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1.
Arch. argent. pediatr ; 118(1): 38-43, 2020-02-00. tab
Article in English, Spanish | LILACS (Americas), BINACIS | ID: biblio-1095346

ABSTRACT

Introducción. El asma es una enfermedad inflamatoria crónica con alta prevalencia en pacientes pediátricos. Existen resultados contradictorios respecto al efecto de esta enfermedad en los índices de caries dental. El objetivo del estudio fue determinar la prevalencia de caries dental en pacientes pediátricos asmáticos con medicación inhalatoria. Población y métodos. Estudio de casos y controles cuya muestra estuvo conformada por pacientes pediátricos que acudieron al Centro Médico Naval "Cirujano Mayor Santiago Távara" de diciembre de 2014 a marzo de 2015. Se dividieron en dos grupos: el primero (casos), integrado por pacientes asmáticos que utilizaban inhaladores en su tratamiento; el segundo (controles), por pacientes sanos del mismo nosocomio. Se realizó una evaluación médica para determinar tipo, tiempo y frecuencia del tratamiento y un examen oral para determinar la prevalencia de caries dental y el índice de dientes cariados, perdidos y obturados (CPOD). Resultados. Se encontró que la prevalencia de caries dental en el grupo control fue del 34,2 %, mientras, en el grupo casos, fue del 28,3 % (p = 0,094). Con respecto al índice de caries dental, el grupo control presentó CPOD de 4,73 ± 0,32, y el grupo casos, de 3,98 ± 0,31 (p = 0,08). Sin embargo, se evidenció que, a mayor tiempo de tratamiento con los inhaladores, el índice CPOD aumentaba significativamente (p = 0,04).Conclusiones. La medicación inhalatoria no incrementa la prevalencia de caries dental en pacientes pediátricos asmáticos. Sin embargo, existe una relación directa entre la duración del tratamiento y la prevalencia de caries dental


Introduction. Asthma is a chronic inflammatory disease that is highly prevalent among pediatric patients. The results about the effect of asthma on the rate of dental caries are contradictory. The objective of this study was to determine the prevalence of dental caries in asthma pediatric patients using inhaled drugs. Population and methods. Case-control study in a sample made up of pediatric patients who attended Centro Médico Naval "Cirujano Mayor Santiago Távara" between December 2014 and March 2015. Patients were divided into two groups: group A (cases) included asthma patients using inhalers as part of their treatment; group B (controls), healthy subjects who attended the same facility. A medical examination was done to determine the type, time, and frequency of treatment and an oral exam, to establish the prevalence of dental caries and the decayed, missing, and filled teeth (DMFT) index. Results. The prevalence of dental caries was 34.2 % in the control group and 28.3 % in the case group (p = 0.094). In relation to the rate of dental caries, the DMFT index in the control group was 4.73 ± 0.32, and 3.98 ± 0.31 in the case group (p = 0.08). However, it was evidenced that a longer duration of inhaler use led to a significantly higher DMFT index (p = 0.04).Conclusions. Inhaled drugs do not increase the prevalence of dental caries in asthma pediatric patients. However, there is a direct relationship between treatment duration and the prevalence of dental caries.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Asthma/drug therapy , Dental Caries Susceptibility , Metered Dose Inhalers , Dry Powder Inhalers , Bronchodilator Agents/administration & dosage , Case-Control Studies , Epidemiology, Descriptive , Prevalence , Tooth Loss , Adrenal Cortex Hormones/administration & dosage , Dental Care for Children
2.
Arch. argent. pediatr ; 117(6): 644-647, dic. 2019. ilus
Article in English, Spanish | LILACS (Americas), BINACIS | ID: biblio-1046628

