Caracterización del dolor abdominal crónico en pacientes del Hospital Pediátrico Provincial Eduardo Agramonte Piña

Introducción: El dolor abdominal recurrente es un síntoma común en los niños y causa gran ansiedad a la familia. Representa hasta el 10 % de las consultas en pediatría, con frecuencia entre escolares y adolescentes, del 85 al 90 % de los casos la causa obedece a un trastorno de tipo funcional. Objetivo: Caracterizar el dolor abdominal recurrente en niños ingresados en el hospital pediátrico Eduardo Agramonte Piña de la provincia Camagüey. Métodos: Se realizó un estudio observacional, descriptivo, transversal, retrospectivo, cuyo universo de trabajo estuvo constituido por 122 pacientes ingresados con diagnóstico de dolor abdominal recurrente, durante el período de estudio. Para la obtención de la información se utilizó el análisis de documentos al revisar las historias clínicas del total de pacientes atendidos y los materiales bibliográficos. Resultados: De 122 pacientes estudiados el grupo más afectado correspondió al de 13-18 años de edad, seguido del grupo escolar de 7-12 años para un total de 73 y 45 casos, respectivamente. Entre los factores que aumentó la frecuencia estuvo la exposición mantenida a situaciones estresantes relacionadas con la disfunción del medio ambiente familiar y social del niño, expresados en los resultados, de 122 pacientes, 91 proceden de medios socio-ambientales disfuncionales, con predominio en las etapas escolares y de la adolescencia. Conclusiones: El número de pacientes con resultados de laboratorio negativos fue mayor que el de los positivos, por lo cual el dolor abdominal de origen funcional superó al de tipo orgánico.

Introduction: Recurrent abdominal pain (RAP) is a common symptom in children and causes great anxiety to the family. It represents up to 10% of pediatric consultations. It occurs frequently among schoolchildren and adolescents and in 85 to 90% of cases the cause is due to a functional disorder. Objective: To characterize the behavior of recurrent abdominal pain in children admitted to the Eduardo Agramonte Piña pediatric hospital in the province of Camagüey. Methods: An observational, descriptive, cross-sectional, retrospective study was carried out, whose universe of work consisted of 122 patients admitted with a diagnosis of recurrent abdominal pain, during the study period. To obtain the information, document analysis was used by reviewing the clinical histories of the total number of patients treated and the bibliographic materials. Results: Of a total of 122 patients studied, the most affected group corresponded to 13 to 18 years of age, followed by the school group of 7 to 12 years for a total of 73 and 45 cases, respectively. Among the factors that increased the frequency was sustained exposure to stressful situations related to the dysfunction of the child's family and social environment, expressed in the results: of 122 patients, 91 come from dysfunctional socio-environmental environments, with predominance in the schoolchildren and adolescents stages. Conclusions: The number of patients with negative laboratory results was greater than that of positive ones, that is why abdominal pain of functional origin exceeded that of organic origin.

Hip pain in childhood / Quadril doloroso na infância

Abstract Hip pain in a child can have infectious, inflammatory, traumatic, neoplastic, or developmental causes, which can make the diagnosis challenging. Meticulous history taking and a detailed clinical examination guide the radiological investigation. In this article, we address some of the main causes of hip pain in childhood and their findings on diagnostic imaging.

Resumo A dor do quadril na criança pode resultar de causas infecciosas, inflamatórias, traumáticas, neoplásicas ou de desenvolvimento, por vezes gerando desafios diagnósticos. Uma história meticulosa e um exame clínico detalhado orientam a investigação radiológica na direção apropriada. Neste artigo abordaremos algumas das principais doenças do quadril doloroso na criança e seus achados nos exames de imagem.

Estudo da dor no período pós-operatório de cirurgia de catarata: utilização de dipirona no intraoperatório / Study on immediate postoperative pain following cataract surgery: intraoperative endovenous administration of dipyrone

