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3.
Arq. Asma, Alerg. Imunol ; 6(2): 262-270, abr.jun.2022. ilus
Article in English, Portuguese | LILACS | ID: biblio-1400207

ABSTRACT

Introdução: O objetivo deste estudo foi avaliar as características das práticas de telemedicina (TM) entre médicos alergistas/ imunologistas (A/I) brasileiros e avaliar seu conhecimento sobre as recomendações regulatórias. Métodos: Uma pesquisa eletrônica autorreferida foi enviada por e-mail uma vez por semana entre agosto e outubro/2021 a 2.600 médicos A/I brasileiros. Resultados: 205 (7,9%) participantes preencheram os formulários. 143 (70,2%) médicos usaram TM em sua prática clínica, e 184 (89,9%) nunca o usaram antes da pandemia de COVID-19. Dentre os médicos, 192 (93,8%) utilizaram a TM para consultas de acompanhamento, 186 (91%) para verificação de exames complementares e 136 (66,7%) nas primeiras consultas. Cento e quarenta e três médicos A/I (70,2%) sentiram-se seguros em seu diagnóstico por meio da TM, e 7 (3,5%) responderam que não conseguiram encontrar um diagnóstico correto usando a TM. Os principais benefícios da TM relatados foram: maior acessibilidade, principalmente em áreas mais distantes 159 (77,6%), redução dos custos de deslocamento 158 (77,1%) e segurança quanto à transmissão do COVID-19 145 (71,2%). Por outro lado, algumas desvantagens da TM foram listadas pelos participantes: ausência de exame físico 183 (89,7%), relação médico-paciente fragilizada 59 (28,8%) e problemas de Internet 45 (22%). Em relação ao campo jurídico/ético, 105 (51,4%) dos especialistas aplicaram o termo de consentimento e 34 (16,7%) registraram a teleconsulta, ambas as etapas exigidas em uma consulta de TM, conforme recomendações regulatórias locais. Além disso, plataformas online inadequadas para TM, como aplicativos de mídia social e programas de reuniões online não específicos, foram relatadas como sendo usadas por 131 (64,1%) dos participantes. Oitenta (40%) não leram as declarações e recomendações oficiais que regulamentam a prática da TM no Brasil. Conclusões: Observouse um uso crescente de TM no Brasil, influenciado principalmente pela pandemia de COVID-19. Apesar de ser ferramenta útil na pandemia, com vantagens e desvantagens, há necessidade de conhecer as recomendações regulatórias.


Introduction: The aim of this study was to evaluate the characteristics of telemedicine (TM) practices among Brazilian allergists/immunologists (A/I) and to assess their knowledge of regulatory recommendations. Methods: A self-report electronic survey was sent by email once a week between August and October 2021 to 2,600 Brazilian A/I physicians. Results: A total of 205 (7.9%) participants completed the survey. TM was used in clinical practice by 143 (70.2%) physicians, and 184 (89.9%) had never used it before the COVID-19 pandemic. Among participants, 192 (93.8%) used TM for follow-up consultations, 186 (91%) for checking complementary exams, and 136 (66.7%) for first consultations. The number of A/I physicians (70.2%) that felt confident in their diagnosis using TM was 143, and 7 (3.5%) reported that they could not reach the correct diagnosis using TM. Participants reported that the main benefits of TM were greater accessibility, especially in more distant areas (159, 77.6%), reduced travel costs (158, 77.1%), and safety regarding the transmission of COVID-19 (145, 71.2%). Conversely, the lack of physical examination (183, 89.7%), poor doctor-patient relationship (59, 28.8%), and internet connection problems (45, 22%) were mentioned as disadvantages. Regarding legal/ethical aspects, 105 (51.4%) physicians reported applying a consent form and 34 (16.7%) reported making a record of the teleconsultation, both of which are required for TM consultations, according to local regulatory recommendations. The use of inappropriate online platforms for TM, such as social media applications and nonspecific online meeting programs, was reported by 131 (64.1%) participants. Eighty (40%) participants did not read the official statements and recommendations that regulate the practice of TM in Brazil. Conclusions: An increasing use of TM was observed in Brazil, mainly influenced by the COVID-19 pandemic. Despite being a useful tool in the pandemic, with advantages and disadvantages, physicians should have knowledge of regulatory recommendations.