ABSTRACT

La enfermedad de Behçet (EB) es un trastorno de vasculitis sistémica poco frecuente, de etiología desconocida, que se caracteriza por la presencia de aftas bucales, úlceras genitales y uveítis recurrentes. Afecta los sistemas nerviosos central y periférico; raramente se produce durante la niñez. La meningitis aséptica aguda aislada es muy poco frecuente. En este artículo, se describe el caso de una paciente de 14 años con diagnóstico de enfermedad de Behçet con afectación neurológica (neuro-Behçet). La paciente tenía cefalea aguda, diplopia, papiledema e irritación meníngea. Tenía antecedentes de úlceras bucales recurrentes. Las imágenes por resonancia magnética de cerebro revelaron paquimeningitis. Los hallazgos en el líquido cefalorraquídeo fueron pleocitosis y aumento de la presión. Pese al tratamiento médico, sus síntomas no se resolvieron. No se detectó uveítis y la prueba de patergia fue negativa. El alelo HLA-B51 fue positivo. Se consideró que los hallazgos apuntaban a la poco frecuente enfermedad de Behçet con afectación neurológica. La paciente mejoró drásticamente luego del tratamiento con corticoesteroides. En el diagnóstico diferencial de meningitis, se debe considerar la EB, a menos que se demuestre la presencia de un agente infeccioso. Hasta donde sabemos, anteriormente no se había descrito un caso de paquimeningitis con neuro-Behçet en la población pediátrica.


Behçet's disease (BD) is a rare systemic vasculitis disorder of unknown etiology characterized by recurrent oral and genital apthae and uveitis. It involves the central or peripheral nervous system; occurs rarely during childhood. Isolated acute aseptic meningitis is extremely uncommon. We report here a case of Neuro-Behçet disease (NBD) diagnosed in a 14-year-old girl. The patient presented acute headache, diplopia, papilla edema, and meningeal irritation. She had a history of recurrent oral ulcers. Brain magnetic resonance imaging revealed pachymeningitis. Pleocytosis and pressure increase were the cerebrospinal fluid findings. Although medical therapy, her complaints were not resolved. Uveitis was not detected, pathergy test was negative. HLA-B51 allele was positive. The findings were considered to unusual NBD. The patient improved dramatically after steroid therapy. BD should be considered in differential diagnosis of meningitis unless an infectious agent is demonstrated. To our knowledge, a case of pachymeningitis with NBD, was not described in children.


Subject(s)
Humans , Female , Adolescent , Behcet Syndrome/diagnosis , Adrenal Cortex Hormones/administration & dosage , Headache , Meningitis, Aseptic/diagnosis
4.
Int. arch. otorhinolaryngol. (Impr.) ; 23(3): 325-330, July-Sept. 2019. tab
Article in English | LILACS (Americas) | ID: biblio-1040031

ABSTRACT

Abstract Introduction Oral antihistamines and intranasal corticosteroids have been shown to be effective and safe for the treatment of allergic rhinitis; however, the evidence suggests a level of superiority of corticosteroids, so they should be preferred over the former. Objective To know the prescription profile of two second generation antihistamines (cetirizine and levocetirizine) and two nasal corticosteroids (mometasone and furoateciclesonide) in a cohort of patients with allergic rhinitis, and to compare the clinical outcomes obtained. Methods A cohort study was carried including patients with allergic rhinitis treated with cetirizine, levocetirizine, mometasone furoate or ciclesonide. The improvement was evaluated with the total nasal symptoms score (TNSS). This scale yields results between 0 and 12. Zero indicates absence of symptoms. Results A total of 314 patients completed 12 weeks of follow-up. Seventy-five percent were treated with antihistamines, 20% with corticosteroids, and 5% with a combination of the above. The TNSS median for corticosteroid was 2.5 points; for antihistamines, its was 5 points, and for combination, it was 4 points. We found differences between corticosteroids and antihistamines. Conclusion The prescription percentage of second generation oral antihistamines is higher than that of intranasal corticosteroids. However, patients with allergic rhinitis treated with the second option obtained better control of symptoms.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Adrenal Cortex Hormones/therapeutic use , Rhinitis, Allergic/drug therapy , Histamine Antagonists/therapeutic use , Drug Prescriptions , Administration, Intranasal , Cohort Studies , Treatment Outcome , Cetirizine/therapeutic use , Adrenal Cortex Hormones/administration & dosage , Colombia , Mometasone Furoate/therapeutic use
5.
Int. arch. otorhinolaryngol. (Impr.) ; 23(1): 101-103, Jan.-Mar. 2019. graf
Article in English | LILACS (Americas) | ID: biblio-1002176

