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1.
Arq. ciências saúde UNIPAR ; 26(2): 187-192, maio-ago. 2022.
Article in Portuguese | LILACS | ID: biblio-1372977

ABSTRACT

O vírus da imunodeficiência humana é o agente etiológico da AIDS, doença crônica que destrói o sistema imunológico e é caracterizada pela baixa contagem de células TCD4, alta contagem de partículas virais no sangue e manifestações clínicas da doença. O diagnóstico se dá com o aparecimento de infecções oportunistas, que levam a contagem de TCD4 a níveis menores que 200 céls/mm³. Os exames laboratoriais para o diagnóstico do HIV foram os principais avanços para o início do tratamento, reduzindo a transmissão. Detecção de anticorpos, detecção de antígenos e amplificação do genoma do vírus são alguns dos exames laboratoriais utilizados para diagnóstico. Os dois principais biomarcadores são os exames de contagem de células TCD4, que verifica o sistema imune, e a quantificação de carga viral, que informa a quantidade de partículas virais, mostrando a progressão da infecção. Quanto maior a carga viral, maior o dano ao sistema imune. Uma carga viral indetectável é inferior a 50 cópias/mL, mas valores menores ou iguais a 200 cópias/mL também impedem a transmissão. Uma declaração de consenso afirma que Indetectável é igual a Intransmissível. Portanto, quando indetectável, a transmissão inexiste. O presente estudo relata e discute o caso clínico de uma paciente diagnosticada com HIV/AIDS aos 28 anos, que sobreviveu, apesar do diagnóstico tardio, e sob presença de doença oportunista com um grave grau de diminuição de células TCD4 (22 cél/mm³). Por meio do diagnóstico, introdução e adesão correta da terapia antirretroviral e monitorização de exames laboratoriais, conseguiu evitar a morte e ter uma vida semelhante à de um HIV negativo. Ultrapassou a expectativa de vida que na descoberta era de 10 anos, com uma qualidade de vida considerável, não sendo transmissora do vírus, diminuindo assim o estigma e preconceito. O biomédico é peça fundamental nesse contexto, considerando que deve fornecer informações precisas e fidedignas, tão necessárias ao acompanhamento de pessoas vivendo com HIV, para que autoridades e profissionais de saúde adotem medidas adequadas, tanto na prevenção, quanto no diagnóstico e monitoramento da doença.


The human immunodeficiency virus is the etiological agent of AIDS, a chronic disease that destroys the immune system and is characterized by low TCD4 cell count, high viral particle count in blood and clinical manifestations of the disease. The diagnosis is due to the appearance of opportunistic infections, which lead to TCD4 counts below 200 cells / mm³. Laboratory tests for the diagnosis of HIV were the main advances in starting treatment, reducing transmission. Antibody detection, antigen detection and virus genome amplification are some of the laboratory tests used for diagnosis. The two main biomarkers are the TCD4 cell count tests, which checks the immune system, and viral load quantification, which reports the number of viral particles, showing the progression of infection. The higher the viral load, the greater the damage to the immune system. An undetectable viral load is less than 50 copies / mL, but values less than or equal to 200 copies / mL also prevent transmission. A consensus statement states that Undetectable equals Non-Transmissible. Therefore, when undetectable, transmission does not exist. The present study reports and discusses the clinical case of a patient diagnosed with HIV / AIDS at age 28, who survived despite late diagnosis and under the presence of opportunistic disease with a severe degree of TCD4 cell reduction (22 cells / mm³). Through the diagnosis, introduction and correct adherence of antiretroviral therapy and monitoring of laboratory tests, she was able to avoid death and have a life similar to that of an HIV negative. Exceeded the life expectancy that in the discovery was 10 years, with a considerable quality of life, not transmitting the virus, thus reducing the stigma and prejudice. The biomedical is a key player in this context, considering that he must provide accurate and reliable information, which is so necessary for the monitoring of people living with HIV, so that authorities and health professionals adopt appropriate measures, both in prevention, diagnosis and monitoring of the disease.


Subject(s)
Humans , Female , Adult , HIV Infections/drug therapy , HIV , Toxoplasmosis/virology , AIDS-Associated Nephropathy/virology , Acquired Immunodeficiency Syndrome , AIDS-Related Opportunistic Infections , Viral Load , Cryptococcosis/drug therapy , Antiretroviral Therapy, Highly Active , Fever/virology , Headache/virology , Anemia/virology , Meningitis/virology
2.
Arch. argent. pediatr ; 120(2): e75-e79, abril 2022. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1363969

ABSTRACT

La morfea lineal en golpe de sable es una entidad dermatológica caracterizada por la inflamación esclerosante y progresiva del tejido cutáneo en la región frontal y/o en el cuero cabelludo. La cefalea y las crisis convulsivas son dos de los síntomas extracutáneos más frecuentes y están causados por el crecimiento subyacente de la lesión. Es importante un diagnóstico temprano para frenar la progresión e intentar evitar las complicaciones secundarias, principalmente neurológicas. El diagnóstico se basa en el cuadro clínico y el estudio histológico, que permite la confirmación definitiva. El tratamiento de elección es la terapia combinada con corticoides orales y metotrexato. Aun con el tratamiento farmacológico adecuado, esta patología puede presentar un curso recidivante y dejar secuelas a largo plazo. Se presenta el caso de una niña en quien se realizó un diagnóstico rápido de esta enfermedad, a pesar de un cuadro clínico inespecífico. Fue tratada con metotrexato oral con buena respuesta, sin efectos secundarios.


Linear morphea in coup de sabre is a dermatological entity characterized by progressive, sclerosing inflammation of the skin tissue in the frontal region and on the scalp. Headache and seizures are two of the most frequent extracutaneous symptoms and they are caused by the growth of the lesion towards underlying structures. An early diagnosis is important to stop cranial progression and try to avoid secondary complications, mainly neurological. The diagnosis is relied on compatible clinical signs and a pathological study that allows a definitive confirmation. The treatment of choice is combination therapy with oral corticosteroids and methotrexate. Despite an adequate pharmacological treatment, this pathology can present a recurrent course and cause long-term sequelae. We present the case of a girl who was diagnosed quickly, despite a not very noticeable symptoms. She has been treated with oral methotrexate with a good response, without side effect


Subject(s)
Humans , Female , Child , Scleroderma, Localized/complications , Scleroderma, Localized/diagnosis , Scleroderma, Localized/drug therapy , Methotrexate , Disease Progression , Headache
3.
Arq. neuropsiquiatr ; 80(2): 129-136, Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1364370

