Relación entre localización, tiempo de evolución y reductibilidad de la invaginación en niños / Relationship among location, length of symptoms and reducibility of intussusception in children

RESUMEN Fundamento: se ha propuesto que la localización de la invaginación intestinal en niños está en relación directa con el tiempo de evolución y que mientras más distal se encuentre la invaginación, menor sería el índice de reducción. Objetivo : determinar la relación de la localización de la invaginación con el tiempo de evolución y la reductibilidad. Métodos: se realizó un estudio descriptivo transversal de los pacientes entre tres meses y dos años de edad con invaginación intestinal en el Hospital Pediátrico Universitario Eduardo Agramonte Piña de la provincia Camagüey, desde enero de 2001 hasta diciembre de 2019. El universo de pacientes estuvo constituido por 257 niños con invaginaciones tratadas mediante este método, donde incluyó episodios iniciales y recurrencias. El diagnóstico fue confirmado mediante ecografía. Se intentó la reducción hidrostática con enemas de solución salina y guía ecográfica en todos los casos con criterios de inclusión. Las variables estudiadas fueron: localización de la invaginación, tiempo de evolución de los síntomas y reductibilidad. Para la validación de los resultados se utilizaron métodos estadísticos de decisión en la modelación del fenómeno en estudio que permitieran determinar la dependencia/independencia estadística de las variables. Resultados : la localización más frecuente de la invaginación fue el colon derecho. La invaginación en los segmentos más distales: colon izquierdo/sigmoides, recto y prolapso, aunque menos frecuente, tuvo un alto por ciento de reductibilidad. En estas localizaciones, la reductibilidad fue elevada tanto en los pacientes en las primeras 24 horas de evolución como en aquellos con 25 a 36 horas de inicio de los síntomas. Conclusiones: no se encontró relación directa de la localización de la invaginación con el tiempo de evolución ni con la reductibilidad.

ABSTRACT Background : it has been proposed that the location of intussusception in children is directly related to the length of symptoms, and that the more distal the intussusception is, the lower the rate of reduction. Objective : to determine the relationship of the location of the intussusception with the length of symptoms and the reducibility. Methods : a descriptive cross-sectional study was carried out in patients between three months and two years of age with intussusception at the Eduardo Agramonte Piña Provincial Pediatric Hospital in Camagüey, from January 2001 to December 2019. The universe of patients consisted of 257 children with intussusception treated by this method, including initial episodes and recurrences.The diagnosis was confirmed by ultrasound. Hydrostatic reduction with saline enemas and ultrasound guidance was attempted in all cases that met the inclusion criteria. The studied variables were: location of intussusception, length of symptoms and reducibility. Statistical decision methods were used in the modeling of the phenomenon under study to determine the statistical dependence / independence of the variables. Results: the right colon was the most frequent location of the apex of intussusception. The most distal locations (left colon/sigmoid, rectum and prolapsed), although less frequent, it had a high percentage of reducibility. In these locations, reducibility was high both in patients in the first 24 hours of evolution and in those with 25 to 36 hours of onset of symptoms. Conclusions : direct relationship between location of intussusception and length of symptoms and between location and reducibility was not found.

Características clínicas de la enfermedad por Coronavirus 2019 en un centro de Argentina. Cohorte retrospective / Clinical characteristics of Coronavirus Disease 2019 in a single center of Argentina. Retrospective cohort

