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Infectio ; 25(2): 89-92, abr.-jun. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1250073


Resumen Objetivo: Detectar la presencia de Enterobacterias productoras de carbapenemasas en hisopados rectales de neonatos mediante técnica de nefelometría láser y caracterización del tipo de carbapenemasa mediante test inmunocromatográfico. Materiales y Métodos: Estudio descriptivo de corte transversal. Fueron incluidos 57 neonatos, tamizados al ingreso a UCI, mediante hisopado rectal, procesado por nefelometría laser HB&L Carbapenemase (Alifax®) y caracterización del tipo de carbapenemasa por inmunocromatografía rápida RESIST-3 (Coris BioConcept®). Resultados: Encontramos un alto porcentaje de colonización rectal (22.9%) correspondiente a 13 hisopados positivos y 44 (77.1%) fueron negativos por nefelometría láser. Por VITEK 2® se obtuvo identificación de Klebsiella pneumoniae resistente a carbapenémicos en los 13 aislamientos y el test inmunocromatográfico reveló la presencia de carbapenemasas blaKPC en estos aislamientos. Discusión: Estudios evidencian el aumento de la colonización por microorganismos productores de carbapenemasas en neonatos. Los resultados de este estudio demuestran que un porcentaje significativo de neonatos que ingresan a las Unidades de Cuidado Neonatal se encuentran colonizados con Enterobacterias productoras de carbapenemasas en tracto intestinal. Lo anterior constituye un riesgo potencial para su diseminación y posterior desarrollo de brotes, en donde surge la importancia de implementar estrategias de vigilancia activa como la tamización rectal para la detección oportuna de neonatos colonizados.

Abstract Objective: To detect the presence of carbapenemase-producing Enterobacteriaceae in rectal swabs of neonates by means of laser nephelometry technique and characterization of the type of carbapenemase by immunochromatographic test. Materials and Methods: Descriptive cross-sectional study. 57 neonatal patients were included; They underwent rectal screening upon admission to the ICU, using swabs which were processed by HB&L Carbapenemase laser nephelometry (Alifax®) and characterization of the type of carbapenemase by RESIST-3 rapid immu nochromatography (Coris BioConcept®). Results: We found a high percentage of rectal colonization (22.9%) corresponding to 13 positive swabs and 44 samples (77.1%) were negative by laser nephelome try. Identification of carbapenem-resistant Klebsiella pneumoniae was obtained by VITEK 2® in the 13 isolates and the immunochromatographic test revealed the presence of blaKPC carbapenemases in these isolates. Discussion: Studies show increased colonization by carbapenemase-producing microorganisms in neonates. The results of this study demonstrate that a significant percentage of neonates who enter Neonatal Care Units are colonized with Enterobacteriaceae that produce carbapenemases in the intestinal tract. This constitu tes a potential risk for its spread and subsequent development of outbreaks, where the importance of implementing active surveillance strategies such as rectal screening for the timely detection of colonized neonates arises.

Humans , Male , Female , Infant, Newborn , Carbapenems , Diagnostic Techniques and Procedures , Enterobacteriaceae , Mass Screening , Cross-Sectional Studies , Watchful Waiting , Intensive Care Units , Nephelometry and Turbidimetry
ABCS health sci ; 46: e021309, 09 fev. 2021.
Article in English | LILACS | ID: biblio-1349415


INTRODUCTION: Premature rupture of membranes remains a challenge for professionals due to the high rates of maternal and neonatal morbidity and mortality, mainly related to complications resulting from prematurity. OBJECTIVE: To analyze the scientific production about premature rupture of membranes in pregnancies above 28 weeks and below 34 weeks. METHODS: Integrative literature review carried out in the Lilacs, SciELO, Medline and Cochrane Library databases, between 2014 and 2018, in Portuguese, English and Spanish, including original articles, available in full online, with free access, that addressed the study theme, using the keywords "premature rupture of ovular membranes", "premature labor" and "pregnancy complications" combined using the Boolean operators "AND" and "OR". RESULTS: Fourteen studies were included. It was possible to highlight the main recommendations regarding preterm premature rupture of membranes, divided into six categories for discussion, namely: indications for expectant management and delivery induction, prophylactic antibiotic therapy, prenatal corticosteroids, use of tocolytics, recommendations regarding the use of magnesium sulfate and amniocentesis. CONCLUSION: It was identified that expectant management is the ideal approach, with constant monitoring of the pregnant woman and the fetus, in addition to the administration of prophylactic antibiotics and prenatal corticosteroids, in the face of premature rupture of membranes in pregnancies between 28 and 34 weeks in order to provide the best maternal and perinatal results, guiding health professionals to evidence-based practice.