ABSTRACT

ABSTRACT Background: Headache is one of the most frequent symptoms that occur during hemodialysis sessions. Despite the high prevalence of dialysis headache, it has been little studied. Objective: To evaluate the characteristics, impact and factors associated with dialysis headache. The behavior of the cerebral vasculature was also compared between patients with and without dialysis headache. Methods: This was a cross-sectional study. Consecutive patients who underwent hemodialysis were assessed through a semi-structured questionnaire, the Headache Impact Test (HIT-6), the Hospital Anxiety and Depression Scale and the Short Form-36 Health Survey (SF-36). Transcranial Doppler ultrasonography was performed in the first and fourth hours of hemodialysis. Results: A total of 100 patients were included; 49 of them had dialysis headache. Women (OR=5.04; 95%CI 1.95-13.04), younger individuals (OR=1.05; 95%CI 1.01-1.08), individuals with higher schooling levels (OR=3.86; 95%CI 1.4-10.7) and individuals who had spent longer times on dialysis programs (OR=0.99; 95%CI 0.98-1) had more dialysis headache (logistic regression). Individuals with dialysis headache had worse quality of life in the domains of pain and general state of health (56.9 versus 76.4, p=0.01; 49.7 versus 60.2, p=0.03, respectively). Dialysis headache was associated with significantly greater impact on life (OR=24.4; 95%CI 2.6-226.6; logistic regression). The pulsatility index (transcranial Doppler ultrasonography) was lower among patients with dialysis headache than among those without them. Conclusions: Dialysis headaches occur frequently and are associated with worse quality of life and patterns of cerebral vasodilatation.


RESUMO Antecedentes: A cefaleia é um dos sintomas mais frequentes que ocorrem durante as sessões de hemodiálise. Apesar da alta prevalência, essa cefaleia é pouco estudada. Objetivo: Avaliar as características, impacto e fatores associados à cefaleia da diálise. O comportamento da vasculatura cerebral também foi comparado entre pacientes com e sem cefaleia da diálise. Métodos: Este foi um estudo transversal. Pacientes consecutivos submetidos à hemodiálise foram avaliados por meio de questionário semiestruturado, do Headache Impact Test (HIT-6), Hospital Anxiety and Depression Scale e Short Form-36 Health Survey (SF-36). Foi realizada ultrassonografia Doppler transcraniana na primeira e na quarta horas de hemodiálise. Resultados: Foram incluídos 100 pacientes, 49 deles tinham cefaleia da diálise. Mulheres (OR=5,04; IC95% 1,95-13,04), indivíduos mais jovens (OR=1,05; IC95% 1,01-1,08), com maior escolaridade (OR=3,86; IC95% 1,4-10,7) e que passaram mais tempo em programas de diálise (OR=0,99, IC95% 0,98-1) tiveram mais cefaleia da diálise (regressão logística). Indivíduos com cefaleia dialítica tiveram pior qualidade de vida nos domínios dor e estado geral de saúde (56,9 versus 76,4, p=0,01; 49,7 versus 60,2, p=0,03, respectivamente). A cefaleia da diálise foi associada a um impacto significativamente maior na vida (OR=24,4; IC95% 2,6-226,6; regressão logística). O índice de pulsatilidade (ultrassonografia Doppler transcraniana) foi menor entre os pacientes com cefaleia da diálise do que entre aqueles sem. Conclusões: A cefaleia da diálise ocorre com frequência e está associada a pior qualidade de vida e a padrões de vasodilatação cerebral.


Subject(s)
Humans , Male , Female , Quality of Life , Renal Dialysis/adverse effects , Cross-Sectional Studies , Surveys and Questionnaires , Headache/etiology , Headache/diagnostic imaging
4.
5.
Chinese Journal of Burns ; (6): 683-690, 2022.
Article in Chinese | WPRIM | ID: wpr-940975

ABSTRACT

Objective: To investigate the effects of compound analgesia on ultra-pulsed fractional carbon dioxide laser (UFCL) treatment of post-burn hypertrophic s in children. Methods: A prospective randomized controlled study was conducted. From April 2018 to March 2020, 169 pediatric patients with post-burn hypertrophic s admitted to the First Affiliated Hospital of Air Force Medical University were randomly divided into general anesthesia alone group (39 cases, 19 males and 20 females, aged 35 (21, 48) months), general anesthesia+lidocaine group (41 cases, 23 males and 18 females, aged 42 (22, 68) months), general anesthesia+ibuprofen suppository group (41 cases, 25 males and 16 females, aged 38 (26, 52) months), and three-drug combination group with general anesthesia + lidocaine+ibuprofen suppository (48 cases, 25 males and 23 females, aged 42 (25, 60) months), and the pediatric patients in each group were treated with corresponding analgesic regimens when UFCL was used to treat s, and the pediatric patients were given comprehensive care throughout the treatment process. The pain degree of pediatric patients scar was evaluated by facial expression,legs,activity,cry,and consolability (FLACC) of children's pain behavior scale at 0 (immediately), 1, 2, and 4 h after awakening from the first anesthesia, respectively. At 4 h after awakening from the first anesthesia of postoperative pain assessment, the self-made analgesia satisfaction questionnaire was used to evaluate the satisfaction for the analgesic effect of the pediatric patients or their families, and the satisfaction rate was calculated. Within 2 h after the first operation, the occurrences of adverse reactions of the pediatric patients, such as nausea and vomiting, headache, dizziness, drowsiness, etc, were observed and recorded. Before the first treatment and 1 month after the last treatment, the Vancouver scar scale (VSS) was used to evaluate the pediatric patients scar, and the difference value between the two was calculated. Data were statistically analyzed with least significant difference test, Kruskal-Wallis H test, chi-square test and Fisher's exact probability test. Results: At 0 h after awakening from the first anesthesia, the FLACC scores of pediatric patients in general anesthesia+lidocaine group, general anesthesia+ibuprofen suppository group and three-drug combination group were significantly lower than those in general anesthesia alone group (P<0.01). The FLACC scores of the pediatric patients in anesthesia+ibuprofen suppository group and three-drug combination group were significantly lower than that in general anesthesia+lidocaine group (P<0.01), and the FLACC score of the pediatric patients in three-drug combination group was significantly lower than that in general anesthesia+ibuprofen suppository group (P<0.01). At 1 and 2 h after awakening from the first anesthesia, the FLACC scores of pediatric patients in general anesthesia+ibuprofen suppository group and three-drug combination group were both significantly lower than those in general anesthesia alone group and general anesthesia+lidocaine group (P<0.01), and the FLACC score of the pediatric patients in three-drug combination group was significantly lower than that in general anesthesia+ibuprofen suppository group (P<0.01). At 4 h after awakening from the first anesthesia, the FLACC scores of the pediatric patients in general anesthesia+ibuprofen suppository group and three-drug combination group were significantly lower than those in general anesthesia alone group and general anesthesia+lidocaine group (P<0.01). At 4 h after awakening from the first anesthesia, the satisfactions rate with the analgesic effect in the four groups of pediatric patients or their families were 79.49% (31/39), 85.37% (35/41), 87.80% (36/41), and 97.92% (47/48), respectively. The satisfaction rate of the pediatric patients in three-drug combination group was significantly higher than those in general anesthesia alone group, general anesthesia+lidocaine group, general anesthesia+ibuprofen suppository group. Within 2 h after the first operation, there was no significant difference in the overall comparison of adverse reactions such as nausea and vomiting, headache, dizziness, and drowsiness of pediatric patients among the 4 groups (P>0.05). The VSS scores of pediatric patients before the first treatment, 1 month after the last treatment, and and the difference value between the two in the 4 groups were not significantly different (P>0.05). Conclusions: Three-drug combination for analgesia has a good effect in the treatment of hypertrophic scars after burn in pediatric patients with UFCL. Pediatric patients or their families are highly satisfied with the effect, and the treatment effect and incidence of adverse reactions are similar to other analgesic regimens, so it is recommended to be promoted in clinical practice.


