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1.
Rev. medica electron ; 43(3): 855-867, 2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1289823

ABSTRACT

RESUMEN Clostridium difficile es una bacteria relacionada con la colitis, asociada a antibióticos y a la diarrea adquirida en pacientes hospitalizados. Sin embargo, su comportamiento ha cambiado en los últimos años, hasta el punto de ser considerada un problema de salud mundial. Su curso clínico varía desde casos asintomáticos, colitis, hasta complicaciones que ponen en peligro la vida del paciente. Dentro de los factores de riesgo descritos se encuentra la enfermedad inflamatoria intestinal, especialmente la colitis ulcerativa idiopática. El caso reportado versa sobre la presentación de esta infección asociada a un brote de colitis ulcerativa en un paciente joven, sin antecedentes de enfermedad inflamatoria intestinal, consumo de antibióticos ni hospitalización (AU).


ABSTRACT Clostridium difficile is a bacterium related to antibiotic-associated colitis and to diarrhea acquired in hospitalized patients. However, its behavior has changed in recent years to the point of being considered as a global health problem. Its clinical course ranges from asymptomatic cases, colitis, to complications with risk for the patient's life. The inflammatory bowel disease, especially idiopathic ulcerative colitis is found among the described risk factors. The case reported deals with the presentation of this infection associated to an outbreak of ulcerative colitis in a young patient, with no previous history of inflammatory bowel disease, consumption of antibiotics or hospitalization (AU).


Subject(s)
Humans , Male , Colitis, Ulcerative/diagnosis , Clostridioides difficile/virology , Diarrhea/complications , Infections/complications , Infections/transmission , Inpatients , Anti-Bacterial Agents/adverse effects
2.
Infectio ; 24(4): 266-269, oct.-dic. 2020. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1114881

ABSTRACT

Resumen Introducción: La endocarditis fúngica es una enfermedad infecciosa agresiva e infrecuente, considerada una emergencia en los servicios hospitalarios. Se ha evidenciado una incidencia de 0-12% del total de las admisiones pediátricas por endocarditis infecciosa. La mortalidad por Candida spp se encuentra alrededor del 50-80% en todos los casos. La Candida lusitaniae afecta principalmente a pacientes inmunocomprometidos, con uso de dispositivos intravasculares y el empleo de antibióticos de amplio espectro. Reporte de caso: Se presenta el caso de un lactante menor quien es diagnosticado con fungemia y endocarditis infecciosa por Candida lusitaniae en válvula nativa posterior a cirugía de corrección por transposición de grandes vasos. Discusión y Conclusiones: La endocarditis infecciosa por Candida lusitaniae es una entidad poco frecuente, con una prevalencia menor al 2% constituyéndose un escenario desafiante en la práctica clínica. Se describen las características de un lactante menor quien presentó endocarditis fúngica ya definidas en la literatura mundial. Es imprescindible la detección temprana y una intervención terapéutica vertiginosa; puesto que, la persistencia del inoculo, la resistencia antimicótica y el retraso en el diagnóstico conllevan a una condición amenazante para la vida del paciente.


Abstract Introduction: Fungal infective endocarditis is an aggressive and infrequent disease, considered an emergency in hospital services. Candida mortality is around 50-80% in all cases. The Candida lusitaniae mainly affects immunocompromised patients with chronic venous access and the use of broad-spectrum antibiotics. Case report: A minor infant is presented who is diagnosed with fungemia and infective endocarditis due to Candida lusitaniae in a native valve secondary to surgery by transposition of large vessels. Discussion and Conclusions: Candida lusitaniae infectious endocarditis is very rare, with a prevalence of less than 2% constituting a challenging scenario in clinical practice. The characteristics of fungemia and endocarditis already defined in the world literature are described. Early detection and a vertiginous therapeutic intervention are essential, since; latent infection, antifungal resistance and delay in diagnosis lead to a threatening condition for the patient's life.


Subject(s)
Humans , Infant , Candida , Endocarditis , Fungemia , Echinocandins , Infections/complications , Anti-Bacterial Agents
3.
Rev. medica electron ; 42(5): 2301-2313, sept.-oct. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1144735

ABSTRACT

RESUMEN Introducción: la infección por Helicobacter pylori es una de las más prevalentes en el planeta. Supone una carga significativa para los sistemas sanitarios, debido a la elevada resistencia a antibióticos que presenta para su erradicación. Objetivo: determinar las características clínico epidemiológicas de infección por Helicobacter pylori de pacientes atendidos en Consulta Provincial de Gastroenterología. Materiales y métodos: se realizó un estudio observacional descriptivo. El universo estuvo conformado por los 167 pacientes con determinación de Helicobacter pylori positivo, por test de ureasa. Las variables a considerar fueron: la edad, el sexo, diagnóstico histológico, síntomas clínicos y la evolución clínica posterior al tratamiento específico para Helicobacter pylori. Se utilizó la técnica estadística de análisis de distribución de frecuencias. Resultados: un 59,6 % de los pacientes resultó con Helicobacter pylori positivo con predominio del sexo masculino. Fue la gastritis crónica la alteración gástrica que más se asoció a la infección. La epigastralgia y distensión abdominal resultaron los síntomas más frecuentes. Evolucionaron de forma satisfactoria el 49 % de los casos y solo un 17 % presentaron una mala respuesta al tratamiento. Conclusiones: se obtuvo un alto porcentaje de infección por Helicobacter pylori y una buena respuesta al tratamiento utilizado (AU).


