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1.
Rev. cuba. pediatr ; 93(3): e1480, 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1347533

ABSTRACT

Introducción: La población infantil presenta una escasa morbilidad y mortalidad por COVID-19; sin embargo, los niños infectados por el SARS-CoV-2 están en aumento y cabe la necesidad de caracterizarlos según sus diversas variables de presentación. Objetivo: Examinar las características sociales, clínicas, condiciones epidemiológicas y cuadro clínico de los niños diagnosticados con COVID-19. Métodos: Estudio descriptivo retrospectivo, con muestra de 88 niños menores de 12 años. Se revisó la base de datos de la oficina de epidemiología del hospital autorizado para el registro de casos confirmados de COVID-19 en la provincia de Chota, Perú. Se obtuvo la autorización de la dirección de la institución para utilizar la data exclusivamente con fines investigativos. El periodo de análisis: 14 de abril (caso cero en la provincia) de 2020-28 de enero de 2021. Resultados: En la muestra 51,1 por ciento fueron mujeres, el promedio de edad 5,6 años; 10,2 por ciento estuvo hospitalizado, 83 por ciento fue puesto en aislamiento, y 98,9 por ciento presentó una recuperación satisfactoria. Las manifestaciones fundamentales en los niños fueron: tos 26,1 por ciento; fiebre 23,9 por ciento y cefalea 19,3 por ciento. Las condiciones epidemiológicas detectadas fueron: 1,4 por ciento viajó en las últimas dos semanas; 47,7 por ciento tuvo contagio intradomiciliario y 67 por ciento asintomático. No se informaron niños fallecidos, intubados, ventilados o con neumonía. Conclusiones: Los niños son igual de susceptibles a la COVID-19 que otras personas; presentan cuadros clínicos menos graves que cursan principalmente con tos, fiebre, cefalea y malestar general; muestran una evolución más favorable y altas prevalencias de asintomáticos y contagios intradomiciliarios(AU)


Introduction: Children population has low morbidity and mortality by COVID-19; however, children infected with SARS-CoV-2 are on the rise and may need to be characterized according to their various presentation variables. Objective: Examine the social, clinical characteristics, epidemiological conditions and clinical picture of children diagnosed with COVID-19. Methods: Retrospective descriptive study, with a sample of 88 children under 12 years old. The database of the hospital´s epidemiology office authorized for the registration of confirmed cases of COVID-19 in Chota province, Peru, was reviewed. Authorization was obtained from the institution's management to use the data exclusively for research purposes. The analysis period was from April 14, 2020 (zero case in the province) to January 28, 2021. Results: In the sample 51.1 percent were women, the average age was 5.6 years; 10.2 percent were hospitalized, 83 percent were put in isolation, and 98.9 percent had a satisfactory recovery. The main manifestations in children were: cough, 26.1 percent; fever, 23.9 percent and headache, 19.3 percent. Epidemiological conditions detected were: 1.4 percent traveled in the last two weeks; 47.7 percent had intradomyciliary contagion, and 67 percent were asymptomatic. No children were reported deceased, intubated, ventilated or with pneumonia. Conclusions: Children are just as susceptible to COVID-19 as other people; they have less severe clinical pictures that occur mainly with cough, fever, headache and general discomfort; they show a more favorable evolution and high prevalence of asymptomatic and intradomyciliary contagions(AU)


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Fever/etiology , SARS-CoV-2 , COVID-19/epidemiology , Headache/etiology , Peru , Epidemiology, Descriptive , Retrospective Studies
3.
Article in Chinese | WPRIM | ID: wpr-879824

ABSTRACT

OBJECTIVE@#To study the clinical features of children with periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome, a polygenic and multifactorial autoinflammatory disease with unknown pathogenesis.@*METHODS@#A retrospective analysis was performed on the medical data of 13 children with PFAPA syndrome.@*RESULTS@#All 13 children had disease onset within the age of 3 years, with a mean age of onset of (14±10) months. They all had periodic fever, with 8-18 attacks each year. The mean interictal period of fever was (30±5) days. Pharyngitis, cervical adenitis, and aphthous stomatitis were the three cardinal symptoms, with incidence rates of 100% (13/13), 85% (11/13), and 38% (5/13) respectively. There were increases in white blood cells, C-reactive protein, and erythrocyte sedimentation rate during fever. Of all the 13 children, 6 underwent whole exome sequencing and 7 underwent panel gene detection for autoinflammatory disease, and the results showed single heterozygous mutations in the @*CONCLUSIONS@#For children with unexplained periodic fever with early onset accompanied by pharyngitis, cervical adenitis, aphthous stomatitis, elevated inflammatory indices, and good response to glucocorticoids, PFAPA syndrome should be considered. This disorder has good prognosis, and early diagnosis can avoid the long-term repeated use of antibiotics.


