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Arq. gastroenterol ; 57(4): 354-360, Oct.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1142334


ABSTRACT BACKGROUND: Cancer patients may have gastrointestinal changes that influence nutritional status. OBJECTIVE: To investigate the occurrence of gastrointestinal changes resulting from outpatient chemotherapy treatment in cancer patients. METHODS: In a retrospective longitudinal study, the nutritional status and chemotherapy gastrointestinal changes (nausea, vomit, diarrhea, constipation, mucositis, dysphagia, xerostomia, inappetence, dysgeusia and heartburn) in cancer patients (n=187) were investigated in an outpatient follow-up. For the study of the parameters over time, the generalized estimating equation (GEE) method was used. Kruskal-Wallis, Mann-Whitney tests and Spearman coefficient, at a significance level of 5% were also used. RESULTS: The majority of the patients were female (63.64%) and the mean age was 57.5±12.1 years. The most frequent symptoms were nausea (18.54%); inappetence (18.31%); intestinal constipation (11.58%); diarrhea (7.98%); xerostomia (7.59%) and vomiting (7.43%). The nutritional status did not exhibit any relevant changes (P=0.7594). However, a higher prevalence of eutrophy was observed, followed by overweight; vomiting exhibited a significant difference (P=0.0211). The nausea symptom exhibited a significant difference with a higher prevalence of colorectal neoplasia when compared to breast neoplasia (P=0.0062); as well as vomiting in lung and colorectal neoplasias (P=0.0022), and dysphagia, in head and neck neoplasia, when compared to other neoplasms (P<0.001). There was a statistically significant difference between the number of medical appointments and gender (P=0.0102) and between dysphagia and gender (P<0.0001). CONCLUSION: The study findings enhance the need for signs and symptoms follow up, as well as nutritional status follow up of patients undergoing outpatient chemotherapy.

RESUMO CONTEXTO: Pacientes oncológicos podem apresentar alterações gastrointestinais que influenciam o estado nutricional. OBJETIVO: Investigar a ocorrência de alterações gastrointestinais decorrentes do tratamento ambulatorial de quimioterapia, em pacientes oncológicos. MÉTODOS: Num estudo longitudinal retrospectivo, investigou-se o estado nutricional e as alterações gastrointestinais (náuseas, vômito, diarreia, constipação, mucosite, disfagia, xerostomia, inapetência, disgeusia e pirose) de pacientes oncológicos (n=187), em acompanhamento ambulatorial de quimioterapia. Para o estudo dos parâmetros ao longo do tempo, utilizou-se o método das equações de estimação generalizadas (EEG). Também foram utilizados os testes de Kruskal-Wallis, Mann-Whitney e o coeficiente de Spearman, com nível de significância de 5%. RESULTADOS: A maioria dos pacientes era do sexo feminino (63,64%) e a média de idade foi 57,5±12,1 anos. Os sintomas mais frequentes foram náuseas (18,54%); inapetência (18,31%); constipação intestinal (11,58%); diarreia (7,98%); xerostomia (7,59%) e vômito (7,43%). O estado nutricional não apresentou alterações relevantes (P=0,7594). No entanto, observou-se maior prevalência de eutrofia, seguido do sobrepeso e o vômito apresentou diferença significativa (P=0,0211). O sintoma de náusea apresentou diferença significativa com maior prevalência na neoplasia colorretal, quando comparado à neoplasia de mama (P=0,0062); assim como o vômito nas neoplasias de pulmão e colorretal (P=0,0022). E a disfagia, na neoplasia de cabeça e pescoço, quando comparada às demais neoplasias (P<0,001). Houve diferença estatisticamente significante entre o número de consultas médicas e sexo (P=0,0102) e entre disfagia e sexo (P<0,0001). CONCLUSÃO: Os achados encontrados no estudo permitem reforçar a necessidade do acompanhamento de sinais e sintomas, bem como do estado nutricional, de pacientes em acompanhamento ambulatorial de quimioterapia.

Humans , Female , Adult , Aged , Outpatients , Gastrointestinal Diseases/etiology , Neoplasms/complications , Neoplasms/drug therapy , Antineoplastic Agents/therapeutic use , Vomiting/etiology , Weight Loss , Nutritional Status , Retrospective Studies , Follow-Up Studies , Longitudinal Studies , Constipation/etiology , Diarrhea/etiology , Dyspepsia/etiology , Middle Aged , Nausea
Einstein (Säo Paulo) ; 18: eRC4641, 2020. graf
Article in English | LILACS | ID: biblio-1142873


ABSTRACT Vomiting episodes in newborns are extremely common and often attributed to gastroesophageal reflux. The symptoms of vomiting, however, may be caused by other complications. In this report, we present two cases of a 1-month-old male and a 2-month-old female, both presenting vomiting episodes that led to malnutrition. Some pediatricians often attribute the diagnosis of gastroesophageal reflux to newborns that are vomiting; however, there is a portion of the population that has other causes that lead to similar symptoms. The pediatrician should be alert to the clinical signs of weight loss, dehydration and malnutrition to investigate other causes of vomiting.

RESUMO Episódios de vômito em recém-nascidos são extremamente comuns e frequentemente atribuídos a refluxo gastresofágico. Os sintomas de vômito, no entanto, podem ser causados por outras complicações. Neste relato, apresentamos dois casos: um lactente masculino, com 1 mês de idade, e um feminino, com 2 meses, ambos apresentando episódios de vômitos que levaram à desnutrição. Alguns pediatras costumam atribuir o diagnóstico de refluxo gastresofágico a recém-nascidos que estão vomitando; mas parcela da população tem outras causas que levam a sintomas semelhantes. O pediatra deve estar atento aos sinais clínicos de perda de peso, desidratação e desnutrição, para investigar outras causas de vômitos.