ABSTRACT Introduction: the infection for Helicobacter pylori is one of the more prevalent in the world; it supposes a significant burden for the sanitary systems, due to the high resistance to antibiotics that it presents for its eradication. Objective: to determine the clinical epidemiological characteristics of the infection due to Helicobacter pylori in patients treated in the provincial consultation of Gastroenterología. Materials and methods: an observational, descriptive study was carried out in a universe formed by 167 patients with positive Helicobacter pylori determined by urease test. The variables to consider were age, sex, histologic diagnosis, clinical symptoms and clinical evolution after the specific treatment for Helicobacter pylori. The statistical technique of analysis of frequencies distribution was used. Results: 59, 6% of the patients was Helicobacter pylori positive with prevalence of the male sex; chronic gastritis was the gastric alteration more associated to the infection. Epigastralgia and abdominal distension were the most frequent symptoms. 49% of the cases evolved in a satisfactory way and only 17% answered bad to the treatment. Conclusions: a high percent of infection by Helicobacter pylori was found and also a good answer to the used treatment (AU).


Subject(s)
Humans , Male , Female , Helicobacter pylori/pathogenicity , Gastroenterology/methods , Patients , Pathological Conditions, Signs and Symptoms , Gastritis/complications , Infections/complications , Infections/parasitology , Anti-Bacterial Agents
4.
J. pediatr. (Rio J.) ; 96(supl.1): 39-46, Mar.-Apr. 2020. tab, graf
Article in English | LILACS | ID: biblio-1098356

ABSTRACT

Abstract Objective The association between diabetes mellitus and infections is very common. These infections, even when mild, interfere with blood glucose control. The aim of this review is to describe infections that occur in children and adolescents with DM, as well as to provide recommendations on glycemia management during these episodes. Source of data A non-systematic review was carried out in the PubMed database, using the terms "diabetes mellitus," "infection," "children," and "adolescents." The most relevant publications were selected. Synthesis of data In addition to the usual community diseases, some infections may occur predominantly in diabetic patients, especially when there is inadequate glycemic control, and common infections can be more severe in these patients. Alterations caused by the disease itself and the immune response are responsible for the risk of higher frequency and severity of infections. During infections, an increase in blood glucose occurs and usually an increase in insulin dose is required. Conclusions Pediatric patients with diabetes have some immune system disorders that, when associated with high glycemia, increase the risk of infections and their severity, and should be promptly identified and treated. The presence of an infectious condition, in turn, raises blood glucose and increases the risk of decompensation, and pediatricians should be cautioned to intensify monitoring and insulin therapy, and to avoid the risk of DKA. It should also be noted that many infections are preventable and can be avoided with adequate vaccine coverage.


Resumo Objetivo A associação entre diabetes mellitus e infecções é muito frequente. Essas infecções, mesmo quando leves, interferem no controle da glicemia. O objetivo desta revisão é descrever as infecções que ocorrem em crianças e adolescentes com DM, bem como orientar o manejo glicêmico nestes episódios. Fonte dos dados Foi feita uma revisão não sistemática na base de dados PubMed, com os termos "diabetes mellitus", "infecção", "crianças" e "adolescentes". Foram selecionadas as publicações mais relevantes. Síntese dos dados Além de infecções comunitárias habituais, algumas infecções ocorrem predominantemente no paciente com diabetes, principalmente quando não há um controle glicêmico adequado, e infecções comuns podem ser mais graves nesse paciente. Alterações da própria doença e da resposta imune, em conjunto com alterações do microbioma, são responsáveis pela maior frequência e gravidade das infecções. Durante as infecções, ocorre um aumento da glicemia e habitualmente é necessário o aumento da dose de insulina. Conclusões O paciente pediátrico com diabetes apresenta algumas desordens imunes que, quando associadas a elevaçao da glicemia, aumentam o risco de infecção e sua gravidade. A presença da infecção, por sua vez, eleva a glicemia e aumenta o risco de descompensação. Desta forma, a monitorização da glicemia, bem como o aumento da dose de insulina, são fundamentais para evitar o risco de cetoacidose diabética. Destaca-se ainda que muitas infecções são imunopreveníveis e podem ser evitadas com uma cobertura vacinal adequada.


Subject(s)
Humans , Child , Adolescent , Diabetes Complications , Infections/complications , Blood Glucose , Diabetes Mellitus , Hyperglycemia , Hypoglycemic Agents/therapeutic use , Insulin
5.
Int. j. cancer ; 147((6):1629-1637): 1629-1637, 20200915. Fig., Tab., Mapa
Article in English | AIM, RSDM, AIM | ID: biblio-1354988

ABSTRACT

Results from two recently established population-based registries in Mozambique are reported: Beira in the central region (2014-2017) and Maputo, the capital city, in the South (2015-2017). The results are compared to those from Maputo (Lourenço Marques at the time) in 1956-1960 (appearing Cancer Incidence in Five Continents Vol 1), and with estimated incidence rates from other regions of Africa. The elevated prevalence of HIV infection (12.6% of adults in 2018) results in high rates for HIV-related cancers, and the greater prevalence in central Mozambique, compared to the south, largely explains the rather higher rates of Kaposi sarcoma (males), non-Hodgkin lymphoma, squamous cell carcinoma of conjunctiva and cervical cancer in Beira than in Maputo. Burkitt lymphoma is the commonest childhood cancer in Beira, with high rates typical of East Africa, while the low rates in Maputo are more typical of Southern Africa. Overall, 44% of cancers in Maputo and 52% in Beira are estimated to be caused by infectious agents. In the last 60 years, cancers more frequent in developed countries, such as breast and prostate, are emerging in Mozambique. The incidence of the former in Maputo has increased fivefold since 1956-1960, that of prostate cancer 2.5-fold, and that of large bowel cancer doubled. The results reported here were used to make national estimates of incidence, mortality and prevalence in Globocan 2018. The two registries were important in providing data to establish priority actions in the National Cancer Control Plan, and are a valuable resource to monitor progress toward its goals.