Subject(s)
Child , Child, Preschool , Fever/etiology , Humans , Infant , Lymphadenitis/diagnosis , Pharyngitis/drug therapy , Pyrin , Retrospective Studies , Stomatitis, Aphthous/genetics
5.
Medicina (B.Aires) ; 80(supl.3): 25-30, June 2020. ilus, graf, tab
Article in Spanish | LILACS | ID: biblio-1135187

ABSTRACT

Se trata de un análisis de características clínicas, hallazgos radiológicos, variables de laboratorio y mecánica respiratoria en pacientes con enfermedad por coronavirus 2019 (COVID-19) durante el primer mes de la pandemia en Buenos Aires. Es un estudio descriptivo de casos, de un solo centro. Se incluyeron todos los casos confirmados de COVID-19 internados en la unidad de terapia intensiva de adultos (UTIA) del Hospital Italiano de Buenos Aires. Todos los casos se confirmaron por reacción en cadena de la polimerasa con transcriptasa inversa. Un total de 7 pacientes con COVID-19 fueron atendidos en la UTIA. La mediana de edad fue de 71 años (intervalos intercuartílicos: 52-75), 4 hombres y 3 mujeres. Las manifestaciones clínicas más comunes fueron fiebre (7), tos (5), astenia (4) y disnea (3). Entre los hallazgos radiológicos, cinco de ellos mostraron opacidades intersticiales y un paciente consolidación pulmonar bilateral. Cinco requirieron ventilación mecánica invasiva y múltiples sesiones de decúbito prono. Ninguno murió durante la hospitalización, aunque aún tres permanecen en UCI.


This is an analysis of clinical characteristics, images findings, laboratory variables and respiratory mechanics in patients with coronavirus disease 2019 (COVID-19) during the first month of the pandemic outbreak in Buenos Aires. In this descriptive case study of a single-centre, we included all confirmed cases of COVID-19 hospitalized in intensive care unit (ICU). All cases were confirmed by reverse transcription polymerase chain reaction. A total of 7 patients with confirmed COVID-19 were referred to out ICU. The median age was 71 years (interquartile range 52-75), including 4 men and 3 women. Patients most common clinical manifestations were fever (7), cough (5), asthenia (4) and shortness of breath (3). Among the radiological findings, five of them showed interstitial opacities and one patient had bilateral pulmonary consolidation. Five required invasive mechanical ventilation and multiple prone sessions. None died during hospitalization, although three still remain in the ICU. According to imaging examination, 71.4% showed interstitial opacities and one patient bilateral consolidation. Five patients required invasive mechanical ventilation and multiple prone sessions. None of them died during hospitalization, although three still remain in the ICU.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Pneumonia, Viral/diagnosis , Respiration, Artificial , Coronavirus Infections/diagnosis , Coronavirus/isolation & purification , Pandemics , Intensive Care Units/organization & administration , Argentina/epidemiology , Asthenia/etiology , Treatment Outcome , Coronavirus Infections/therapy , Coronavirus Infections/epidemiology , Coronavirus/genetics , Cough/etiology , Dyspnea/etiology , Fever/etiology , Betacoronavirus , SARS-CoV-2 , COVID-19
6.
Rev. Hosp. Ital. B. Aires (2004) ; 40(2): 53-55, jun. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1102484

ABSTRACT

Una de las características de la afección pulmonar por enfermedad por coronavirus (COVID-19) es la disociación entre la gravedad de la hipoxemia y el mantenimiento de una mecánica respiratoria relativamente conservada. En este contexto se ha establecido una teoría en relación con dos fenotipos de pacientes con síndrome de distrés respiratorio del adulto (SDRA): un fenotipo Low, caracterizado por baja elastancia y baja reclutabilidad, y un fenotipo High, con características de alta elastancia y alta reclutabilidad. Presentamos el caso de un paciente que cursó internación en la Unidad de Terapia Intensiva de Adultos de nuestro hospital, con clínica, mecánica ventilatoria y patrón tomográfico compatible con el fenotipo Low de SDRA por COVID-19. (AU)