Subject(s)
Analgesia , Analgesics , Child , Cicatrix, Hypertrophic/pathology , Dizziness/drug therapy , Female , Headache/drug therapy , Humans , Ibuprofen/therapeutic use , Lasers, Gas/therapeutic use , Lidocaine , Male , Nausea/drug therapy , Pain/drug therapy , Prospective Studies , Treatment Outcome , Vomiting/drug therapy
6.
Article in Chinese | WPRIM | ID: wpr-939501

ABSTRACT

OBJECTIVE@#To observe the clinical effect of acupuncture at sphenopalatine ganglion combined with conventional acupuncture for episodic cluster headache (CH).@*METHODS@#One hundred and eighty patients with episodic CH were randomly divided into a combined group (60 cases, 3 cases dropped off),an acupuncture group (60 cases, 2 cases dropped off) and a sphenopalatine ganglion group (60 cases, 2 cases dropped off and 1 case was removed). The patients in the acupuncture group were treated with conventional acupuncture at Touwei (ST 8), Yintang (GV 24+), Yangbai (GB 14), Hegu (LI 4), etc., once a day, 6 times a week. The patients in the sphenopalatine ganglion group were treated with acupuncture at sphenopalatine ganglion, once every other day, 3 times a week. On the basis of the conventional acupuncture, the combined group was treated with acupuncture at sphenopalatine ganglion once every other day. Two weeks were taken as a course of treatment, and 3 courses of treatment were required in the 3 groups. The score of visual analogue scale (VAS), the number of headache attacks per week, the duration of each headache attack and the score of migraine-specific quality of life questionnaire version 2.1 (MSQ) were observed before and after treatment and in follow-up of 3 months after treatment. The clinical efficacy of each group was compared.@*RESULTS@#After treatment and in follow-up, the VAS score of headache, the number of headache attacks per week, the duration of each headache attack, and each various scores and the total score of MSQ of each group were lower than those before treatment (P<0.01). Except that the number of headache attacks per week in the combined group was lower than the sphenopalatine ganglion group (P<0.01), other indexes in the combined group were lower than the other two groups (P<0.05, P<0.01). The total effective rate in the combined group was 93.0% (53/57), which was higher than 75.9% (44/58) in the acupuncture group and 73.7% (42/57) in the sphenopalatine ganglion group(P<0.05, P<0.01).@*CONCLUSION@#Acupuncture at sphenopalatine ganglion combined with conventional acupuncture could reduce the degree of pain in patients with episodic CH, reduce the number and duration of headache attacks, and improve the quality of life of patients. It is more effective than simple conventional acupuncture or acupuncture at sphenopalatine ganglion alone.


Subject(s)
Acupuncture Points , Acupuncture Therapy , Cluster Headache/therapy , Headache/therapy , Humans , Quality of Life , Treatment Outcome
7.
Clin. biomed. res ; 42(1): 96-99, 2022.
Article in Portuguese | LILACS | ID: biblio-1391399

ABSTRACT

A fístula liquórica para o osso temporal constitui um evento raro que decorre da comunicação anormal entre o espaço subaracnóideo e as células da mastoide, permitindo que o líquido cefalorraquidiano flua para as porções pneumatizadas do osso temporal. Tem como consequência a hipotensão intracraniana espontânea, caracterizada por perda de líquor e pela manifestação clínica de cefaleia ortostática. Acredita-se que a hipotensão intracraniana espontânea crie condições hemodinâmicas favoráveis à ocorrência de trombose venosa cerebral, uma desordem potencialmente fatal e de difícil diagnóstico, visto a inespecificidade de sinais clínicos e sintomas. Dessa forma, é pertinente atentar para a possibilidade de trombose venosa cerebral em pacientes com fístulas liquóricas, especialmente quando houver mudança do padrão da cefaleia, que passa de ortostática a intensa e contínua.


Temporal bone cerebrospinal fluid fistula is a rare event that results from abnormal communication between the subarachnoid space and the mastoid cells, allowing the cerebrospinal fluid to flow into the pneumatized portions of the temporal bone. It leads to spontaneous intracranial hypotension, characterized by loss of cerebrospinal fluid and orthostatic headache as a clinical manifestation. Spontaneous intracranial hypotension is believed to create favorable hemodynamic conditions to the occurrence of cerebral venous thrombosis, a potentially fatal disorder of difficult diagnosis given the nonspecific clinical signs and symptoms. Therefore, it is pertinent to consider the possibility of cerebral venous thrombosis in patients with cerebrospinal fluid fistulas, especially when there is a modification in the headache pattern from orthostatic to intense and continuous pain.