Subject(s)
Humans , Telemedicine , Remote Consultation , Allergists , COVID-19 , Patients , Physical Examination , Physician-Patient Relations , Physicians , Societies, Medical , Cross-Sectional Studies , Surveys and Questionnaires , Internet , Diagnosis , Allergy and Immunology , Social Media
4.
Rev. bras. ortop ; 57(3): 467-471, May-June 2022. tab
Article in English | LILACS | ID: biblio-1388027

ABSTRACT

Abstract Objective To compare clinical data from the physical examination with arthroscopic findings in rotator cuff rupture. Methods A total of 177 patients submitted to arthroscopic treatment of rotator cuff rupture were selected, and arthroscopic findings were compared with physical examination. Results The impingement tests showed high sensitivity for rotator cuff rupture. Among the strength tests, the most sensitive was the Patte test (85.7%), and the one with the highest positive predictive value (PPV) was the Jobe test (95%). The Drop Sign test showed higher specificity and negative predictive value (NPV) (98.7 and 95.9%, respectively). Patients with a history of trauma were 3.5 times more likely to have a positive Lift Off test. Conclusion The impingement tests had high sensitivity for rotator cuff ruptures. The Jobe test showed similar sensitivity among patients who had partial or total supraspinal injury. For complete lesions of the subscapularis, The Lift Off and Belly Press tests showed high sensitivity and specificity.


Resumo Objetivo Comparar dados clínicos do exame físico com os achados artroscópicos na ruptura do manguito rotador. Métodos Foram selecionados 177 pacientes submetidos ao tratamento artroscópico de ruptura do manguito rotador e foram comparados os achados artroscópicos com o exame físico. Resultados Os testes irritativos de impacto apresentaram alta sensibilidade para ruptura do manguito rotador. Dentre os testes de força, o de maior sensibilidade foi o teste de Patte (85,7%) e o de maior valor preditivo positivo (VPP) foi o teste de Jobe (95%). O teste Drop Sign apresentou maior especificidade e valor preditivo negativo (VPN) (98,7 e 95,9%, respectivamente). Pacientes com história de trauma possuíam 3,5 vezes mais chances de apresentarem o teste Lift Off positivo. Conclusão Os testes irritativos tiveram alta sensibilidade para rupturas do manguito rotador. O teste de Jobe apresentou sensibilidade semelhante entre os pacientes que tinham lesão parcial ou total do supraespinhal. Para as lesões completas do subescapular, as testes Lift Off e Belly Press apresentaram alta sensibilidade e especificidade.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Physical Examination , Arthroscopy , Rupture , Rotator Cuff , Shoulder Injuries
5.
Arch. pediatr. Urug ; 93(1): e801, jun. 2022. tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1383633

ABSTRACT

Se presentan, en un trabajo conjunto, las recomendaciones para la evaluación cardiovascular de personas menores de 35 años que realizan ejercicio y deportes. Se establecen pautas en cuanto a la valoración y la habilitación que tendrá dicha evaluación, quiénes estarán a cargo de su realización y cuáles son los componentes fundamentales de una correcta valoración cardiovascular. Se toman en cuenta los antecedentes familiares y personales, el examen físico exhaustivo y se considera conveniente la realización del ECG como parte integrante obligatorio. Se hacen referencia a otros estudios funcionales como opcionales, así como la posible derivación a los especialistas cuando se considere necesario.


We hereby present joint recommendations for cardiovascular assessment of people under 35 years of age who do exercise and sports. We set the guidelines regarding evaluation and score of such assessment, the agents in charge of implementing it and the main components of a correct cardiovascular assessment. We take into account the family and personal history and perform a comprehensive physical examination as well as an ECG as a mandatory part of this comprehensive approach. We mention other optional functional studies as well as reference to specialists whenever necessary.


Apresentamos através dum paper conjunto recomendações para a avaliação cardiovascular de pessoas de 35 anos de idade que praticam exercício e esportes. Estabelecem-se as diretrizes quanto à qualificação dessa avaliação, quem a realizará e quais são os componentes fundamentais de uma correta avaliação cardiovascular. Consideramos obrigatório incluir a história familiar e pessoal, o exame físico exaustivo e o ECG opcional. Referimo-nos a outros estudos funcionais opcionais, assim como ao possível encaminhamento para especialistas quando for necessário.


Subject(s)
Humans , Child , Adolescent , Adult , Young Adult , Sports , Cardiovascular Diseases/prevention & control , Exercise , Physical Examination , Cardiovascular Diseases/diagnosis , Death, Sudden, Cardiac/prevention & control , Electrocardiography , Medical History Taking
6.
Rev. Col. Bras. Cir ; 49: e20223124, 2022. tab
Article in English | LILACS | ID: biblio-1365398

ABSTRACT

ABSTRACT The number of surgical procedures in the world is large and in Brazil it has been expressing a growth trend higher than the population growth. In this context, perioperative risk assessment safeguards the optimization of the outcomes sought by the procedures. For this evaluation, anamnesis and physical examination constitute an irreplaceable initial stage which may or may not be followed by complementary exams, interventions for clinical stabilization and application of risk estimation tools. The use of these tools can be very useful in order to obtain objective data for decision making by weighing surgical risk and benefit. Global and cardiovascular risk assessments are of greatest interest in the preoperative period, however information about their methods is scattered in the literature. Some tools such as the American Society of Anesthesiologists Physical Status (ASA PS) and the Revised Cardiac Risk Index (RCRI) are more widely known, while others are less known but can provide valuable information. Here, the main indices, scores and calculators that address general and cardiovascular perioperative risk were detailed.