Subject(s)
Humans , Male , Female , Adolescent , Middle Aged , Young Adult , Chancre , Neoplasms/immunology , HIV Infections/complications , HIV Infections/immunology , HIV Infections/epidemiology , Infections/complications , Mozambique/epidemiology , Neoplasms/virology
6.
Rev. Col. Bras. Cir ; 47: e20202524, 2020. tab, graf
Article in English | LILACS | ID: biblio-1136565

ABSTRACT

ABSTRACT Objective: to identify predictive factors for lethality and complications of deep fascial space infections of the neck (DFSIN), establishing an early and aggressive treatment in the neck before the progression to descending mediastinitis. Methods: we retrospectively analyzed 133 cases of DFSIN treated at Discipline of Head and Neck Surgery of the Medicine School of Santa Casa de Misericórdia de São Paulo. We accessed demographic characteristics, associated diseases, clinical presentation, laboratorial tests, length of hospital stay, number of involved anatomic neck spaces, intra-operative and microbiology findings. We analyzed these data using logistic regression to predict DFSIN lethality and life threatening complications (mediastinitis, septic shock, pneumonia, pleural empyema, skin necrosis). Results: lethality and complication ratios were 9% and 50.3%, respectively. The logistic regression model showed that patients with septic shock were more likely to have progression to death (p < 0.001) and, the presence of more than two involved neck spaces (p < 0.001) and older individuals (p = 0.017) were more likely to have complicated deep neck infections. Descending necrotizing mediatinitis increased the lethality ratio by 50%, and was associated to necrotizing fasciitis (p=0.012) and pleural empyema (p<0.001). Conclusion: septic shock is a lethal predictive factor and age as well as more than two involved neck spaces are the predictive factors for complications. Necrotizing fasciitis is an important factor for complications and death. Therefore, its surgical treatment must be more aggressive. Descending mediastinitis has a high lethal rate and the successful treatment is based on early diagnosis and aggressive surgical approach.


RESUMO Objetivo: identificar os fatores preditivos de letalidade e complicações associados às infecções dos espaços fasciais profundos do pescoço, com intuito de estabelecer tratamento mais precoce antes de evolução para a mediastinite. Métodos: estudo retrospectivo de 133 casos, tratados na Disciplina de Cirurgia de Cabeça e Pescoço da Faculdade de Ciências Médicas da Santa Casa de São Paulo. Por meio da análise de regressão logística, estes dados foram estudados para a predição de letalidade e complicações graves (mediastinite, choque séptico, empiema pleural, pneumonia e necrose de pele). Resultados: a taxa de letalidade identificada foi de 9% e, de complicações de 50,3%. Identificou-se como fator preditivo de letalidade, a presença de choque séptico (p<0,001) e, para o ocorrência de complicações, a idade (p=0,017) e o acometimento de mais de dois espaços anatômicos (p<0,001). A ocorrência de mediastinite descendente necrosante esteve associada à presença de fasciíte necrosante (p=0,012) e empiema pleural (p<0,001). Conclusão: o fator preditivo de letalidade foi a presença de choque séptico e, para ocorrência de complicações graves, a idade e/ou a presença de mais de dois espaços anatômicos acometidos pela infecção. A fasciíte necrosante é fator importante para ocorrência de complicações e morte. Nestes casos, a conduta cirúrgica deve ser mais agressiva. A mediastinite descendente apresenta taxa de letalidade alta e o sucesso no tratamento está no diagnóstico precoce e na intervenção cirúrgica agressiva.


Subject(s)
Humans , Adult , Fasciitis, Necrotizing/mortality , Infections/complications , Infections/etiology , Neck , Retrospective Studies , Empyema, Pleural , Fascia , Middle Aged
7.
Rev. Assoc. Med. Bras. (1992) ; 65(10): 1308-1313, Oct. 2019. graf
Article in English | LILACS | ID: biblio-1041036

ABSTRACT

SUMMARY Fever of undetermined origin (FUO) is a challenging entity with a striking presence in hospitals around the world. It is defined as temperature ≥ 37.8 ° C on several occasions, lasting ≥ three weeks, in the absence of diagnosis after three days of hospital investigation or 3 outpatient visits. The main etiologies are infectious, neoplastic, and non-infectious inflammatory diseases. The diagnosis is based on the detailed clinical history and physical examination of these patients, in order to direct the specific complementary tests to be performed in each case. The initial diagnostic approach of the FUO patient should include non-specific complementary exams. Empirical therapy is not recommended (with few exceptions) in patients with prolonged fever, as it may disguise and delay the diagnosis and conduct to treat the specific etiology. The prognosis encompasses mortality of 12-35%, varying according to the baseline etiology.