INTRODUÇÃO: A ruptura prematura de membranas continua a ser um desafio para os profissionais devido às altas taxas de morbimortalidade materna e neonatal, relacionada principalmente às complicações decorrentes da prematuridade. OBJETIVO: Analisar a produção científica acerca das evidências frente a ruptura prematura de membranas em gestações acima de 28 semanas e abaixo de 34 semanas. MÉTODOS: Revisão integrativa da literatura realizada nas bases de dados Lilacs, SciELO, Medline e Cochrane Library, entre 2014-2018, em português, inglês e espanhol, incluídos artigos originais, disponíveis completos online, com acesso livre, que abordassem a temática do estudo, utilizando os descritores "ruptura prematura de membranas ovulares", "trabalho de parto prematuro" e "complicações na gravidez" combinados por meio dos operadores booleanos "AND" e "OR". RESULTADOS: Foram incluídos 14 estudos, nos quais foi possível evidenciar as principais recomendações frente a ruptura prematura de membranas fetais pré-termo, divididos em seis categorias para discussão, sendo elas: indicações para o manejo expectante e indução do parto, antibioticoterapia profilática, corticosteroides pré-natais, uso de tocolíticos, recomendações quanto ao uso de sulfato de magnésio e realização de amniocentese. CONCLUSÃO: O estudo possibilitou identificar que o manejo expectante é a conduta ideal, com monitorização constante da gestante e do feto, além da administração de antibióticos profiláticos e corticosteroides pré-natais, frente a ruptura prematura de membranas em gestações entre 28 e 34 semanas a fim de proporcionar os melhores resultados maternos e perinatais, guiando os profissionais da saúde para uma prática baseada em evidências.

Humans , Female , Pregnancy , Fetal Membranes, Premature Rupture , Obstetric Labor, Premature , Tocolysis , Adrenal Cortex Hormones , Antibiotic Prophylaxis , Watchful Waiting , Amniocentesis , Labor, Induced , Magnesium Sulfate
Rev. bras. ginecol. obstet ; 43(8): 627-637, 2021. tab, graf
Article in English | LILACS | ID: biblio-1351763


Abstract Objective To compare the effects of expectant versus interventionist care in the management of pregnant women with severe preeclampsia remote from term. Data sources An electronic search was conducted in the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL), Latin American and Caribbean Health Sciences Literature (LILACS, for its Spanish acronym), World Health Organization's International Clinical Trials Registry Platform (WHO-ICTRP), and Open- Grey databases. The International Federation of Gynecology and Obstetrics (FIGO, for its French acronym), Royal College of Obstetricians and Gynaecologists (RCOG), American College of Obstetricians and Gynecologists (ACOG), and Colombian Journal of Obstetrics and Gynecology (CJOG) websites were searched for conference proceedings, without language restrictions, up to March 25, 2020. Selection of studies Randomized clinical trials (RCTs), and non-randomized controlled studies (NRSs) were included. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of the evidence. Data collection Studies were independently assessed for inclusion criteria, data extraction, and risk of bias. Disagreements were resolved by consensus. Data synthesis Four RCTs and six NRS were included. Low-quality evidence from the RCTs showed that expectant care may result in a lower incidence of appearance, pulse, grimace, activity, and respiration (Apgar) scores<7 at 5 minutes (risk ratio [RR]: 0.48; 95% confidence interval [95%CI]: 0.23%to 0.99) and a higher average birth weight (mean difference [MD]: 254.7 g; 95%CI: 98.5 g to 410.9 g). Very low quality evidence from the NRSs suggested that expectant care might decrease the rates of neonatal death (RR: 0.42; 95%CI 0.22 to 0.80), hyalinemembrane disease (RR: 0.59; 95%CI: 0.40 to 0.87), and admission to neonatal care (RR: 0.73; 95%CI: 0.54 to 0.99). Nomaternal or fetal differences were found for other perinatal outcomes. Conclusion Compared with interventionist management, expectant care may improve neonatal outcomes without increasing maternal morbidity and mortality.

Resumo Objetivo Comparar os efeitos dos cuidados expectantes versus intervencionistas no manejo de gestantes com pré-eclâmpsia grave distante do termo. Fontes de dados Foi realizada uma busca eletrônica no Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS, para o espanhol) acrônimo), Plataforma Internacional de Registro de Ensaios Clínicos da Organização Mundial da Saúde (OMS-ICTRP) e bancos de dados OpenGrey. Foram pesquisados os sites da Federação Internacional de Ginecologia e Obstetrícia (FIGO, por sua sigla em francês), do Royal College of Obstetricians e Ginecologistas (RCOG), do American College of Obstetricians e Ginecologistas (ACOG) e do Colombian Journal of Obstetrics and Gynecology (CJOG) procedimentos da conferência, sem restrições de idioma, até 25 de março de 2020. Seleção de estudos Ensaios clínicos randomizados (RCTs) e estudos controlados não randomizados (NRSs) foram incluídos. A abordagem de Classificação de Recomendações, Avaliação, Desenvolvimento e Avaliação (GRADE) foi usada para avaliar a qualidade da evidência. Coleta de dados Os estudos foram avaliados de forma independente quanto aos critérios de inclusão, extração de dados e risco de viés. As discordâncias foram resolvidas por consenso. Síntese de dados Quatro RCTs e seis NRS foram incluídos. Evidências de baixa qualidade dos ECRs mostraram que o cuidado expectante pode resultar em uma incidência menor de pontuações de aparência, pulso, careta, atividade e respiração (Apgar) <7 em 5 minutos (razão de risco [RR]: 0,48; intervalo de confiança de 95% [IC 95%]: 0,23% a 0,99) e um peso médio ao nascer superior (diferença média [MD]: 254,7 g; IC 95%: 98,5 ga 410,9 g). Evidências de qualidade muito baixa dos NRSs sugeriram que os cuidados expectantes podem diminuir as taxas de morte neonatal (RR: 0,42; IC de 95% 0,22 a 0,80), doença da membrana hialina (RR: 0,59; IC de 95%: 0,40 a 0,87) e admissão à assistência neonatal (RR: 0,73; IC 95%: 0,54 a 0,99). Nenhuma diferença materna ou fetal foi encontrada para outros resultados perinatais. Conclusão Em comparação com o manejo intervencionista, o cuidado expectante pode melhorar os resultados neonatais sem aumentar a morbidade e mortalidade materna.