RESUMO O número de procedimentos cirúrgicos no mundo é amplo e no Brasil vem expressando tendência de crescimento superior ao crescimento populacional. Nesse contexto, a avaliação de risco perioperatório resguarda a otimização dos desfechos buscados pelos procedimentos. Para a realização dessa avaliação, a anamnese e exame físico constituem etapa inicial insubstituível, a qual pode ou não ser seguida de exames complementares, intervenções para estabilização clínica e aplicação de ferramentas de estimativa de risco. A utilização destas ferramentas pode ser bastante útil a fim de se obter um dado objetivo para a tomada de decisão pesando-se risco e benefício cirúrgico. As avaliações de risco global e cardiovascular são as de maior interesse no pré-operatório, entretanto informações sobre seus métodos encontram-se dispersas na literatura. Algumas ferramentas como o American Society of Anesthesiologists Physical Status (ASA PS) e Índice de Risco Cardíaco Revisado (RCRI) são mais amplamente conhecidos, enquanto outros são menos conhecidos em nosso meio mas podem fornecer informações valiosas. Aqui detalhou-se os principais índices, escores e calculadoras que abordam risco perioperatório geral e cardiovascular.


Subject(s)
Physical Examination , Heart Disease Risk Factors , Brazil , Risk Assessment/methods
7.
Article in Chinese | WPRIM | ID: wpr-935761

ABSTRACT

Objective: To understand the diagnosis of suspected occupational diseases reported in Guangzhou from 2014 to 2019, so as to provide theoretical basis and technical support for the supervision of suspected occupational disease reports. Methods: By cluster sampling, the suspected occupational disease report card, occupational disease report card and pneumoconiosis report card reported by Guangzhou from January 1, 2014 to December 31, 2019 in the occupational disease and occupational health information monitoring system were collected for matching analysis to understand the diagnosis of suspected occupational disease patients. Results: From 2014 to 2019, a total of 1426 suspected occupational cases in 7 categories and 32 species were reported in Guangzhou. The average number of reported cases per year was about 240. The main diseases of suspected occupational diseases were suspected occupational noise deafness (68.44%, 976/1426) , suspected occupational chronic benzene poisoning (16.48%, 235/1426) , suspected occupational other pneumoconiosis (4.84%, 69/1426) , suspected occupational silicosis (3.23%, 46/1426) and suspected occupational welder pneumoconiosis (1.82%, 26/1426) . The diagnostic rate required to enter the occupational disease diagnostic program is 36.61% (522/1426) , and the diagnostic rate is 59.20% (309/522) . In 2019, the diagnosis rate of suspected occupational diseases was the lowest (23.92%, 61/255) , Huadu District was the lowest (8.33%, 9/108) , suspected occupational pneumoconiosis was the lowest (28.03%, 44/157) , the diagnosis rate of suspected occupational diseases reported by the Centers for Disease control and prevention was the lowest (17.43%, 19/109) , and the diagnosis rate of suspected occupational diseases reported by outpatient treatment was the lowest (22.22%, 2/9) . The suspected occupational diseases reported by institutions outside Guangzhou did not enter the occupational disease diagnosis procedure. Suspected occupational skin diseases, suspected occupational diseases caused by physical factors and suspected occupational tumors were diagnosed, and the diagnosis rate of occupational disease prevention and control institutions was the highest (94.87%, 37/39) . Conclusion: The main types of suspected occupational diseases reported during these six years are noise deafness, chronic benzene poisoning and pneumoconiosis. The overall diagnosis rate and diagnosis rate of suspected occupational diseases are not high. It is suggested to improve the network direct reporting system of suspected occupational diseases and strengthen the follow-up management and supervision of suspected occupational diseases.


Subject(s)
China/epidemiology , Humans , Noise, Occupational , Occupational Diseases/epidemiology , Physical Examination , Pneumoconiosis/epidemiology , Silicosis
8.
Article in Chinese | WPRIM | ID: wpr-928298

