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Resumen Introducción: La arteritis de Takayasu es una vasculitis de grandes vasos que afecta a las arterias elásticas de gran calibre, fundamentalmente la aorta y sus ramas principales. Ocurre frecuentemente en mujeres entre los 20-30 años, por lo que es muy infrecuente en la edad pediátrica. Caso clínico: Se presenta el caso de una paciente de 15 años en seguimiento desde los 9 años por enfermedad celiaca. A los 13 años se detectó anemia de trastornos crónicos, elevación de proteína C reactiva y velocidad de sedimentación globular. La paciente permaneció en todo momento asintomática. Tras descartar otros procesos, se solicitó tomografía computarizada por emisión de positrones (PET-TC), donde se detectaron lesiones compatibles con vasculitis de grandes vasos. La valoración por Cardiología evidenció un aneurisma en coronaria derecha. Se realizó angio-TC, que sugirió arteritis de Takayasu tipo III. Conclusiones: Es frecuente un retraso en el diagnóstico de la arteritis de Takayasu en los pacientes pediátricos. En este caso se encontraron lesiones de la fase II sin la presencia de síntomas correspondientes a la fase I. El PET-TC permitió el diagnóstico de vasculitis, clave para el diagnóstico de la paciente.
Abstract Background: Takayasu arteritis is a large-vessel vasculitis which affects large-caliber elastic arteries, primarily the aorta and its main branches. It mainly affects women between 20-30 years, so it is rare in children. Case report: We describe the case of a 15-year-old female who was followed up since she was 9 years old due to celiac disease. At the age of 13, anaemia of chronic disorders associated to elevated C-reactive protein and erythrocyte sedimentation were detected. The patient remained asymptomatic. After excluding other diseases, we requested a positron emission computed tomography (PET-CT); lesions compatible with large-vessel vasculitis were detected. Cardiology evaluation showed an aneurysm in the right coronary artery. Angio-CT suggested Takayasu type III arteritis. Conclusions: The delay in the diagnosis of Takayasu arteritis in pediatric patients is quite common. In this case, we have found phase II lesions, with no previous phase I symptoms. However, PET-CT allowed the diagnosis of vasculitis, key to the diagnosis of the patient.
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ABSTRACT: The effect of chemical composition of silages on in vitro gas fermentation profiles in rabbits was examined. The study was performed using 7 silages: beans (Phaseolus vulgaris), faba bean (FB, Vicia faba), common vetch (CV, Vicia sativa), ryegrass (Lolium perenne), barley (B, Hordeum vulgare), barley with common vetch (BCV) and barley with faba bean (BFB). We used 3 New Zealand White (NZW) rabbits as donors of caecal content in each incubation run (n=3). Data were analyzed in a completely randomized experimental design. The CV silage showed higher values of crude protein (CP), followed by FB and bean silages (P<0.001). Barley silage had the lowest CP content (96g kg-1 DM) (P=0.001). The NDF and ADF content were lower (P<0.001) for beans and CV compared with the rest of the forage silages. Ryegrass silage had higher values of dry matter degradation, organic matter degradation, relative GP and SCFA (P<0.001). The highest values of digestible energy were for CV and bean silages (P<0.001). Ryegrass and CV silages showed higher levels in GP parameters, which could be associated with their better chemical composition characteristics, mainly protein and fiber content.