Humans , Male , Female , Vomiting/etiology , Gastroesophageal Reflux/diagnostic imaging , Duodenum/diagnostic imaging , Ultrasonography , Diagnosis, Differential , Esophagus/diagnostic imaging
Chinese Acupuncture & Moxibustion ; (12): 1164-1168, 2020.
Article in Chinese | WPRIM | ID: wpr-877580


OBJECTIVE@#To observe the effect of ginger-partitioned moxibustion on digestive tract reaction, quality of life and white blood cell count after chemotherapy in advanced malignant bone tumors patients.@*METHODS@#A total of 64 patients were randomly divided into an observation group and a control group, 32 cases in each group. Both groups were treated with adriamycin combined with cisplatin (AP) chemotherapy. The patients in the control group were treated by tropisetron hydrochloride intravenous on preventing the vomiting 1 h before receiving chemotherapy. On the basis of the control group, the patients in the observation group were treated with ginger-partitioned moxibustion at Neiguan (PC 6), Zusanli (ST 36), Shenque (CV 8), and Zhongwan (CV 12) 2 h after chemotherapy, once a day, 30 min each time. The course of chemotherapy, ginger-partitioned moxibustion and tropisetron hydrochloride intravenous was 5 days. The digestive tract reaction rating, quality of life score and white blood cell count were compared 1 d before chemotherapy, 2 d after chemotherapy and 7 d after chemotherapy between the two groups.@*RESULTS@#The number of 0 grade in digestive tract reaction 2 d and 7 d after chemotherapy in the observation group was significantly higher than that in the control group (@*CONCLUSION@#Ginger-partitioned moxibustion can prevent and treat vomiting after chemotherapy in advanced malignant bone tumors, and improve the quality of life and white blood cell count of patients.

Acupuncture Points , Bone Neoplasms/drug therapy , Ginger , Humans , Moxibustion , Quality of Life , Vomiting/etiology
Clinics ; 75: e2209, 2020. tab
Article in English | LILACS | ID: biblio-1133484


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

Humans , Male , Child , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Coronavirus Infections/complications , Coronavirus Infections/mortality , Coronavirus , Pandemics , Respiration, Artificial , Vomiting/etiology , Abdominal Pain/etiology , Cross-Sectional Studies , Immunoglobulins, Intravenous/therapeutic use , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Systemic Inflammatory Response Syndrome/epidemiology , Diarrhea/etiology , Fever/etiology , Betacoronavirus , SARS-CoV-2 , COVID-19 , Glucocorticoids/therapeutic use , Mucocutaneous Lymph Node Syndrome/therapy , Mucocutaneous Lymph Node Syndrome/epidemiology , Mucocutaneous Lymph Node Syndrome/virology
Rev. bras. enferm ; 72(4): 1114-1118, Jul.-Aug. 2019. graf
Article in English | LILACS, BDENF | ID: biblio-1020515


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

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

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

Humans , Female , Adolescent , Peritonitis/complications , Cardiopulmonary Resuscitation/adverse effects , Hypothermia, Induced/methods , Appendicitis/surgery , Appendicitis/complications , Peritonitis/surgery , Vomiting/etiology , Body Temperature Regulation/physiology , Tomography, X-Ray Computed/methods , Abdominal Pain/etiology , Cardiopulmonary Resuscitation/methods , Cardiopulmonary Resuscitation/standards , Fever/etiology
Med. infant ; 25(4): 303-310, diciembre 2018. tab, ilus
Article in Spanish | LILACS | ID: biblio-970470


Introducción: La trombosis de senos venosos cerebrales (TSVC) es infrecuente en pediatría. Está asociada a condiciones como infecciones, deshidratación, fallo renal, traumatismo de cráneo, neoplasias, trastornos hematológicos, etc. Cefalea, vómitos, alteración del sensorio y hemiparesia son los síntomas más frecuentes. El diagnóstico es confirmado por TC con angio y/o RM con angio. La anticoagulación es el tratamiento de elección. Los pacientes suelen evolucionar favorablemente. Materiales y Métodos: Estudio descriptivo observacional de pacientes con TSVC atendidos en el Hospital Garrahan desde 2010 a 2017. Las variables registradas fueron: edad, sexo; manifestaciones clínicas, factores de riesgo; estudios diagnósticos, tratamiento y evolución. Resultados: Se describen 34 pacientes con TSVC. Los adolescentes fueron el grupo mayor. La cefalea fue el síntoma más frecuente. Angio TC, RM y/o angio RM confirmaron el diagnóstico; los senos transverso, sagital superior y sigmoideo fueron los más comprometidos. 21 pacientes tenían patología oncológica y 14 procesos infecciosos. El tratamiento de elección fue la anticoagulación. Tuvieron buena evolución el 82%. Conclusiones: Debemos sospechar esta entidad en dos grupos: el primero formado por lactantes y pre-escolares con patología infecciosa; y un segundo integrado por escolares y adolescentes con patología oncológica, especialmente aquellos que reciben L-ASA.Es importante resaltar el valor de la TC y angio TC para hacer diagnóstico oportuno, resultando accesible las 24 horas en el hospital

Introduction: Cerebral venous sinus thrombosis (CVST) is uncommon in children. CVST is associated with conditions, such as infections, dehydration, renal failure, head trauma, cancer, and hematological disorders. Headache, vomiting, sensory alterations, and hemiparesis are the most common symptoms. Diagnosis is confirmed by angio CT and/or MRA. Anticoagulation is the treatment of choice. Outcome is generally good. Material and Methods: An observational, descriptive study of patients with CVST seen at Garrahan Hospital between 2010 and 2017. The following variables were recorded: age, sex; clinical manifestations, risk factors; diagnostic studies, treatment, and outcome. Results: 34 patients with CVST were studied. Most patients were adolescents. Headache was the most common symptom. Angio CT, MRI, and/or MRA confirmed the diagnosis; the transverse, superior sagittal, and sigmoid sinuses were most frequently affected. Of the patients, 21 had oncological disease and 14 infections. Anticoagulation was the treatment of choice. Outcome was good in 82%. Conclusions: CVST should be suspected in the following two groups: A first group consisting of infants and preschool children with infections and a second group of school-age children and adolescents with cancer, especially those receiving L-ASA. It is important to highlight the role of CT and angio CT for early diagnosis as the study is available day and night at the hospital.