Dissociation between severity of hypoxemia and relative preserved respiratory mechanics is a characteristic observed in lung impairment due to coronavirus disease (COVID-19). Patients with COVID-19 that present adult respiratory distress syndrome (ARDS) are identified for one of two phenotypes according to a theory recently established. The Low phenotype is distinguished by low elastance and low recruitability; and the High phenotype, by high elastance and high recruitability. The case describes a patient admitted in the adult Intensive Care Unit of Hospital Italiano de Buenos Aires with observed symptoms, ventilatory mechanics and tomographic pattern that are compatible with Low phenotype of ARDS due to COVID-19. (AU)


Subject(s)
Humans , Male , Middle Aged , Respiratory Distress Syndrome/microbiology , Coronavirus Infections/therapy , Phenotype , Respiratory Distress Syndrome/genetics , Respiratory Mechanics , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Cough/etiology , Dyspnea/etiology , Fever/etiology , Hypertension/complications , Intensive Care Units , Hypoxia/physiopathology , Obesity/complications
8.
Rev. Soc. Bras. Med. Trop ; 53: e20200494, 2020. tab
Article in English | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1136860

ABSTRACT

Abstract Diagnosing cases of coronavirus disease (COVID-19) with only non-respiratory symptoms has been challenging. We reported the diagnosis of a child who tested positive for COVID-19 with abdominal pain/diarrhea and tracked his family cluster. One member of the family tested positive for COVID-19 on real-time reverse-transcription polymerase chain reaction assay and three other family members had anti-SARS-CoV-2 antibodies.


Subject(s)
Humans , Male , Pneumonia, Viral/diagnosis , Coronavirus Infections/diagnosis , Coronavirus/isolation & purification , Diarrhea/diagnosis , Pandemics , Pharyngitis/etiology , Abdominal Pain/etiology , Cluster Analysis , Contact Tracing , Coronavirus Infections , Clinical Laboratory Techniques , Diarrhea/etiology , Fever/etiology , Betacoronavirus
9.
Article in Chinese | WPRIM | ID: wpr-879794

ABSTRACT

OBJECTIVE@#To study the clinical features of children with recurrent Kawasaki disease (KD).@*METHODS@#PubMed, Web of Science, Embase, CNKI, Wanfang Med Online, and Weipu Data were searched for case-control studies on the clinical features of initial and recurrent KD. The articles were screened according to the inclusion and exclusion criteria. RevMan 5.3 software was used to perform the Meta analysis. Effect models were selected based on the results of heterogeneity test, and then pooled @*RESULTS@#A total of 9 case-control studies were included, with 12 059 children with KD in total, among whom 206 children had recurrent KD (127 boys/61.7%; 79 girls/38.3%). The results of the Meta analysis showed that compared with the initial KD onset, the children with recurrent KD had a shorter duration of fever (@*CONCLUSIONS@#Current evidence shows that children with recurrent KD tend to have a shorter duration of fever and a lower incidence of swelling of the hands and feet. KD recurrence is more common in boys. Current evidence does not show an increased risk of developing coronary artery lesions in children with recurrent KD.


Subject(s)
Child , Chronic Disease , Coronary Vessels/pathology , Edema/etiology , Female , Fever/etiology , Humans , Male , Mucocutaneous Lymph Node Syndrome/physiopathology , Recurrence
10.
Rev Assoc Med Bras (1992) ; 66(Suppl 2): 58-64, 2020. tab
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1136398

ABSTRACT

SUMMARY OBJECTIVES The 2019 Novel coronavirus disease puts a serious burden on the health system. Therefore, the detection of particularly serious patients at an early stage is extremely important in terms of controlling the outbreak and improving the prognosis. We investigated the role of inflammatory markers studied in patients suspected of COVID-19 at an emergency department in predicting PCR and CT results. METHODS This retrospective study was carried out with 133 patients who were admitted between 13 March and 1st April 2020 with suspicion of COVID-19. The patients were divided into four groups according to CT and RT-PCR results and evaluated. RESULTS Considering all patients, no specific findings were found in the hematological and biochemical values of patients in the laboratory analyses. Although all of the results remained within the reference range, there was a significant difference in white blood cell, neutrophil, platelet, and lymphocyte values when the groups were compared [p = 0.000; p = 0.004; p = 0.022; p = 0.023]. CONCLUSION Laboratory is not specific enough in the pre-diagnosis. In addition, this result does not alter with PCR or CT positivity. However, minimal changes observed in laboratory results may be partially guiding in patients in whom both PCR and CT are positive.