RESUMO: O objetivo do presente estudo foi avaliar a composição química e os padrões in vitro de fermentação cecal em coelhos em crescimento. Foram realizados 7 silagens: feijão (Phaseolus vulgaris), fava (FB, Vicia faba), ervilhaca (CV, Vicia sativa), azevém (Lolium perenne), cevada (B, Hordeum vulgare), cevada com ervilhaca (BCV) e da cevada com fava (BFB). oram usados 3 coelhos New Zealand White (NZW) como doadores de conteúdo cecal em cada série de incubação (n=3). Os dados foram analisados em um delineamento experimental inteiramente casualizado. A silagem de CV apresentaram maiores valores de proteína bruta (PB), seguido de silagens de FB e de feijão (P<0,001). Silagem de cevada apresentou o menor teor de PB (96g kg-1 de MS) (P=0,001). O conteúdo FDN e FDA foram menores (P<0,001) para Feijão e CV em comparação com o resto das silagens de forrageiras. Silagens de azevém apresentaram valores mais elevados de degradação de matéria seca, degradação da matéria orgânica, GP relativa e AGCC (P<0,001). Os maiores valores de energia digestível foram de CV e silagens de feijão (P<0,001). Azevém e CV apresentaram melhores níveis de parâmetros GP, que poderiam ser relacionadas com as suas melhores características de composição química, principalmente proteína e teor de fibra.
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A pesar de los notables avances en la prevención, la parada cardiorrespiratoria sigue siendo un problema de salud pública. OBJETIVO: determinar el nivel de conocimientos sobre reanimación cardiopulmonar Pediátrica (RCP) en los residentes del tercer año de Pediatría. METODOS: Investigación de tipo no experimental, prospectiva y exploratoria. Población representada por 46 residentes que se encontraban laborando en las unidades docentes hospitalarias de Maracaibo entre septiembre y noviembre de 2012, a quienes se le aplicó una encuesta sobre los conocimientos teórico-prácticos en rcP de las Guías Americana o europea 2010. RESULTADOS: el 41% de los residentes había recibido clases teórico-prácticas en pregrado y el 70% las recibió en postgrado; sobre el basamento de las nuevas pautas, sólo el 34.78% lo conocen; en cuanto a las respuestas, el 60.87% respondió correctamente acerca de la relación compresiones/ventilación, la respuesta sobre la frecuencia de las compresiones fue incorrecta en el 52.17%; sobre la frecuencia respiratoria correcta, el 63.04% contestó incorrectamente; la respuesta sobre la dosis de adrenalina fue correcta en el 78.26% y sobre la edad de inicio del uso de deA fue incorrecta en el 47.82%; la respuesta sobre la dosis de choque fue incorrecta en el 13,04%; no obstante, el 87% se siente apto para realizar la RCP. CONCLUSION: la formación sobre la rcP pediátrica en los residentes del tercer año de pediatría en las diferentes unidades docentes hospitalarias no alcanza el estándar internacional que se amerita, y se sugiere el reciclaje cada año del postgrado.
Despite the remarkable advances in prevention, cardiac arrest remains a public health problem. OBJETIVE: to determine the level of knowledge about pediatric cardiopulmonary resuscitation (CPR) in third year residents of Pediatrics. METHODS: A non-experimental, prospective and exploratory investigation. the study group was represented by 46 residents who worked at Maracaibos teaching hospital units between september and november 2012, to whom a theoretical and practical survey was applied to evaluate their knowledge regarding the American or european 2010 cPr Guide. RESULTS: 41% of residents had received theoretical and practical classes as undergraduates while 70% received it as graduates; only 34.78% had some knowledge about the basis of the new guidelines; in terms of compression / ventilation ratio, 60.87% answered correctly ; the frequency of compressions was incorrectly answered by 52.17%; on proper respiratory rate, 63.04% answered incorrectly; the adrenaline dose was answered correctly by 78.26%; answers about the age of the first use of deA were incorrect in 47.82% and about the shock dose in 13.04%; however, 87% feel fit to perform CPR. CONCLUSION: Pediatric cPr training for third year residents in different pediatric hospital teaching units does not meet the international standard. For this reason it is suggested that this training should be refreshed every residency year.