Humans , Infant , Child, Preschool , Child , Adolescent , Sinus Thrombosis, Intracranial/complications , Sinus Thrombosis, Intracranial/diagnosis , Sinus Thrombosis, Intracranial/diagnostic imaging , Vomiting/etiology , Cerebral Veins/diagnostic imaging , Headache/etiology , Sinus Thrombosis, Intracranial/drug therapy , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Prospective Studies , Anticoagulants/therapeutic use
Rev. gaúch. enferm ; 39: e20180095, 2018. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-978499


Resumo OBJETIVO Identificar as reações adversas ligadas à infusão de células-tronco hematopoéticas no dia zero do transplante de células-tronco hematopoéticas. MÉTODO Revisão integrativa da literatura, sem recorte temporal, a partir de fontes de informação: PubMed, CINAHL, SCOPUS, BVS, SciELO, Web of Science e CAPES; a amostra final foi constituída por dezoito artigos científicos, publicados entre 1998 e 2017, com base nos critérios de inclusão e exclusão. RESULTADOS Reações adversas leves e moderadas foram mais frequentes nos estudos que utilizaram a classificação por severidade, sendo náusea e êmese as de maior incidência; os sistemas orgânicos mais afetados foram o cardiovascular, respiratório e gastrointestinal. CONCLUSÕES As principais reações adversas identificadas nos estudos foram náusea e êmese. As classificadas como leves e moderadas foram as mais frequentes nos estudos que utilizaram a classificação por severidade; e os sistemas cardiovascular, respiratório e gastrointestinal foram os mais afetados naqueles que utilizaram a classificação por sistemas orgânicos.

Resumen OBJETIVO Identificar las reacciones adversas ligadas a la infusión de células madre hematopoyéticas en el día cero del trasplante de células madre hematopoyéticas. METODOLOGÍA Revisión integrativa de la literatura, sin recorte temporal, a partir de los siguientes bancos de datos: PubMed, CINAHL, SCOPUS, BVS, SciELO, Web of Science y CAPES; la muestra final fue constituida por 18 artículos científicos, publicados entre 1998 y 2017, sobre la base de los criterios de inclusión y exclusión. RESULTADOS Las reacciones adversas leves y moderadas fueron las más frecuentes en los estudios que utilizaron la clasificación por severidad, siendo náuseas y vómito las de mayor incidencia; los sistemas orgánicos más afectados fueron el cardiovascular, respiratorio y gastrointestinal. CONCLUSIÓN Las principales reacciones adversas identificadas en los estudios fueron náuseas y éstas. Las clasificadas como leves y moderadas fueron las más frecuentes en los estudios que utilizaron la clasificación por severidad; y los sistemas cardiovascular, respiratorio y gastrointestinal fueron los más afectados en aquellos que utilizaron la clasificación por sistemas orgánicos.

Abstract OBJECTIVE To identify the adverse reactions associated with the infusion of hematopoietic stem cells on day zero of hematopoietic stem cell transplantation. METHODOLOGY Integrative literature review, without temporal cut, with search in the following databases: PubMed, CINAHL, SCOPUS, BVS, SciELO, Web of Science and CAPES; the final sample consisted of 18 scientific articles, published between 1998 and 2017, based on the inclusion and exclusion criteria. RESULTS Mild and moderate adverse reactions were the most frequent in studies that used the classification by severity, and nausea and emesis had the highest incidence; the most affected organ systems were the cardiovascular, respiratory and gastrointestinal. CONCLUSION The main adverse reactions identified in the studies were nausea and emesis. Those classified as mild and moderate were the most frequent in the studies that used the severity classification; and the cardiovascular, respiratory and gastrointestinal systems were the most affected in those that used the classification by organic systems.

Humans , Postoperative Complications/etiology , Hematopoietic Stem Cell Transplantation/adverse effects , Respiration Disorders/etiology , Time Factors , Vomiting/etiology , Cardiovascular Diseases/etiology , Cryopreservation , Cryoprotective Agents , Epoxy Compounds/adverse effects , Gastrointestinal Diseases/etiology , Nausea/etiology
Medwave ; 18(2): e7184, 2018.
Article in English, Spanish | LILACS | ID: biblio-911926


INTRODUCCIÓN: El cáncer de vesícula biliar es una neoplasia poco común, y su frecuencia es variable en las regiones de Perú. OBJETIVO: Determinar la frecuencia y describir las características clínicas del cáncer de vesícula biliar en un hospital de referencia al sur de Perú. MÉTODOS: Estudiamos los informes de todas las muestras de colecistectomías realizadas entre los años 2009 y 2014, en el servicio de anatomía patológica del Hospital Regional Honorio Delgado. Además, revisamos las historias clínicas de los pacientes que tuvieran algún resultado compatible con cáncer de vesícula biliar. RESULTADOS: De 2991 colecistectomías, 75 (2,5%) tuvieron cáncer de vesícula biliar. El síntoma más frecuente en ambos grupos fue el dolor (96,7%), seguido de náusea (87,5%) y vómitos (65,0%). La mayoría de pacientes fueron mujeres (83,3%) mayores de 60 años (65,0%). El tipo histológico más frecuente fue el adenocarcinoma (80,0%). CONCLUSIÓN: La frecuencia de cáncer de vesícula biliar en un hospital de referencia del sur de Perú, es de 2,5% mayor a la reportada en otros estudios en las regiones centro y norte del país.