RESUMO OBJETIVOS A nova doença de coronavírus de 2019 coloca um fardo sério para o sistema de saúde. Portanto, a detecção de pacientes especialmente graves em um estágio inicial é extremamente importante em termos de controle do surto e melhoria do prognóstico. Investigamos o papel dos marcadores inflamatórios estudados em pacientes suspeitos de COVID-19 no pronto-socorro na previsão de resultados de PCR e CT. MÉTODOS Este estudo retrospectivo foi realizado entre 133 pacientes que foram admitidos entre 13 de março e 1o de abril de 2020 com suspeita de COVID-19. Os pacientes foram divididos em quatro grupos de acordo com os resultados da TC e RT-PCR e avaliados. RESULTADOS Considerando todos os pacientes, não foram encontrados achados específicos nos valores hematológicos e bioquímicos dos pacientes em análises laboratoriais. Embora todos os resultados tenham permanecido dentro do intervalo de referência, houve uma diferença significativa nos valores de glóbulos brancos, neutrófilos, plaquetas e linfócitos quando os grupos foram comparados [p = 0,000; p = 0,004; p = 0,022; p = 0,023]. CONCLUSÃO O laboratório não é suficientemente específico no pré-diagnóstico. Além disso, este resultado não se altera com a positividade para PCR ou CT. No entanto, alterações mínimas observadas nos resultados laboratoriais podem ser parcialmente norteadoras em pacientes com PCR e CT positivos.


Subject(s)
Humans , Pneumonia, Viral/diagnosis , Thorax/diagnostic imaging , Tomography, X-Ray Computed/methods , Coronavirus/isolation & purification , Clinical Laboratory Techniques/methods , Pneumonia, Viral/epidemiology , Retrospective Studies , Coronavirus Infections , Coronavirus Infections/diagnosis , Coronavirus/genetics , Emergency Service, Hospital , Pandemics , Fever/etiology , Real-Time Polymerase Chain Reaction , Betacoronavirus
11.
Clinics ; 75: e2209, 2020. tab
Article in English | LILACS | ID: biblio-1133484

ABSTRACT

OBJECTIVES: To assess the outcomes of pediatric patients with laboratory-confirmed coronavirus disease (COVID-19) with or without multisystem inflammatory syndrome in children (MIS-C). METHODS: This cross-sectional study included 471 samples collected from 371 patients (age<18 years) suspected of having severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The study group comprised 66/371 (18%) laboratory-confirmed pediatric COVID-19 patients: 61 (92.5%) patients tested positive on real-time reverse transcription-polymerase chain reaction tests for SARS-CoV-2, and 5 (7.5%) patients tested positive on serological tests. MIS-C was diagnosed according to the criteria of the Center for Disease Control. RESULTS: MIS-C was diagnosed in 6/66 (9%) patients. The frequencies of diarrhea, vomiting, and/or abdominal pain (67% vs. 22%, p=0.034); pediatric SARS (67% vs. 13%, p=0.008); hypoxemia (83% vs. 23%, p=0.006); and arterial hypotension (50% vs. 3%, p=0.004) were significantly higher in patients with MIS-C than in those without MIS-C. The frequencies of C-reactive protein levels >50 mg/L (83% vs. 25%, p=0.008) and D-dimer levels >1000 ng/mL (100% vs. 40%, p=0.007) and the median D-dimer, troponin T, and ferritin levels (p<0.05) were significantly higher in patients with MIS-C. The frequencies of pediatric intensive care unit admission (100% vs. 60%, p=0.003), mechanical ventilation (83% vs. 7%, p<0.001), vasoactive agent use (83% vs. 3%, p<0.001), shock (83% vs. 5%, p<0.001), cardiac abnormalities (100% vs. 2%, p<0.001), and death (67% vs. 3%, p<0.001) were also significantly higher in patients with MIS-C. Similarly, the frequencies of oxygen therapy (100% vs. 33%, p=0.003), intravenous immunoglobulin therapy (67% vs. 2%, p<0.001), aspirin therapy (50% vs. 0%, p<0.001), and current acute renal replacement therapy (50% vs. 2%, p=0.002) were also significantly higher in patients with MIS-C. Logistic regression analysis showed that the presence of MIS-C was significantly associated with gastrointestinal manifestations [odds ratio (OR)=10.98; 95%CI (95% confidence interval)=1.20-100.86; p=0.034] and hypoxemia [OR=16.85; 95%CI=1.34-211.80; p=0.029]. Further univariate analysis showed a positive association between MIS-C and death [OR=58.00; 95%CI=6.39-526.79; p<0.0001]. CONCLUSIONS: Pediatric patients with laboratory-confirmed COVID-19 with MIS-C had a severe clinical spectrum with a high mortality rate. Our study emphasizes the importance of investigating MIS-C in pediatric patients with COVID-19 presenting with gastrointestinal involvement and hypoxemia.