ABSTRACT

OBJECTIVE@#To investigate the diagnostic value of 6 conventional physical examination tests for the diagnosis of supraspinatus tendon tears, and how well they could tell the difference between partial-and full-thickness tears.@*METHODS@#A total of 91 patients with different shoulder symptoms who received shoulder arthroscopic procedure were enrolled in the study from June 2017 to September 2020. The intraoperative findings were compared with the results of the preoperative physical examination of 6 clinical tests, including the Hug-up test, the Jobe test, the 0°abduction test, the drop arm test, the Neer test, and the Hawkins test, to determine the sensitivity, specificity, positive and negative predictive value, accuracy, positive and negative likelihood ratio of each test.@*RESULTS@#By arthroscopy, a total of 44 full-thickness tears, 34 partial-thickness tears, and 13 intact supraspinatus tendons were found in all 91 cases. The Hug-up and the Jobe tests significantly correlated with the intraoperative findings. The sensitivity of the Hug-up test, the Jobe test, the 0° abduction test, the drop arm test, the Neer test, and the Hawkins test was 0.90, 0.79, 0.64, 0.42, 0.49, 0.24 respectively;the specificity was 0.61, 0.69, 0.54, 0.38, 0.31, 0.77;the positive predictive value was 0.93, 0.94, 0.89, 0.80, 0.81, 0.86;the negative predictive value was 0.50, 0.36, 0.20, 0.10, 0.09, 0.14;the accuracy was 0.86, 0.78, 0.63, 0.42, 0.46, 0.32;the positive likelihood ratio was 2.30, 2.58, 1.39, 0.69, 0.71, 1.06;and the negative likelihood ratio was 0.16, 0.30, 0.67, 1.50, 1.65, 0.98.@*CONCLUSION@#The Jobe test and the Hug-up test are both effective at accurately diagnosing supraspinatus tendon tears, the Hug-up test detects supraspinatus tears with a high sensitivity, and similar specificity. The tests assessed in this study are not capable of distinguish between partial-and full thickness supraspinatus tendon tears.


Subject(s)
Arthroscopy , Humans , Physical Examination/methods , Rotator Cuff , Rotator Cuff Injuries/surgery , Tendons
9.
Repert. med. cir ; 31(2): 187-193, 2022. ilus.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1390634

ABSTRACT

La prevalencia de artrosis de cadera en personas mayores de 45 años es de 9.2% y 27% de ellos evidencian signos radiológicos de la enfermedad, siendo el dolor uno de los motivos de consulta más comunes de quienes acuden al médico general y al ortopedista. La historia clínica precisa y el examen físico adecuado pueden llevar al clínico a determinar el origen del dolor. Sin embargo, nuestra experiencia en la consulta es que la mayoría de los médicos generales no conocen cuáles son los síntomas de la patología de la cadera. El objetivo de este artículo es presentar una guía práctica de su evaluación clínica y la patología más común, que sea útil para el estudiante de medicina, el médico general y el especialista. El artículo se desarrollará en el orden en que se realiza la evaluación de la cadera para al final poder tener un diagnóstico claro.


The prevalence of osteoarthritis of the hip among people over 45 years of age is 9.2% and 27% of them show radiological signs of this joint disorder, with pain being one of the most common reasons for consultation of patients seen by general practitioners and orthopedic surgeons. An accurate clinical history and a proper physical examination can lead the clinician to determine the origin of the pain. However, our experience in office visits shows that most general practitioners are unaware of the symptoms of hip disorders. The purpose of this article is to present a practice guideline for clinical examination of the hip and the most common disorders, which is useful for the medical student, general practitioner and specialist. The article will outline the steps in which hip evaluation is performed to obtain a clear diagnosis in the end


Subject(s)
Humans , Male , Female , Middle Aged , Physical Examination , Hip , Pain , Osteoarthritis, Hip , Joints
10.
Arch. argent. pediatr ; 119(6): e616-e620, dic. 2021. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1353046

ABSTRACT

La neurorretinitis como manifestación de la enfermedad por arañazo de gato se presenta en el 1-2 % de los pacientes con afecciones oculares porBartonella henselae. Las manifestaciones oculares suelen suceder a las sistémicas, aunque pueden aparecer en ausencia de estas. La presencia de exudado macular en forma de estrella es característico y sugestivo de dicha infección. Se presenta el caso de un paciente de 14 años de edad, previamente sano, con disminución de la agudeza visual de 15 días de evolución, que ingresó por sospecha de neuritis óptica izquierda con edema de papila. El seguimiento oftalmológico reveló la aparición de la lesión característica en "estrella macular" que permitió arribar al diagnóstico de infección por B. henselae, confirmándose luego con serología positiva


Neurorretinitis as a manifestation of cat scratch disease occurs in 1-2 % of patients with Bartonella Henselae eye disease. Ocular manifestations tend to follow systemic ones, although they can appear in their absence. The presence of star-shaped macular exudate is characteristic and suggestive of this infection. We report a case of a 14-year-old healthy boy, with 15 days of decreased visual acuity, who was admitted for suspected left optic neuritis with papilledema. Ophthalmological examination revealed the characteristic "macular star" that led to the diagnosis of infection by Bartonella Henselae, later confirmed by positive serology.