Resumo Objetivos: Quantificar a dor dos pacientes submetidos a cirurgia de facoemulsificação sob anestesia tópica e anestesia tópica mais dipirona e avaliar se há correlação da dor com o tempo operatório, a graduação da catarta e a Energia Ultrassônica Dissipada Acumulada. Métodos: Cento e quatro olhos de 52 pacientes foram submetidos a cirurgia de catarata por facoemulsificação. Um olho foi submetido a anestesia tópica associado à sedação. O outro olho foi submetido a anestesia anterior acrescida de 1g de dipirona venosa. 15 minutos e 24 horas após a cirurgia, uma Escala Visual de Dor era respondida. Registraram-se a graduação da catarata, tempo cirúrgico, energia ultrassônica. Resultados: Dor no grupo sem dipirona 15 minutos e 24 horas apresentou decréscimo com correlação estatística significativa (p=0,004). Não houve significância estatística na redução da dor no grupo submetido à infusão de dipirona. Pacientes com cataratas de maior graduação apresentaram dor maior no pós-operatório (p=0,046). Conclusão: Ausência de redução significativa da dor com a dipirona apresentou resultados semelhantes a outros estudos. Redução da dor 24 horas após a cirurgia no grupo sem o analgésico pode ser devido à subjetividade da dor. Pacientes com cataratas de grau mais avançados apresentam dor mais intensa.

Abstract Objectives: Evaluate the effect of intraoperative endovenous administration of dipyrone on postoperative pain in patients submitted to phacoemulsification by correlating pain scores with duration of surgery and the amount of cumulative dissipated energy (CDE) delivered to the eye. Methods: The sample consisted of 104 eyes from 52 patients submitted to phacoemulsification under topic anesthesia and sedation. In each patient, one eye was treated intraoperatively with 1g dipyrone. Information was collected on cataract grade/type, duration of surgery and CDE. Postoperative pain was scored on a visual analog scale at 15 min and 24 hours. Results: Between 15 min and 24 hours, pain decreased significantly (p=0.004) among patients not treated with dipyrone, but no change was observed in patients receiving dipyrone. Caratact severity was positively associated with postoperative pain (p=0.046). Conclusion: The absence of a measurable effect of dipyrone on pain scores matched the literature. The decrease in pain scores at 24 hours among patients not treated with dipyrone may be explained by the influence of subjective psychological factors on pain perception. Higher grades of cataract were associated with greater postoperative pain.

Dolor precordial en pediatría: puesta al día / Precordial pain in pediatrics: update

El dolor precordial en pediatría representa un bajo porcentaje del total de consultas, sin embargo genera una alta preocupación tanto en los padres como en el equipo de salud. En general se trata de un proceso benigno y la etiología cardíaca es infrecuente, alcanzando apenas el 1-4%. En el presente trabajo de actualización se revisan las diferentes etiologías, con el propósito de identificar factores que orienten a etiología cardíaca y así derivar al especialista u hospitalizar en forma oportuna si se requiere.

The chest pain in pediatrics represents a low percentage of the total of consultations, nevertheless it generates a high concern both in the parents and in the health team. In general, it is a benign process and the cardiac etiology is infrequent, reaching only 1-4%. In the present update work, the different etiologies are reviewed, in order to identify factors that guide the cardiac etiology and thus refer to the specialist or hospitalize in a timely manner if required.

Indução da dor pelo quimioterápico docetaxel em mulheres com câncer de mama / Pain induction by chemotherapy medication docetaxel in women with breast cancer

Resumo Objetivo Descrever a frequência, características, localização, intensidade da dor em pacientes com câncer de mama em uso do quimioterápico Docetaxel. Métodos Estudo longitudinal realizado com 17 mulheres com câncer de mama em tratamento com Docetaxel. As pacientes foram avaliadas durante três ciclos da quimioterapia quanto à dor, utilizando-se os instrumentos Questionário McGill de Dor (Br-MPQ) e Brief Pain Inventory (BPI). Utilizou-se a correlação de Spearman e o teste de Mann-Whitney. Resultados Houve aumento na média da dor em todas as variáveis do BPI. Quando comparados os valores do Pain Rating Index (PRI) total foram verificados respectivamente 0,20; 0,33 e 0,24 na primeira, segunda e terceira avaliações, sendo encontrada correlação entre a intensidade da dor e a interferência em todas as atividades do cotidiano no BPI na segunda avaliação. Conclusão Houve aumento na ocorrência da dor, comprometendo as atividades diárias de vida das mulheres participantes.

Abstract Objective To describe the frequency, characteristics, location, pain intensity in breast cancer patients using the chemotherapy medication Docetaxel. Methods Longitudinal study involving 17 women with breast cancer under treatment using Docetaxel. The patients’ pain was assessed during three chemotherapy cycles, using the tools McGill Pain Questionnaire (Br-MPQ) and the Brief Pain Inventory (BPI). Spearman’s correlation and the Mann-Whitney test were used. Results The mean pain score increased in all variables of the BPI. When comparing the total coefficients on the Pain Assessment Index, 0.20; 0.33 and 0.24 were found in the first, second and third assessment, showing a correlation between the pain intensity and the interference in all daily activities on the BPI for the second assessment. Conclusion The occurrence of pain increased, compromising the participating women’s activities of daily living.