INTRODUCTION: Gallbladder cancer is a rare neoplasm, its frequency is variable in the regions of Peru. OBJECTIVE: To determine the frequency and describe the clinical characteristics of gallbladder cancer in southern Peru. METHODS: The reports of the anatomopathological department of the Honorio Delgado Regional Hospital were selected from all samples of cholecystectomies performed between 2009 and 2014 and those that had some result compatible with gallbladder cancer were looked for. Subsequently, the clinical histories were searched to obtain the characteristics of these patients. RESULTS: Of 2991 cholecystectomies, 75 (2.5%) had gall bladder cancer. The most frequent symptom in both groups was pain (96.7%), followed by nausea (87.5%) and vomiting (65.0%). The majority of patients were women (83.3%) older than 60 years (65.0%). The most frequent histological type was the adenocarcinoma (80.0%). CONCLUSION: The frequency of gallbladder cancer in a reference hospital in southern Peru is 2.51%, higher than that reported in other studies in the central and northern regions of Peru.

Humans , Male , Female , Middle Aged , Cholecystectomy , Adenocarcinoma/epidemiology , Gallbladder Neoplasms/epidemiology , Pain/etiology , Pain/epidemiology , Peru/epidemiology , Vomiting/etiology , Vomiting/epidemiology , Adenocarcinoma/diagnosis , Adenocarcinoma/pathology , Retrospective Studies , Sex Distribution , Age Distribution , Gallbladder Neoplasms/diagnosis , Gallbladder Neoplasms/pathology , Nausea/etiology , Nausea/epidemiology
Encarnación; s.n; 2017; 2017. 57 p. ilus; tab; graf.
Thesis in Spanish | LILACS | ID: biblio-1021608


Introducción: La Terapia Nutricional Enteral (TNE) en el paciente crítico forma parte del manejo integral y se asociada a una mejor evolución clínica. Objetivo: Determinar el porcentaje de adecuación de la TNE y la relación con la evolución en pacientes adultos críticos durante su estancia en el Sanatorio San Sebastián en el año 2016 al 2017. Materiales y Métodos: Estudio Observacional, descriptivo, prospectivo con componente analítico en pacientes adultos críticos de la Unidad de Cuidados Intensivos (UCI) que cumplieron con los criterios de inclusión. Se evaluaron 54 pacientes críticos sometidos a NE mayores de 18 años de edad de ambos sexos desde el periodo 2016 al 2017. Se consideró un porcentaje de adecuación calórico-proteica como suficiente a partir de ≥ 70%. Resultados: El 85,2% recibió un aporte calórico suficiente y un aporte proteico suficiente, el 59,3%. El promedio de calorías y proteínas administradas fueron de 1303 ±308 kcal y 62,26 ±30,8 gr respectivamente, mientras que la adecuación calórica alcanzada fue 86 ±16% y la proteica 72,8 ±22,9%. La complicación gastrointestinal más frecuente fue la diarrea y Residuo Gástrico aumentado (RG). Conclusión: Aunque no se observaron diferencias significativas entre aporte calórico y proteico con los días de ventilación mecánica, estancia hospitalaria y mortalidad; no se descarta la posibilidad que los mismos resulten significativos con una población más homogénea y numerosa, junto con un aumento de los días de evaluación.

Introduction: Enteral Nutritional Therapy (ENT) is part of an integral management and has been associated to better clinical outcomes in critically ill adult patients. Purpose: To determine the percentage of adequacy to ENT and its relationship with clinical outcomes in critically ill adult patients during their stay at the Sanatorio San Sebastián from 2016 to 2017. Material and methods: Observational, descriptive, cross-sectional study with analytic component in critically ill adult patients admitted to the ICU who met the inclusion criteria. 54 patients of both sexes, over 18 years old with EN were studied during the evaluation period between 2016-2017. It was considered as a goal a percentage of caloric-protein adequacy of ≥ 70%. Results: 85.2% received a sufficient caloric intake and the 59.3% also received sufficient protein intake. The average intake of calories and protein were 1303 ±308 kcal and 62,26 ±30,8 gr respectively, while the adequacy of calories was 86 ±16% and protein 72,8 ±22,9%. The most common gastrointestinal complication was diarrhea and the increase in gastric residue. Conclusions: Although there was no statistical significant difference between the amount of energy and protein intake with days of mechanical ventilation, length of hospital stay and mortality, the possibility that these could be significant with a more homogeneous and numerous population, together with an increase of the evaluation days, is not ruled out

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Critical Illness/therapy , Enteral Nutrition , Critical Care Outcomes , Intensive Care Units , Nutritional Requirements , Paraguay , Vomiting/etiology , Energy Intake , Prospective Studies , Enteral Nutrition/adverse effects , Malnutrition/complications , Malnutrition/prevention & control , Diarrhea/etiology , Diet, High-Protein , Gastrointestinal Contents
Rev. chil. pediatr ; 87(6): 449-454, Dec. 2016. tab
Article in Spanish | LILACS | ID: biblio-844564


Introducción: La alergia a proteína de leche de vaca (APLV) es frecuente en lactantes (2-5% en < 1 año). Tiene múltiples formas de presentación y un amplio diagnóstico diferencial, por lo que es relevante confirmar el diagnóstico. El estándar de oro del diagnóstico es el test de provocación oral (TPO), que en la práctica no siempre se realiza. En Chile hay escasa literatura respecto a esta entidad. Objetivo: Describir características demográficas, clínicas y manejo de lactantes < 1 año con sospecha de APLV. Pacientes y Método: Estudio retrospectivo en menores de 1 año atendidos por sospecha de APLV entre 2009-2011. Se registraron datos demográficos, historia perinatal, antecedentes de atopia, alimentación al momento del diagnóstico, síntomas de sospecha de APLV, estudios realizados para su confirmación, y respuesta a tratamiento. Se consideró como estándar de diagnóstico la respuesta a la dieta y la contraprueba. Se definió como respuesta a la dieta la ausencia de los síntomas atribuidos a la APLV al menos 4 semanas desde el cambio de leche. Se realizó estadística descriptiva mediante programa Epiinfo™. Resultados: Se incluyeron 106 lactantes, 51% varones, 80% recién nacidos de término, 74% con al menos un progenitor atópico, 34% con alguno de los padres o algún hermano con alergia alimentaria. La mediana de edad al inicio fue 1,5 meses (rango: 1,5-2 m). El 15% recibió fórmula desde el período neonatal y el 50% antes del tercer mes. Los síntomas más frecuentes fueron: vómitos (63%), cólicos (50%) y rectorragia (40%); el 61% presentó ≥ 2 síntomas al comienzo. Solo en el 34% se hizo TPO, en el resto se evaluó la respuesta a la dieta de exclusión y se realizaron exámenes. La realización de exámenes no cambió la conducta. Tratamiento: 43% lactancia materna con dieta de exclusión, 24% solo fórmula extensamente hidrolizada, 26% solo fórmula aminoacídica y 7% otros. Conclusión: Las características demográficas y antecedentes de los pacientes concuerdan con lo descrito en la literatura extranjera. El inicio clínico fue precoz, predominando los síntomas digestivos. Se realizaron exámenes en una proporción alta de pacientes, sin contribuir a un cambio de conducta; el TPO fue subutilizado como herramienta diagnóstica.