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Summary In this manuscript we describe results obtained for Group III of the Integral Rehabilitation Program for Outpatient Schizophrenic Patients (IRPS III) at the National Institute of Psychiatry Ramón de la Fuente. This program was created for Mexican schizo-phrenic patients as a refined alternative for the treatment, rehabilitation and integration to a productive life within society. It is interdisciplinary and integral in nature; both patients and their relatives are involved in the treatment and rehabilitation. It includes admission, stabilization of clinical symptoms, and application of strategies for rehabilitation for one year (pharmacological treatment, group psychotherapy, labor -vocation induction therapy, music therapy, psychosocial psychotherapy, occupational therapy, artistic painting, drawing, and Hata-Yoga workshops, psycho-educational workshops for relatives, group dynamics therapy with responsible relatives, and unifamilial psychotherapy); there were assessments at the beginning and at end of the study. Objective To evaluate the efficacy of an interdisciplinary and integral program in these patients, with respect to a control group that received the usual medical-psychiatric treatment. Evaluation was carried out according to: a) Severity of psychiatric symptoms, b) Treatment compliance, c) Everyday performance, d) Psychosocial functioning, e) Global activity, f) Home occupational activities, g) Expressed emotion and attribution of the illness, and h) Patterns of communication and relationship within the family. The goals of this program were to reduce the disabilities and to profit from the conserved functions, as well as to develop other skills in order to increase the quality of life of patients. Methods This was a quasi-experimental pretest-postest prospective study where an experimental group and a control group were compared. The control group (n=39) received the usual psychiatric management, while the experimental group (n=39), participated in addition to this management, in a one-year integral rehabilitation program at the outpatient service of the institute. The sample was obtained in a non-probabilistic and sequential way, according to the established inclusion and exclusion criteria. Variables:Efficacy was evaluated through: a) Severity of psychiatric symptoms; b) Treatment compliance; c) Everyday functioning; d) Psychosocial functioning; e) Occupational activities at home; f) Expressed emotion; g) Patterns of communication and relationship within the family. Instruments: Composite International Diagnostic Interview (CIDI), Positive and Negative Syndrome Scale (PANNS), Clinical Interview and File, Everyday Unemployment Scale, Psychosocial Functioning Scale, Global Assessment Scale, Assessment and Follow-up Questionnaire, Patient Labor Performance Scale, Social Behavior Assessment Schedule (SBAS), Five Minute Speech Sample (FMSS), Verification of the Performance in Occupational Activities for Schizophrenic Patients, Extrapyramidal Symptom Scale. Procedures: a) Incorporation of patients and relatives to the study; b) Stabilization of clinical symptoms; c) Initial assessment; d) Program application; e) Final assessment. Results Demographic data: There were 47 subjects in the final sample, 25 in the experimental group, and 22 controls. There were more males than females in both groups (76% in the experimental group and 63.6% in controls). Being single was the most frequent marital status among patients (88% in the experimental group and 91% in controls). Education was slightly higher in the experimental group, were 40% had a bachelor´s degree as opposed to 27.2% in controls. Treatment compliance: The program had a final efficiency of 64% for the experimental group and 56% for controls. Some of the experimental subject's characteristics at the beginning of the program were related with treatment compliance: age, years of illness history, and number of different diagnoses. It was determined that 62% of the patients who completed the program were less than 30 years old, and in 80% of the cases the onset of the illness was less than 10 years ago. Regarding the number of diagnoses per patient, 60% of those who completed the study had one diagnosis, 40% had two or more. On the contrary, 30% of the patients who abandoned the study had one diagnosis and 70% had two or more. In other words, almost three fourths of the sub-sample that abandoned the Program had more than one diagnosis: 31% had two, 31% had three, and 10% had four or more. Clinical area: In the clinical area, there were no significant differences between groups. However, patients in the experimen-tal group had a higher level of clinical adaptation and treatment compliance. Everyday performance: The everyday performance was improved in patients from the experimental group, with statistically significant changes in 