Humans , Female , Pregnancy , Infant, Newborn , Pre-Eclampsia/therapy , Birth Weight , Watchful Waiting
Rev. bras. ginecol. obstet ; 42(11): 717-725, Nov. 2020. tab, graf
Article in English | LILACS | ID: biblio-1144178


Abstract Objective: To compare the type of management (active versus expectant) for preterm premature rupture of membranes (PPROM) between 34 and 36 + 6 weeks of gestation and the associated adverse perinatal outcomes in 2 tertiary hospitals in the southeast of Brazil. Methods: In the present retrospective cohort study, data were obtained by reviewing the medical records of patients admitted to two tertiary centers with different protocols for PPROM management. The participants were divided into two groups based on PPROM management: group I (active) and group II (expectant). For statistical analysis, the Student t-test, the chi-squared test, and binary logistic regression were used. Results: Of the 118 participants included, 78 underwent active (group I) and 40 expectant management (group II). Compared with group II, group I had significantly lower mean amniotic fluid index (5.5 versus 11.3 cm, p = 0.002), polymerase chain reaction at admission (1.5 versus 5.2 mg/dl, p = 0.002), time of prophylactic antibiotics (5.4 versus 18.4 hours, p < 0.001), latency time (20.9 versus 33.6 hours, p = 0.001), and gestational age at delivery (36.5 versus 37.2 weeks, p = 0.025). There were no significant associations between the groups and the presence of adverse perinatal outcomes. Gestational age at diagnosis was the only significant predictor of adverse composite outcome (x2 [1] = 3.1, p = 0.0001, R2 Nagelkerke = 0.138). Conclusion: There was no association between active versus expectant management in pregnant women with PPROM between 34 and 36 + 6 weeks of gestation and adverse perinatal outcomes.

Resumo Objetivo: Comparar o tipo de manejo (ativo versus expectante) para ruptura prematura de membranas (PPROM, na sigla em inglês) entre 34 e 36 semanas e 6 dias de gestação e os resultados perinatais adversos relacionados, em 2 hospitais terciários do sudeste brasileiro. Métodos: No presente estudo de coorte retrospectivo, os dados foram obtidos através da revisão dos prontuários de gestantes internadas em dois centros terciários com protocolos diferentes para o seguimento da PPROM. As gestantes foram divididas em dois grupos com base no manejo da PPROM: grupo I (ativo) e grupo II (expectante). Para análise estatística, foram utilizados o teste t de Student, qui-quadrado e regressão logística binária. Resultados: Das 118 gestantes incluídas, 78 foram submetidas a tratamento ativo (grupo I) e 40 a seguimento expectante (grupo II). Comparado ao grupo II, o grupo I apresentou índice de líquido amniótico médio significativamente menor (5,5 versus 11,3 cm, p = 0,002), reação em cadeia da polimerase na admissão (1,5 versus 5,2 mg/dl, p = 0,002), tempo de antibióticos profiláticos (5,4 versus 18,4 horas, p < 0,001), tempo de latência (20,9 versus 33,6 horas, p = 0,001) e idade gestacional no parto (36,5 versus 37,2 semanas, p = 0,025). Não houve associações significativas entre os grupos e a presença de resultados perinatais adversos. A idade gestacional no diagnóstico foi o único preditor significativo de desfecho composto adverso (x2 [1] = 3,1, p = 0,0001, R2 Nagelkerke = 0,138). Conclusão: Não houve associação entre manejo ativo e expectante em gestantes com PPROM entre 34 e 36 semanas e 6 dias de gestação e resultados perinatais adversos.