Introduction: Cow's milk protein allergy (CMPA) is highly prevalent in infants (2-5%). It has a wide clinical spectrum, and confirmation through an oral food challenge (OFC) is relevant for its differential diagnosis. Information on this topic is scarce in Chile. Objective: To describe the demographic and clinical features of infants with suspected CMPA. Patients and Method: A retrospective study of patients < 1 year-old, treated for suspected CMPA between 2009 and 2011. Demographic data, symptoms of atopy, nutrition at the time of diagnosis, CMPA symptoms, diagnostic studies, and response to treatment were recorded. Diet response at least 4 weeks after milk modification, and clinical behavior when suspected foods were added back to the diet were considered standard diagnostic criteria. Descriptive statistics were performed using Epiinfo ™ software. Results: The study included 106 infants, of whom, 51% male, 80% term newborns, 74% with ≥ 1 atopic parent, and 34% with ≥ 1 parent/sibling with food allergy. The median age at onset of symptoms was 1.5 months (range 1.5-2 m). Almost half (46%) were breast-feeding ≥ 6 m, with 15% receiving formula milk since the neonatal period, and 49% before the third month. Common symptoms were: vomiting (63%), colic (49%), and bleeding on passing stools (41%). No anaphylaxis was identified, and 61% had ≥ 2 symptoms at debut. Only 34% were subjected to OFC. The most frequently requested tests were, test patch (43%), prick test (40%), and blood in stools (37%). Treatment: 43% breast feeding with exclusion diet, 24% extensively hydrolysed formula, 26% amino acid formula, and 7% others. Conclusion: Demographic characteristics and risk factors were similar to those previously described in international literature. Clinical presentation was early in life, and digestive symptoms predominated. OFC was underused for diagnosis, and most of the tests requested did not change management.

Humans , Male , Female , Infant, Newborn , Infant , Vomiting/etiology , Colic/etiology , Milk Hypersensitivity/diagnosis , Milk Proteins/adverse effects , Vomiting/epidemiology , Breast Feeding , Chile , Colic/epidemiology , Prevalence , Retrospective Studies , Risk Factors , Milk Hypersensitivity/epidemiology , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/epidemiology , Milk Proteins/immunology
Rev. pediatr. electrón ; 13(3): 18-23, oct. 2016. ilus
Article in Spanish | LILACS | ID: biblio-836299


La estenosis hipertrófica del píloro (EHP) es una patología quirúrgica común en la edad pediátrica. Apesar de ser una condición frecuente, su etiología aún no está claramente dilucidada. La presentación clínica corresponde a vómitos explosivos lácteos, no biliosos y en algunos casos oliva palpable en el abdomen u ondas peristálticas luego de ser alimentados. Si bien el manejo resolutivo de esta patología requiere la intervención del cirujano infantil, la sospecha inicial incluye al médico general y pediatra. Este artículo presenta una revisión de la literatura disponible sobre el tema.

Hypertrophic pyloric stenosis (EHP) is a common surgical pathology in children. Despite being a common condition, its etiology is not yet clearly known. The clinical presentation corresponds to milky, explosive and nonbilious threw up, and in some cases palpable olive in the abdomen or peristaltic waves after being fed. While surgical management of this condition requires the intervention of child surgeon, the initial suspicion includes the general physician and pediatrician. This article presents a review of the available literature on the subject.

Humans , Male , Female , Infant , Pyloric Stenosis, Hypertrophic/diagnosis , Pyloric Stenosis, Hypertrophic/therapy , Diagnosis, Differential , Pyloric Stenosis, Hypertrophic/complications , Prognosis , Vomiting/etiology
Rev. chil. pediatr ; 87(2): 137-142, abr. 2016. ilus
Article in Spanish | LILACS | ID: lil-783496


Introducción Los quistes de la vía biliar o quistes de colédoco (QC) son una patología rara en nuestro medio. La etiología es desconocida, siendo la hipótesis más aceptada las anomalías en la unión biliopancreática. Objetivo Analizar los datos clínicos, diagnóstico y tratamiento de una serie de pacientes diagnosticados de QC y realizar una actualización sobre el tema. Metodo Se revisaron retrospectivamente los diagnósticos de QC en 20 años en un hospital terciario. Casos clínicos Se identificaron 4 casos, con predominio del sexo femenino. Rango de edad 16 meses a 4 años. Los signos y síntomas fueron ictericia y coluria (100%), vómitos (75%), dolor abdominal y acolia (50%). Ninguno tuvo masa palpable. La ecografía abdominal orientó el diagnóstico que se confirmó con colangio-resonancia magnética (colangio-RM). Se clasificaron como QC tipo I tres de los casos y uno como tipo IVa. El tratamiento fue quirúrgico, ningún paciente presentó complicaciones hasta la fecha. Conclusiones Los quistes de las vías biliares son de baja prevalencia. El tratamiento de elección es quirúrgico, requiriendo seguimiento estrecho, dado el riesgo de colangiocarcinoma.