71.5% of the pretest-postest evaluated areas, with emphasis on self-care, family and interpersonal relationships, and remunerated work. In the control group, there was an improvement only in 28.5% of the areas. Psychosocial functioning: Global and by-area psychosocial functioning showed statistically significant differences in the experimental group in all functioning areas; there was an improvement from three to two, the latter number meaning feeling satisfied. This was not the case in the control group. Behavior at home: In the experimental group, the perception in families was that occupational behavior at home was improved, according to the final score. Family assessment: Relatives in the experimental group attributed the problems they had with the patient to personality characteristics. These problems were diminished at the end of the study, but not in the control group. When relatives attributed problems to the way of being and attitudes of patients, there was a decrease of problems from 31.6% to 26.3%. Emotional Expression in relatives from the experimental group was observed in 79.2% at the beginning of the treatment program, which decreased to 33.3% at the end of the study, with a significant difference of p <0.006, as opposed to relatives in the control group, who did not show statistically significant differences. Clinical assessment of families: At the beginning of the program, this group established reiterative communication patterns. The patient showed rejection to communication. Relatives blamed schizophrenia for the lack of communication. At the end of the program, patterns of communication had importantly improved. Conclusions Demographic data in our sample are similar to those described in previous reports for male:female ratio, marital status, and education. Some characteristics of the patients, in particular age, years from onset of illness, and psychiatric comorbidity assessed at recruitment were associated with completing or not the program. At the end of the study it was clear the program reached its goals of reducing the patients' disabilities and profiting of conserved functions: 64% of the patients in the experimental group were more stable in clinical terms, and treatment compliance was better. Also, everyday performance was notably improved. In the experimental group there were pretest-postest statistically significant differences in 71.5% of the studied area, especially in self-care and interpersonal relationships. In the control group there were significant changes only in 28.5% of the areas. One level of improvement was observed in global and by-area psychosocial functioning in the experimental group, but not in controls. Patients at the end of the study had switched from a score of three (neutral, unconcerned) to level two (satisfied with their own functioning). In the control group there were no statistically significant differences. Emotional expression in relatives in the experimental group significantly decreased at the end of the study (p< .006), but not in the control group, given that the latter did not show statistically significant differences. Occupational activities at home were also improved in the experimental group, with better scores at the end of the study. Regarding the assessment of occupational therapy, there were significant differences in four areas. Other areas with positive changes were: disease attribution to the patient, and patterns of communication in the family. The areas with better results were self-care, socialization, and family dynamics, which are frequently altered in schizophrenic patients. These results showed the efficacy of the program in its integral version (pluridimensional). Once the proposed objectives are reached, we propose to continue this program with important modifications of the method, which will be described in future publications.
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A severe outbreak of Paralytic Shellfish Poisoning (PSP) occurred in Manzanillo and Guayacán, northwestern coast of Margarita Island, Venezuela, between August and October 1991. A bloom of dinoflagellates including Prorocentrum gracile, Gymnodinium catenatum and Alexandrium tamarense seemed to be responsible for this outbreak. Levels of PSP toxins in mussels (Perna perna) exceeded the international safety limit of saxitoxin, 80 µg STX/100 g meat. PSP toxin values varied between 2 548 and 115 µg STX/100 g meat in Manzanillo, and between 1 422 and 86 µg STX/100 g meat in Guayacán. At both locations, the highest levels were detected in August, when 24 patients exhibited typical symptoms of PSP toxicity after consuming cooked mussels (16 required hospitalization). A high pressure liquid chromatographic (HPLC) procedure was recently used on the 1991 samples. The major toxin detected in samples of both locations was decarbamoyl saxitoxin (dcSTX), but low concentrations of saxitoxin were also found in Manzanillo samples. Gonyautoxins GTX1, GTX2 and GTX3 were detected only at Guayacán, while in both locations, decarbamoylgonyatouxin (dcGTX2,3) toxins were detected. These findings represent the first time that causative toxins of PSP in Venezuela have been chemically identified, and confirm the presence of dcSTX and dcGTX in mussels from the Caribbean Sea. The presence of dcSTX and dcGTX in shellfish is indicative that Gymnodinium catenatum was a causative organism for outbreak of PSP