Subject(s)
Humans , Female , Adult , Cerebral Veins/physiopathology , Venous Thrombosis/physiopathology , Intracranial Hypotension/diagnosis , Fistula/diagnosis , Headache/complications
8.
Rev. Méd. Inst. Mex. Seguro Soc ; 59(6): 545-550, dic. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1357564

ABSTRACT

Introducción: la enfermedad por SARS-CoV-2 denominada COVID-19 originada en China adquirió dimensiones pandémicas. De acuerdo con el reporte situacional de la OMS al 15 de marzo de 2021, la tasa de letalidad global es del 2.2%; en México se han confirmado alrededor de 194 944 defunciones por COVID-19. Estudios en China identificaron que los pacientes con COVID-19 severo, al compararlos con aquellos que cursaron con COVID-19 no severo, presentaron manifestaciones neurológicas más graves. Objetivo: determinar la frecuencia de síntomas y manifestaciones neurológicas en pacientes con COVID-19 severo en un centro de tercer nivel de atención. Material y métodos: estudio transversal, observacional y analítico, llevado a cabo en el Hospital de Especialidades del Centro Médico Nacional Siglo XXI, en pacientes hospitalizados con COVID-19 severo. Resultados: se analizaron 183 casos, de los cuales 130 eran hombres (71%). La mediana de edad fue de 55 años (RIC: 44-65). Los síntomas neurológicos fueron: cefalea, anosmia y disgeusia. Las manifestaciones neurológicas se presentaron en 27 pacientes, la más frecuente fue la enfermedad vascular cerebral tipo isquémica (EVC) en 12 pacientes (44%) en pacientes con mayor edad, 76.5 frente a 54 años (p = 0.000), y con antecedente de enfermedad cardiovascular. Conclusiones: los síntomas neurológicos más frecuentes fueron cefalea, anosmia y disgeusia. La manifestación neurológica más frecuente fue la EVC isquémica que se presentó en pacientes con COVID-19 severo de mayor edad y con antecedente de enfermedad cardiovascular.


Background: The SARS-CoV-2 disease, called COVID-19, emerged in China has acquired pandemic dimensions. According to the WHO situational report of March 15, 2021, the global fatality rate is 2.2%; in Mexico, around 194 944 deaths have been confirmed by COVID-19. Studies in China identified that patients with severe COVID-19, when compared with those who had non-severe COVID-19, presented more severe neurological manifestations. Objective: To determine the frequency of neurological symptoms and manifestations in patients with severe COVID-19 in a tertiary care center. Material and methods: A cross-sectional, observational and analytical study was carried out at the Hospital de Especialidades del Centro Médico Nacional Siglo XXI, in patients hospitalized with severe COVID-19. Results: 183 cases were analyzed, of which 130 were men (71%). The median age was 55 years (IQR: 44-65). The neurological symptoms were: headache, anosmia and dysgeusia. Neurological manifestations occurred in 27 patients (16%), the most frequent was ischemic-type cerebrovascular disease (CVD) in 12 (44%), in patients older than 76.5 years vs. 54 years (p = 0.000), with history of cardiovascular disease. Conclusions: The most frequent neurological symptoms were headache, anosmia and dysgeusia. The most frequent neurological manifestation was ischemic CVD that appeared in older patients with severe COVID-19 with a history of cardiovascular disease.


Subject(s)
Humans , Male , Female , Tertiary Healthcare , Cerebrovascular Disorders , COVID-19 , Neurologic Manifestations , Tertiary Healthcare , Headache
9.
Arq. Asma, Alerg. Imunol ; 5(4): 422-425, out.dez.2021. ilus
Article in English, Portuguese | LILACS | ID: biblio-1399807

ABSTRACT

A reativação da BCG pode ocorrer em diversos contextos: associada a quadros infecciosos, imunossupressão, autoimunidade e pós-vacinações. Além disso, especialmente em crianças abaixo de 5 anos de idade, deve ser valorizada como um achando presente em cerca de 50% dos casos de Doença de Kawasaki. Neste artigo, relatamos o primeiro caso publicado na literatura de uma paciente adulta jovem, a qual manifestou uma reativação de BCG após receber a primeira dose de vacina contra COVID-19 (AztraZeneca/Oxford/Biomanguinhos). Dentro das primeiras 24h após a administração da vacina, a paciente desenvolveu febre alta, sudorese, dor local, mialgia difusa e cefaleia. Após dois dias, iniciou eritema e enduração no local da cicatriz da vacina BCG. Ela tem como comorbidade a urticária crônica espontânea, porém estava assintomática sem crises há mais de 1 ano. Tem como antecedente familiar relevante o óbito materno por síndrome complexa de sobreposição de autoimunidade (lúpus eritematoso sistêmico, síndrome de Sjögren e síndrome do anticorpo antifosfolípide). Após ser medicada com anti-inflamatórios não esteroides (AINE) e corticoterapia tópica de moderada potência por 3 dias, houve resolução completa da reativação da BCG. A paciente, após 3 meses, recebeu a segunda dose da vacina e não manifestou nenhum sintoma. Acredita-se que a reativação da BCG ocorra devido a um mecanismo de reação cruzada entre HSP do indivíduo, elicitadas como mediadores da imunidade inata frente à inflamação vacinal, com alguns epítopos do M. bovis. Recomendase que seja investigada alguma condição imunossupressora ou autoimune nos pacientes que manifestem reativação da BCG, principalmente em adultos, na qual a doença de Kawasaki é bastante rara. As vacinas, incluindo as contra COVID-19, também podem desencadear o surgimento deste fenômeno imunológico ainda pouco compreendido.


BCG reactivation can occur in different contexts: associated with infectious conditions, immunosuppression, autoimmunity and post-vaccinations. Also, especially in children below of 5 years of age, should be valued as a finding present in about 50% of cases of Kawasaki disease. In this article, we report the first case published in the literature of a young adult patient, who manifested a reactivation of BCG after receiving the first dose of vaccine against COVID-19 (AztraZeneca/Oxford/Biomanguinhos). Within the first 24 hours after the administration of the vaccine, the patient developed high fever, sweating, local pain, diffuse myalgia and headache. After 2 days, erythema and induration at the site of the BCG vaccine scar began. she has how comorbidity to chronic spontaneous urticaria, but she was asymptomatic without crises for more than 1 year. The relevant family history is maternal death due to the complex syndrome of autoimmunity overlap (systemic lupus erythematosus, Sjögrens syndrome, and anti-phospholipid antibody). After being medicated with NSAID and moderate topical corticosteroid therapy potency for 3 days, there was complete resolution of BCG reactivation. The patient, after 3 months, received the 2nd dose of the vaccine and had no symptoms. It is believed that the reactivation of BCG occurs due to a cross-reaction mechanism between the individuals HSP, elicited as mediators of innate immunity against vaccine inflammation, with some epitopes of M. bovis. It is recommended that any immunosuppressive or autoimmune condition be investigated in patients that manifest BCG reactivation, especially in adults, in which Kawasaki disease is quite rare. Vaccines, including those against COVID-19, can also trigger of this immunological phenomenon still poorly understood.