RESUMO Febre de origem indeterminada (FOI) é uma entidade desafiadora com presença marcante nos hospitais de todo o mundo. É definida como temperatura ≥37,8 ° C em várias ocasiões, com duração ≥3 semanas, na ausência de diagnóstico após três dias de investigação hospitalar ou três consultas ambulatoriais. As principais etiologias são de ordem infecciosa, neoplásica e doenças inflamatórias não infecciosas. O diagnóstico é baseado na história clínica e no exame físico minuciosos desses pacientes, com a finalidade de direcionar os exames complementares específicos a serem realizados em cada caso. A abordagem diagnóstica inicial do paciente com FOI deve incluir exames complementares inespecíficos. A terapia empírica não é recomendada (com poucas exceções) em pacientes com febre prolongada, uma vez que ela pode camuflar e retardar o diagnóstico e a conduta para tratar a etiologia específica. O prognóstico engloba uma mortalidade de 12-35%, variando de acordo com a etiologia de base.


Subject(s)
Humans , Male , Female , Fever of Unknown Origin/diagnosis , Fever of Unknown Origin/etiology , Cross Infection , Infections/complications , Inflammation/complications , Neoplasms/complications , Neutropenia
8.
ABC., imagem cardiovasc ; 32(3): 214-216, jul.-set. 2019. ilus
Article in Portuguese | LILACS | ID: biblio-1006712

ABSTRACT

Relatamos o caso de um paciente jovem admitido no pronto-socorro com quadro de dor precordial. O eletrocardiograma de admissão identificou supradesnivelamento do segmento ST localizado em parede lateral associado à imagem em "espelho", com enzimas cardíacas altamente elevadas, o que sugere diagnóstico de síndrome coronariana com supradesnivelamento de ST. O ecocardiograma evidenciou derrame pericárdico com fração de ejeção preservada e ausência de alterações segmentares, sugerindo, assim, pericardite aguda, com comprometimento do miocárdio. Desta forma, foi realizada ressonância magnética cardíaca, que evidenciou presença de realce tardio não isquêmico, confirmando o diagnóstico de perimiocardite. Trata-se de situação pouco frequente na prática clínica e que merece maior compreensão e atenção por parte dos médicos que trabalham em prontos-socorros


Subject(s)
Humans , Male , Adolescent , Electrocardiography/methods , Myocarditis , Pericardial Effusion/complications , Pericardial Effusion/diagnosis , Infections/complications , Myocardial Infarction
10.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 217-226, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1002227

ABSTRACT

Myocardial revascularization surgery (MRS) is the most frequently performed cardiac surgery in Brazil. However, data on mortality rates among patients undergoing MRS in hospitals other than the main referral centers in the northern Brazil are scarce. Objective: To describe the clinical course of patients that submitted to MRS in the major public cardiology referral hospital in the Brazilian Amazon. Methods: Retrospective cohort analysis, by review of medical records of patients who had undergone MRS at Hospital das Clínicas Gaspar Vianna (FHCGV) from January 2013 to June 2014. Results: A total of 179 patients were evaluated. Mortality rate was 11.7% until 30 days after surgery. Waiting time for surgery ≥ 30 days (OR 2.59, 95%CI 1.02 - 6.56, p = 0.039), infection during hospitalization (OR 3.28, 95%CI 1.15 - 9.39, p = 0.021) and need for hemodialysis after surgery (OR 9.06 95%CI 2.07 - 39.54, p = 0.001) were predictors of mortality after CABG. Conclusion: A high mortality rate in the study population was found, higher than that reported in the literature and in other regions of Brazil


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Postoperative Complications , Brazil/epidemiology , Hospitals, Public , Myocardial Revascularization/mortality , Comorbidity , Sex Factors , Statistical Analysis , Risk Factors , Age Factors , Treatment Outcome , Acute Coronary Syndrome/complications , Observational Study , Infections/complications , Angina, Unstable/complications , Myocardial Infarction , Myocardial Infarction/complications
11.
Rev. bras. neurol ; 55(2): 33-35, abr.-jun. 2019.
Article in Portuguese | LILACS | ID: biblio-1010041

ABSTRACT

OBJETIVO: Descrever um quadro clínico subagudo pós-infeccioso caracterizado por ataxia de tronco e flutter ocular. RELATO DE CASO: Um homem de 37 anos previamente hígido, pouco após um quadro sistêmico inespecífico que se resolveu espontaneamente, deu início a movimentos involuntários hipercinéticos dos olhos, da cabeça e desequilíbrio importante. Os sintomas evoluíram em poucos dias. Ao exame, apresentava ataxia de tronco e presença de flutter ocular. O líquor mostrou pleocitose discreta. Ressonância magnética (RM) de crânio e exames laboratoriais normais. Houve melhora espontânea e total dos sintomas em cerca de três semanas. CONCLUSÃO: A síndrome de flutter ocular e ataxia de tronco é rara e é destacado a benignidade do quadro.


OBJECTIVE: To describe a post-infectious subacute clinical picture characterized by truncal ataxia and ocular flutter. CASE REPORT: A healthy 37-year-old man, a few days after spontaneously resolved nonspecific systemic disease, initiated involuntary hyperkinetic movements of the eyes, head, and major imbalance. The symptoms progressed within a few days. He presented ataxia of the trunk and presence of ocular flutter. CSF showed pleocytosis. Magnetic resonance of the skull and laboratory tests were normal. There was spontaneous and total improvement of symptoms in about three weeks. CONCLUSION: The ocular flutter syndrome and truncal ataxia is rare and the benignity of the condition is highlighted.