Subject(s)
Humans , Male , Adolescent , Retinitis/diagnosis , Cat-Scratch Disease/complications , Cat-Scratch Disease/diagnosis , Papilledema , Bartonella henselae , Physical Examination
12.
Rev. cir. traumatol. buco-maxilo-fac ; 21(3): 7-11, jul.-set.2021. ilus, tab
Article in Portuguese | LILACS, BBO | ID: biblio-1391085

ABSTRACT

Introdução: A Disfunção Temporomandibular (DTM) é a dor orofacial crônica mais comum, encontrada por dentistas e outros profissionais de saúde. Sua etiologia tem caráter multifatorial, e pode envolver, desde fatores hereditários, hábitos parafuncionais, maloclusões, até ansiedade e estresse. Objetivo: Este estudo investigou a frequência da DTM e a sua relação entre hábitos parafuncionais em uma população de pacientes classe II esquelética. Método: Uma amostra composta por pacientes classe II esquelética foi selecionada de forma não probabilística. Setenta e três indivíduos concordaram em participar da pesquisa, se submetendo ao exame físico que consistia na aplicação do Eixo I do (RDC/TMD). Resultados: Quarenta e seis por cento dos pacientes examinados apresentaram diagnóstico positivo. A média de idade dos pacientes foi de 27 anos+ 8,73 anos, 82% do gênero feminino e 80% brancos. Trinta e quatro pacientes referiram alguma atividade parafuncional. Desses a onicofagia representou o grupo com maior frequência, seguido pelo bruxismo, interposição de objetos entre os dentes e por último o apertamento. As variáveis não apresentaram associação estatisticamente significante com o desfecho primário estudado. Conclusão: Na amostra estudada não se observou associação entre a ocorrência de DTM e hábitos parafuncionais em pacientes classe II esquelética... (AU)


Introduction: Temporomandibular disorder (TMD) is the most common chronic orofacial pain, found by dentists and other health professionals. Its etiology has a multifactorial character, and may involve, from hereditary factors, parafunctional habits, malocclusions, to anxiety and stress. Objective: This study investigated the TMD frequency and its relationship among parafunctional habits in a population of skeletal class II patients. Method: A sample composed by a class II patients was selected in a non probabilistic manner. Seventy-three members agreed to participate in the research, submitting themselves to a physical examination that consists in the application of Axis I (RDC/TMD). Results: Forty-six percent of patients diagnosed with a positive diagnosis. The average age of the patients was 27 years ± 8.73 years, 82% female and 80% white. Thirty-four patients reported some parafunctional activity. Of these, biting nail represented the group most frequently, followed by bruxism, interposition of objects between the teeth and lastly clenching. As variables did not present a statistically significant association with the primary outcome studied. Conclusion: In the sample studied, it is observed that there is no association between TMD occurrence and parafunctional habits in skeletal class II patients... (AU)


Subject(s)
Humans , Male , Female , Facial Pain , Bruxism , Temporomandibular Joint Disorders , Dentofacial Deformities , Dentofacial Deformities/complications , Malocclusion , Nail Biting , Anxiety , Physical Examination , Nails
13.
J. bras. nefrol ; 43(3): 445-449, July-Sept. 2021. graf
Article in English, Portuguese | LILACS | ID: biblio-1340125

ABSTRACT

ABSTRACT Point-of-Care Ultrasound (POCUS) has been gaining momentum as an extension to physical examination in several specialties. In nephrology, POCUS has generally been used in a restricted way in urinary tract evaluation. We report the case of a patient with nephrotic syndrome secondary to amyloidosis, previously diagnosed by renal biopsy, who was oligosymptomatic when seen the an outpatient clinic, where the POCUS, focused on the heart, lung and abdomen, revealed anasarca, pulmonary congestion and cardiac changes suggestive of cardiac amyloidosis. After evaluation by the cardiology and hematology services, the diagnosis of AL amyloidosis with cardiac involvement was confirmed. This case emphasizes the importance of extending the physical examination using POCUS, which, ideally, should not be restricted to the urinary tract.


RESUMO A ultrassonografia Point of Care (POCUS) vem ganhando momentum como uma extensão ao exame físico em várias especialidades. Na nefrologia, a POCUS tem sido geralmente utilizada de forma restrita na avaliação do trato urinário. Relatamos o caso de uma paciente com síndrome nefrótica secundária à amiloidose previamente diagnosticada por biópsia renal, que se apresentava oligossintomática quando atendida em ambulatório, onde a POCUS, com foco no coração, pulmão e abdômen, revelou anasarca, congestão pulmonar e alterações cardíacas sugestivas de amiloidose cardíaca. Após avaliação pelos serviços de cardiologia e hematologia, foi confirmado o diagnóstico de amiloidose AL com envolvimento cardíaco. Esse caso enfatiza a importância da extensão do exame físico pela POCUS, que, idealmente, não deve se restringir ao trato urinário.


