ABSTRACT
Objetivo: Molusco contagioso é uma infecção cutânea, causada pelo Molluscipox vírus. Diante da inexistência de um tratamento específico, esta pesquisa tem como objetivo verificar, segundo a literatura recente, os melhores métodos de tratamento em crianças imunocompetentes. Métodos: Revisão sistemática de literatura realizada no PubMed, bem como no Lilacs, Scielo, Medline e demais bases de dados abrangidas na Biblioteca Virtual em Saúde (BVS), com publicações de 2010 a 2016. Para evitar viés, foram utilizadas recomendações do PRISMA. Critérios do Oxford Centre for Evidence-Based Medicine e do sistema GRADE foram usados para classificação do nível de evidência dos estudos. Resultados: Curetagem, laser pulsado de contraste, crioterapia, exérese cirúrgica, KOH 2,5%, 5% e 10%, ácido tricloroacétrico, combinação de ácido lático e ácido salicílico, tretinoína 0,05% apresentaram boa proporção de cura, facilidade de realização e tempo de resolução. Os métodos de injeção intralesional do antígeno da Cândida e da vacina MMR, dieta balanceada, óleo de Malaleuca alternifólia e Ingenol Mebutate 0,05% mostraram-se promissores. Entretanto, cantaridina e imiquimod 5% creme não foram recomendados. Conclusão: As evidências obtidas não permitem indicar um método preferencial. A escolha do método de tratamento deve ser individualizada. Recomenda-se realizar mais pesquisas voltadas para cultura do vírus.
Objective: Molluscum contagiosum is a skin infection caused by the Molluscipox virus. Given the absence of a specific treatment, this study aims to verify according to recent literature the best methods for molluscum contagiosum treatment in immunocompetent children. Methods: This study is a systematic review conducted in PubMed, as well as Lilacs, Scielo, Medline and other data bases from the Biblioteca Virtual em Saúde (BVS), including publications from 2010 to 2016. The bias is avoided by using PRISMA recommendations . Criteria of the Oxford Center for Evidence-Based Medicine and the GRADE system were used to rank the level of evidence of the studies. Results: Curettage, pulsed dye laser, cryotherapy, surgical abscission, KOH 2.5%, 5% and 10%, trichloroacetic acid, combination of lactic acid and salicylic acid and 0.05% tretinoin showed good performances regarding cure rate, ease of implementation and resolution time. Moreover, methods such intralesional injection of antigen Candida and the MMR vaccine, balanced diet, Malaleuca oil alternifolia and ingenol Mebutate 0.05% showed relevant results. However, the use of cantharidin and imiquimod 5% cream is not recommended. Conclusion: It is not possible to indicate the most eligible method based on the evidence found. Therefore, treatment should be individualized. Future researches about the virus culture are recommended.
Objetivo: El molusco contagioso es una infección de la piel causada por el virus Molluscipox. Dada la ausencia de un tratamiento específico, la presente investigación tiene como objetivo verificar, de acuerdo con la literatura reciente, los mejores métodos de tratamiento en niños inmunocompetentes. Métodos: Revisión sistemática de la literatura realizada en el Pubmed, así como en Lilacs, Scielo, Medline y otras bases de datos en la Biblioteca Virtual de Salud (BVS), con publicaciones de 2010 a 2016. Para evitar sesgos, se utilizaron las recomendaciones del PRISMA. Se utilizaron los criterios del Centro de Oxford para la Medicina Basada en la Evidencia y el sistema GRADE para clasificar el nivel de evidencia de los estudios. Resultados: Curetaje, láser pulsado de contraste, crioterapia, exéresis quirúrgica, KOH 2,5%, 5% y 10%, ácido tricloroacétrico, la combinación de ácido láctico y ácido salicílico, tretinoína 0,05% exhibieron buena tasa de curación, facilidad de realización y tiempo de resolución. Los métodos de inyección intralesional de antígenos de Cándida y la vacuna triple vírica, dieta equilibrada, aceite de alternifolia Malaleuca y ingenol mebutate 0,05% se muestran prometedores. Sin embargo, no se recomienda las cremas de cantaridina y imiquimod al 5%. Conclusión: Las evidencias obtenidas no han elegido un método preferido. La elección del método de tratamiento debe ser individualizada. Se recomienda la realización de más investigaciones relcionadas con el cultivo del virus.
Subject(s)
Humans , Molluscum Contagiosum/therapy , Treatment Outcome , Skin Diseases, Viral , Virus DiseasesABSTRACT
BACKGROUND AND OBJECTIVES: For the present study, we investigated the factors that influence the quality of standardized treatment for patients with post-cardiac arrest syndrome (PCAS) to improve the quality of PCAS treatment. SUBJECTS AND METHODS: We collected data on patients with cardiac arrest (CA) who were admitted to the intensive care units (ICUs) of 11 hospitals-Class II Grade A or above-in Suzhou from January to October 2013. Indexes of standardized treatment were observed within 72 hrs of CA. We analyzed monitoring techniques, monitoring frequency, ICU human and material resources, and intensivists' knowledge of PCAS treatment to explore how those factors affected the management of patients with PCAS. RESULTS: The bed/nurse ratio and the frequency with which core temperature was recorded correlated closely with the implementation of therapeutic hypothermia (TH) within 6 hrs of CA. The bed/doctor ratio and intensivists' knowledge about PCAS correlated closely with high-quality blood glucose control within 6 hrs of CA. Furthermore, the frequency with which core temperature was recorded was an independent factor influencing the quality of TH implementation, and the number times blood gas was analyzed was an independent factor influencing how well partial pressure of carbon dioxide was kept within the normal range in the 6 hrs after CA. CONCLUSION: The frequency of core temperature measurements and the number of times blood gas is analyzed are the most important factors influencing the quality of standardized treatment for patients with PCAS.