Effect of DREAM on GLT-1 expression in spinal cord in rats with bone cancer pain and morphine tolerance / 中国医师杂志

Objective To investigate the effects of downstream regulatory element antagonist modulator (DREAM) on the expression of glutamate transporter-1 (GLT-1) in spinal cord in rats with bone cancer pain and morphine tolerance.Methods Sixty female healthy Sprague-Dawley (SD) rats weighing 200 ～230 g were randomly divided into tow groups,group Ⅰ cancer pain (CP,n =48) and group Ⅱ Sham (S,n =12).Cancer pain in each group was produced by inoculation of syngenetic Walker 256 rat mammary gland carcinoma cells (5 × 105) to left tibia.Pain threshold to mechanical stimulus was measured before (baseline) and after the surgical procedure.From 14 d to 18 d after the inoculation of carcinoma cells,36 rats from group CP received subcutaneous injection of morphine at 3 times per day with doses increasingly from 10 mg/kg initially to 20 mg/kg,30 mg/kg,40 mg/kg,and 60 mg/kg.Equal volume of normal saline was applied to the 12 rats left in group CP.On 19th day after the carcinoma cells inoculation once subcutaneous injection of morphine at 3mg/kg was performed in all rats in group CP.From the next day,the rats in group CP ever receiving injections of morphine for 5 days were randomized into thre subgroups,including subgroups morphine tolerance (MT,n =12),vehicle (V,n =12),and RNAi (R,n =12).They were injected intrathecally with 20 μl of normal saline (NS),10 μl vehicle plus 10 μ1 NS,and 10 μ1 of DREAM-shRNA plus l0 μ1 NS,respectively,once a day for 5 days.Focusing on the affected limb,mechanical pain threshold was measured one day before surgery (T0),and at day7 (T1),day 14 (T2),day 18 (T3),day 19 (T4),day21 d (T5),day 25 (T6),and day 28 (T7) after surgery.The animals were sacrificed at day 28 after the procedure.The lumbar 4 segments in rats were removed for detection of DREAM and GLT-1.Results The mechanical threshold was significantly decreased at T1 compared to the baseline in all groups,returned to the baseline at T2 ～ T7 in group S,at T4 in group CP,and at T2 in group MT,V,and R,but remained low at T5 ～T7 in group CP,and at T3 ～T7 in group MT,V,and R.Compared to that at T1,it was decreased at T2 ～T3 and T5 ～ T7 in group CP,at T4 ～ T7 in group MT and V,and at T4 ～ T5 in group R,going back to the baseline at T4 in group CP and at T2 in group MT,V and R,and increased at T6 ～ T7 in group R.Compared to that in group S,the mechanical threshold in group CP,MT,V and R was decreased,and lower at T2 in group CP and at T4 in group MT,V and R.Compared to that in group CP,the mechanical threshold was significantly higher at T2 ～ T3 but lower at T4 in group MT,V,and R,decreased at T5 in group R and at T5 ～ T7 in group MT and V.The mechanical threshold was increased at T6 ～ T7 in group R and higher than that in groups MT and V.The expression of DREAM,compared to that in group S,was down-regulated in other groups.Compared to group CP,increment was shown in groups MT and V,and decrease was exhibited in group R.It was cut down in group R compared to that in groups MT and V.Compared to group S,GLT-1 was decreased in other groups.It was down-regulated in groups MT,V and R compared to group CP.Conclusions DREAM is involved in the development of allodynia after morphine tolerance in rats with bone cancer pain.No evidence in this study supports a link between DREAM and GLT-l in spinal cord.

Review of the literature: cervical radiculopathy. An update / Revisión de la literatura: actualización en radiculopatía cervical / Revisão da literatura: atualização sobre radiculopatia cervical