Subject(s)
Humans , Nephrology , Physical Examination , Ultrasonography , Point-of-Care Systems , Lung
15.
Arch. argent. pediatr ; 119(4): S159-S170, agosto 2021. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1281029

ABSTRACT

La displasia del desarrollo de la cadera (DDC) es una anomalía de la articulación coxofemoral caracterizada por una laxitud o posicionamiento anormal de la cabeza femoral con respecto al acetábulo. Es la patología ósea perinatal más frecuente, e incluye alteraciones que van desde el aplanamiento o la displasia acetabular hasta una luxación completa de la cabeza femoral fuera de la articulación, que puede comprometer el desarrollo y la estabilidad articular. Nuestro objetivo es transmitir una sistemática de estudio en la valoración de la cadera del recién nacido, haciendo énfasis en un examen físico correcto como pilar fundamental en la detección de la DDC, y orientar al pediatra en la selección adecuada del método diagnóstico complementario acorde a edad del paciente, con el fin de optimizar la detección y reducir el número de caderas luxadas en etapas tempranas y tardías, y así disminuir la incidencia de patologías asociadas desarrolladas a partir de este trastorno


Developmental dysplasia of the hip (DDH) is a hip joint anomaly that is characterized by a laxity or abnormal positioning of the femoral head with respect to the acetabulum. It is the most common perinatal pathology of the skeleton and includes a spectrum of alterations ranging from flattening or acetabular dysplasia, to a complete dislocation of the femoral head outside the joint that can compromise joint development and stability. The purpose of this presentation is to transmit a systematic study in the evaluation of the newborn's hip, emphasizing a correct physical examination as primordial in the detection of DDH. Also, guide the pediatriciain the proper selection of the complementary diagnostic method to be used according to the age of the patient, in order to optimize detection and reduce the number of dislocated hips in early and late stages as well as the incidence of related pathologies.


Subject(s)
Humans , Male , Female , Infant, Newborn , Developmental Dysplasia of the Hip/diagnosis , Physical Examination/methods , Risk Factors , Early Diagnosis , Developmental Dysplasia of the Hip/etiology , Hip Dislocation, Congenital/diagnosis , Hip Dislocation, Congenital/etiology
17.
Rev. cuba. invest. bioméd ; 40(2): e627, 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1347462

ABSTRACT

Introducción: El inicio de la pubertad está determinado por la interacción entre factores genéticos y reguladores. En las niñas ocurre alrededor de los ocho años. Puede afectarse cuando existe una pubertad adelantada, pubertad precoz o una variante de la pubertad. Para su diferenciación los estudios imagenológicos se han convertido en una herramienta vital. Objetivo: Describir aspectos fisiopatológicos, clínico-epidemiológicos y del diagnóstico por imágenes de la pubertad precoz y de sus variantes puberales en las niñas. Métodos: Se realizó una revisión sistemática a través de términos de búsqueda según descriptores en ciencias de la salud. Se utilizaron artículos de libre acceso en las bases de datos de PubMed, SciELO y Google Académico. De un total de 125 artículos, se utilizaron 45 de mayor interés: 34 en idioma español y nueve en inglés, que incluyeron libros y revistas. Análisis e integración de la información: Constituye un desafío distinguir la pubertad precoz de la telarquia, pubarquia, adrenarquia o menarquia aislada de aparición precoz, ya que son variantes del desarrollo puberal. Para su diagnóstico es importante descartar una causa tratable subyacente. El examen físico, análisis de laboratorio y estudios por imágenes, permiten diferenciar las formas completas de sus variantes y las posibles causas que determinan la estimulación de la producción hormonal. Conclusiones: El conocimiento del desarrollo normal de la pubertad y la aparición de sus variantes en las niñas resultan de gran utilidad. Su detección temprana ayudaría a recibir atención médica y descartar mediante métodos de imágenes sus causas secundarias(AU)


Introduction: The start of puberty is determined by the interaction between genetic and regulatory factors. Among girls this occurs around the age of eight years. However, the process may be affected by the presence of early puberty, precocious puberty or a variant of puberty. Imaging studies have become a vital tool for their differentiation. Objective: Describe the pathophysiological, clinical-epidemiological and imaging diagnostic aspects of precocious puberty and its pubertal variants in girls. Methods: A systematic review was conducted using search terms obtained from health sciences descriptors. The documents reviewed were open access papers from the databases PubMed, SciELO and Google Scholar. Of a total 125 papers retrieved, a selection was made of the 45 of greatest interest: 34 in Spanish and 9 in English, including books and journals. Data analysis and integration: Distinguishing precocious puberty from thelarche, pubarche, adrenarche or isolated premature menarche is a challenge, for these are variants of pubertal development. Ruling out an underlying treatable cause is important for diagnosis. Physical examination, laboratory analysis and imaging studies make it possible to differentiate complete forms from their variants and the possible causes determining the stimulation of hormone production. Conclusions: Knowledge about the normal development of puberty and the emergence of its variants in girls is very useful. Early detection would pave the way for medical care, including imaging studies to rule out its secondary causes(AU)