ABSTRACT

Abstract Introduction Eosinophilic chronic rhinosinusitis (ECRS) is characterized by an eosinophilic inflammation driven by Th2-type cytokines. Glucocorticosteroids are the most common first-line treatment for ECRS with nasal polyps. Objective We have evaluated the long-term treatment with double-dose intranasal corticosteroids in refractory ECRS nasal polyps resistant to the conventional dose and assessed the risk of adverse systemic effects Methods Sixteen subjects were enrolled in this study. All subjects had ECRS after endoscopic sinus surgery that resulted in recurrentmild andmoderate nasal polyps and were undergoing a postoperative follow-up application of mometasone furoate at a dose of 2 sprays (100 μg) in each nostril once a day (200 μg). All the patients were prescribed mometasone furoate, administered at a dose of 2 sprays (100 μg) in each nostril twice a day (400 μg) for 6 months. Results The average scores of the symptoms during the regular dose of intranasal steroid treatment were 5.2 ± 2.2, but 6 months after the high-dose application, they had significantly decreased to 2.5 ± 1.4 (p < 0.05). The polyp size showed an average score of 1.38 during the regular dose which was significantly reduced to 0.43 (p < 0.01) by the double dose. Glycated hemoglobin (HbA1c) showed normal ranges in all the patients tested. The cortisol plasma concentration was also normal. Conclusion Doubling the dose of the nasal topical spray mometasone furoate might be recommended for the treatment of recurrent nasal polyps in the postoperative follow-up of intractable ECRS. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Sinusitis/drug therapy , Rhinitis/drug therapy , Mometasone Furoate/administration & dosage , Mometasone Furoate/adverse effects , Postoperative Care , Sinusitis/surgery , Administration, Intranasal , Rhinitis/surgery , Nasal Polyps/physiopathology , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/adverse effects , Endoscopy , Nasal Sprays
6.
Rev. méd. Minas Gerais ; 29: e-2024, 2019.
Article in Portuguese | LILACS (Americas) | ID: biblio-1048021

ABSTRACT

Este documento é uma revisão do protocolo de asma grave da SMPCT de 2015, que se fez necessária devido à atualização de avanços em pesquisas, principalmente em fenotipagem/genotipagem e terapêutica da asma grave, além de asma grave na pediatria. A maioria da publicações relata que 5% a 10% dos asmáticos podem apresentar asma grave. Porém, levantamento na Holanda encontrou uma prevalência menor, de 3,6% ou 10,4/10000 habitantes, que parece ser mais próximo da realidade. Este protocolo tem como população alvo os pacientes com asma grave, adultos e pediátricos, conforme definições de asma grave da"International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma" de 2014 e GINA 2018.1,3 Seus potenciais utilizadores são especialistas em doenças respiratórias que lidam com asma grave, e que devem ser os responsáveis pela aplicação do protocolo, e também clínicos gerais, pediatras, médicos de cuidados primários, enfermeiros, fisioterapeutas e outros profissionais da saúde. É aconselhável consulta com um especialista em asma nos seguintes casos: asma de difícil diagnóstico, suspeita de asma ocupacional, asma persistente não controlada com exacerbações frequentes, asma com risco de morte, eventos adversos significativos ou suspeita de subtipos de asma grave.4 Este documento não tem a intenção de instituir um tratamento padronizado, mas estabelecer bases racionais para decisões em pacientes com asma grave, pois as recomendações não conseguem abranger toda a complexidade do julgamento clínico em casos individuais. Os autores recomendam sua revisão e atualização no período máximo de 3 anos, ou, se necessário, em tempo menor.


Subject(s)
Humans , Child , Adolescent , Adult , Asthma , Adrenal Cortex Hormones , Adrenergic beta-2 Receptor Agonists , Asthma/diagnosis , Asthma/drug therapy , Asthma/therapy , Interleukin-5/antagonists & inhibitors , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/agonists , Chemical Compounds , Adrenergic beta-2 Receptor Agonists/administration & dosage
7.
J. pediatr. (Rio J.) ; 95(supl.1): S10-S22, 2019. tab
Article in English | LILACS (Americas) | ID: biblio-1002480