[{"text": "Cervical radiculopathy is a dysfunction of a nerve root of the cervical spine. The seventh root (C7) is affected in 60% \r\nof cases and the sixth root (C6) in 25%. The cervical nerves are most commonly affected in our environment. Appro\r\n-\r\nximately 10% of the adult population had neck pain at some point in their lives. This prevalence is similar to the \r\npain frequency, but very few patients with neck pain become disabled and less than 1% develop neurological deficit. \r\nClinical disorders affecting the cervical spine can be categorized as those that primarily cause pain in the neck and \r\nmost often cause limb pain and/or neurological dysfunction. The pathologies resulting in neck pain are cervical sprain, \r\ninternal compression disc syndrome or discogenic pain, whiplash-type neck pain of neuropathic origins and myofas\r\n-\r\ncial pain. Disorders that cause symptoms predominantly in the extremities and/or neurological dysfunction include \r\ncervical radiculopathy and cervical spondylotic myelopathy. Factors associated with increased risk include heavy \r\nmanual labor requiring lifting more than 25 pounds, smoking and driving or operating vibrating equipment. Less \r\ncommon causes include tumors of the spine, an extension of synovial cysts, synovial chondromatosis, arteritis and \r\nspinal infections. This article reflects contemporary concepts and review of the treatment for cervical radiculopathy \r\nfrom degenerative disorders through clinical trial in general practice until analysis in the department of surgical spine \r\nsurgery through the evaluation of the findings of the updates in medical literature until May 2012. The objectives of \r\nthis article allow for optimal diagnostic evaluation and determine the best clinical and surgical treatment for easier \r\nfunctional recovery.", "_i": "en"}, {"text": "La radiculopatía cervical es una disfunción de una raíz \r\nnerviosa de la columna cervical. La séptima raíz (C7) se \r\ncompromete en un 60% de los casos y la sexta (C6) en un \r\n25%. A menudo, las raíces nerviosas cervicales son las \r\nmás afectadas en nuestro medio. Aproximadamente el 10 \r\n% de la población adulta ha tenido dolor en el cuello en \r\nalgún momento de su vida. Esta prevalencia es similar al \r\ndolor lumbar, pero muy pocos pacientes con dolor cervical \r\nse incapacitan y menos del 1% desarrolla déficit neuro\r\n-\r\nlógico. Los trastornos clínicos que afectan la columna \r\ncervical pueden ser categorizados como la causa prin\r\n-\r\ncipal del dolor en el cuello. Estos trastornos son los que \r\ncon mayor frecuencia causan dolor en las extremidades \r\no disfunción neurológica. Las patologías que involucran \r\ndolor en el cuello son: esguince cervical, síndrome de \r\ncompresión interna de disco o dolor discogénico, dolor \r\ncervical de tipo latigazo de origen neuropático y dolor \r\nmiofascial. Los trastornos que de manera predominante \r\ncausan síntomas en las extremidades o con disfunción \r\nneurológica incluyen la radiculopatía cervical y mielo\r\n-\r\npatía cervical espondilótica. Los factores asociados con \r\nmayor riesgo son el trabajo manual pesado que requiere \r\nel levantamiento de más de 25 libras, el tabaquismo y \r\nconducir o utilizar equipo vibratorio. Otras causas menos \r\nfrecuentes son los tumores de la columna vertebral, una \r\nampliación de quiste sinovial, condromatosis sinovial, \r\narteritis y las infecciones de la columna vertebral.\r\nEn este artículo se estudian los conceptos contem\r\n-\r\nporáneos del tratamiento de la radiculopatía cervical \r\nmediante la evaluación de los hallazgos de la actuali\r\n-\r\nzación en literatura clínica hasta mayo de 2012. Dichos \r\nhallazgos abarcan desde los desórdenes degenerativos \r\nhasta los análisis en el departamento de cirugía de \r\ncolumna, pasando por un estudio clínico en medicina \r\ngeneral. Busca facilitar una óptima evaluación diagnós\r\n-\r\ntica y determinar el mejor tratamiento clínico y quirúrgico \r\npara una recuperación funcional de mayor facilidad.", "_i": "es"}, {"text": "Radiculopatia cervical é a disfunção de uma raiz nervosa \r\nda coluna cervical. A raiz sétima (C7) está comprometida \r\nem 60% dos casos e (C6) 25%. Os nervos cervicais são \r\nmais frequentemente afetadas em nosso meio ambiente. \r\nAproximadamente 10% da população adulta têm dor no \r\npescoço em algum ponto de suas vidas. Esta prevalência \r\né igual à frequência da dor, mas em poucos pacientes \r\ncom dor no pescoço se tornam inválidos e menos de 1% \r\npor cento desenvolvem um deficit neurológico. Distúr\r\n-\r\nbios clínicos que afectam a coluna cervical podem ser \r\nclassificados essencialmente como aqueles causados por \r\ndor no pescoço e mais frequentemente causados por dor \r\nnos membros e / ou disfunção neurológica.\r\nAs patologias resultando em dor no pescoço são \r\ndistensão cervical, síndrome de compressão interna do \r\ndisco ou dor discogênica, a dor no pescoço tipo "chicote" \r\nde origem neuropática e miofascial. Os distúrbios que \r\ncausam sintomas predominantemente nas extremidades \r\ne / ou disfunção neurológica incluem radiculopatia \r\ncervical e mielopatia espondilótica. Fatores associados \r\ncom o aumentado de risco incluem trabalho manual \r\npesado exigindo levantar mais de 25 libras, tabagismo \r\ne dirigir ou operar equipamentos que vibram. As causas \r\nmenos comuns incluem tumores da coluna vertebral, \r\numa extensão do cisto sinovial, condromatose sinovial, \r\nartrite e infecções da coluna vertebral. Este artigo reflete \r\nconceitos contemporâneos e estuda o tratamento da \r\nradiculopatia cervical de doenças degenerativas desde o \r\nestudo feito em clínica geral até a análise no departa\r\n-\r\nmento cirúrgico de coluna vertebral através da avaliação \r\ndos resultados da atualização na literatura médica até \r\nmaio de 2012. Os objetivos deste artigo permitem uma \r\navaliação diagnóstica ideal e determinam o melhor trata\r\n-\r\nmento clínico e cirúrgico para a recuperação funcional \r\nmais fácil.", "_i": "pt"}]