Resumen La enfermedad por coronavirus (COVID-19) es un problema prioritario de salud. El objetivo del trabajo fue evaluar las características clínicas, evolución y gravedad de COVID-19 en un centro hospitalario de tercer nivel de la provincia de Buenos Aires, Argentina. Se realizó un estudio de cohorte retrospectiva de pacientes con COVID-19, entre el 3 de marzo y 21 de junio de 2020. Se evaluaron las características en función de la presencia o ausencia de neumonía y de la gravedad de la enfermedad. Se incluyeron 101 pacientes, la mediana de edad fue de 42 años y el 53% mujeres. Los síntomas más frecuentes fueron: fiebre 66% y tos 57%. La disnea y la fiebre se asociaron a la presencia de neumonía. Las comorbilidades más prevalentes fueron: hipertensión 22%, obesidad 18%, enfermedad cardiovascular 7% y enfermedad respiratoria crónica 7%. Los hallazgos de laboratorio más comunes fueron: linfopenia 55%, dímero-D elevado 38% y plaquetopenia 20%. El 26% presentó neumonía y el 24% fue personal de salud. En el 24% de los casos se necesitó más de una muestra de RT-PCR para el diagnóstico. Un valor moderado-alto del Índice de severidad de neumonía (PSI) fue más frecuente en la neumonía grave que en la leve (63 contra 17%, p 0.032). Se registró una mortalidad del 5%. Las características clínicas, la gravedad y evolución fueron similares a las descritas a nivel mundial. Destacamos la proporción elevada del personal de salud infectado, la tasa de falsos negativos de la RT-PCR y la utilidad del PSI para discriminar la gravedad de la neumonía.

Abstract Coronavirus disease (COVID-19) became a priority health problem. The objective was to evaluate the clinical characteristics, evolution and severity of COVID-19 in a third-level hospital, in the province of Buenos Aires, Argentina. We conducted a retrospective cohort of 101 patients with COVID-19 from March 3 to June 21, 2020. The patients were divided according to the presence or absence of pneumonia and the severity of the disease. The median age was 42 years and 53% were women. The most common symptoms were fever 66% and cough 57%. Dyspnea and fever were associated with the presence of pneumonia. The most prevalent comorbidities were: hypertension 22%, obesity 18%, cardiovascular disease 7% and chronic respiratory disease 7%. The presence of any comorbidity and hypertension were more common in severe cases. The most frequent laboratory findings were: lymphopenia 55%, elevated D-dimer 38%, and thrombocytopenia 20%. In severe diseases, the level of C-reactive protein and D-dimer were higher. Twenty six patients had pneumonia and 24% were healthcare workers. For diagnosis, more than one reverse transcriptase polymerase chain reaction (RT-PCR) sample was needed in 24% of cases. A moderate-high value of the Pneumonia Severity Index (PSI) was more prevalent in severe than mild pneumonia (63% vs. 17%, p 0.032). A mortality of 5% was registered (95% CI 1-11%). The clinical characteristics, severity and prognosis were similar to those described worldwide. We highlight a high proportion of healthcare workers were SARS-CoV-2 positive, the false negative rate of the RT-PCR and the usefulness of the PSI to discriminate the severity of pneumonia.

Convivendo com múltiplos sintomas: a experiência de crianças e adolescentes com condição crônica / Living with multiple symptoms: the experience of children and adolescents with chronic condition / Vivir con múltiples síntomas: la experiencia de niños y adolescentes con condición crónica

Objetivo: compreender como é a experiência das crianças/adolescentes de conviver com sintomas de uma condição crônica. Método: abordagem qualitativa, utilizando como referencial a Teoria Fundamentada nos Dados. Os participantes foram 11 crianças e adolescentes de seis a 18 anos incompletos hospitalizados em um hospital estadual universitário. Como instrumentos de coleta de dados, utilizou-se a entrevista semiestruturada e a técnica "draw, write and tell". As entrevistas foram audiogravadas e transcritas, e a análise seguiu os passos do referencial. Resultados: apreendeu-se a categoria "Tendo que conviver com os sintomas", que engloba cinco subcategorias que apresentam sintomas físicos, emocionais e gerais, a convivência com a multiplicidade de sintomas simultâneos e as consequências de se conviver com eles. Conclusão: a convivência com diversos sintomas leva a limitações. A enfermagem precisa favorecer a expressão das vivencias das crianças/adolescentes, minimizando situações de estresse e melhorar o gerenciamento dos sintomas, através do planejamento de estratégias individualizadas.