ABSTRACT

Abstract Objectives: To assess the impact of asthma and its treatment (inhaled corticosteroids and other control medications) on growth. Data sources: The authors searched PubMed (up to August 24, 2018) and screened the reference lists of retrieved articles. Systematic reviews and meta-analysis were selected. If there was no such article, the authors selected either randomized clinical trials or observational studies. Data synthesis: A total of 37 articles were included in this review. The findings from 21 studies suggest that asthma per se, especially more severe and/or uncontrolled cases, can transitorily impair child's growth. Two Cochrane reviews of randomized clinical trials showed a small mean reduction in linear growth (-0.91 cm/year for beclomethasone, -0.59 cm/year for budesonide, and -0.39 cm/year for fluticasone) in the first year of treatment with inhaled corticosteroids in prepubertal children with persistent asthma. The effects were likely to be molecule- and dose-dependent. A recent review showed that most of "real-life" observational studies had not found significant effects of inhaled corticosteroids on growth in asthmatic children. Fifteen studies showed that the maintenance systemic corticosteroids could cause a dose-dependent growth suppression in children with severe asthma, but other controllers (cromones, montelukast, salmeterol, and theophylline) had no significant adverse effects no growth. Conclusions: Severe and/or uncontrolled asthma can transitorily impair child's growth. Regular use of inhaled corticosteroids may cause a small reduction in linear growth in children with asthma, but the well-established benefits of inhaled corticosteroids in controlling asthma outweigh the potential adverse effects on growth. Use of the minimally effective dose of inhaled corticosteroids and regular monitoring of child's height during inhaled corticosteroids therapy are recommended.


Resumo Objetivos: Avaliar o impacto da asma e seu tratamento (corticosteroides inalados e outros medicamentos de controle) no crescimento. Fontes de dados: Uma busca foi feita no PubMed (até 24 de agosto de 2018) e foram triadas as listas de referência dos artigos recuperados. Revisões sistemáticas e metanálises foram selecionadas. Se não houvesse tal artigo, ensaios clínicos randomizados ou estudos observacionais eram selecionados. Síntese dos dados: Trinta e sete artigos foram incluídos nesta revisão. Os achados de 21 estudos sugerem que a asma por si só, especialmente os casos mais graves e/ou descontrolados, podem prejudicar o crescimento da criança. Duas revisões Cochrane de ensaios clínicos randomizados mostraram uma pequena redução média no crescimento linear (−0,91 cm/ano para beclometasona, −0,59 cm/ano para budesonida e −0,39 cm/ano para fluticasona) no primeiro ano de tratamento com corticosteroides inalados em crianças pré-púberes com asma persistente. Os efeitos pareciam ter efeito dose- e molécula-dependente. Uma revisão recente mostrou que a maioria dos estudos observacionais da "vida real" não encontrou efeitos significativos dos corticosteroides inalados no crescimento de crianças asmáticas. Quinze estudos mostraram que a manutenção de corticosteroides sistêmicos poderia causar uma supressão do crescimento dose-dependente em crianças com asma grave, mas outros controladores (cromonas, montelucaste, salmeterol e teofilina) não tiveram efeitos adversos significativos no crescimento. Conclusões: A asma grave e/ou descontrolada pode prejudicar o crescimento da criança. O uso regular de corticosteroides inalados pode causar uma pequena redução no crescimento linear em crianças com asma, mas os benefícios bem estabelecidos dos corticosteroides inalados no controle da asma superam os potenciais efeitos adversos no crescimento. Recomenda-se o uso de doses minimamente eficazes de corticosteroides inalados e o monitoramento regular da altura da criança durante a terapia com corticosteroides inalados.


Subject(s)
Humans , Child , Asthma/drug therapy , Adrenal Cortex Hormones/administration & dosage , Anti-Asthmatic Agents/adverse effects , Growth Disorders/chemically induced , Severity of Illness Index , Anti-Asthmatic Agents/administration & dosage , Evidence-Based Medicine
8.
Acta cir. bras ; 34(12): e201901206, 2019. tab
Article in English | LILACS (Americas) | ID: biblio-1054688

ABSTRACT

Abstract Purpose To evaluate the effects of prednisolone against sodium diclofenac both with ciprofloxacin compared to artificial tears on the symptoms and signs of acute viral conjunctivitis. Methods Study included 37 patients diagnosed with acute conjunctivitis and distributed by three groups: A (1% prednisolone acetate + ciprofloxacin (0.3%); B (Sodium diclofenac (0.1%) + ciprofloxacin (0.3%) and C (artificial tears + ciprofloxacin (0.3%). Patients received medication 6/6 hours daily. Signs and symptoms (e.g. lacrimation, burning, photophobia, etc.) were scored at baseline and on the first, third, fifth and seventh days and in the end of treatment using a standardized questionnaire and slit lamp anterior segment examination. Results All three groups demonstrated an improvement in the signs and symptoms of conjunctivitis in their follow-up visits. There was no significant difference in symptom and sign scores between Group A and B and B and C in the study visits ( p >0.05). However, the comparison between groups A and C showed a clinical trend (p=0.05) on third evaluation suggesting better clinical action using the corticosteroids. Conclusion The prednisolone acetate was not superior to the use of sodium diclofenac or artificial tears in relieving the signs and symptoms of viral conjunctivitis.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Prednisolone/analogs & derivatives , Ciprofloxacin/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Conjunctivitis, Viral/drug therapy , Diclofenac/administration & dosage , Adrenal Cortex Hormones/administration & dosage , Ophthalmic Solutions/administration & dosage , Prednisolone/administration & dosage , Acute Disease , Analysis of Variance , Interleukins/analysis , Interferon-gamma , Tumor Necrosis Factor-alpha/analysis , Treatment Outcome , Nitric Oxide Synthase/analysis , Lubricant Eye Drops/administration & dosage
9.
Rev. chil. cir ; 70(6): 510-516, dic. 2018. tab, graf, ilus
Article in Spanish | LILACS (Americas) | ID: biblio-978023