Diagnóstico de dores do crescimento em uma população pediátrica brasileira: uma investigação prospectiva / Diagnosis of growing pains in a Brazilian pediatric population: a prospective investigation

Objective: To establish the clinical aspects of growing pains and to determine, through differential diagnosis, how many patients who referred themselves to a specialized clinic were found to have growing pains. Methods: This study prospectively examined the presence of growing pains in a self-reported population of children and adolescents with signs and symptoms (lower limb pains) of unexplained etiology. Results: A total of 345 children and adolescents were evaluated; 174 (50.4%) were males and 171 (49.6%) were females. Three hundred cases were classified as growing pains (87%). Conclusion: A high frequency of growing pains was found in our study population; it shows that in a prospective evaluation of patients with signs and symptoms of unknown etiology we can find a frequency higher than that reported in literature.

Objetivo: Estabelecer os aspectos clínicos de dores do crescimento e determinar, por meio de diagnóstico diferencial, quantos pacientes com essas dores foram espontaneamente a uma clínica especializada e obtiveram o diagnóstico de dores de crescimento. Métodos: Este estudo analisou prospectivamente a presença de dores do crescimento em uma população de crianças e adolescentes com sinais e sintomas (dores nos membros inferiores) de etiologia desconhecida. Resultados: Foram avaliados 345 crianças e adolescentes; 174 (50,4%) eram do sexo masculino e 171 (49,6%) do sexo feminino. Trezentos casos foram classificados como dor de crescimento (87%). Conclusão: Foi encontrada uma elevada frequência de dor de crescimento na população estudada e isso mostra que, em avaliação prospectiva de pacientes com sinais e sintomas de etiologia desconhecida, pode ser encontrada uma frequência maior de dores de crescimento do que a relatada na literatura.

Síndrome Sump: um relato de caso / Sump Syndrome: a case report

Objetivos: descrever o diagnóstico e tratamento de um caso de Síndrome Sump. Descrição do Caso: uma mulher de 33 anos vinha apresentando episódios recorrentes de dor abdominal, acompanhados de febre e calafrios. A paciente havia sido submetida previamente à cirurgia de vias biliares, sendo realizado o diagnóstico atual de Síndrome Sump. Optou-se pelo tratamento cirúrgico, diante da impossibilidade de tratamento endoscópico. Conclusões: a Síndrome Sump, entidade rara na atualidade, consiste em uma complicação da coledocoduodenoanastomose, causada pelo contato de resíduos gástricos com o colédoco distal, levando à sua obstrução. Deve ser lembrada como causa de colangite de repetição.

Aims: To describe the diagnosis and treatment of a case of Sump Syndrome. Case Description: A 33 years old woman presented recurrent episodes of abdominal pain accompanied by fever and chills. The patient had previously undergone surgery of the biliary tract, and the current diagnosis of Sump Syndrome was performed. A surgical treatment was indicated given the impossibility of endoscopic treatment. Conclusions: The Sump Syndrome, rare nowadays, consists of a complication of choledocoduodenoanastomosis caused by contact of gastric residues with the distal common bile duct, causing obstruction. It should be considered as a cause of recurrent cholangitis.