Humans , Female , Pregnancy , Adolescent , Adult , Young Adult , Prenatal Care , Fetal Membranes, Premature Rupture/therapy , Watchful Waiting , Brazil , Pregnancy Outcome , Retrospective Studies , Cohort Studies , Gestational Age , Delivery, Obstetric , Tertiary Care Centers
Pers. bioet ; 24(1): 57-76, ene.-jun. 2020. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1279522


Resumen La disforia de género es una marcada incongruencia entre el sexo que se siente o expresa y el que se asigna al nacer, asociada a un malestar clínicamente significativo o deterioro en lo social, que puede darse en niños, adolescentes y adultos. En relación con los pacientes pediátricos, no existe actualmente consenso sobre su tratamiento, así como tampoco evidencia que apoye claramente un enfoque por sobre otro. En la literatura se describen principalmente tres tipos de abordaje en niños preadolescentes: modelo terapéutico, watchful waiting (espera atenta) y modelo afirmativo. En este trabajo se realiza una breve revisión de la literatura existente sobre la disforia de género, se describen los distintos abordajes en niños y se analizan las visiones antropológicas que los sustentan. Plantearemos que existen al menos dos modos de entender la identidad de género, lo que ha dado lugar, en gran medida, a las controversias en los tratamientos propuestos. Por ello, resulta de gran importancia comprender los supuestos antropológicos en que se fundamentan estos modelos, ya que a cada uno de ellos subyacen diferentes maneras de entender la relación sexo-género en la persona y, por tanto, el rol de la corporalidad y de la autoconsciencia en la identidad de género.

Abstract Gender dysphoria is a marked mismatch between the sex felt or expressed by an individual and that assigned to them at birth. It is associated with clinically significant discomfort or social impairment and can occur in children, adolescents, and adults. The literature mainly describes three approaches for preadolescents: therapeutic model, watchful waiting, and gender affirmative model. However, there is currently no consensus on its treatment nor any evidence that favors one approach over another. This paper provides a brief review of the existing literature on gender dysphoria, explains various approaches for children, and discusses the anthropological views behind them. We argue that at least two ways of understanding gender identity have given rise to disagreements over the proposed treatments. It is quite important to comprehend the anthropological assumptions on which these models are based since they underlie different conceptions of the person's sex-gender relationship and, therefore, the role of corporality and self-awareness in gender identity.

Resumo A disforia de gênero é uma marcada incongruência entre o sexo que se sente ou expressa e o que é designado ao nascer, associada a um malestar clinicamente significativo ou a uma deterioração no âmbito social, que pode ocorrer em crianças, adolescentes e adultos. Quanto aos pacientes pediátricos, não existe atualmente consenso em seu tratamento nem evidência que apoie com clareza uma abordagem sobre outro. Na literatura, são descritos três tipos de abordagem em crianças pré-adolescentes: modelo terapêutico, watchful waiting (observação vigilante) e modelo afirmativo. Neste trabalho, é realizada uma breve revisão da literatura sobre a disforia de gênero, são descritas as diferentes abordagens em crianças e são analisadas as visões antropológicas que as justificam. É provável que haja, pelo menos, dois modos de entender a identidade gênero, o que abre espaço a controvérsias nos tratamentos propostos. Por isso, é de grande importância compreender os pressupostos antropológicos nos quais esses modelos estão fundamentados, já que a cada um deles subjazem diferentes maneiras de entender a relação sexo-gênero na pessoa e, portanto, o papel da corporeidade e da autoconsciência na identidade de gênero.

Therapeutics , Child, Preschool , Watchful Waiting , Gender Dysphoria , Gender Identity , Anthropology
Rev. argent. coloproctología ; 31(2): 70-72, jun. 2020. ilus
Article in English, Spanish | LILACS | ID: biblio-1117014


Objetivo: Presentar el caso infrecuente de sangrado tardío posterior al tratamiento con macroligadura elástica de hemorroides, tratamiento propuesto por A. Reis Neto. Caso Clínico: Mujer de 26 años con tratamiento de hemorroides con macroligadura elástica. A los 28 días es admitida en urgencia por proctorragia abundante sin signos de shock hipovolémico. Laboratorio: Hematocrito 27%, Hemoglobina 8,9 mg/dl. Se realiza colonoscopia evidenciando la cicatriz de macroligadura con signos de coágulo desprendido sin sangrado activo. Se decide conducta expectante con tratamiento de la hipovolemia incial y anemia. Evoluciona sin resangrado con control endoscópico a los 60 y 180 (sin sangrado y excelentes resultados). Discusión: La macroligadura es una técnica alternativa para el tratamiento de hemorroides con excelentes resultados anatómicos y funcionales. Presenta menor dolor postoperatorio, bajo índice de complicaciones (ninguna severa o propia del método). No existen comunicaciones sobre sangrado tardío grave tanto en ligaduras convencionales como macroligadura. Conclusiones: Se presenta el primer caso comunicado a la fecha de un sangrado tardío en macroligaduras que fue resuelto en forma conservadora.