Subject(s)
Humans , Female , Physical Examination , Puberty, Precocious , Medical Care , Adrenarche
18.
Medisur ; 19(3): 524-529, 2021. graf
Article in Spanish | LILACS | ID: biblio-1287334

ABSTRACT

RESUMEN: La ingestión intencional de cuerpos extraños es frecuente entre prisioneros. Es un fenómeno asociado a un aumento de la morbimortalidad y los costos. Generalmente no requiere de intervención específica, aunque pueden aparecer complicaciones severas, que requieren, en ocasiones, tratamiento quirúrgico urgente. Se presenta un paciente masculino, de 24 años de edad, sin antecedentes relevantes, recluido en la prisión de máxima seguridad de la provincia Camagüey. Se introdujo por la boca un alambre de 40 cm de longitud, con un gancho en su punta. Presentó sialorrea y molestias retroesternales. Al examen físico se encontró normalidad de sus parámetros vitales, sin alteraciones en el examen del tórax, con abdomen doloroso a la palpación profunda del cuadrante inferior derecho. Se realizaron radiografías simples de tórax posteroanterior, lateral, y de abdomen simple, se encontraron un cuerpo extraño desde la boca hasta el tercio inferior del esófago torácico y otro cuerpo extraño ubicado en la pelvis, que refirió haber ingerido intencionalmente hace un año. Se realizó laparotomía urgente y extracción de ambos cuerpos extraños. El paciente evolucionó satisfactoriamente sin desarrollar complicaciones. La ingestión intencional de cuerpos extraños en la población penal es un problema de salud complejo. La prevención es uno de los pilares fundamentales de su tratamiento. Es importante un alto índice de sospecha sobre la ingestión de múltiples objetos, en este grupo de pacientes la cirugía es frecuentemente requerida.


ABSTRACT The conscious ingestion of foreign bodies is frequent among prisoners. It is a phenomenon associated with an increase in morbidity - mortality and costs. Generally, it does not require specific intervention, although severe complications may appear, which sometimes require urgent surgical treatment.to present the case of a prisoner with recurrent intentional ingestion of multiple foreign bodies, one of them not previously diagnosed. Case presentation: A 24-years-old male patient, with no relevant history, held in the Camagüey province maximum security prison. The wire was introduced through the mouth 40 cm long, with a hook at its tip. Referring to hypersalivation and retrosternal discomfort. The physical examination found normality of his vital parameters, without alterations in the chest examination, with a painful abdomen on deep palpation of the right lower quadrant. A posteroanterior and lateral chest X-ray was performed, finding a foreign body from the mouth to the lower third of the thoracic esophagus, an abdominal X-ray where another foreign body was located in the pelvis, which he reported having intentionally ingested a year ago. An urgent laparotomy was performed and both foreign bodies were removed. The patient evolves satisfactorily without developing complications. The intentional ingestion of foreign bodies in the prison population is a complex health problem. Prevention is one of the fundamental pillars of its treatment. A high index of suspicion on the ingestion of multiple objects is important; in this group of patients surgery is frequently required.


Subject(s)
Humans , Male , Adult , Prisoners/psychology , X-Rays , Costs and Cost Analysis , Foreign Bodies/complications , Physical Examination , Indicators of Morbidity and Mortality , Foreign Bodies/therapy
19.
Rev. fac. cienc. méd. (Impr.) ; 18(1): 42-48, ene.-jun. 2021. ilus., tab., graf.
Article in Spanish | LILACS, BIMENA | ID: biblio-1395566

ABSTRACT

La leucemia Monoblástica o Monocítica Aguda, es similar a otros subtipos de leucemias agudas, algunas peculiaridades que las diferencian son la hiperleucocitosis, infiltración extramedular y coagulación intravascular diseminada. El tratamiento de inducción se basa en drogas antracíclicas combinadas con citarabina; las complicaciones pueden ser fatales y la sobrevida a largo plazo se estima en 25% a 40%. Objetivo: documentar la r espuesta y complicaciones del tratamiento (quimioterapia) de inducción en la leucemia monoblástica aguda. Presentación de caso clínico: mujer de 34 años, acude con cuadr o inicial de congestión nasal bilateral y fiebre; examen físico normal, a excepción de equimosis en sitios de venopunción, el hemograma reveló anemia, leucocitosis y trombocitopenia. El frotis de sangre periférica, la biopsia y aspirado de médula ósea, fueron característicos de leucemia mieloide aguda tipo monocítica. Durante el tratamiento se administró dos ciclos de quimioterapia de inducción y coadyuvantes con base en hemoderivados, factor estimulante de colonias de granulocitos, antieméticos, antibióticos y antimicóticos. Complicaciones: se presentó toxicidad manifiesta por náuseas y vómitos grado II, mucositis, pérdida de peso y alopecia total, alteraciones hematológicas y complicaciones infecciosas grado IV. Se obtuvo remisión hematológica completa. Conclusión: es posible tr atar pacientes que sufr en leucemia monoblástica aguda tipo M5, en nuestro 1Universidad Nacional Autónoma de Honduras, Facultad de Ciencias Médicas, Tegucigalpa, Honduras. 2Laboratorios Molina, Tegucigalpa, Honduras. 3Investigador Independiente, Western International School, San Pedro Sula, Honduras. Autor de correspondencia: José Angel Sánchez N., jose.skiro@gmail.com Recibido: 03/12/2020 Aceptado: 15/05/2021 medio, con quimioterapia agresiva y obtener remisión hematológica completa. La identificación temprana de complicaciones y manejo oportuno es fundamental para evitar consecuencias fatales...(AU)