Un severo brote de intoxicación paralizante por moluscos (PSP en inglés) ocurrió en Manzanillo y Guayacán en la costa noroeste de la Isla de Margarita, Venezuela entre agosto y octubre de 1991. Una proliferación de Prorocentrum gracile, Gymnodinium catenatum y Alexandrium tamarense causó el brote. Los niveles de PSP en mejillón (Perna perna) superaron los niveles máximos permisibles de saxitoxina, 80 µg STX/100g carne. Los niveles de toxinas variaron entre 2 548 y 115 µg STX/100 g carne en Manzanillo y entre 1 422 y 86 µg STX/100g carne en Guayacán. En ambas localidades, los máximos niveles se detectaron en agosto, cuando 24 personas presentaron síntomas típicos de PSP después de consumir mejillones cocidos (16 fueron hospitalizados). Se aplicó recientemente cromatografía líquida de alta presión (HPLC) a muestras del año 1991 y la toxina más detectada fue decarbamoyl saxitoxina (dcSTX), pero también se encontró saxitoxinas en muestras de Manzanillo. Las gonyautoxinas GTX1, GTX2 y GTX3 solo se encontraron en Guayacán; en ambas localidades se detectó decarbamoylgonyatouxin (dcGTX2,3). Estos hallazgos representan la primera vez que las toxinas causantes de un brote de PSP en Venezuela han sido químicamente identificadas, confirmando la presencia de dcSTX y dcGTX en mejillones del mar Caribe. La presencia de dcSTX y dcGTX en moluscos, indica que G. catenatum fue el organismo responsable de la intoxicación
Subject(s)
Humans , Animals , Rats , Bivalvia/chemistry , Ciguatera Poisoning/epidemiology , Dinoflagellida/growth & development , Eutrophication/physiology , Saxitoxin/poisoning , Shellfish/poisoning , Bivalvia/metabolism , Chromatography, High Pressure Liquid , Ciguatera Poisoning/metabolism , Disease Outbreaks , Dinoflagellida/chemistry , Dinoflagellida/classification , Environmental Monitoring , Fluorescence , Saxitoxin/analysis , Saxitoxin/metabolism , Shellfish/analysis , Time Factors , Venezuela/epidemiologyABSTRACT
El manejo del paciente quemado se ha desarrollado vertiginosamente como emergencia médica, sin embargo, es relativamente poco el conocimiento que se tiene sobre el impacto psicológico que sucede en el niño. Esta investigación tiene como objetivo, describir las vivencias emocionales del paciente gravemente quemado y su familia. Se revisaron 30 historias clínicas y de evolución psicológica de niños entre 3 y 11 años, ingresados en la Unidad de Cuidados Intermedios del Hospital Universitario de Maracaibo durante el período mayo 1994 y mayo 1995. Se utilizaron dos instrumentos para recolectar datos: Formato de Entrevista para padres (Molina, 1986, modificado por Bencomo, 1994) y el Protocolo de Observación para niños en UCIP (Bencomo 1994). Tanto los pacientes como sus padres experimentaron alguna etapa de crisis, observándose respuestas emocionales como ansiedad, inhibición, revivir el trauma, culpa, negación, contención emocional, llanto y dificultades interpersonales. Tanto el niño como la familia pasan por una crisis y se considera la necesidad de entrenar al personal de salud en el manejo de las respuestas emocionales de estos
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Humans , Male , Female , Burns/psychology , Burns/therapy , Child , Emotions/physiology , Psychology, Clinical/methods , Psychology, Applied , Shock, Traumatic/psychologyABSTRACT
Se examinaron muestras provenientes del Parque Nacional Archipiélago Los Roques, en el Mar Caribe Sur-Oriental (Venezuela), mediante microscopía óptica. Se describen quince (15) especies de dinoflagelados (Pyrrhophyta) pertenecientes a las familias Procentraceae y Ostreopsidaceae. Los símbolos (*) y (**) señalan nuevos registros para Venezuela y el Mar Caribe respectivamente. Se encontraron diez especies para Prorocetraceae: Mesoporos perforatus (Gran) Lillick, Prorocentrum compressum (Bailey) Abé ex Dodge, *Prorocentrum concavum Fukuyo, *Prorocentrum emarginatum Fukuyo, *Prorocentrum gracile Schütt, Prorocentrum lima (Ehrenberg) Dodge, Prorocentrum micans Ehrenberg, *Prorocentrum rhathymun loeblich III, Sherley & Schmidt, *Prorocentrum scutellum Schröder y Prorocentrum triestinum Schiller. En Ostreopsidaceae se encontraron cinco especies: Coolia monotis Meunier, *Gambierdiscus toxicus Adachi&Fukuyo, ** Ostreopsis lenticularis Schmidt, *Ostreopsis ovata Fukuyo y **Ostreopsis siamensis Schmidt. Finalmente se presenta una clave para las especies Prorocentrum y Ostreopsis encontradas en este estudio.