Subject(s)
Humans , Male , Adult , Ataxia/diagnosis , Ocular Motility Disorders/diagnosis , Ocular Motility Disorders/etiology , Ocular Motility Disorders/physiopathology , Infections/complications , Remission, Spontaneous , Follow-Up Studies , Encephalitis
12.
Actual. SIDA. infectol ; 26(97 Suplemento 1): 26-40, 20180000. graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1355033

ABSTRACT

Los tumores sólidos representan el 90% de las patologías oncohematológicas que se diagnostican en Argentina. Las infecciones son una de las complicaciones más frecuentes, causando una importante morbimortalidad, y en muchos casos retrasan la prosecución de los tratamientos específicos. La incidencia y tipo de infección depende del sitio específico del tumor, los fenómenos post obstructivos, el tipo e intensidad del tratamiento que se administre, las comorbilidades del paciente y la epidemiología local, entre otros factores. En forma constante se van incorporando nuevos tratamientos al arsenal terapéutico, tales como nuevos esquemas de quimioterapia, terapias blanco e inmunoterapia, y el manejo de las complicaciones asociadas a los mismos representa un desafío para el equipo tratante.En esta revisión abordamos la epidemiología, prevención y manejo de las complicaciones infecciosas más frecuentes en los pacientes con tumores de sistema nervioso central y de cabeza y cuello


Solid tumours represent 90 percent of the oncohematologic pathologies diagnosed in Argentina. Infections are one of the most frequent complications causing important morbidity and mortality and delay in prosecution of their specific treatment. The type of infection depends on the specific site of the tumour, the presence of post obstructive phenomena, the treatment administered, comorbidity and local epidemiology, among others. New therapies are being continuously incorporated to the armamentarium of cancer treatment such as new chemotherapies regimes, target therapy and immunotherapy. The management of adverse events and infectious complications associated with them are a challenge for the physician in charge of these patients.The epidemiology, prevention and management of the most frequent infectious complications in patients with tumours of the central nervous system and head and neck are reviewed in this paper


Subject(s)
Humans , Radiotherapy , General Surgery , Central Nervous System Infections/complications , Central Nervous System Neoplasms/prevention & control , Central Nervous System Neoplasms/epidemiology , Drug Therapy , Head and Neck Neoplasms/prevention & control , Head and Neck Neoplasms/epidemiology , Immunotherapy , Infections/complications
13.
Bol. méd. postgrado ; 34(1): 55-60, Ene-Jun. 2018. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1121152

ABSTRACT

El score Quick-SOFA (qSOFA) no ha sido diseñado para utilizarlo en niños, aunque se ha utilizado en numerosos estudios como marcador de disfunción orgánica en sepsis a falta de un score propio para tal fin. Con el objetivo de determinar la utilidad del score Quick-SOFA en el diagnóstico de sepsis en pacientes pediátricos que asistieron al Servicio de Emergencias del Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga durante el lapso marzo-abril 2018, se realizó un estudio descriptivo transversal seleccionando un total de 60 pacientes los cuales se caracterizaron por un promedio de edad de 3,03 ± 3,76 años con predominio de lactantes menores (40%,) así como del sexo masculino (63,3%). Los principales focos de infección fueron respiratorio (41,6%) y digestivo (31,6%). 61,6% de los pacientes contaban con un puntaje de Glasgow mayor de 13 puntos, 68,3% una frecuencia respiratoria elevada y 55% registraron una presión arterial sistólica menor del percentil para la edad. 75% reportaron un qSOFA ≥ 2 puntos y 38,3% presentaron sepsis. De los pacientes con sepsis, 37,7% registraron un puntaje ≥ 2 y 40% menor de 2 puntos. La sensibilidad del qSOFA en este estudio fue de 73,9%, especificidad de 24,3%, valor predictivo positivo de 37,7% y el valor predictivo negativo de 60%. El qSOFA es una escala sencilla de aplicar en cualquier nivel asistencial, lo cual puede facilitar la identificación y estratificación adecuada del riesgo en los pacientes pediátricos con sepsis(AU)


The Quick-SOFA score (qSOFA) has not been designed for use in children, although it has been used in numerous studies as a marker of organic dysfunction in sepsis in the absence of a proper score. In order to determine the usefulness of the Quick-SOFA score in the diagnosis of sepsis in pediatric patients who were attended at the Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga during the period March-April 2018, a cross-sectional descriptive study was conducted with a total of 60 patients with an average age of 3.03 + 3.76 years of age, predominantly younger infants (40%) as well as male sex (63.3%). The main sites of infection were respiratory (41.6%) and digestive (31.6%). 61.6% of patients had a Glasgow value > 13 points, 68.3% had an elevated respiratory rate and 55% had a systolic blood pressure lower than the percentile for their age. Overall, 75% reported a qSOFA > 2 points and 38.3% presented sepsis. 37.7% of patients with sepsis had a score > 2 and 40% less than 2 points. In this study, qSOFA had a sensitivity of 73.9%, specificity of 24.3%, positive predictive value of 37.78% and negative predictive value of 60%. qSOFA is a simple scale which can facilitate the adequate stratification of risk in pediatric patients with sepsis(AU)


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Risk Factors , Sepsis/complications , Medication Therapy Management , Organ Dysfunction Scores , Pneumonia/etiology , Diarrhea, Infantile , Infections/complications
14.
Arch. argent. pediatr ; 116(1): 28-34, feb. 2018. graf, tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-887423