ABSTRACT

Introducción: Las resecciones hepáticas mayores pueden presentar una alta morbimortalidad en relación al sangrado intraoperatorio. La utilización de la maniobra de Pringle permite disminuir esta complicación a costa de un daño por isquemia-reperfusión. Una estrategia para minimizarla es el uso de corticoides perioperatorios. Objetivo: Evaluar el uso de metilprednisolona en dosis bajas (< 500 mg) en pacientes sometidos a resección hepática mayor con maniobra de Pringle en la incidencia de daño por isquemiareperfusión, morbilidad y mortalidad perioperatoria. Material y Métodos: Estudio retrospectivo utilizando la base de datos de hepatectomías entre los años 2000 y 2015. De un total de 171 resecciones hepáticas mayores, 62 utilizaron clampeo vascular. Se establecieron dos grupos: (A) aquellos que recibieron metilprednisolona inmediatamente previo al clampeo (n = 27) y (B) pacientes sin metilprednisolona (n = 35). Se evaluó el daño por isquemia-reperfusión por alteración de las pruebas hepáticas en los días 1, 3 y 5. Resultados: Los pacientes del grupo A tuvieron mayor tiempo de isquemia (43 + 3,3 vs 27 + 2,1 min, p < 0,05) que el grupo B, con una significativamente menor elevación de las fosfatasas alcalinas y bilirrubina en los días 1 y 5 poshepatectomía. No se observó diferencias en la magnitud del sangrado y no hubo diferencias en morbimortalidad. Conclusiones: La utilización de dosis bajas de metilprednisolona parece disminuir el impacto del DIR relacionado a la resección hepática bajo clampeo vascular, evitando los efectos adversos de la administración de esteroides en dosis altas.


Introduction: Liver resections may be associated with high morbidity and mortality due to intraoperative bleeding. Pringle maneuver reduces this complication at the expense of ischemia-reperfusion injury. Current strategies to minimize reperfusion injury include the use of perioperative corticosteroids. Objective: To assess the use of methylprednisolone in low doses (< 500 mg) in patients submitted to major hepatic resection under Pringle maneuver in the incidence of ischemia-reperfusion injury, peri-operative morbidity, and mortality. Material and Methods: Retrospective study from the liver resections database undertaken between the years 2000-2015 in our center. One hundred and seventy-one major liver resections were done, in 62 under Pringle maneuver. Two groups were established: (A) Patients administered methylprednisolone immediately before Pringle maneuver (n = 27) and (B) those without steroid (n = 35). We assessed ischemia-reperfusion injury by measuring liver tests on days 1, 3 and 5. Results: Patients in group A had longer ischemia time (43 ± 3.3 vs. 27 ± 2.1 min, p < 0.05) than those of group B, and significantly lower elevation of serum phosphatase alkaline and bilirubin on days 1 and five post-hepatectomy. We did not observe any difference in bleeding magnitude, and there were no differences in morbidity or mortality. Conclusions: The use of low doses of methylprednisolone seems to diminish the impact of ischemia-reperfusion injury related to major hepatic resection under Pringle maneuver avoiding the adverse side effects of high dose steroid.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Methylprednisolone/administration & dosage , Reperfusion Injury/prevention & control , Hepatectomy/methods , Retrospective Studies , Blood Loss, Surgical/prevention & control , Adrenal Cortex Hormones/administration & dosage , Hepatectomy/adverse effects
10.
An. bras. dermatol ; 93(4): 598-600, July-Aug. 2018. graf
Article in English | LILACS (Americas) | ID: biblio-1038276