Subject(s)
Humans , Male , Child , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Coronavirus Infections/complications , Coronavirus Infections/mortality , Coronavirus , Pandemics , Respiration, Artificial , Vomiting/etiology , Abdominal Pain/etiology , Cross-Sectional Studies , Immunoglobulins, Intravenous/therapeutic use , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Systemic Inflammatory Response Syndrome/epidemiology , Diarrhea/etiology , Fever/etiology , Betacoronavirus , SARS-CoV-2 , COVID-19 , Glucocorticoids/therapeutic use , Mucocutaneous Lymph Node Syndrome/therapy , Mucocutaneous Lymph Node Syndrome/epidemiology , Mucocutaneous Lymph Node Syndrome/virology
12.
Clinics ; 75: e2027, 2020. tab, graf
Article in English | LILACS | ID: biblio-1133362

ABSTRACT

The coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in Wuhan city and was declared a pandemic in March 2020. Although the virus is not restricted to the lung parenchyma, the use of chest imaging in COVID-19 can be especially useful for patients with moderate to severe symptoms or comorbidities. This article aimed to demonstrate the chest imaging findings of COVID-19 on different modalities: chest radiography, computed tomography, and ultrasonography. In addition, it intended to review recommendations on imaging assessment of COVID-19 and to discuss the use of a structured chest computed tomography report. Chest radiography, despite being a low-cost and easily available method, has low sensitivity for screening patients. It can be useful in monitoring hospitalized patients, especially for the evaluation of complications such as pneumothorax and pleural effusion. Chest computed tomography, despite being highly sensitive, has a low specificity, and hence cannot replace the reference diagnostic test (reverse transcription polymerase chain reaction). To facilitate the confection and reduce the variability of radiological reports, some standardizations with structured reports have been proposed. Among the available classifications, it is possible to divide the radiological findings into typical, indeterminate, atypical, and negative findings. The structured report can also contain an estimate of the extent of lung involvement (e.g., more or less than 50% of the lung parenchyma). Pulmonary ultrasonography can also be an auxiliary method, especially for monitoring hospitalized patients in intensive care units, where transfer to a tomography scanner is difficult.


Subject(s)
Humans , Pneumonia, Viral/diagnostic imaging , Coronavirus Infections/diagnostic imaging , Coronavirus/isolation & purification , Pandemics , Lung/diagnostic imaging , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Radiography, Thoracic , Tomography, X-Ray Computed , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Clinical Laboratory Techniques , Cough/etiology , Diagnostic Tests, Routine , Fever/etiology , Betacoronavirus , COVID-19 Testing , SARS-CoV-2 , COVID-19
13.
Rev. bras. enferm ; 72(4): 1114-1118, Jul.-Aug. 2019. graf
Article in English | LILACS, BDENF | ID: biblio-1020515

ABSTRACT

ABSTRACT Objective: to report the experience of conducting directed temperature control of a post-cardiopulmonary resuscitation patient, with reduced and basic inputs available at the institution. Method: an experience report of directed temperature control in patient (age 15 years), after four hours of cardiopulmonary resuscitation in an Intensive Care Unit of a hospital in São Paulo State countryside in 2016, according to the protocol suggested by the American Heart Association, in 2015. There were applications of cold compresses, plastic bags with crushed ice and rectal temperature control. Results: after eight hours, temperature had reached 93.2 ºF. Body cooling was maintained for 24 hours. However, bags with crushed ice were used in the first 6 hours. Conclusion: conduct of nurses to obtain the body cooling with reduced and basic inputs was effective during the stay at the Intensive Care Unit.