ABSTRACT

Introducción. El manejo inadecuado del dolor es frecuente en Urgencias. El objetivo fue analizar el manejo del dolor de niños con patología infecciosa o traumática del área facial/oral en Urgencias y evaluar el cumplimiento y satisfacción sobre la analgesia prescrita al momento del alta. Población y métodos. Estudio transversal, observacional y analítico en niños que acudieron a Urgencias con patología infecciosa/traumática de la región facial/oral durante 2 meses. Se recogieron el manejo del dolor en Urgencias, la analgesia prescrita para el domicilio y, tras el contacto telefónico con los padres, el tratamiento realizado y su adecuación al dolor del niño. Resultados. Fueron incluidos 252 pacientes (edad media de 4,5 años, desvío estándar 3,89). En 8,7%, figuraba la evaluación del dolor en triaje y, en 3,6%, en el informe médico. Se administró analgesia en Urgencias al 41,3%. Al momento del alta, en un 13,9%, no se prescribió analgesia; en 25,4%, se prescribió pautada y, en 60,3%, a demanda. Los pediatras usaron más analgesia pautada que los cirujanos (34,4% vs. 16,5%, p < 0,01). En el domicilio, no administraron analgesia en el 39,3%; en un 36,1%, pautada y, en un 23%, a demanda. Existió escasa correlación entre la pauta al momento del alta y la administrada en el domicilio (kappa: 0,178). Se consideró la analgesia adecuada en el 84%, con más frecuencia en patología traumática que infecciosa (85,7% vs. 14,3%, p < 0,01). Conclusiones. Se observó escasa evaluación y tratamiento del dolor en Urgencias. La prescripción más usada fue a demanda en vez de pautada, al contrario de lo recomendado en las guías. El control analgésico fue mejor en patología traumática que infecciosa.


Introduction. An inadequate pain management is common in the emergency department. Our objective was to analyze pain management among children with an orofacial infection or trauma in the emergency department and to assess compliance and satisfaction with analgesia prescribed at discharge. Population and methods. Cross-sectional, observational and analytical study in children attending the emergency department for an orofacial infection or trauma over 2 months. Pain management in the emergency department, analgesia prescribed at home and, following a call to parents, treatment provided and its adequacy to control pain were registered. Results. In total, 252patients (mean age: 4.5 years, SD: 3.89) were included. Pain assessment was recorded at the triage for 8.7%, and in the medical report, for 3.6%. Analgesia was administered to 41.3% in the emergency room. At discharge, no analgesia was prescribed to 13.9%; scheduled analgesia, to 25.4%; and as needed, to 60.3%. Pediatricians prescribed scheduled analgesia more frequently than surgeons (34.4% versus 16.5%, p < 0.01). At home, no analgesia was administered to 39.3%; scheduled analgesia, to 36.1%; and as needed, to 23%. There is little correlation between prescription at discharge and at home (Kappa: 0.178). Analgesia was considered adequate in 84% of cases, and was more frequent in trauma injuries than in infections (85.7% versus 14.3%, p < 0.01). Conclusions. Pain assessment and management was scarce in the emergency department. The most common prescription was as needed, contrary to what is recommended in the guidelines. Analgesic control worked better for trauma injuries than for infections.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Facial Pain/therapy , Pain Management , Home Care Services , Analgesia , Parents , Patient Discharge , Pediatrics , Pain Measurement , Facial Pain/etiology , Cross-Sectional Studies , Treatment Outcome , Patient Satisfaction , Guideline Adherence , Emergency Service, Hospital , Facial Injuries/complications , Infections/complications
15.
Gastroenterol. latinoam ; 29(supl.1): S36-S39, 2018.
Article in Spanish | LILACS | ID: biblio-1117670

ABSTRACT

Infectious gastroenteritis is a risk factor for developing post-infectious functional gastrointestinal disorders (PI-FGDs), mainly irritable bowel syndrome (IBS) and functional dyspepsia (FD). It is a significant subgroup of patients due to frequent episodes of gastrointestinal infections. Symptoms in PI-FGD patients can prevail for more than twelve months, especially if infective agents are bacteria or parasites. Symptoms are indistinguishable from their non-infective equivalents (IBS and FD). Risk factors for developing PI-FGD are: female gender, type and severity of the gastrointestinal infection, high anxiety levels and younger age. Main pathogenic mechanisms are alteration of permeability and immunity. Mucosa inflammation prevails only at early stage; however, with follow-up it can be reduced or normalized. Nevertheless, certain alterations prevail, such as hypersensitivity. These events are treated in the same way as IBS or FD.


La gastroenteritis infecciosa es un factor de riesgo para desarrollar un trastorno digestivo funcional postinfeccioso (TDF-PI), principalmente síndrome de intestino irritable (SII) y dispepsia funcional (DF). Es un subgrupo de pacientes relevante debido a lo frecuente que son las infecciones gastrointestinales. Los síntomas en los pacientes con TDF-PI se pueden prolongar por más de un año, especialmente cuando los agentes infecciosos son bacterias o parásitos. Los síntomas son indistinguibles con respecto a los de sus equivalentes no infecciosos (SII y DF). Los factores de riesgo para desarrollar TDF-PI son el sexo femenino, el tipo y la severidad de la infección gastrointestinal, los niveles altos de ansiedad, y la menor edad. Los principales mecanismos patogénicos son la alteración de la permeabilidad y de inmunidad. La inflamación de la mucosa predomina solo al principio pero con el seguimiento esta disminuye o se normaliza, a pesar de lo cual ciertas alteraciones como la hiperensibilidad permanecen. Estos cuadros se tratan de la misma manera que un SII o DF.