ABSTRACT

Abstract: Wet wrap dressings provide an ancillary treatment option for erythrodermic patients. Wet wrap therapy consists of the application of topical corticosteroids on all affected surfaces, followed by the application of a warm moist cotton cloth with a dry cotton cloth on top. The advantages of this procedure include its safety, as well as the prompt and marked improvement of the erythroderma. For erythrodermic psoriasis, wet wrap dressings can serve as an important rescue therapy option. The purpose of this study is to report a case series of seven patients with erythrodermic psoriasis that responded promptly to wet wrap therapy prior to the initiation of systemic treatment.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Bandages , Adrenal Cortex Hormones/administration & dosage , Dermatitis, Exfoliative/drug therapy , Administration, Topical , Treatment Outcome
11.
Arch. argent. pediatr ; 116(3): 385-391, jun. 2018. tab
Article in English, Spanish | LILACS (Americas), BINACIS | ID: biblio-950016

ABSTRACT

Objetivo. Determinar la frecuencia de mutaciones del gen MEFV en niños con diagnóstico de púrpura de Schonlein-Henoch y evaluar el efecto que tienen en el pronóstico. Materiales y métodos. Estudio transversal que incluyeron pacientes pediátricos de entre 2 y 11 años, con diagnóstico de púrpura de Schonlein-Henoch. Se estudiaron para detectar 6 mutaciones en el gen MEFV (M694V, M680I, A744S, R202Q, K695R y E148Q). Resultados. Se incluyeron ochenta pacientes, de los cuales el 55% eran de sexo masculino (n= 44). La media de edad fue 6,44 ± 2,52 años. Durante el seguimiento, 9 pacientes presentaron recurrencia de la enfermedad, 5 sufrieron invaginación intestinal y 1 paciente tuvo convulsiones. Aproximadamente la mitad de los pacientes recibió corticoides. En 44 pacientes (55%) no se detectaron mutaciones en el gen MEFV. En 19 pacientes (22%) hubo una mutación heterocigota. Se encontró E148Q en 8 pacientes, M694V en 5 pacientes, A744S en 4 pacientes y la mutación heterocigota R202Q en 2 pacientes. En 1 paciente se detectó la mutación heterocigota M608I y en otro paciente se encontró la mutación homocigota M694V. En 15 pacientes se encontraron mutaciones heterocigotas compuestas en el gen MEFV. Las mutaciones en el gen MEFV no se correlacionaban con la frecuencia de compromiso renal y gastrointestinal ni con el pronóstico, desarrollo de complicaciones y uso de corticoides. Conclusiones. Las mutaciones en el gen MEFV no se correlacionan con la evolución clínica ni con las complicaciones en pacientes pediátricos con púrpura de Schonlein-Henoch en Turquía.


Objective. To determine the frequency of the MEFV gene mutations in pediatric patients diagnosed with HSP and to assess the effect of the MEFV gene mutations on their prognosis. Material and Methods. Ccross-sectional study; pediatric patients between 2-11 years diagnosed with HSP were included. These cases were investigated for 6 MEFV gene mutations (M694V, M680I, A744S, R202Q, K695R, E148Q). Results. Eighty cases were included in the study of which 55% were male (n= 44). The mean age was 6.44 ± 2.52 years. Disease recurrence occurred in 9 patients, invagination in 5 patients and convulsion in 1 patient during follow-up. Approximately half of the patients received steroids. The MEFV gene mutations was not detected in 44 (55%) of the patients. There was a heterozygous mutation in 19 (22%). E148Q was found in 8 patients, M694V in 5 patients, A744S in 4 patients, and the R202Q heterozygous mutation in 2 patients. The M608I homozygous mutation was detected in 1 patient and the M694V homozygous mutation in 1 patient. The compound heterozygous MEFV gene mutations was found in 15 patients. The presence of the MEFV gene mutations was not correlated with the frequency of renal and gastrointestinal involvement and prognosis, the development of complications and the use of steroids. Conclusion. The presence of the MEFV gene mutations does not correlate with the clinical course and complication in Turkish pediatric patients with HSP.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Purpura, Schoenlein-Henoch/physiopathology , Adrenal Cortex Hormones/administration & dosage , Pyrin/genetics , Prognosis , Purpura, Schoenlein-Henoch/genetics , Purpura, Schoenlein-Henoch/drug therapy , Recurrence , Turkey , Cross-Sectional Studies , Follow-Up Studies , Heterozygote , Mutation
12.
Neumol. pediátr. (En línea) ; 13(2): 75-80, mar. 2018. tab, graf
Article in Spanish | LILACS (Americas) | ID: biblio-947306