Subject(s)
Humans , Female , Adult , Leukemia, Monocytic, Acute/diagnosis , Induction Chemotherapy/methods , Physical Examination , Leukemia, Myeloid , Fever
20.
Arq. Asma, Alerg. Imunol ; 5(2): 208-210, abr.jun.2021. ilus
Article in Portuguese | LILACS | ID: biblio-1398934

ABSTRACT

O angioedema hereditário por défice de C1-inibidor é uma doença rara autossômica dominante com uma prevalência estimada em 1:50.000. Habitualmente a história familiar aponta para este diagnóstico. No entanto, a apresentação atípica com história familiar negativa pode atrasar o diagnóstico de meses a anos. Os autores apresentam o caso de uma criança de 6 anos sem antecedentes pessoais ou familiares relevantes que recorreu ao Serviço de Urgência pediátrico por edema, calor e rubor do cotovelo, joelho e maléolos direitos com 12h de evolução, sem fatores associados. Ao exame objetivo: edema do cotovelo, joelho e maléolos direitos, exantema não pruriginoso maleolar homolateral com discreto desconforto à palpação. Sem elevação dos parâmetros infeciosos ou inflamatórios. Foi iniciada corticoterapia sistêmica, com melhoria lenta do quadro. Teve alta, referenciada à consulta de Imunoalergologia. Na anamnese foram apurados quatro episódios de edema periarticular nos doze meses prévios. A avaliação analítica da criança revelou C1 inibidor 62 mg/dL, C1 inibidor funcional 29%, confirmada em duas determinações, e a dos pais e dos dois irmãos foi normal. No estudo genético não foram identificadas mutações nos genes SERPING. O angioedema hereditário por défice de função do C1-inibidor - tipo II - representa 15 a 20% dos casos. Embora a história familiar seja o maior sinal de alerta para o diagnóstico desta patologia, em 20-25% dos casos ocorre mutação espontânea. Nestes casos um elevado grau de suspeição é necessário e um atraso no diagnóstico pode levar a consequências graves. As opções terapêuticas em crianças menores de 12 anos são ainda limitadas.


Hereditary angioedema with C1-inhibitor deficiency is a rare autosomal dominant disease with an estimated prevalence of 1:50 000. Usually, family history points to this diagnosis. However, atypical presentation with negative family history may delay diagnosis in months to years. The authors describe the case of a 6-year-old girl with apparently no significant family or past medical history, presenting to the emergency department for edema, warmth, and redness of the right elbow, knee, and ankle, which started 12 hours earlier, without associated factors. On physical examination, edema of the right elbow, knee, and ankle, and nonpruritic rash on the right ankle with a slight discomfort on palpation were found. Laboratory infection or inflammation markers were not elevated. Systemic corticosteroids were started, with slow improvement. She was discharged and referred to an immunoallergology outpatient clinic. On medical history taking, four episodes of periarticular edema in the past 12 months were identified. Laboratory evaluation revealed C1-inhibitor at 62 mg/dL and functional C1-inhibitor at 29%, confirmed in two samples; the parents and two siblings were normal. On genetic testing, there were no mutations on the SERPING genes. Hereditary angioedema with C1-inhibitor deficiency ­ ie, type II ­ accounts for 15 to 20% of cases. Even though family history is the major indicator for diagnosis of this condition, a de novo mutation occurs in 20 to 25% of cases. In these cases, a high suspicion is necessary, and a delayed diagnosis could have severe implications. Therapeutic options in children under the age of 12 are limited.


Subject(s)
Humans , Female , Child , Tranexamic Acid , Genetic Testing , Ibuprofen , Adrenal Cortex Hormones , Elbow , Angioedemas, Hereditary , Genes , Knee , Ankle , Mutation , Physical Examination , Therapeutics , Rare Diseases , Diagnosis , Edema , Allergy and Immunology , Delayed Diagnosis , Inflammation
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