Subject(s)
Humans , Irritable Bowel Syndrome/etiology , Dyspepsia/etiology , Gastroenteritis/complications , Risk Factors , Irritable Bowel Syndrome/physiopathology , Irritable Bowel Syndrome/epidemiology , Dyspepsia/physiopathology , Dyspepsia/epidemiology , Infections/complications
16.
Rev. odontopediatr. latinoam ; 8(2): 112-122, 2018. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-999351

ABSTRACT

Objetivo: Determinar la prevalencia de complicaciones sistémicas derivadas de celulitis facial odontogénica y su relación con el peso y la talla de niños de 1 a 6 años hospitalizados en el Servicio de Infectología Pediátrica del Hospital Universitario de Caracas en el periodo 2006-2014. Materiales y métodos: Se realizó un estudio epidemiológico de prevalencia, no experimental, retrospectivo, transversal y analítico en una muestra seleccionada a conveniencia de 310 niños en edades entre 1 y 6 años, con análisis de frecuencias, porcentajes, promedios, prueba de significancia estadística chi cuadrado, correlación de Pearson y Odds-Ratio. Resultados: la prevalencia de complicaciones sistémicas derivadas de la celulitis facial odontogénica en esta muestra fue del 32%, y se reportan 5: meningitis 15%, absceso cerebral 2%, neumonía 6%, endocarditis infecciosa 5% y septicemia 4%. El 65,48% y el 68,06% de la muestra total presentó talla baja y peso bajo respectivamente. El peso bajo se relacionó estadísticamente con la presencia de complicaciones sistémicas en esta población. Al comparar con niños de talla y peso normal, los niños con baja talla (percentil 10) tuvieron una probabilidad 3 veces mayor de presentar complicaciones y los de bajo peso (percentil 10) presentaron 4 veces más probabilidades de presentar complicaciones sistémicas. Conclusiones: las complicaciones sistémicas que se pueden derivar de una celulitis facial odontogénica son varias y pueden comprometer la vida del paciente, en este estudio la más frecuente fue la meningitis. El peso y la talla son variables importantes a considerar al evaluar y tratar enfermedades infecciosas odontogénicas en la población pediátrica ya que pueden ser factores de riesgo en la aparición de complicaciones sistémicas asociadas.


Determinar a prevalência de complicações sistêmicas de celulite facial odontogenica e sua relação com o peso e altura de crianças de 1 a 6 anos hospitalizadas nas Serviço de Doenças Infecciosas Pediátricas del Hospital Universitário de Caracas, no período 2006-2014. Materiais e métodos. Um estudo epidemiológico de prevalência foi realizado, não-experimental, retrospectivo, transversal e analíticas em uma amostra de conveniência selecionada de 310 crianças de 1 a 6 anos, com análise de freqüência, porcentagens, médias, teste de shows de significância estatística chi quadrado, de correlação de Pearson e Odds ratio. Resultados. A prevalência de complicações sistémicas de celulite facial odontogénica nesta amostra foi de 32%, e relatou 5: 15% meningite, abcesso cerebral 2%, 6% pneumonia, endocardite infecciosa e septicemia 5% 4%. O 65,48% e ele 68,06% e a amostra total mostrou LHA e peso respectivamente. Baixo peso foi estatisticamente relacionada com a presença de complicações sistêmicas nesta população. Quando comparado com crianças de estatura normal e peso, crianças com baixa estatura (percentil 10) tinha 3 vezes mais propensos a ter complicações e baixo peso ao nascer (percentil 10) apresentou 4 vezes mais propensos a ter complicações Conclusões. Complicações sistémica que pode ser derivada a partir de celulite facial odontogénica são vários e podem comprometer a vida do paciente, no presente estudo o mais frequente foi a meningite. O peso e tamanho são variáveis importantes a considerar quando se avalia e tratamento de doenças infecciosas em pediátrica odontogénica população, pois podem ser factores de risco associados com o aparecimento de complicações sistémicas. Palavras-chave: celulite odontogenic facial, complicações sistêmicas, baixo peso, baixa estatura.


Aim: To determine the prevalence of systemic complications derived from odontogenic facial cellulitis and its relation to weight and height of children from 1 to 6 years hospitalized in the Pediatric Infectology Service of the University Hospital of Caracas in a period between 2006 and 2014. Materials and methods: An epidemiological and prevalence, non-experimental, retrospective, cross-sectional and analytical study was performed in convenience sample selected from 310 children aged 1 to 6 years. Data was analyzed by frequencies, percentages, averages, chi square test, Pearson correlation and Odds-Ratio. Results: The prevalence of systemic complications derived lofrom odontogenic facial cellulitis in this sample was 32% including: meningitis 15%, brain abscess 2%, pneumonia 6%, infective endocarditis 5% and septicemia 4%. 65.48% of the total sample presented low height and 68.06% low weight. Low weight was statistically related to the presence of systemic complications in this population. When compared with children of normal height and weight, children with low height (10th percentile) were 3 times more likely to present systemic complications and low weight children (10th percentile) 4 times higher chance for systemic complications. Conclusions: There are several systemic complications derived from an odontogenic facial cellulitis and can compromise the patient´s life. In this study the most frequent was meningitis. Weight and height are important variables to consider when evaluating and treating odontogenic infectious diseases in the pediatric population, since may constitute risk factors in the development of associated systemic complications.