RESUMEN Objetivo: relatar la experiencia de la conducción de control dirigido de la temperatura de una paciente después de la resucitación cardiopulmonar, con insumos reducidos y básicos disponibles en la institución. Método: el informe de experiencia de control direccionado de la temperatura en paciente (edad 15 años), después de cuatro horas de resucitación cardiopulmonar en una Unidad de Terapia Intensiva de un hospital del interior del estado de São Paulo, en el año 2016, conforme protocolo sugerido por la American Heart Association en 2015. Se utilizaron aplicaciones de compresas embebidas en agua helada, bolsas plásticas con hielo triturado y control de la temperatura rectal. Resultados: en ocho horas, la temperatura alcanzó los 34 ºC. El enfriamiento corporal se mantuvo durante 24 horas, sin embargo, las bolsas con hielo triturado se utilizaron en las primeras 6 horas. Conclusión: la conducta de los enfermeros para obtener el enfriamiento corporal con insumos reducidos y básicos, se mostró efectiva durante la permanencia en la Unidad de Terapia Intensiva.


RESUMO Objetivo: relatar a experiência da condução de controle direcionado da temperatura de uma paciente pós ressuscitação cardiopulmonar, com insumos reduzidos e básicos disponíveis na instituição. Método: relato de experiência de controle direcionado da temperatura em paciente (idade 15 anos) após quatro horas de ressuscitação cardiopulmonar em uma unidade de terapia intensiva de um hospital do interior do Estado de São Paulo, no ano de 2016, conforme protocolo sugerido pela American Heart Association 2015. Utilizou-se aplicações de compressas embebidas em água gelada, sacos plásticos com gelo triturado e controle da temperatura retal. Resultados: em oito horas a temperatura atingiu 34ºC. O resfriamento corporal foi mantido por 24 horas, todavia os sacos com gelo triturado foram utilizados nas primeiras 6 horas. Conclusão: a conduta dos enfermeiros para obter o resfriamento corporal com insumos reduzidos e básicos, mostrou-se efetiva durante a permanência na unidade de terapia intensiva.


Subject(s)
Humans , Female , Adolescent , Peritonitis/complications , Cardiopulmonary Resuscitation/adverse effects , Hypothermia, Induced/methods , Appendicitis/surgery , Appendicitis/complications , Peritonitis/surgery , Vomiting/etiology , Body Temperature Regulation/physiology , Tomography, X-Ray Computed/methods , Abdominal Pain/etiology , Cardiopulmonary Resuscitation/methods , Cardiopulmonary Resuscitation/standards , Fever/etiology
14.
Säo Paulo med. j ; 137(4): 349-355, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1043431

ABSTRACT

ABSTRACT BACKGROUND: Making the differential diagnosis between central fever and infectious fever is critically important among intracerebral hemorrhage patients followed up in intensive care units (ICUs). Serum procalcitonin (PCT) has been found to be a promising biomarker for the initial diagnosis of infection, even before culturing results. OBJECTIVES: To investigate the relationship between PCT and both fever etiologies and C-reactive protein (CRP) levels among critically ill patients with suspected intracerebral hemorrhage. DESIGN AND SETTING: Cross-sectional study in a public university hospital in Elazig, Turkey. METHODS: ICU patients diagnosed with intracerebral hemorrhage and normal procalcitonin levels were included in this study. From clinical assessments and cultures, they were classified as presenting either infectious or central fever. The sensitivity and specificity of PCT and CRP for predicting infection were calculated using a receiver operating characteristic (ROC) curve. RESULTS: There were 98 ICU patients with diagnoses of intracerebral hemorrhage. The median (interquartile range) PCT levels of patients with infectious and central fever were 4 (0.9-11) and 0.1 (0.1-0.4) ng/ml, respectively, with a statistically significant intergroup difference (P < 0.001). The areas under the ROC curve for predicting infectious or central fever PCT and CRP were 0.958 (P < 0.001) and 0.816 (P < 0.001), respectively. A statistically significant positive correlation was detected between PCT and CRP levels in patients with infectious fever (rho: 0.461; P = 0.003), but not in patients with central fever. CONCLUSIONS: PCT can possibly be used as a biomarker to differentiate between infectious and central fever among ICU patients.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Intracranial Hemorrhages/complications , Fever/blood , Procalcitonin/blood , Severity of Illness Index , Biomarkers/blood , Cross-Sectional Studies , Predictive Value of Tests , Sensitivity and Specificity , Intracranial Hemorrhages/blood , Diagnosis, Differential , Fever/etiology , Fever/microbiology , Intensive Care Units
16.
Article in English | AIM, AIM | ID: biblio-1264284