ABSTRACT

Introduction. The early use of systemic steroids has been associated with a decrease in the rate of hospitalizations in pediatric patients with asthma exacerbation. The objective was to compare the equivalence of two forms of administration, as well as to determine the optimal time for its indication. Material and methods: Observational, randomized, open study of equivalence, comparing oral versus parenteral steroids. The primary outcomes were changes in the severity scale and the rate of hospitalizations. The secondary result was the time until improvement was reached. ANOVA and Chi square tests were used to determine the statistical significance; it was considered significant when p <0,05. Results: In both groups both the severity scale and the hospitalization rate were considerably modified with early administration. At 30 minutes after using hydrocortisone (p<0,05). The greatest variation in the severity scale was observed. Conclusion: both routes of administration proved to be effective and should be used early.


Introducción: El uso precoz de los esteroides sistémicos ha sido asociado con disminución de la tasa de hospitalizaciones en los pacientes pediátricos con exacerbación asmática. El objetivo de este estudio es comparar la equivalencia de dos formas de administración, así como determinar el tiempo óptimo para su indicación. Material y métodos: Estudio observacional, aleatorizado, abierto de equivalencia, comparando esteroides por via oral contra parenteral. Los outcomes primarios fueron los cambios en la escala de gravedad y la tasa de hospitalizaciones y el secundario fue el tiempo en alcanzar la mejoría. Se utilizó ANOVA, prueba Chi cuadrado para determinar las significaciones estadísticas, se consideró significancia p<0,05. Resultados: En ambos grupos tanto la escala de gravedad como la tasa de mortalidad se modificaron de forma importante con la administración precoz. A los 30 minutos de administrar hidrocortisona (p<0,05) se observó la mayor variación en la escala de gravedad. Conclusión: ambas vías de administración demostraron ser efectivas y deben ser usadas de forma precoz.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Asthma/drug therapy , Adrenal Cortex Hormones/administration & dosage , Anti-Asthmatic Agents/administration & dosage , Recurrence , Asthma/physiopathology , Time Factors , Therapeutic Equivalency , Chi-Square Distribution , Administration, Oral , Analysis of Variance , Observational Study
15.
An. bras. dermatol ; 92(3): 419-420, May-June 2017. graf
Article in English | LILACS (Americas) | ID: biblio-886961

ABSTRACT

Abstract A 59-year-old woman reported a 20-day history of slightly scaly erythematous infiltrated patches on her palms and soles with a histopathological result which was consistent with interstitial-pattern granuloma annulare, clinically classified as patch granuloma annulare. This is a rare clinical variant of granuloma annulare, with an unknown incidence and characteristic clinical and histopathological features. The patient evolved with a complete remission of the lesions after biopsy and the use of high-potency topical corticosteroid.


Subject(s)
Humans , Female , Middle Aged , Granuloma Annulare/pathology , Administration, Topical , Granuloma Annulare/drug therapy , Adrenal Cortex Hormones/administration & dosage
16.
Rev. med. interna Guatem ; 21(1): 21-24, ene.-abr. 2017. ilus
Article in Spanish | LILACS (Americas) | ID: biblio-995533

ABSTRACT

Necrólisis Epidérmica Tóxica (NET) es una rara pero grave emergencia caracterizada por difusa exfoliación de la piel y las membranas mucosas debido a pérdida de la epidermis, mediada por respuesta inmune que puede llevar a sepsis y fallo ventilatorio. El Trimetropin-Sulfametoxazol es un antibiótico ampliamente utilizado que es causa de dicha entidad. El diagnóstico prematuro y el tratamiento agresivo es esencial para la reducción de los elevados niveles de morbilidad y mortalidad asociadas con esta enfermedad. Presentamos un caso que fue precipitado debido al uso de Trimetropin-Sulfametoxazol en un hombre de 22 años de edad...(AU)