Introduction Cysts of the bile duct or choledochal cysts are rare diseases in our area. The aetiology is unknown, with the most accepted hypothesis being a pancreatobiliary maljunction anomaly. Objective To analyse the clinical data, diagnosis and treatment of a number of patients with choledochal cyst, as well as presenting an update on this condition. Method A retrospective descriptive study was performed on paediatric patients diagnosed with choledochal cyst in the last 20 years in a tertiary hospital. Case reports A total of 4 choledochal cyst cases in childhood, predominantly female, are pre- sented. The most frequent reason for consultation was vomiting, and presenting with jaundice and choluria in all cases. Patients with choledochal cyst were classified as type I in 3 cases, and one case of type IVa. In all cases surgical treatment was performed; any patient had complications to date. Conclusions Cysts of the bile ducts have a low prevalence. The treatment of choice is surgical, requiring close monitoring due to the risk of cholangiocarcinoma.

Humans , Male , Female , Infant , Vomiting/etiology , Jaundice/etiology , Choledochal Cyst/diagnosis , Choledochal Cyst/pathology , Retrospective Studies
Article in English | WPRIM | ID: wpr-218580


Transurethral resection has been the gold standard in the operative management of benign prostatic hyperplasia and bladder tumor; however, it is associated with several complications that may cause patient discomfort. We evaluated the usefulness of continuous infusion of dexmedetomidine on emergence agitation, hemodynamic status, and recovery profiles in patients undergoing elective surgery by a randomized clinical trial. Sixty patients aged 30 to 80 yr who were scheduled for elective transurethral resection under general anesthesia were included in this study. Participants were randomly assigned to two groups (control group, group C; dexmedetomidine group, group D). A total of 60 male patients were enrolled in this study and randomly assigned to group C (n=30) or group D (n=30). The quality of emergence in group D was marked by a significantly lower incidence of emergence agitation than in group C (P=0.015). Patients in group D therefore felt less discomfort induced by the indwelling Foley catheter than those in group C (P=0.022). No statistically significant differences were found between the two groups with respect to side effects including bradycardia (P=0.085), hypotension (P=0.640), and postoperative nausea and vomiting (P=0.389). Our study showed that intraoperative dexmedetomidine infusion effectively reduced the incidence and intensity of emergence agitation and catheter-induced bladder discomfort without delaying recovery time and discharge time, thus providing smooth emergence during the recovery period in patients undergoing transurethral resection (Clinical Trial Registry No. KT0001683).

Adult , Aged , Aged, 80 and over , Blood Pressure , Bradycardia/etiology , Dexmedetomidine/adverse effects , Hemodynamics , Humans , Hypnotics and Sedatives/adverse effects , Hypotension/etiology , Male , Middle Aged , Nausea/etiology , Prostatic Hyperplasia/surgery , Psychomotor Agitation/drug therapy , Transurethral Resection of Prostate , Vomiting/etiology
Yonsei Medical Journal ; : 254-259, 2016.
Article in English | WPRIM | ID: wpr-220774


PURPOSE: Glufosinate poisoning can cause neurologic complications that may be difficult to treat due to delayed manifestation. Studies assessing possible predictors of complications are lacking. Although serum ammonia level is a potential predictor of severe neurotoxicity, it has only been assessed via case reports. Therefore, we investigated factors that predict neurologic complications in acute glufosinate-poisoned patients. MATERIALS AND METHODS: We conducted a retrospective review of 45 consecutive glufosinate-poisoning cases that were diagnosed in the emergency department (ED) of Wonju Severance Christian Hospital between May 2007 and July 2014. Patients with a Glasgow Coma Scale (GCS) score of <8, seizure, and/or amnesia were defined to a neurologic complication group. RESULTS: The neurologic complication group (29 patients, 64.4%) comprised patients with GCS<8 (27 patients, 60.0%), seizure (23 patients, 51.1%), and amnesia (5 patients, 11.1%). Non-neurologic complications included respiratory failure (14 patients, 31.1%), intubation and ventilator care (23 patients, 51.1%), shock (2 patients, 4.4%), pneumonia (16 patients, 35.6%), acute kidney injury (10 patients, 22.2%), and death (4 patients, 8.9%). Complications of GCS<8, seizure, respiratory failure, and intubation and ventilator care appeared during latent periods within 11 hrs, 34 hrs, 14 hrs, and 48 hrs, respectively. Initial serum ammonia was a predictor of neurologic complications [odds ratio 1.039, 95% confidence interval (1.001-1.078), p=0.046 and area under the curve 0.742]. CONCLUSION: Neurologic complications developed in 64.4% of patients with acute glufosinate poisoning. The most common complication was GCS<8. Initial serum ammonia level, which can be readily assessed in the ED, was a predictor of neurologic complications.

Adult , Aged , Aged, 80 and over , Aminobutyrates/blood , Ammonia/blood , Emergency Service, Hospital , Female , Glasgow Coma Scale , Humans , Male , Middle Aged , Nausea/etiology , Neurotoxicity Syndromes/blood , Respiratory Insufficiency/etiology , Retrospective Studies , Seizures/etiology , Severity of Illness Index , Vomiting/etiology
Gastroenterol. latinoam ; 26(supl.1): S32-S36, 2015. tab
Article in Spanish | LILACS | ID: biblio-868973


Vomiting is a reflex action of motor and autonomous responses, resulting in violent expulsion of gastric contents through the mouth, triggered by humoral and neural stimuli. It must be distinguished from regurgitation or gagging. Nausea, on the other hand, is a subjective uncomfortable feeling that most people have experienced and is generally described as an imminent need to vomit, felt in the epigastrium and throat. These can be symptoms of a series of pathologies, and represent a reason for frequent consultation at emergency health care units. Both acute and chronic occurrence must be assessed carefully to identify its etiological agent in order to administer proper treatment focused on the symptoms. Nausea and vomiting during pregnancy, after chemotherapy, and cyclic vomiting syndrome will be further developed. In addition, nausea and vomiting treatment in the emergency room is reviewed.