Subject(s)
Humans , Female , Young Adult , BCG Vaccine , Autoimmunity , Cicatrix , COVID-19 , ChAdOx1 nCoV-19 , Pain , Signs and Symptoms , Sjogren's Syndrome , Anti-Inflammatory Agents, Non-Steroidal , Antiphospholipid Syndrome , Adrenal Cortex Hormones , Erythema , Fever , Chronic Urticaria , COVID-19 Vaccines , Headache , Lupus Erythematosus, Systemic , Mucocutaneous Lymph Node Syndrome , Mycobacterium bovis
10.
Infectio ; 25(4): 293-295, oct.-dic. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1286725

ABSTRACT

Resumen La trombosis venosa cerebral (TVC) es una presentación clínica poco común del tromboembolismo venoso caracterizada por cefalea, crisis convulsivas, déficits neurológicos focales y papiledema. El diagnóstico es confirmado con Tomografía axial computarizada (TAC) de cráneo y Resonancia magnética nuclear (RMN) cerebral. La TVC tiene una relación importante con el virus de inmunodeficiencia humana (VIH), ya que los pacientes VIH positivos cursan con hiperviscosidad san guínea, alteraciones de factores anticoagulantes endógenos y riesgo de sobreinfección, entre otros; que predisponen a estados protrombóticos y lesión vascular como lo es la TVC. El tratamiento de la TVC es terapia anticoagulante, por lo general se utiliza heparina no fraccionada o heparina de bajo peso molecular para la fase aguda y anticoagulantes orales como la warfarina para el mantenimiento posterior. Reportamos el primer caso documentado de TVC en un paciente VIH positivo en Colombia.


Abstract Cerebral venous thrombosis (CVT) is a rare clinical presentation of venous thromboembolism characterized by headache, seizures, neurological deficits and papi lledema. The diagnosis is confirmed using computed tomography scan (CT scan) and magnetic resonance imaging (MRI) of the brain. CVT has an important relationship with the human immunodeficiency virus (HIV) given that HIV-positive patients may present with blood hyperviscosity, irregular levels of endogenous anticoagulation factors and risk of sepsis among others, that predispose to prothrombotic states and vascular injury such as CVT. The treatment of CVT is anticoagulant therapy, generally unfractionated heparin or low molecular weight heparin for the early phase and oral anticoagulants such as warfarin for the late phase. This case reports the first documented case of CVT in an HIV positive patient in Colombia.


Subject(s)
Humans , Male , Adult , Venous Thromboembolism , Skull , Brain , Magnetic Resonance Imaging , HIV , Headache , Hepatitis B
11.
Infectio ; 25(4): 289-292, oct.-dic. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1286724

ABSTRACT

Resumen La trombosis de senos venosos cerebrales es un evento infrecuente en la población pediátrica y sus manifestaciones clínicas pueden variar dependiendo de la localización y extensión de la lesión, etiología o grupo etario (1); así mismo, la asociación de esta patología con virus es poco común, sin embargo, se han repor tado casos de trombosis de senos venosos en pacientes adultos con SARS-CoV-2 en relación con los mecanismos de lesión endotelial y respuesta inflamatoria que desencadena mecanismos procoagulantes. A continuación se presenta el primer caso reportado en Colombia de un caso de trombosis venosa cerebral en un lactante previamente sano, que debuta con un cuadro infeccioso gastrointestinal que resuelve y una semana después se presenta con cefalea y paralisis del VI par craneal derecho. Se documentó por angioto mografía trombosis del seno venoso sagital con extensión a senos transversos; los laboratorios fueron negativos para otras causas sistémicas y con prueba de anticuerpos para coronavirus positiva.


Abstract Cerebral venous sinus thrombosis is infrequent in the pediatric population and its clinical manifestations may vary depending on the anatomical location and the extent of the lesion, etiology or age group(1). The association of this pathology with viruses is uncommon, however, cases in adults with SARS-Cov2 have been reported triggered by procoagulant mechanisms due to endothelial injury and inflammatory response. The following article is the first reported case in Colombia of cerebral venous thrombosis in a previously healthy child, who debuted with gastrointestinal infectious disease and a week later with headache and sixth right cranial nerve palsy . The diagnosis of sagittal venous sinus thrombosis with extension to transverse sinuses was documented in a computed tomography angiography; laboratories for systemic diseases were negative and antibodies for coronavirus were positive.


Subject(s)
Humans , Male , Infant , Sinus Thrombosis, Intracranial , SARS-CoV-2 , COVID-19 , Thrombosis , Viruses , Coronavirus , Venous Thrombosis , Cranial Nerve Diseases , Transverse Sinuses , Headache
12.
Infectio ; 25(4): 256-261, oct.-dic. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1286719

ABSTRACT

Resumen Objetivo: Determinar los factores de riesgo en adultos con COVID-19 en población rural andina durante 2020. Métodos: En este estudio de cohorte retrospectivo multicéntrico, incluimos a 184 pacientes adultos (≥18 años) con pruebas serológicas y moleculares para CO VID-19 de tres hospitales de la sierra peruana (Ancash y Apurímac) incluidos con sospecha clínica entre abril y junio. Se utilizó análisis descriptivos y regresión logística univariable para explorar los factores de riesgo asociados a los pacientes con COVID-19. Resultados: Del total de pacientes, 14 (7.6%) tuvieron SARS-CoV-2. En los pacientes infectados 12 (85.7%) fueron varones con promedio de edad de 47.3±21 años. Las comorbilidades estuvieron presentes en cerca de la tercera parte de pacientes, siendo la hipertensión y diabetes las más frecuentes (ambas 14.3%), y la sinto matología más frecuentes fueron fiebre y cefalea (57.2%). La regresión univariable mostró mayores probabilidades de infección con SARS-CoV-2 en la población rural andina asociada con la edad avanzada (OR: 1.1 IC95% 0.7-1.8; p=0,019), comorbilidades previas (OR: 1.7, IC95% 0.32-9.39; p=0,006), y sintomatología previa (OR: 49.8, IC95% 5.6-436.9; p=0,0011). Conclusiones: Los posibles factores de riesgo como la edad avanzada, las comorbilidades y sintomatología previas están relacionados con el desarrollo de CO VID-19 en población rural andina de Perú.