Objetive: To present an infrequent clinical report of a case of late bleeding after rubber macroband ligation. Case report: A 28-year-old female with severe rectal bleeding but no associated shock was presented 28 days after rubber macroband ligation at emergency room. Blood samples showed acute anemia. An urgent colonoscopy was performed which showed a scar without acute bleeding. Medical treatment was settled. There was no secondary bleeding in follow up. Endoscopic control was done at 60 and 180 days. Discusion: Hemorrhoidal rubber macroband ligation is a modification of conventional rubber band ligation. It was proposed and developed by J.A. Reis Neto (Campinas, SP, Brazil). Morbidity is low and results are excellent. There is no previous report of delayed bleeding considering both rubber band and macroband ligation. Conclusion: The First case of late bleeding after rubber band ligation treated with conservative measures.

Humans , Female , Adult , Gastrointestinal Hemorrhage/diagnosis , Hemorrhoids/surgery , Ligation/methods , Postoperative Complications , Colonoscopy , Watchful Waiting
Rev. chil. obstet. ginecol. (En línea) ; 85(1): 60-67, feb. 2020. graf
Article in Spanish | LILACS | ID: biblio-1092776


ANTECEDENTES El embarazo ectópico abdominal es el menos habitual de los embarazos ectópicos, con una prevalencia situada entre el 0.9 - 1.4%. La mortalidad materna es elevada, alcanzando un 20% y la viabilidad fetal mínima. El manejo médico en estas situaciones es complicado ya que no está bien establecido debido a su baja frecuencia. CASO CLÍNICO Mujer de 35 años, con antecedente de esterilidad por endometriosis y salpinguectomía bilateral. Tras 5 fecundaciones in vitro (FIV) consigue una primera gestación, con finalización mediante cesárea por no progresión de parto. Acude a urgencias en su segundo embarazo, logrado tras 3 (FIV), con edad gestacional de 7 semanas. Presenta sangrado vaginal escaso y la ecografía demuestra a nivel de Douglas y hacia fosa iliaca izquierda un saco gestacional de 3 cm con embrión sin latido cardiaco de 5 mm. El nivel de β-hcg es de 1477 mUI/ml. Se diagnostica de gestación ectópica abdominal y se opta por actitud expectante dada la estabilidad clínica de la paciente. En un control a las 48h la β-Hcg es de 464 mUI/ml y la paciente se mantiene estable. En controles posteriores se observan niveles descendentes de β-Hcg y tras un mes la resolución es completa. CONCLUSIÓN El embarazo ectópico abdominal es una entidad poco frecuente pero con una alta tasa de mortalidad. Aunque lo más común es optar por un abordaje quirúrgico es necesario individualizar cada caso y basarse en la clínica y las diferentes pruebas diagnósticas para seleccionar aquellos casos que se pueden beneficiar de un manejo conservador.

BACKGROUND Abdominal ectopic pregnancy accounts for only 0.9-1.4% of all ectopic pregnancies. The maternal mortality rate is high (up to 20%) and fetal viability mínimum. The managment, specially the conservatory management of these cases is difficult because of our limited experiencie due to its low frecuency. CASE PRESENTATION 35-year-old woman, with history of sterility due to endometriosis that required bilateral laparoscopic salpinguectomy. Her first pregnancy (after 5 in vitro fertilization cicles (IVF)) finalized with a caesarean section because of to the lack of labour progresion. She was admitted to our emergency department during her second pregnancy (after 3 IVF cicles), with 7 weeks of gestational age. She had a little vaginal bleeding. Ultrasound scan showed a 5mm gestational sac with a 3mm embryo without cardiac activity in the pouch of Douglas. The β-Hcg level was 1477mUI/ml. The final diagnosis was ectopic abdominal pregnancy and it was decided to undertake an expectant management because she was clinically stable. The β-Hcg level after 48 hours was 464 mUI/ml. In subsequent examinations β-Hcg showed descending levels and after one month the resolution was completed. CONCLUSION Abdominal ectopic pregnancy is very infrequent but it has a high mortality rate. The most common approach is surgical but it is necessary to study all signs and diagnostic tests to select patients that could get profit from a conservatory management.

Humans , Female , Pregnancy , Adult , Pregnancy, Abdominal/diagnosis , Fertilization in Vitro/adverse effects , Salpingectomy/adverse effects , Infertility, Female/etiology , Pregnancy, Abdominal/blood , Pregnancy, Ectopic , Ultrasonography, Prenatal , Chorionic Gonadotropin, beta Subunit, Human/blood , Watchful Waiting , Conservative Treatment
Article in English | WPRIM | ID: wpr-811114