Objective: to comprehend children's or adolescents' experiences of living with symptoms of a chronic condition. Method: on a qualitative approach, taking Grounded Theory as a frame of reference and 11 children and adolescents aged 6 to 18 years hospitalized in a state university hospital as participants, data were collected by semi-structured interview using the "draw, write, and tell" technique. The interviews were recorded and transcribed, and then analyzed following the steps of Grounded Theory. Results: analysis identified the category "Having to live with symptoms", which comprised 5 subcategories featuring physical, emotional and general symptoms, the experience of living with multiple simultaneous symptoms, and the consequences of living with them. Conclusion: living with several symptoms entails limitations. Nursing needs to favor children's and adolescents' expressions of their experiences in order to minimize stressful situations and improve symptom management by planning individualized strategies.

Objetivo: comprender las experiencias de niños o adolescentes de vivir con síntomas de una enfermedad crónica. Método: con un enfoque cualitativo, tomando como marco de referencia la Teoría Fundamentada y como participantes a 11 niños y adolescentes de 6 a 18 años hospitalizados en un hospital universitario estatal, los datos se recolectaron mediante entrevista semiestructurada utilizando el método "dibujar, escribir y decir "técnica. Las entrevistas fueron grabadas y transcritas, y luego analizadas siguiendo los pasos de Grounded Theory. Resultados: el análisis identificó la categoría "Tener que vivir con síntomas", que comprendía 5 subcategorías que presentaban síntomas físicos, emocionales y generales, la experiencia de vivir con múltiples síntomas simultáneos y las consecuencias de vivir con ellos. Conclusión: vivir con varios síntomas conlleva limitaciones. La enfermería debe favorecer la expresión de las experiencias de los niños y adolescentes para minimizar las situaciones estresantes y mejorar el manejo de los síntomas mediante la planificación de estrategias individualizadas

Ryan index for detection of laryngopharyngeal reflux diseases / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the utility of pharyngeal pH monitoring which positive standard is Ryan index in diagnosis of laryngopharyngeal reflux disease.@*Methods@#In a retrospective study, clinical data of 590 patients who had symptoms laryngopharyngeal reflux disease from February 2016 to March 2017 were analyzed. All patients were received electronic laryngoscopy, assessment of reflux symptom index(RSI) and reflux finding score(RFS), and pharyngeal pH monitoring. SPSS 19.0 software was used to analyze the date.@*Results@#There were 94 patients whose Ryan index were positive(15.93%). Among the 94 patients, 70 were positive during upright, 12 during supine and 12 during both upright and supine. There were 40 patients(6.78%)with pH decline events related to symptoms, while those Ryan index were normal. There were 536(90.85%), 417(70.68%), 233(39.49%) and 117(19.83%) patients with pH<6.5, pH<6.0, pH<5.5 and pH<5.0 events respectively. The positive rate of RSI, RFS, RSI and RFS, RSI or RFS were 44.24%, 16.78%, 7.12%, 53.90% respectively. The RFS score in Ryan index positive group was higher than that in Ryan index negative group[(8.2±2.4) vs (4.0±2.9), u=5.424, P<0.05], while the RSI score in Ryan index positive group was not statistically different from that in Ryan index negative group[(11.3±6.2) vs (12.7±5.8), t=1.247, P=0.167].@*Conclusions@#Pharyngeal pH monitoring is an objective and non-invasive method which can reflect laryngopharyngeal reflux directly. However, with the Ryan index as a criterion for the diagnosis of laryngopharyngeal reflux disease, partial patients may be missed. Further studies are needed to obtain more accurate and objective laryngopharyngeal pH statistical index for diagnosis of laryngopharyngeal reflux disease.