Subject(s)
Ciguatoxins/administration & dosage , Dinoflagellida/analysis , Phytoplankton/analysis , VenezuelaABSTRACT
Se evaluó clínicamente la eficasia del 5-fluorouracilo (5-Fu), tópico aplicado en forma ambulatoria, durante estudios previos, a pacientes con cromomicosis de la zona endérmica del Estado Falcón. De 62 casos conocidos en el Municipio Autónomo Democracia: 30 (48.38 por ciento ) estaban curados y 32 (51.62 por ciento ); enfermos. En 48 pacientes se había aplicado 5-Fu tópico al 5 por ciento ; 23 (47.91 por ciento ) estaban curados y 25 (52.08) enfermos. Se detecta 25 casos de cromomicosis por estudios clínicos y micológicos. En los casos Cladosporium Carrionii fue el agente etiológico. En 57 casos activos, se administró 5-Fu tópico a 25 (43.85 por ciento ), 12 (21.05 por ciento ) se sometieron a cirugía, y 20 (22.98 por ciento ) no se trataron por escasez de medicamentos, de los cuales 14 (70 por ciento ) tenía lesiones extensas. Se comentan la dificultades terapéuticas y la problemática de la cromomicosis en la zona. Se confirma la eficacia del 5-Fu tópico y su contribución para limitar la evolución de lesiones incipientes hacia cuadros deformantes o invalidantes y la necesidad del diagnóstico precoz. Se propone un plan de control regional para el Estado Falcón
Subject(s)
Humans , Male , Female , Chromoblastomycosis/therapy , Cladosporium/drug effects , Dermatomycoses , Fluorouracil/therapeutic use , MycosesABSTRACT
Se realizó un estudio con 60 recien nacidos pretérmino de alto riesgo procedentes de los retenes generales y especiales de la Maternidad Concepción Palacios en el lapso comprendido entre mayo y diciembre de 1988. Se revisaron los antecedentes y se hizo seguimiento de los recién nacidos con sospecha de hemorragia intracraneana en base a criterio clínico y se les realizó ultrasonido. Fallecieron 37 recién nacidos. En 29 de ellos se encontró hemorragia intracraneana de diferentes tipos en autopsia: Subaranoidea 12 (40 por ciento ), de fosa posterior 8 (28 por ciento ), intraventricular 7 (24 por ciento ), subependimaria 1 (4 por ciento ) e intraparenquimatosa 1 (4 por ciento ). En los ocho casos restantes se encontraron otros hallazgos en sistema central diferentes de hemorragia. En 23 (44 por ciento ) pacientes se demostró hemorragia intracraneana por ultrasonido cerebral. La incidencia de hemorragia intracraneana fue de 88 por ciento (ultrasonido + autopsia, en 52 de 60 pacientes)