BACKGROUND: Spontaneous disease stabilization of desmoid-type fibromatosis (DF) has been demonstrated in many reports, and the watchful waiting approach without any frontline treatment is becoming popular as an initial management strategy. In this study, we aimed to assess the disease stabilization rate and identify predictive factors for disease stabilization of DF in patients with conservative treatment.METHODS: We reviewed 76 patients with sporadic extra-abdominal DF who were managed with frontline conservative treatment in our institute. The minimum follow-up was 12 months. Stabilization was defined as radiological evidence of no change or continuous decrease in size of the tumor for six months or more. The primary endpoint was stabilization of DF. Possible patient-, disease-, and treatment-related factors predictive of disease stabilization were analyzed with multivariate analysis.RESULTS: At final follow-up, 54 of the 76 tumors (71%) were stable, and mean time to stabilization was 30.4 months (range, 7 to 112 months). On Kaplan-Meier survival analysis, the spontaneous stabilization rate was 25.4% at one year, 52.7% at two years, and 70.9% at three years. The mean time to spontaneous stabilization was longer in patients with ≤ 40 years of age (p = 0.022) or recurrence (p = 0.041). On multivariate analysis with the Cox proportional hazard method, recurrence (hazard ratio [HR], 1.79; p = 0.041) and younger age (HR, 2.04; p = 0.022) were identified as independent prognostic factors for longer time to disease stabilization.CONCLUSIONS: Frontline conservative treatment seems to be the optimal treatment for most patients with DF. Younger patients or those with recurrence may require longer time to spontaneous disease stabilization.

Fibroma , Fibromatosis, Aggressive , Follow-Up Studies , Humans , Methods , Multivariate Analysis , Recurrence , Watchful Waiting
Rev. chil. infectol ; 36(6): 750-755, dic. 2019. tab
Article in Spanish | LILACS | ID: biblio-1058107


Resumen Introducción: Las convulsiones febriles son eventos supuestamente atribuidos a la vacunación e inmunización (ESAVI) frecuentemente asociados a vacuna difteria - tétanos- pertussis a células completas. Objetivo: Analizar la asociación de convulsiones febriles con la administración de la vacuna pentavalente en niños bajo 2 años de edad asistidos en el Centro Hospitalario Pereira Rossell durante el año 2014. Material y Métodos: Estudio de series de casos auto-controlados. Se incluyeron niños procedentes de Montevideo con 2 a 24 meses de edad con diagnóstico de convulsión febril. Se estimó el riesgo relativo (RR) de los períodos de riesgo (0 a 3 días) y de lavado (4a 14 días), en comparación con el período de no riesgo (más de 14 días). Resultados: Se registraron 135 convulsiones febriles, que ocurrieron en 114 niños; 16 niños presentaron dos o más episodios. El total de eventos ocurridos en el período de riesgo fueron 7 (5,2%) y 8 (5,9%) en el período de lavado. El período de riesgo mostró un RR significativo de 4,14 (IC 95%: 1,73; 8,36). Conclusiones: Este trabajo permitió establecer una línea de base nacional sobre el riesgo de convulsiones febriles asociadas con la vacunación pentavalente al utilizar por primera vez en el país una metodología específica para tal fin.

Background: Febrile seizures are VAERS often associated with whole-cells Diphtheria-Pertussis-Tetanus vaccines. Aim: To analyze the association of febrile seizures with the administration of pentavalent vaccine in children under two-years-old assisted in the Centro Hospitalario Pereira Rossell (CHPR), in Montevideo during 2014. Methods: Self-controlled case series study. We included children from Montevideo from two to 24-month-old at the time of admission, with diagnosis of febrile seizure at the time of discharge. We estimated the relative risk in three time periods: 0 to 3 days (risk period), 4 to 14 days (wash-out) and more than 14 days after vaccination (no-risk). Results: We recorded 135 febrile seizures in 114 children, 16 of whom presented two or more events. The total number of events was 7 (5.2%) in risk periods and 8 (5.9%) in wash-out periods. The risk period showed a significantly increased risk (RR = 4.14, CI 95% = [1.73; 8.36]). Conclusions: This work allowed us to establish a national base line for the risk of febrile seizures associated with pentavalent vaccination, by using for the first time in the country a methodology specifically designed for this goal.

Humans , Infant , Child, Preschool , Child , Seizures, Febrile/chemically induced , Uruguay/epidemiology , Diphtheria-Tetanus-Pertussis Vaccine , Watchful Waiting , Hospitals
Arch. endocrinol. metab. (Online) ; 63(5): 462-469, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1038501


ABSTRACT Objectives To determine the percentage of patients with papillary thyroid carcinoma (PTC) who accepted active surveillance as an alternative to surgery in our clinical practice and to describe the clinical characteristics and outcomes of patients with Bethesda category V and VI thyroid nodules who chose active surveillance. Subjects and methods We included 136 PTC patients from the Hospital de Clínicas, University of Buenos Aires without (i) US extrathyroidal extension, (ii) tumors adjacent to the recurrent laryngeal nerve or trachea, and/or (iii) US regional lymph-node metastasis or clinical distant metastasis. PTC progression was defined as the presence of i) a tumor larger than ≥ 3 mm, ii) novel appearance of lymph-node metastasis, and iii) serum thyroglobulin doubling time in less than one year. For patients with these features, surgery was recommended. Results Only 34 (25%) of 136 patients eligible for active surveillance accepted this approach, and around 10% of those who accepted abandoned it due to anxiety. The frequency of patients with tumor enlargement was 17% after a median of 4.6 years of follow-up without any evidence of nodal or distant metastases. Ten patients who underwent surgical treatment after a median time of 4 years of active surveillance (AS) had no evidence of disease after a median of 3.8 years of follow-up after surgery. Conclusion Although not easily accepted in our cohort of patients, AS would be safe and easily applicable in experienced centers.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Thyroid Neoplasms/diagnostic imaging , Watchful Waiting/methods , Thyroid Cancer, Papillary/diagnostic imaging , Thyroidectomy , Thyroid Neoplasms/surgery , Thyroid Neoplasms/pathology , Follow-Up Studies , Tumor Burden , Thyroid Cancer, Papillary/surgery , Thyroid Cancer, Papillary/pathology
Rev. colomb. psiquiatr ; 48(3): 133-139, jul.-set. 2019. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1058413