El vómito es un reflejo coordinado de respuestas motoras y autonómicas que resulta en la expulsión violenta del contenido gástrico por la boca, activado por estímulos humorales o neuronales. Debe distinguirse de regurgitación o arcadas. La náusea, por otro lado, es una sensación subjetiva desagradable que la mayoría de las personas han experimentado en algún momento de su vida y, por lo general, reconocen como una sensación de inminente vómito, en el epigastrio o garganta. Son un síntoma de una pléyade de diversas patologías, y corresponde a un motivo de consulta frecuente en servicios de urgencia. Tanto su presentación aguda, como crónica deben ser evaluadas en forma integral de modo de identificar la etiología y poder brindar un tratamiento, tanto sintomático como dirigido. Las náuseas y vómitos en el embarazo, en relación a quimioterapia, y el síndrome de vómito cíclico serán abordados en profundidad. Del mismo modo se realiza una revisión del tratamiento de náuseas y vómitos indiferenciados, en el servicio de urgencia.

Humans , Nausea/diagnosis , Nausea/etiology , Nausea/therapy , Vomiting/diagnosis , Vomiting/etiology , Vomiting/therapy
Article in English | WPRIM | ID: wpr-79647


Epidemiological data of Bordetella pertussis infection among adolescents and adults are limited in Korea. Patients (> or = 11 yr of age) with a bothersome cough for less than 30 days were enrolled during a 1-yr period at 22 hospitals in Korea. Nasopharyngeal swabs were collected for polymerase chain reaction (PCR) and for bacteriologic culture. In total, 490 patients were finally enrolled, and 34 (6.9%) patients tested positive for B. pertussis; cough duration (14.0 days [7.0-21.0 days]) and age distribution were diverse. The incidence was the highest in secondary referral hospitals, compared to primary care clinics or tertiary referral hospitals (24/226 [10.6%] vs. 3/88 [3.4%] vs. 7/176 [4.0%], P = 0.012), and the peak incidence was observed in February and August (15.8% and 15.9%), with no confirmed cases between March and June. In the multivariate analysis, post-tussive vomiting was significantly associated with pertussis (odds ratio, 2.508; 95% confidence interval, 1.146-5.486) and secondary referral hospital showed a borderline significance. In conclusion, using a PCR-based method, 6.9% of adolescent and adult patients with an acute cough illness had pertussis infection in an outpatient setting. However, hospital levels and seasonal trends must be taken into account to develop a better strategy for controlling pertussis.

Adolescent , Adult , Bordetella pertussis/genetics , Child , DNA, Bacterial/analysis , Demography , Female , Humans , Incidence , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Polymerase Chain Reaction , Republic of Korea/epidemiology , Seasons , Vomiting/etiology , Whooping Cough/epidemiology , Young Adult
Rev. chil. pediatr ; 84(6): 641-649, dic. 2013. tab
Article in Spanish | LILACS | ID: lil-703287


Introducción: La calidad de vida y estado nutricional del lactante con alergia a la proteína de leche de vaca (APLV) pueden comprometerse sin un adecuado diagnóstico y tratamiento oportuno. Objetivo: Describir síntomas digestivos, antecedentes familiares y perinatales, estado nutricional y respuesta de lactantes < 12 meses con APLV entre junio de 2007 y agosto de 2011. Pacientes y Método: Estudio retrospectivo, descriptivo en lactantes < 12 meses de edad que consultan por sospecha de APVL. Se investigaron antecedentes familiares, perinatales y características clínicas. Se excluyó a los casos sin prueba de alimentación o provocación abierta, o cuyo motivo de consulta correspondió a otra patología. Se usó el programa STATA especial edición 11,1 para el análisis estadístico. Se consideró estadístico y significativo un p < 0,05. Resultados: Se diagnosticaron 40 lactantes (57,5 por ciento varones), edad 3,0 +/- 0,4 meses, clínica de 2 +/- 0,3 meses de: vómito/regurgitación: 20, diarrea sanguinolenta: 8, falla en el crecimiento: 4, cólico/irritabilidad: 4, deposición normal con sangre en 3. Los antecedentes familiares y perinatales fueron ingesta de biberón en la 1ª semana de vida: 35, madre > 30 años: 31 casos, atopia en 2 familiares (padres/hermanos): 28, parto por cesárea: 27. Al seguimiento de 14 +/- 1,4 meses, 19 respondieron a fórmula ampliamente hidrolizada +/- seno; 19 a fórmula de aminoácidos +/- seno y un paciente lactancia exclusiva. El Z-score de P/E:-1,05 +/- 1,28; T/E: -0,96 +/- 1,60; IMC: -0,61 +/- 1,03 en primera consulta, mejoró al año: P/E: -0,15 +/- 1,24; T/E: -0,29 +/- 1,14 e IMC: -0,04 +/- 1,20 (p < 0,05), independiente de la fórmula (p = NS). Veintitres toleraron leche entera al año. Conclusiones: En este estudio los síntomas predominantes al inicio de los pacientes con APLV fueron vómitos, regurgitación y diarrea sanguinolenta. Entre los antecedentes destacan la exposición temprana a PLV, atopia familiar y parto por cesárea...