ABSTRACT

Introduction: Malaria, a public health problem in tropical countries, depends on several factors, some of which are social and environmental. In Mali in the Sahel zone, a socio-security crisis has prevailed in recent years. It was therefore interesting to study the epidemiology of this condition in situation. Objective: To determine the frequency of malaria among febrile syndromes in children aged 1 to 59 months in the pediatric ward of the Regional Hospital of Timbuktu. Material and methods: the study was longitudinal retrospective descriptive for a period from January 1 to December 31, 2015. The data were collected with fact sheets and consultation records. They were captured and analyzed on the Statistical Package for Social Scientist (SPSS) software version 21. Results: a total of 789 children hospitalized, 276 children had a febrile syndrome (35%). During the study period, we collected 180 cases of malaria, with a positive biological examination. The hospital frequency of malaria was 22.8% (180/789) and a frequency in febrile syndromes of 65.2% (180/276) of malaria cases. Of these 180 cases, 147 cases of uncomplicated malaria (81.7%) and 33 cases of severe malaria (18.3%) were found. In 34.8%, the etiology of febrile syndromes was other than malaria. Seasonal variation in malaria was found in terms of months of the year, peaking in September. The hospital lethality was 1.1% in our series. Conclusion: Malaria was the leading febrile syndromes among children under 5 in hospitals in Tombouctou


Subject(s)
Armed Conflicts , Child , Fever/etiology , Hospitals, Pediatric , Malaria/diagnosis , Malaria/epidemiology , Mali
17.
Arch. argent. pediatr ; 116(4): 542-547, ago. 2018. ilus, tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-950047

ABSTRACT

Introducción. El objetivo del estudio fue investigar la relación entre reflujo vesicoureteral (RVU) y daño renal en pacientes con infección urinaria (IU) sin fiebre, primera IU febril e IU recurrente. El objetivo secundario, determinar si la proteína C-reactiva (PCR) actuaría como predictor de nefroesclerosis en las IU febriles. Población y métodos. Estudio prospectivo; pacientes pediátricos con IU sin fiebre, primera IU febril e IU recurrente. Los análisis de laboratorio de rutina incluyeron hemograma completo, urea, creatinina, análisis de orina completamente automatizado, urocultivo y PCR. Se realizó ecografía urológica luego del diagnóstico de IU, cistouretrografía miccional tras seis semanas y gammagrafía renal estática con ácido dimercaptosuccínico marcado con 99mTc tras seis meses a todos los participantes. Resultados. Participaron 47 niños con IU sin fiebre, 48 con primera IU febril y 61 con IU recurrente. Hubo una diferencia estadísticamente significativa entre los grupos respecto de RVU y nefroesclerosis (p= 0,001 y p= 0,011, respectivamente). También hubo una diferencia estadísticamente significativa respecto de nefroesclerosis entre los pacientes con y sin RVU (p= 0,001). Además, se estableció una diferencia estadísticamente significativa respecto de nefroesclerosis (p < 0,05) en los pacientes con PCR cinco veces mayor o menor que el valor de corte aceptado (5 mg/dl). Conclusión. La proporción de nefroesclerosis fue paralela a la frecuencia de RVU. Cuanto mayor era el grado de RVU, mayor era el daño renal. Se determinó una correlación positiva entre PCR elevada y nefroesclerosis, lo que señala esclerosis durante el diagnóstico de pielonefritis.


Introduction. The aim was to investigate the relationship between vesicoureteral reflux (VUR) and renal damage in non-febrile, febrile for the first time and recurrent urinary tract infection (UTI) patients. The secondary aim was to determine whether C-reactive protein (CRP) in febrile UTIs could be a predictor of renal scarring. Population and methods. This prospective study included non-febrile, febrile for the first time and recurrent pediatric UTI cases. The routine lab analyses comprised a complete blood count, urea, creatinine, fully automated urinalysis, urine culture and CRP analyses. All the participants were examined using urine ultrasonography subsequent to their UTI diagnosis, voiding cystourethrography (VCUG) after six weeks and Tc-99m dimercaptosuccinic acid (DMSA) static renal scintigraphy after six months. Results. There were included 47 children with non-febrile UTIs, 48 with first febrile UTIs and 61 with recurrent UTIs. A statistically significant difference was found among the groups in terms of VUR and renal scarring (p= 0.001 and p= 0.011, respectively). A statistically significant difference was also found in terms of renal scarring between patients with and without VUR (p= 0.001). Moreover, a statistically significant difference was also present in relation to renal scarring (p <0.05) in patients with five-fold lower or higher CRP values than the accepted cut-off value (5mg/dl). Conclusion. The ratio of renal scars detected was found to be parallel to the VUR frequency. The higher the VUR grade, the more renal damage was found. A positive correlation between elevated CRP and renal scarring was determined, indicating the presence of scarring during the diagnosis of pyelonephritis.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Urinary Tract Infections/complications , Vesico-Ureteral Reflux/epidemiology , Cicatrix/epidemiology , Kidney/pathology , Pyelonephritis/complications , Pyelonephritis/diagnosis , Recurrence , Urinary Tract Infections/epidemiology , Vesico-Ureteral Reflux/etiology , C-Reactive Protein/metabolism , Prospective Studies , Ultrasonography/methods , Cicatrix/etiology , Technetium Tc 99m Dimercaptosuccinic Acid/administration & dosage , Fever/etiology , Fever/epidemiology , Kidney/diagnostic imaging
18.
Rev. Col. Bras. Cir ; 45(4): e1858, 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-956568