Toxic Epidermal Necrolysis (TEN) is a rare but serious emergency characterized by diffuse exfoliation of the skin and mucous membranes due to loss of the epidermis, mediated by immune response that can lead to sepsis and ventilatory failure. Trimetropin-Sulfamethoxazole is a widely used antibiotic that causes this entity. Premature diagnosis and aggressive treatment is essential for reducing the high levels of morbidity and mortality associated with this disease. We present a case that was precipitated due to the use of Trimetropin-Sulfamethoxazole in a man of 22 years of age ... (AU)


Subject(s)
Humans , Male , Adult , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Stevens-Johnson Syndrome/complications , Stevens-Johnson Syndrome/drug therapy , Adrenal Cortex Hormones/administration & dosage , Trimethoprim Resistance/drug effects , Guatemala
17.
ImplantNewsPerio ; 2(2): 293-300, mar.-abr. 2017.
Article in Portuguese | LILACS (Americas), BBO | ID: biblio-847152

ABSTRACT

O uso crônico de alguns medicamentos, em especial os corticosteroides, pode alterar a morfologia e a fisiologia dos tecidos periodontais, podendo induzir de forma exacerbada o crescimento gengival e gerar efeitos deletérios sobre a resposta imunológica dos tecidos frente a uma agressão de origem microbiana. Os corticosteroides agem reprimindo a ação de células do sistema imune e, em longo prazo, geram aumento da atividade osteoclástica associada com a redução da atividade osteoblástica, acelerando a perda óssea de maneira progressiva. O objetivo deste trabalho foi discutir, através de uma revisão da literatura, a influência dos medicamentos corticosteroides nos tecidos periodontais, abordando aspectos morfológicos e a resposta imunológica a nível local.


The chronic use of some medications, especially corticosteroids, can alter the morphology and physiology of periodontal tissues and can enhance the gingival growth and create deleterious effects on the immune tissue response facing an assault of microbial origin. Corticosteroids act by suppressing the immune system cell activity and in the long-term, produce increased osteoclastic activity associated with reduced osteoblastic activity, accelerating bone loss in a progressive manner. The objective of this study was to discuss the influence of corticosteroid medications in periodontal tissues, addressing morphology and the immune response locally.


Subject(s)
Humans , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/immunology , Adrenal Cortex Hormones/therapeutic use , Bone and Bones , Cells , Inflammation
18.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci Torres; Oliveira Junior, Múcio Tavares de; Kalil Filho, Roberto. Manual da condutas da emergência do InCor: cardiopneumologia / IInCor Emergency Conduct Manual: Cardiopneumology. São Paulo, Manole, 2ª revisada e atualizada; 2017. p.983-992.
Monography in Portuguese | LILACS (Americas) | ID: biblio-848542
19.
Braz. j. med. biol. res ; 50(4): e5976, 2017. tab, graf
Article in English | LILACS (Americas) | ID: biblio-839282

ABSTRACT

We evaluated the efficacy and safety of tacrolimus (TAC) combined with corticosteroids in treating patients with idiopathic membranous nephropathy (IMN). One hundred seventy-seven biopsy-proven IMN patients were recruited in this retrospective clinical study. Sixty patients received TAC (target blood concentration of 4–8 ng/mL) and 117 patients received daily cyclophosphamide (CYC, 100 mg) combined with prednisone. Remission rates at the end of the first, second and third month in the TAC group were significantly higher than that in the CYC group (1st: 35.0 vs 19.7%, P<0.05; 2nd: 56.7 vs 38.5%, P<0.05; 3rd: 76.7 vs 59.0%, P<0.05). In the first 3 months, daily urinary protein and serum albumin in the TAC group obtained a better improvement than that in the CYC group (P<0.05). At the end of the sixth and the twelfth month, the remission rates, daily urinary protein and serum albumin were all comparable between the two groups (P>0.05). No significant difference of relapse rate between the groups was found (16.3 vs 12.0%, P>0.05). Patients were more likely to develop glucose intolerance in the TAC group. The TAC regimen obtained more benefits in treating IMN patients, especially in the first 3 months, than the CYC regimen.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Adrenal Cortex Hormones/administration & dosage , Cyclophosphamide/administration & dosage , Glomerulonephritis, Membranous/drug therapy , Immunosuppressive Agents/administration & dosage , Prednisone/administration & dosage , Tacrolimus/administration & dosage , Creatinine/blood , Drug Therapy, Combination , Follow-Up Studies , Proteinuria , Reproducibility of Results , Retrospective Studies , Serum Albumin/analysis , Time Factors , Treatment Outcome
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