Introduction: Quality of life and nutritional status of infants with cow's milk protein allergy (CMA) can be compromised without a proper diagnosis and treatment. Objective: To describe digestive symptoms, family and perinatal history and nutritional status of < 12 month infants with CMA between June 2007 and August 2011. Patients and Method: A retrospective and descriptive study in < 12 month old infants suspecting CMA was performed. Family history, perinatal and clinical characteristics were studied. Cases without food test or open challenge test, or whose reason for consultation corresponded to other pathology were excluded. The program STATA 11.1 was used for statistical analysis and p < 0.05 was considered statistically significant. Results: 40 infants (57.5 percent boys), age 3 +/- 0.4 months and history of 2 +/- 0.3 months presenting the following: 20 of them (50 percent, vomiting/regurgitation; 8 (20 percent, bloody diarrhea; 4 (10 percent) failure to thrive; 4 (10 percent), colic/irritability and bloody normal deposition was present in 3 individuals (7.5 percent). Family and perinatal history: 35 (87.5 percent were bottle-fed during the first week of life; 31 (77.5 percent) had > 30 year old mothers; 28 (70 percent described 2 family members (parents/siblings) with atopy; 27 (67.5 percent were delivered via cesarean. At the 14 +/- 1.4-month follow-up, 19 (47.5 percent responded to extensively hydrolyzed formula +/- breastfeeding; 19 to amino acid formula +/- breastfeeding and one patient to breastfeeding exclusively. The Z -score for P/E was: -1.05 +/- 1.28; T/E: -0.96 +/- 1.60; BMI: -0.61 +/- 1.03 in the first consultation; after a year, scores improved: P/E: -0.15 +/- 1.24; T/E: -0.29 +/- 1.14 and BMI: -0.04 +/- 1.20 (p < 0.05), independent from formula (p = NS). 23 (74 percent) tolerated whole milk when reached a year old. Conclusions: In this study, the predominant early symptoms were...

Humans , Male , Animals , Female , Infant , Digestive System Diseases/etiology , Milk Hypersensitivity/diagnosis , Milk Hypersensitivity/therapy , Milk Proteins/adverse effects , Diarrhea/etiology , Milk Hypersensitivity/epidemiology , Infant Formula , Nutritional Status , Milk Proteins/administration & dosage , Retrospective Studies , Risk Factors , Laryngopharyngeal Reflux/etiology , Skin Tests , Vomiting/etiology
Invest. clín ; 54(3): 299-310, sep. 2013. ilus, tab
Article in Spanish | LILACS | ID: lil-740327


El dengue se caracteriza por fiebre, cefalea, artralgia y mialgia. La presencia de signos y síntomas gastrointestinales (SSGI), se considera señal de alarma en dengue; sin embargo, existe poca información respecto a la ocurrencia de estas manifestaciones. El objetivo de este estudio fue determinar la frecuencia de signos y síntomas gastrointestinales en una cohorte de pacientes con dengue. Se revisaron 1484 fichas clínicas de pacientes con diagnóstico confirmado de dengue, clasificados como: dengue con signos de alarma (DCSA) (n=700); sin signos de alarma (DSSA) (n=700) y dengue grave (DG) (n=84). El 65,71% de los pacientes con DSSA, el 92,59% DCSA y el 100% de los pacientes con DG presentaron SSGI. En los pacientes con DSSA, las náuseas/vómitos fue el síntoma más frecuente 319/700 (45,57%), seguido de dolor abdominal 142/700 (20,29%) y diarrea 125/700 (17,86%). No se registraron casos con melena, hepatomegalia y/o hematemesis. Mientras que en DCSA las náuseas/vómitos estuvieron en 529/700 (75,57%), dolor abdominal 439/700 (62,71%) y diarrea 198/700 (28,28%), fueron los más frecuentes (p<0,0001). Melena, hematemesis y hepatomegalia variaron de 0,57% a 1,86%. En DG, las náuseas/vómitos se registraron en el 100%, dolor abdominal 82/84 (97,62%), diarrea 65/84 (77,38%), melena 32/84 (38,10%), hepatomegalia 28/84 (33,33%) y hematemesis 26/84 (30,95%). Se evidencia alta frecuencia de SSGI en los casos de DCSA y DG a diferencia de DSSA, en los cuales fue significativamente menor. Se sugiere relación de los SSGI con la severidad del dengue y su presencia debe considerarse en la toma de decisiones del equipo de salud para el manejo adecuado del paciente.

Dengue is characterized by fever, headache, arthralgia and myalgia. The presence of gastrointestinal signs and symptoms (GISS) is considered a sign of alarm in dengue; however, little information exists regarding the occurrence of these events. The aim of this study was to determine the frequency of gastrointestinal signs and symptoms in a cohort of patients with dengue. A total of 1484 medical records of patients with confirmed dengue were reviewed and classified as: dengue without warning signs (DNWS) (n = 700), dengue with warning signs (DWWS) (n = 700) and severe dengue (SD) (n = 84). Of the studied records, 65.71% of patients with DNWS, 92.59% with DWWS and 100% of patients with SD had GISS. In patients with DNWS, nausea / vomiting were the most common symptoms in 319/700 cases (45.57%), followed by abdominal pain in 142/700 (20.29%) and diarrhea in 125/700 (17.86%). There were no cases with melena, hepatomegaly or hematemesis. While in DWWS nausea/vomiting were present in 529/700 (75.57%), abdominal pain in 439/700 (62.71%) and diarrhea in 198/700 (28.28%),(p <0.0001). Melena, hematemesis and hepatomegaly ranged from 0.57% to 1.86% of cases. In SD, nausea/vomiting were registered in 100% of the cases, abdominal pain in 82/84 (97.62%), diarrhea in 65/84 (77.38%), melena in 32/84 (38.10%), hepatomegaly in 28/84 (33.33%) and hematemesis in 26/84 (30.95%). It was evident the high frequency of GISS in cases of DWWS and SD, in contrast to DNWS, in which the frequency of GISS was significantly lower. This suggests a relationship of GISS with the severity of dengue, and their presence should be considered by the decision-making health team for appropriate patient management.

Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Young Adult , Dengue/complications , Gastrointestinal Diseases/etiology , Abdominal Pain/etiology , Cohort Studies , Dengue/epidemiology , Diarrhea/etiology , Endemic Diseases , Gastrointestinal Hemorrhage/etiology , Hepatomegaly/etiology , Nausea/etiology , Venezuela/epidemiology , Vomiting/etiology