Abstract Objective: To evaluate the coverage, characteristics and the risk of suicide in the indigenous people of Tabatinga in the Brazilian Amazon. Methods: An active surveillance strategy for suicide cases was used: records of the Ministry of Health, the Municipal Health Secretariat, the Special Indigenous Health District of the Upper River Solimões (Distrito Sanitario Especial Indígena Alto Río Solimões), the Military Hospital of Tabatinga, the National Indian Foundation (Fundación Nacional del Indio) and the civil registry offices were examined from 2007 to 2011 for individuals over 9 years of age. Adjusted rates were estimated using the direct method and according to age. A descriptive analysis was performed and the hypothesis tests were considered significant if p-values were <0.05. Results: The coverage of indigenous suicide was 82.8%, since 11 (17.2%) were classified as hidden suicides. For men between 15 and 29 years of age, and for women aged from 12 to 20 years, the probability of suicide was around 70.0%. In 17.2% of the sample there was a record of alcohol consumption before death and relationship between victims. The corrected adjusted mortality rate was 111.7/100,000 (95% CI, 84.6-148.6). Conclusions: The risk of suicide in the indigenous people of the Tabatinga is very high. Coping strategies should consider the complex relationship between suicide and alcohol consumption, gender differences and the existence of vulnerable groups, such as young people, especially those with close relatives who have committed suicide.

Resumen Objetivo: Evaluar el alcance, las características y el riesgo de suicidio de los indígenas de Tabatinga, en la Amazonia brasileira. Métodos: Se utilizó una estrategia de vigilancia activa del suicidio y se examinaron los registros de mayores de 9 años, de 2007-2011, del Ministerio de Salud, la Secretaría Municipal de Salud, el Distrito Sanitario Especial Indígena Alto Río Solimões, el Hospital Militar de Tabatinga, la Fundación Nacional del Indio y la notaría del Registro Civil. Las tasas ajustadas se calcularon utilizando el método directo, según la edad. Se realizó un análisis descriptivo y se consideró que las pruebas de hipótesis eran significativas si p < 0,05. Resultados: El alcance del suicidio indígena fue del 82,8%, ya que 11 (17,2%) se clasificaron como suicidios ocultos. Alrededor del 70,0% de la probabilidad de suicidio de los varones se situó a los 15-29 años y la de las mujeres, a los 12-20 años. En el 17,2% de la muestra, se registró consumo de alcohol antes de la muerte y relación parental entre las víctimas. La tasa de mortalidad ajustada corregida fue 111,7/100.000 (IC95%, 84,6-148,6). Conclusiones: El riesgo de suicidio de los indígenas de Tabatinga es muy alto. Las estrategias de afrontamiento deben considerar la compleja relación entre el suicidio y el consumo de alcohol, las diferencias de sexo y la existencia de grupos vulnerables, como los jóvenes, especialmente aquellos con parientes cercanos que ya cometieron suicidio.

Humans , Male , Female , Adult , Suicide , Health of Indigenous Peoples , Indigenous Peoples , Brazil , Family , Death , Watchful Waiting , Indium
Prensa méd. argent ; 105(3): 106-109, may 2019.
Article in Spanish | LILACS, BINACIS | ID: biblio-1025200


Contexto: La litiasis vesicular asintomática es un cuadro clínico cuyo abordaje terapéutico resulta controversial. Objetivos: Definir qué pacientes con litiasis vesicular son asintomáticos, identificar riesgos y beneficios de la conducta expectante en pacientes asintomáticos, mencionar qué grupos de pacientes asintomáticos se beneficia con la cirugía preventiva. Material y métodos: Se realizó una revisión de trabajos publicados en la plataforma. Pubmed para identificar y analizar aquellos que consideramos más representativos sobre litiasis vesicular asintomática, y así describir la conducta más apropiada ante dicha situación. Resultados: Al realizar la revisión de artículos con bajo nivel de evidencia (C-D) observamos que par la litiasis vesicular asintomática la conducta expectante es la más recomendada. Sin embargo varios trabajos hacen referencia a grupos de pacientes seleccionados que debido a su condición de base se beneficiarían con la cirugía. Conclusiones: Con la información obtenida de los artículos analizados se concluye que No está recomendada de forma rutinaria la colecistectomía profiláctica en los pacientes con litiasis asintomática; los pacientes que se benefician de la cirugía y en los cuales la indicación de colecistectomía es clara son: pacientes con riesgo elevado de desarrollar cáncer de vesícula (existencia de pólipos vesiculares con crecimiento rápido o mayor de 1 cm, vesícula en porcelana, cáculo mayor de 3 cm, mujer joven de origen ameroindio) y pacientes con mayor riesgo de desarrollar coplicaciones como son los jóvenes con anemia hemolítica crónica. El procedimiento quirúrgico iindicado es la colecistectomía por vía laparoscópica, siendo éste el procedimiento quirúrgico con menor tasa de morbimortalidad y mejor recuperarción postoperatoria disponibe (AU)