Abstract Objective: To determine the risk factors in adults with COVID-19 in the rural Andean population during 2020. Methods: This multicenter retrospective cohort study included 184 adult patients (≥18 years) with COVID-19's serological and molecular tests from three Hospitals in the Peruvian mountains (Ancash and Apurímac) included with clinical suspicion between April and June. Descriptive analysis and univariate logistic regression were used to explore the risk factors associated with patients with COVID-19. Results: Of total of patients, 14 (7.6%) had a SARS-CoV-2. In infected patients 12 (85.7%) were men with an average age of 47.3±21 years. Comorbidities were present in about a third of patients, with hypertension and diabetes being the most frequent (both 14.3%), and the most frequent symptoms were fever and hea dache (57.2%). Univariate regression showed higher probabilities of infection with SARS-CoV-2 in the rural Andean population associated with advanced age (OR: 1.1 95% CI 0.7 - 1.8; p = 0.019), previous comorbidities (OR: 1.7, 95%CI 0.32 - 9.39; p = 0.006), and previous symptoms (OR: 49.8, 95%CI 5.6 - 436.9; p = 0.0011). Conclusions: Possible risk factors such as advanced age, comorbidities and previous symptoms are related to the development of COVID-19 in the rural Andean population of Peru.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , COVID-19 , Peru , Rural Population , Risk Factors , Cohort Studies , SARS-CoV-2 , Headache , Hospitals , Hypertension , Infections
13.
Arq. neuropsiquiatr ; 79(12): 1095-1100, Dec. 2021. tab
Article in English | LILACS | ID: biblio-1355698

ABSTRACT

ABSTRACT Background: Medication overuse headache (MOH) is the worsening of an underlying headache due to the overuse of its acute treatment. Unintentionally, healthcare professionals may contribute to this condition. Health professionals play an important role in preventing this increasingly frequent and difficult-to-treat condition. Objective: To investigate MOH awareness among physicians with headache through a survey conducted among medical doctors on our university campus. Methods: This was an observational cross-sectional study about MOH awareness. The total number of medical doctors working in the Dokuz Eylül University Health Campus was provided by the administrative unit. A total of 18 questions were prepared and administered on a voluntary basis to obtain information about MOH awareness. Results: A total of 312 medical doctors were surveyed, including 198 (63.5%) from internal medical sciences, 81 (26%) from surgical medical sciences, and 33 (10.5%) from basic medical sciences. Half of the physicians in our sample were unaware of MOH. Our results showed that awareness of MOH, was quite low even among medical doctors. Conclusions: MOH causes both labor and financial losses to countries and impairs the quality of life of patients. Preventing excessive use of medications by raising awareness among doctors is an important step to prevent the development of MOH.


RESUMO Antecedentes: A cefaleia por uso excessivo de medicamentos (CEM) é o agravamento de uma cefaleia subjacente devido ao uso excessivo do seu tratamento agudo. Involuntariamente, os profissionais de saúde podem contribuir para essa condição. Os profissionais de saúde desempenham um papel importante na prevenção dessa condição cada vez mais frequente e de difícil tratamento. Objetivo: Investigar a conscientização da CEM entre médicos com dor de cabeça por meio de uma pesquisa realizada entre médicos em nosso campus universitário. Métodos: Este foi um estudo transversal observacional sobre a consciência da CEM. O número total de médicos que trabalham no Campus de Saúde da Universidade Dokuz Eylül foi fornecido pela unidade administrativa. Um total de 18 questões foram preparadas e aplicadas de forma voluntária para obter informações sobre a conscientização da CEM. Resultados: Um total de 312 médicos foram pesquisados, incluindo 198 (63,5%) das ciências médicas internas, 81 (26%) das ciências médicas cirúrgicas e 33 (10,5%) das ciências médicas básicas. Metade dos médicos de nossa amostra desconhecia a CEM. Nossos resultados mostraram que o conhecimento sobre a CEM era bastante baixo, mesmo entre os médicos. Conclusões: A CEM causa perdas laborais e financeiras aos países e prejudica a qualidade de vida dos pacientes. Prevenir o uso excessivo de medicamentos por meio da conscientização dos médicos é um passo importante para prevenir o desenvolvimento da CEM.


Subject(s)
Humans , Quality of Life , Headache Disorders, Secondary , Cross-Sectional Studies , Surveys and Questionnaires , Headache , Analgesics
14.
Cambios rev. méd ; 20(2): 5-11, 30 Diciembre 2021. tabs.
Article in Spanish | LILACS | ID: biblio-1368176

ABSTRACT

INTRODUCCIÓN. En Ecuador, las enfermedades cerebrovasculares son la tercera causa de muerte en la población general; existen pocos datos en la literatura médica sobre la hemorragia subaracnoidea aneurismática y aneurismas no rotos, por lo que fue fundamental describir un perfil clínico. OBJETIVO. Caracterizar la clínica de los pacientes con diagnóstico de aneurisma cerebral. MATERIALES Y MÉTODOS. Estudio observacional descriptivo. Población de 450 y muestra de 447 pacientes con diagnóstico de aneurisma cerebral atendidos en la Unidad de Neurología del Hospital Carlos Andrade Marín, periodo enero 2010 a diciembre 2018. Los datos clínicos e imagenológicos fueron recolectados a través de la revisión de historias clínicas digitales obtenidas del sistema informático MIS/AS400, y se analizaron en el programa estadístico International Business Machines Statistical Package for the Social Sciences, versión 23. RESULTADOS. Se identificaron 605 aneurismas en 447 pacientes. El 80,5% (360; 447) presentó aneurismas rotos, de éstos el 81,4% (293; 360) tuvo un solo aneurisma. El factor de riesgo más frecuente fue la hipertensión arterial con el 44,3% (198; 447), las manifestaciones observadas fueron: hemorragia subaracnoidea con el 98,9% (356; 360) en aneurismas rotos; y cefalea con el 65,5% (57; 87) en aneurismas no rotos. DISCUSIÓN. Se encontró datos relevantes no coincidentes con la literatura científica mundial, como el bajo número de aneurismas asintomáticos y no rotos, comparados con su contraparte. CONCLUSIÓN. Se evidenció que los aneurismas intracraneales produjeron una amplia gama de manifestaciones clínicas, que fluctuaron desde la hemorragia subaracnoidea como la más frecuente en el grupo de aneurismas rotos, hasta pacientes completamente asintomáticos en el grupo de aneurismas no rotos.