Subject(s)
Humans , Child , Odontodysplasia , Dental Caries/complications , Focal Infection, Dental , Cellulite/complications , Infections/complications , Meningitis
17.
RELAMPA, Rev. Lat.-Am. Marcapasso Arritm ; 30(4): f:167-l:170, out.-dez. 2017. ilus
Article in Portuguese | SES-SP, LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-879947

ABSTRACT

Infecções relacionadas aos dispositivos eletrônicos cardíacos exigem sua completa remoção, sendo necessário o conhecimento das técnicas percutâneas de extração de cabos-eletrodos, evitando-se, assim, a cirurgia cardíaca com esternotomia e bypass cardiopulmonar. Apresentamos o caso de paciente do sexo feminino, com 23 anos de idade, portadora de bloqueio atrioventricular total congênito e marcapasso definitivo implantado há 18 anos, que evoluiu com infecção de loja relacionada a cirurgia recente. A paciente foi submetida a extração de cabos-eletrodos por meio de técnicas percutâneas, com sucesso, e recebeu implante de novo sistema à direita. A extração percutânea de cabos-eletrodos ainda é considerada um procedimento de alto risco, com significativas taxas de morbidade e mortalidade. Entre suas complicações, destacam-se: morte, lesão de grandes vasos, perfuração atrial, avulsão de estruturas cardíacas, lesão de valvas cardíacas, e embolização sistêmica. Embora o sucesso da extração de cabos-eletrodos seja dependente da experiência do médico e da disponibilidade de equipamentos adequados, também é especialmente dependente do tempo de implante dos cabos-eletrodos. A extração de cabos-eletrodos por abordagem percutânea pode ser realizada com segurança e eficácia quando utilizados material adequado e equipe treinada


Infections related to cardiac electronic devices require their complete removal, and percutaneous lead extraction techniques are required to avoid cardiac surgery with sternotomy and cardiopulmonary bypass. We present the case of a 23 year old female patient with third degree congenital atrioventricular block and definitive pacemaker implanted 18 years ago, evolving with a pocket infection related to a recent surgery. Electrode extraction was performed using percutaneous techniques and implanting a new system on the right. Percutaneous electrode extraction is still considered a high risk procedure with significant morbidity and mortality rates. Complications include: death, large vessel damage, atrial perforation, avulsion of cardiac structures, cardiac valve damage, and systemic embolization. Although a success electrode extraction depends on the physician's experience and the availability of suitable equipment, it is also especially dependent on the electrode implant time. Lead extraction using the percutaneous approach may be performed safely and effectively when appropriate materials are used in combination with a well-trained team.


Subject(s)
Humans , Female , Adult , Pacemaker, Artificial , Prostheses and Implants , Device Removal/methods , Electrodes , Defibrillators, Implantable , Atrioventricular Block , Infections/complications
19.
J. vasc. bras ; 16(1): f:60-l:62, Jan.-Mar. 2017.
Article in Portuguese | LILACS | ID: biblio-841406

ABSTRACT

Resumo Algumas infecções virais sistêmicas podem estar relacionadas ao desenvolvimento de trombose venosa profunda e/ou embolia pulmonar. Essa associação já está bem descrita em pacientes com infeções pelo vírus da imunodeficiência humana (HIV), hepatite C ou influenza. Recentemente introduzido no continente americano, o vírus chicungunha, agente etiológico da febre de chicungunha, ainda não tem essa relação bem sedimentada, mas com o aumento progressivo de sua incidência e pelo fato dessa infecção causar, muitas vezes, uma restrição severa da locomoção por poliartralgia e uma possível lesão endotelial direta, casos de tromboembolismo venoso podem começar a ser descritos. Neste relato de caso, descrevemos um paciente que desenvolveu trombose de veia poplítea direita durante internação para tratamento de febre por infecção por vírus chicungunha e poliartralgia severa.


Abstract Some systemic viral infections can be linked to development of deep venous thrombosis and/or pulmonary embolism. This association has already been well described in patients infected by human immunodeficiency virus (HIV), hepatitis C, and influenza. The chikungunya virus is the etiologic agent of chikungunya fever and it has recently been introduced to the American continent. As yet, there is no firm foundation for a relationship between chikungunya and thromboembolism, but the progressive increase in its incidence, the fact that this infection very often causes severe locomotion restrictions due to polyathralgia, and the possibility of direct endothelial injury suggest that cases of venous thromboembolism may begin to be described. In this case report, we describe a patient who developed thrombosis of the right popliteal vein after being admitted for treatment of severe polyathralgia and fever caused by chikungunya virus infection.


Subject(s)
Humans , Male , Middle Aged , Chikungunya virus , Venous Thrombosis/complications , Aedes/parasitology , Chikungunya Fever/complications , Fever/complications , Infections/complications , Popliteal Vein
20.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci; Accorsi, Tarso augusto Duenhas; Gualandro, Danielle Menosi; Oliveira Junior, Múcio Tavares de; Kalil Filho, Roberto. Manual da residência em cardiologia / Manual residence in cardiology. São Paulo, Manole, 2016. p.723-728.
Monography in Portuguese | LILACS | ID: biblio-971590
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