Diplopia as first symptom of multiple sclerosis / Diplopia como primeiro sintoma de esclerose múltipla

Purpose: To determine the frequency and clinical features of the extrinsic ocular motility changes in patients with multiple sclerosis living in the state of Sao Paulo (Brazil), consecutive cases series from 1996 to 2011. Methods: Eighty-three consecutive multiple sclerosis subjects were enrolled, aged from 17 to 59 years. All patients had a history taking and a comprehensive ocular exam. Results: Extrinsic ocular motility changes was detected in 17 (20,48%) out of 83 individuals. Diplopia as the first symptom of the disease occurred in 11 (13,25%) individuals. Conclusions: Frequency of diplopia as first symptom of multiple sclerosis is relevant. According to this statement, crucial importance should be given concerning spreading of knowledge and skills to internal medicine and general ophthalmology practicing physicians about early diagnosis of multiple sclerosis, which would reduce a delay in diagnosis of the disease and would help patients in the prognosis of the disease which they endure.

Objetivo:Determinar a frequência e as características clínicas das alterações da motilidade ocular extrínseca em indivíduos portadores de esclerose múltipla, residentes no estado de São Paulo, em série de casos consecutivos de 1996 a 2011.Métodos:Foram selecionados oitenta e três indivíduos com esclerose múltipla, com idade entre 17 e 59 anos. Todos foram submetidos à anamnese e exame ocular completo.Resultados:Alterações da motilidade ocular extrínseca foram encontradas em 17 ( 20,48%) dos 83 indivíduos. A diplopia ocorreu como primeiro sintoma da doença em 11 (13,25%) indivíduos.Conclusão:A frequência de diplopia como primeiro sintoma de esclerose múltipla é relevante. Por esse fato, é fundamental ressaltar a importância da difusão do conhecimento desse achado para a realização de diagnóstico precoce de esclerose múltipla, tanto para o oftalmologista geral, como para o médico generalista, melhorando assim o prognóstico dos pacientes que dela padecem.

Clinical analysis of peripheral neuropathy in patients with systemic lupus erythematosus / 中华风湿病学杂志

Objective To investigate the frequence and clinical characteristics of peripheral neuropathy (PN) of patients with systemic lupus erythematosus (SLE) in China.Methods The data of 67 consecutive PN related with SLE (SLE-PN) patients admitted to Peking Union Medical College Hospital (PUMCH) during January 1995 to August 2011 were retrospectively analyzed.At the same time,a total of 201 cases were randomly selected as controls from 4447 SLE patients without SLE-PN in PUMCH during the same period.Chi-square test,t test and Mann-Whitney test were used for statistical analysis.Results The prevalence of SLE-PN in SLE patients was 1.5％(67/4514).Seventy-two cases of PN were discovered in 67 patients.Polyneuropathy was the most frequent presentation and was diagnosed in 45 cases(62.5％),mononeuropathy in 9 cases (12.5％),myasthenia gravis in 8 cases (11.1％),cranial neuropathy in 7 cases (9.7％),autonomic disorder in 2 cases (2.8％) and acute inflammatory demyelinating polyradiculoneuropathy in 1 case (1.4％).No plexopathy was diagnosed.No symptoms were observed in 5 cases (6.9％) PN.There were differences between SLE patients with and without SLE-PN in age[(37±14) years vs (32±14) years,P＜0.05],fever(65.7％ vs 47.8％,P＜0.05),myositis (17.9％ vs 5.0％,P＜0.01),skin and mucous involvement of skin and mucous (80.6％ vs 59.7％,P＜0.01),central nervous system involvement (38.8％ vs 19.9％,P＜0.01),gastrointestinal involvement (6.0％ vs 18.4％,P＜0.05),anti-Sm antibody positivity (34.4％ vs 18.6％,P＜0.05),anti-RNP antibody positivity (46.9％ vs 29.9％,P＜0.05),elevation of IgG (52.4％ vs 30.1％,P＜0.01),and SLEDAI score [12.0(9.0) vs 9.5(10.8),P＜0.05].Conclusion SLE-PN is not rare in patients with SLE.SLE patients with peripheral neuropathy tend to have more active disease.Multidisciplinary collaboration and comprehensive treatment can help to relieve pain and improve the quality of life.