INTRODUCTION. In Ecuador, cerebrovascular diseases are the third leading cause of death in the general population; there are few data in the medical literature on aneurysmal subarachnoid hemorrhage and unruptured aneurysms, so it was essential to describe a clinical profile. OBJECTIVE. To characterize the clinical profile of patients diagnosed with cerebral aneurysm. MATERIALS AND METHODS. Descriptive observational study. Population of 450 and sample of 447 patients with a diagnosis of cerebral aneurysm seen in the Neurology Unit of the Carlos Andrade Marín Hospital, period January 2010 to December 2018. Clinical and imaging data were collected through the review of digital medical records obtained from the MIS/AS400 computer system, and were analyzed in the statistical program International Business Machines Statistical Package for the Social Sciences, version 23. RESULTS. A total of 605 aneurysms were identified in 447 patients. A total of 80,5% (360; 447) had ruptured aneurysms, of which 81,4% (293; 360) had a single aneurysm. The most common risk factor was hypertension with 44,3% (198; 447), the manifestations observed were: subarachnoid hemorrhage with 98,9% (356; 360) in ruptured aneurysms; and headache with 65,5% (57; 87) in unruptured aneurysms. DISCUSSION. We found relevant data not consistent with the world scientific literature, such as the low number of asymptomatic and unruptured aneurysms, compared with its counterpart. CONCLUSION. It was evidenced that intracranial aneurysms produced a wide range of clinical manifestations, ranging from subarachnoid hemorrhage as the most frequent in the group of ruptured aneurysms, to completely asymptomatic patients in the group of unruptured aneurysms.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Subarachnoid Hemorrhage , Intracranial Aneurysm , Aneurysm, Ruptured , Headache , Aneurysm , Neurology , Angiography, Digital Subtraction , Cerebral Arterial Diseases , Statistics, Nonparametric , Ecuador , Hemorrhagic Stroke , Hypertension
15.
Rev. Hosp. Ital. B. Aires (2004) ; 41(4): 201-205, dic. 2021. tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1367059

ABSTRACT

La COVID-19 puede producir síntomas persistentes luego de la infección inicial. En cuadros más graves, pueden corresponder a la evolución propia de una patología crítica o a secuelas inflamatorias/fibróticas pulmonares, entre otras. Esto puede confirmarse por estudios respiratorios e imagenológicos. En el caso de la COVID-19 no grave, el denominado síndrome pos-COVID-19, se trata de síntomas persistentes luego de al menos 28 días sin una secuela orgánica clara. Los síntomas más comunes en este caso son fatiga, cefalea y disnea, que pueden persistir meses luego de la infección inicial. Su curso puede ser oscilante e incluso aumentar progresivamente. El espectro de síntomas es muy amplio y requiere una adecuada evaluación del paciente. Se cree que tiene su origen en la desregulación inmunológica luego de la infección inicial. Su evaluación y seguimiento requieren un adecuado manejo sintomático y acompañamiento por el profesional a cargo. (AU)


Patients who underwent COVID-19 can develop persisting symptoms and sequelae. Severe cases may exhibit systemic complications of critical care and/or inflammatory/fibrotic lung injury. Imaging and respiratory function tests can assist in the evaluation of both. Nonsevere cases can also develop persisting symptoms for more than 28 days, which has been defined as the post COVID-19 syndrome. The most common symptoms in said syndrome are fatigue, headache and dyspnea, which can last for months. Its course can be oscillating or even increase progressively within the first months. The considerable range of symptoms requires proper patient assessment. Post-infectious immune disregulation is believed to be the source of this syndrome. Proper assessment and followup warrant measured symptom management and emphatic care by the attending physician. (AU)


Subject(s)
Humans , Pneumonia, Viral/complications , Dyspnea/etiology , Fatigue/etiology , COVID-19/complications , Headache/etiology , SARS-CoV-2 , COVID-19/physiopathology , COVID-19/epidemiology
16.
Arq. neuropsiquiatr ; 79(11): 982-988, Nov. 2021. tab, graf
Article in English | LILACS | ID: biblio-1350139

ABSTRACT

ABSTRACT Background: Headache is a very common complaint and it is increasingly prevalent among university students. Tinnitus consists of subjectively perceived sounds that occur in the absence of an external auditory signal. Presence of headache and tinnitus in association has implications for therapy and prognosis, because this describes the temporality of the symptoms. Recognition of the epidemiological profile of symptomatic students might contribute to interventions. Objective: To investigate the prevalence of the association between headache and tinnitus, and to describe the epidemiological profile of the study population and the chronological order of appearance of these symptoms. Methods: Cross-sectional, observational and analytical study on a sample representative of an academic center. Data referring to the epidemiological and clinical profile of headache and tinnitus among medical students were collected through an online questionnaire built using the Google Forms tool. Results: Out of the 234 participants, 26.1% reported having tinnitus and headache (p < 0.001). The participants with headache were more likely to be women (p = 0.045), white (p = 0.009) and 21-25 years old (p = 0.356). Among right-sided, left-sided and non-unilateral headaches, tinnitus was present predominantly in the non-unilateral type, but without statistical significance. Regarding timing, 18.0% of the students said that tinnitus started before headache, 57.4% said that headache started before tinnitus and 24.6% said that they started simultaneously. Conclusions: An important association between headache and tinnitus regarding lateralization and temporality was demonstrated. Thus, these data match the presumption that headache and tinnitus have a physiopathological connection.


RESUMO Antecedentes: A cefaleia é uma queixa muito frequente e a prevalência em estudantes universitários vem sendo cada vez mais comum. Os zumbidos constituem percepções subjetivas de sons que acontecem na ausência de um sinal auditivo externo ou não. A correlação desses sintomas é importante para fins terapêuticos e prognóstico, pois descrever a temporalidade dos sintomas e conhecer o perfil epidemiológico dos estudantes sintomáticos pode contribuir com intervenções. Objetivo: Investigar a prevalência da relação da cefaleia e zumbido, descrever o perfil epidemiológico da população estudada e a ordem temporal do aparecimento desses dois sintomas. Métodos: Estudo de corte transversal, observacional e analítico representativo de um centro acadêmico. Foram coletados dados referentes ao perfil epidemiológico e clínico da cefaleia e zumbido entre acadêmicos de Medicina, por meio de um questionário online construído na ferramenta Google Forms. Resultados: Dos 234 participantes, 26,1% relataram a presença de zumbido e cefaleia. Os participantes com cefaleia apresentaram maior probabilidade de serem mulheres, da raça branca e ter entre 21-25 anos. Dentre as cefaleias sem unilateralidade, as localizadas à direita e as localizadas à esquerda, o zumbido predominou no tipo sem unilateralidade, entretanto sem significância estatística. Observou-se que 18,0% dos acadêmicos relataram o início do zumbido antes da cefaleia, 57,4% relataram o início da cefaleia antes do zumbido, e 24,6% início simultâneo. Conclusões: Foi demonstrada uma importante relação entre cefaleia e zumbido acerca da lateralidade e temporalidade. Assim, esses dados se encaixam na presunção de que a cefaleia e o zumbido possuem uma ligação fisiopatológica.