ABSTRACT

RESUMO Objetivo: avaliar a incidência, características epidemiológicas, diagnóstico e evolução dos pacientes que retornaram às unidades de pronto atendimento (UPA) do Hospital Albert Einstein em São Paulo/SP com sinais e sintomas sugestivos de complicações até 30 dias após realização de colonoscopia. Métodos: estudo retrospectivo uni-institucional de pacientes submetidos à colonoscopia em 2014 e que retornaram, em até 30 dias após o procedimento, a uma UPA. Resultados: foram realizadas colonoscopias em 8968 pacientes, dos quais 95 (1,06%) tiveram queixa relacionada à possível complicação. A maioria dos procedimentos foi realizada eletivamente. Complicações menores (dor abdominal inespecífica/distensão) foram frequentes (0,49%) e a maioria dos pacientes recebeu alta após consulta na UPA. Complicações graves foram menos frequentes: perfuração (0,033%), hemorragia digestiva baixa (0,044%) e obstrução intestinal (0,044%). A procura à UPA em menos de 24 horas após o procedimento associou-se a maior índice de colonoscopias normais (P=0,006), mais diagnóstico de febre (P=0,0003) e síndrome dispéptica (P=0,043) e menos diagnóstico de colite/ileíte (P=0,015). A presença de febre em pacientes atendidos na UPA associou-se ao diagnóstico de pólipos na colonoscopia (P=0,030). Conclusão: os dados do presente estudo corroboram as evidências de segurança do exame de colonoscopia e apontam para redução nos índices de complicações mais graves deste exame.


ABSTRACT Objective: to evaluate the incidence, epidemiological characteristics, diagnosis and evolution of patients who returned to the emergency care units of the Albert Einstein Hospital in São Paulo/SP with signs and symptoms suggestive of colonoscopy complications up to 30 days after the procedure. Methods: we conducted a retrospective, uni-institutional study of patients submitted to colonoscopy in 2014 who returned to the Emergency department (ED) within 30 days after the procedure. Results: 8968 patients underwent colonoscopies, 95 (1.06%) of whom had complaints related to possible complications. Most of the procedures were elective ones. Minor complications (nonspecific abdominal pain/distension) were frequent (0.49%) and most of the patients were discharged after consultation at the ED. Severe complications were less frequent: perforation (0.033%), lower gastrointestinal bleeding (0.044%), and intestinal obstruction (0.044%). ED consultations in less than 24 hours after the procedure was associated with a higher index of normal colonoscopies (p=0.006), more diagnosis of fever (p=0.0003) and dyspeptic syndrome (p=0.043), and less diagnosis of colitis/ileitis (p=0.015). The observation of fever in patients treated at the ED was associated with the diagnosis of polyps at colonoscopy (p=0.030). Conclusion: the data corroborate the safety of the colonoscopy exam and points to a reduction in major complications rates.


Subject(s)
Humans , Male , Female , Adult , Aged , Colonoscopy/adverse effects , Colon/injuries , Gastrointestinal Hemorrhage/epidemiology , Intestinal Perforation/epidemiology , Patient Readmission/statistics & numerical data , Abdominal Pain/etiology , Abdominal Pain/epidemiology , Incidence , Retrospective Studies , Colonoscopy/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Fever/etiology , Fever/epidemiology , Gastrointestinal Hemorrhage/etiology , Intestinal Perforation/etiology , Middle Aged
20.
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.809-820.
Monography in Portuguese | LILACS | ID: biblio-848523
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