, aún no se han determinado estos efectos en población adolescente con riesgo de DM2. Objetivo: Analizar el impacto antropométrico y metabólico de la metformina en adolescentes obesas con riesgo de DM2. Pacientes y Método: Estudio randomizado, doble ciego, en que participaron 19 adolescentes obesas con riesgo de DM2 distribuidas aleatoriamente en dos grupos. Ambos fueron sometidos a un período de tratamiento (3 meses) con cambios en estilo de vida y farmacoterapia (dosis diaria de metformina 500 mg de liberación prolongada o placebo, respectivamente), continuado por un período de seguimiento (3 meses). Se compararon las variaciones en antropometría (peso, IMC, circunferencia cintura, presión arterial) y perfil metabólico (glicemia, HOMA, perfil lipídico, GOT y GPT) entre ellos al finalizar ambos períodos. Resultados: El grupo tratado con metformina mostró reducción significativa del peso e IMC. La disminución de IMC fue significativamente mayor que la del grupo que recibió placebo. Ningún grupo demostró mejora en el perfil de riesgo metabólico. Conclusión: La terapia con metformina, combinada con intervención en el estilo de vida, reduce el peso e IMC en adolescentes obesas con riesgo de DM2 en comparación con pacientes que reciben intervención en estilo de vida y placebo.
In adults, metformin promotes weight loss and prevents the development of type 2 diabetes mellitus (DM2). However, these effects have not been demonstrated in adolescents at risk for DM2. Objective: To analyze the anthropometric and metabolic impact of metformin in obese adolescents at risk for DM2. Patients and Methods: A double-blind, placebo-controlled study was conducted in 19 obese female adolescents at risk for DM2. A structured lifestyle intervention with nutritional and exercise education and motivational support was assessed over 3 month with an additional follow up period of 3 months. Subjects were randomized to 500 mg/ daily of extended release metformin or placebo. Anthropometric (weight, BMI, waist circumference, blood pressure) and metabolic profiles (glycemia, HOMA, lipid profile, AST, ALT) were compared between both groups at the end of both periods. Results: Metformin treated group showed a significant reduction in weight and body mass index (BMI) compared with placebo group. No improvement in the metabolic risk profile was showed in any group. Conclusion: In this study, metformin therapy in combination with a lifestyle intervention helps to reduce weight and BMI in obese adolescent females at risk for DM2, compared to lifestyle and placebo intervention.
ABSTRACT
Introducción: La asistencia ventilatoria no invasiva domiciliaria (AVNI) es una modalidad de ventilación mecánica prolongada que puede ser proporcionada a niños con insuficiencia ventilatoria crónica. Objetivo: Describir las características clínicas, resultados en su evolución y calidad de vida relacionada a salud (CVRS) en pacientes ingresados a un programa nacional de AVNI. Pacientes y Métodos: Se revisaron los registros de pacientes del programa durante 24 meses (2006-2008). Se utilizó un protocolo de seguimiento previamente definido. Resultados: 177 niños, edad promedio 9,7 ± 4,7 años. Catorce fallecieron por causas no relacionadas a la AVNI. Diagnósticos: enfermedad neuromuscular (ENM) 64%, mielomeningocele operado 6%, síndrome apnea obstructiva del sueño 6%, enfermedad del parénquima pulmonar 20% y miscelánea 4%. Respecto al año previo al ingreso las hospitalizaciones disminuyeron de 60 a 21% (p < 0,00001) y de 1,3 hospitalizaciones/ paciente/año a 0,3 (p < 0,00001). En 82 pacientes la CVRS mejoró, AUQUEI 17,2 ± 5,6 puntos (p < 0,05), IRS 26,4 ± 8,2 puntos (p < 0,05). En 21 pacientes con ENM y entrenamiento respiratorio hubo mejoría de la Pimax (27 cmH2O; p < 0,05) y no hubo disminución en la CVF. Conclusiones: AVNI disminuyó las hospitalizaciones y mejoró la CVRS de los pacientes ingresados al programa nacional. En un grupo de pacientes mejoró la fuerza muscular con estabilización de la función respiratoria.
Introduction: Prolonged mechanical ventilation may be provided to children with chronic ventilatory failure as non-invasive ventilatory assistance at home (NIVA). Objective: To describe clinical characteristics, evolution outcomes and Health Related Quality of Life (HRQOL) of pediatric patients admitted into the Chilean NIVA program. Patients and Methods: Medical files of patients included in the program, were reviewed during a period of 24 months (2006-2008), using follow-up protocols. Results: There were a total of 177 children, with an average age of 9.7 ± 4.7 years. Fourteen patients died of non-related causes. Diagnoses were: neuromuscular disease (NMD) 64%, myelomeningocele 6%, obstructive sleep apnea syndrome 6%, lung disease 20% and miscellaneous 4%. Compared to the previous year, hospitalization decreased from 60 to 21% (p < 0.00001) and from 1.3 hospitalizations/patient/year to 0.3 (p < 0.00001). HRQOL improved significantly, AUQUEI 17.2 ± 5.6 (p < 0.05), IRS 26.4 ± 8.2 points (p < 0.05) in 82 patients. In 21 patients with NMD an average increase of 27 cmH2O on muscular inspiratory pressure (p < 0.05) after respiratory training was observed. Conclusions: The NIVA program reduced hospitalizations and improved HRQOL. In a group of patients the muscle strength increased with stable respiratory function.
ABSTRACT
The Duchenne Muscular Dystrophy (DMD) is a recessive genetic disease linked to chromosome X. Thisdisease is characterized by an absence or dysfunction in the expression of dystrophin. Experimental modelsmdxare widely used for the development of research addressing the DMD. The objective of this research is tocontribute to a detailed study of possible renal morphological changes resulting from DMD. We used five pairsof kidneys frommdxmice and five from normal mice, which were subjected to measurement, light microscopy,and scanning electron microscopy. The morphological findings of kidneys frommdxmice are within thepatterns described in animal studies with severe dehydration, which exhibit signs of diffuse hemorrhage inthe cortical and medullary area, while the glomeruli in the cortical region showed a decrease in urinary space,located between the Bowmans capsule and the inner cell mass of the glomeruli. However, future experimentswith animals in different ages can assist in the proving of the morphological changes found here.