Subject(s)
Humans , Female , Students, Medical , Tinnitus/epidemiology , Prevalence , Cross-Sectional Studies , Headache/epidemiology
17.
Medicina UPB ; 40(2): 84-87, 13 oct. 2021. Ilus
Article in Spanish | LILACS, COLNAL | ID: biblio-1342239

ABSTRACT

Se describe el caso de un paciente de 70 años que consultó por cefalea súbita, tipo trueno, sin alteración del estado de consciencia, acompañada de dolor torácico de una hora de evolución y de baja intensidad. A su ingreso fue enfocado como cefalea en trueno, que es clasificada, en cuanto a la atención, como bandera roja. La medición de troponina fue negativa y una tomografía de cráneo fue leída como normal. Desde el ingreso presentaba signos vitales normales, cuando iba a ser dado de alta se torna hipotenso (completamente asintomático) y por su síntoma cardinal (cefalea), que se asoció a dolor torácico leve y no anginoso, se solicitó angiotomografía toracoabdominal, con la que se demostró aneurisma disecante de la aorta. Con la presentación de este caso, se busca resaltar la importancia en el servicio de urgencias de la asociación de la cefalea tipo trueno, con condiciones vasculares como la disección aórtica.


We describe the case of a 70-year-old patient, who seeks medical advice due to sudden, thunder headache, without alteration of the state of consciousness, accompanied by chest pain of 1 hour of evolution and of low intensity. Upon his admission, the patient was treated as a thunderclap headache, which is considered a red flag. His troponin was negative, and his head tomography was interpreted as normal. From admission he had normal vital signs, but when he was going to be discharged, he became hypotensive (completely asymptomatic) and due to his cardinal symptom (headache) that was asso-ciated with mild non-anginal chest pain, a thoracoabdominal angioCT was requested, with which dissecting aneurysm of the aorta was evidenced. With the presentation of this case, we seek to highlight the importance of the association of thunder-type headache with possible vascular conditions such as aortic dissection in the emergency department.


Descrevemos o caso de uma paciente de 70 anos que consultou por quadro de cefaleia súbita, tipo trovão, sem alteração do estado de consciência, acompanhada de dor torácica de uma hora de evolução e de baixa intensidade. Na admissão, foi tratado como cefaleia em trovoada, que é classificada, em termos de atenção, como bandeira vermelha. A me-dição da troponina foi negativa e uma tomografia de crânio foi lida como normal. Desde a admissão apresentava sinais vitais normais, quando ia receber alta ficou hipotenso (totalmente assintomático) e devido ao seu sintoma cardinal (cefaleia), que se associou a dores torácicas ligeiras e não anginosas, foi solicitada angiografia toracoabdominal, com cujo aneurisma dissecante da aorta foi demonstrado. Com a apresentação deste caso, o objetivo é destacar a importância no pronto-socorro da associação da cefaleia do tipo trovão com afecções vasculares como a dissecção da aorta.


Subject(s)
Humans , Aneurysm, Dissecting , Aorta , Chest Pain , Angiography , Headache
18.
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
19.
Rev. colomb. anestesiol ; 49(3): e600, July-Sept. 2021. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1280183

ABSTRACT

Abstract Tuberous sclerosis (TSC) is a rare disease with multi-systemic involvement, predominantly neurological. Little evidence exists about the anesthetic management of patients with this disorder, particularly in pregnant women. This article discusses a case of a patient with TSC admitted to our hospital for the delivery of a twin gestation. Twenty-four hours after surgery, the patient presented left-side facial-brachial hypoesthesia and headache. A brain CT revealed a right frontal cortical bleeding tumor, which was diagnosed as glioblastoma multiforme. The patient was discharged 15 days after admission and a neurosurgical approach was suggested.


Resumen La esclerosis tuberosa es una enfermedad poco frecuente asociada con compromiso multisistémico, principalmente neurológico. Es poca la evidencia sobre el manejo anestésico de los pacientes con este trastorno, en particular las mujeres embarazadas. En este artículo presentamos el caso de una paciente con esclerosis tuberosa ingresada en nuestro hospital para el parto de una gestación gemelar. Veinticuatro horas después de la cirugía, la paciente presentó hipoestesia facial y braquial izquierda y cefalea. La tomografía cerebral mostró un tumor cortical sangrante en el lóbulo frontal derecho, diagnosticado como glioblastoma multiforme. La paciente fue dada de alta 15 días después de su ingreso y, con recomendación de manejo por neurocirugía.


Subject(s)
Humans , Female , Pregnancy , Cesarean Section , Glioblastoma , Headache , Anesthesia, Epidural , Anesthetics , Neurosurgery , Tuberous Sclerosis , Brain , Rare Diseases , Parturition , Hemorrhage , Hospitals , Hypesthesia , Neoplasms , Nervous System Diseases
20.
Rev. colomb. anestesiol ; 49(3): e300, July-Sept. 2021. graf
Article in English | LILACS, COLNAL | ID: biblio-1280179

ABSTRACT

Abstract Post-dural puncture headache is a frequent complication in neuraxial approaches. It may result in disability, healthcare dissatisfaction and potentially serious complications. The traditional initial management includes general and analgesia measures with poor evidence. The treatment approach best supported by the literature is the epidural blood patch for which rates of up 70% improvement have been reported. Regional techniques have been recently described that may be helpful because they are less invasive than the epidural blood patch, under certain clinical circumstances. This article suggests an algorithm that uses such techniques for the management of this complication.


Resumen La cefalea pospunción dural es una complicación frecuente del abordaje del neuroeje. Puede producir incapacidad, insatisfacción con la atención en salud y complicaciones potencialmente graves. Tradicionalmente su manejo inicial incluye medidas generales y de analgesia las cuales tienen baja evidencia. La medida para su tratamiento, con mejor soporte en la literatura, es la realización de parche hemático, el cual informa tazas de mejoría hasta del 70 %. Recientemente se han descrito técnicas regionales, que pueden resultar útiles por ser menos invasivas que el parche hemático, en ciertos contextos clínicos. En este artículo se propone un algoritmo que permite incorporar dichas técnicas al manejo de esta complicación.


Subject(s)
Humans , Male , Female , Therapeutics , Blood Patch, Epidural , Post-Dural Puncture Headache , Headache , Analgesia , Nerve Block , Delivery of Health Care , Anesthesia, Conduction
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