The presence of stones in the gallbladder is a condition relatively common in many parts of the world, being present in 10% to 15% of the adult population, and the presence of stones in the gallbladder afficts more than 21.9 % of the population of the city of Buenos Aires. When patients present with symptoms of biliary lithiasis, there is consense toward the surgical removal. But in the patients with asymptomatic gallstones that have no pain and do not have compications, the management of these silent gallstones is somewhat controversial. Data coupled with results suggesting that persons's life expectancy is not increased by prophylactic cholecystectomy, have discouraged surgical tratment of gallstones unless symptoms are present. The aim of this report was to determine which patients with biliary lithiasis should be considered as asymptomatic patients, and to consider which group of the expectant management in asymptomatic patients, and to consider which group of these patients can be beneficiated with a preventive cholecystectomy. A revision of the literature was performed, considering the management of the asymptomatic gallstone disease, whether if it should be preferable the expectant management or instead an active treatment. The expectant management was the mos recommended procedure fot these patients (AU)

Humans , Gallstones/therapy , Cholecystectomy, Laparoscopic , Asymptomatic Diseases/therapy , Watchful Waiting
Prensa méd. argent ; 105(2): 76-81, apr 2019. taab, fig
Article in English | LILACS, BINACIS | ID: biblio-1025694


In the past few decades, ectopic pregnancy has been termed by medical practitioners has a global epidemic. With the questions lingering on everbody minds how this menace can be tamed. In a bid to reduce the mortality and financial burden brought by this evolving growing health concern, the medic has developed non-surgical alteratives to deal with ectopic pregnancy, i.e., treatment using methotrexate. In a bid to explore this topic further, these study goals were to share the experience of treating mothers who have un-ruptured ectopic pregnancies traditionally. Mothers who were found to have an ectopic pregnancy and fit the medical care were encompassed in the program, a total of 37 women. For instance, those with serum beta HCG in the range of 1000 mIU per liter were treatment expectantly whereas those with a level more than a thousand were given an injection of methotrexate. To monitor the response of experiment, beta HCG levels were monitored for each mother. The results of the current study established that 88.0% of women who underwent the study, only 12.0% of them exhibited full rsolution while the remaining lot resolved only after a sole dose of methotrexate. From the results of this study, it is evidently clear that a lot of pregnant mothers would be greatly helped if they are enrolled in such therapy at early days

Humans , Female , Pregnancy , Adult , Pregnancy, Ectopic/mortality , Pregnancy, Ectopic/therapy , Methotrexate/therapeutic use , Chorionic Gonadotropin, beta Subunit, Human/administration & dosage , Watchful Waiting/trends
Article in Korean | WPRIM | ID: wpr-787228


The stomach is the most common primary site of an extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) type, which is characterized by an indolent clinical course. A diagnosis of gastric MALT lymphoma requires an endoscopic biopsy that should be confirmed by an experienced pathologist. Gastric MALT lymphoma shows a variable endoscopic appearance, including erosion, erythema, discoloration, atrophy, ulcer, and subepithelial lesion. The distribution is often multifocal. Therefore, clinical suspicion and multiple biopsies are essential for an accurate diagnosis. Gastric MALT lymphoma is almost invariably associated with a Helicobacter pylori (H. pylori) infection. H. pylori eradication therapy is the mainstay of treatment, which must be delivered to all patients regardless of the H. pylori infection status or stage. For patients who have failed to achieve remission following eradication therapy, radiotherapy or chemotherapy can be considered. Radiotherapy is an effective treatment modality for a localized stage and shows excellent outcomes. In the presence of disseminated or advanced disease, chemotherapy and/or immunotherapy with the anti-CD20 monoclonal antibody, rituximab, can be applied. Treatment should be individualized according to the stage and symptoms, as well as the patients' preference. Given that the clinical course of gastric MALT lymphoma is usually indolent, watchful waiting may be an adequate strategy in selected cases where scheduled follow-up is guaranteed.

Atrophy , Biopsy , Diagnosis , Drug Therapy , Erythema , Follow-Up Studies , Helicobacter pylori , Humans , Immunotherapy , Lymphoma, B-Cell, Marginal Zone , Radiotherapy , Rituximab , Stomach , Ulcer , Watchful Waiting