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1.
Arch. argent. pediatr ; 120(2): e71-e74, abril 2022. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1363967

ABSTRACT

Las intoxicaciones medicamentosas son un motivo de consulta frecuente en pediatría, además de una de las principales causas externas de mortalidad en adolescentes. El diagnóstico y tratamiento tempranos son fundamentales para el manejo adecuado de estos casos. Se presenta una niña de 13 años que, luego de ingerir un fármaco desconocido, muestra decaimiento y manifestaciones clínicas gastrointestinales. Por sospecha de intoxicación con hierro y la imposibilidad de determinar los niveles de sideremia de manera urgente, se realiza radiografía de abdomen, que confirma el diagnóstico y permite el tratamiento adecuado de la paciente. En este caso, se destaca la utilidad de la radiología para el diagnóstico en la sospecha de intoxicación con hierro, gracias a la radiopacidad de sus sales


Drug intoxication is a common reason for pediatric emergency department (ED) visits and one of the leading causes of death among teenagers. Early diagnosis and treatment are essential for a proper management of these patients. We present a 13-year-old girl attended at the ED showing excessive sleepiness and gastrointestinal symptoms after taking an unknown drug. Due to suspected iron overdose and the impossibility of measuring urgent iron levels, an abdominal X-ray was performed, which confirmed the diagnosis. We highlight the utility of radiology in the diagnosis of iron poisoning, which is possible due to its radiopacity.


Subject(s)
Humans , Female , Adolescent , Emergency Service, Hospital , Iron , Poisoning , X-Rays
2.
Braz. J. Pharm. Sci. (Online) ; 58: e18630, 2022. tab, graf
Article in English | LILACS | ID: biblio-1364418

ABSTRACT

Abstract The objective of the present investigation was to design, optimize and characterize the gastro retentive floating levofloxacin tablets and perform in-vivo evaluation using radiographic imaging. The floating tablets were prepared by using polymers i.e hydroxy propyl methyl cellulose (HPMC-K4M) and carbopol-940 individually and in combination by nonaquous granulation method. All the Formulations were evaluated for swelling index (S.I), floating behavior and in-vitro drug release kinetics. The compatibility study of levofloxacin with other polymers was investigated by FTIR, DSC, TGA and XRD. Results from FTIR and DSC revealed no chemical interaction amongst the formulation components. The optimized formulation (F11) showed floating lag time (FLT), total floating time (TFT) swelling index (S.I) of 60 sec, >16h and approximately 75 %, respectively. Moreover, F11 showed zero order levofloxacin release in simulated gastric fluid over the period of 6 h. X-ray studies showed that total buoyancy time was able to delay the gastric emptying of levofloxacin floating tablets in rabbits for more than 4 hours. In conclusion the optimized formulation (F11) can be used for the sustained delivery of levofloxacin for the treatment of peptic ulcer.


Subject(s)
Drug Liberation , Peptic Ulcer/classification , Tablets/pharmacology , X-Rays/adverse effects , In Vitro Techniques/instrumentation , Spectroscopy, Fourier Transform Infrared , Drug Compounding/instrumentation , Process Optimization/analysis , Levofloxacin/analysis , Gastric Emptying/drug effects
3.
Rev. bras. ortop ; 56(6): 790-795, Nov.-Dec. 2021. graf
Article in English | LILACS | ID: biblio-1357137

ABSTRACT

Abstract Objective The present study aimed to evaluate and compare the total surgical procedure time and intraoperative X-ray exposure during different techniques for fixation of transtrochanteric fractures of the femur in elderly patients, using extramedullary and intramedullary methods based on cephalic traction screws. Methods The Orthopedics and Traumatology Service from our hospital evaluated 107 patients with transtrochanteric fractures, including 34 males and 73 females, with age ranging from 61 to 101 years old. Fracture fixation was performed with a dynamic hip system (DHS) in 21 patients, a standard proximal femoral nail (PFN) in 55 subjects, and a standard gamma nail in 31 patients. All procedures were performed by the same surgeon and his team of nursing assistants, along with the same radiology technician using the same image intensifier. Total surgery time (in minutes) and X-ray emission (in centigrays [cGy]) were evaluated. Results Transtrochanteric fracture fixation with PFN provides a significantly shorter surgical time (p = 0.013) in comparison to the 2 other techniques. Intraoperative exposure to X-rays was significantly lower when using DHS (p = 0.015) as a fixation method when compared with gamma nail and PFN. Conclusion Although PFN resulted in the shortest surgical time, DHS was associated with the lowest X-ray exposure levels within the studied sample.


Resumo Objetivo Avaliar e comparar o tempo total do procedimento cirúrgico e a exposição ao raio X no intraoperatório em diferentes técnicas de fixação das fraturas transtrocanterianas do fêmur em pacientes idosos, utilizando técnicas extramedulares e intramedulares baseadas em parafuso de tração cefálico. Métodos Foram avaliados no serviço de ortopedia e traumatologia do nosso hospital 107 pacientes com fraturas transtrocanterianas, sendo 34 do sexo masculino e 73 do sexo feminino, com idade mínima de 61 anos e máxima de 101 anos. As fraturas fixadas, utilizando a técnica com dynamic hip system (DHS, na sigla em inglês) somaram 21 pacientes; em 55 pacientes, foi utilizado o proximal femur nail (PFN, na sigla em inglês) standard; e em 31 idosos, foi optado pelo uso do gama nail standard. Todos os procedimentos foram realizados pelo mesmo cirurgião acompanhado de sua equipe de auxiliares de enfermagem, assim como pelo mesmo técnico de radiologia manuseando o mesmo intensificador de imagens. Foram avaliados o tempo total da cirurgia (em minutos) e a emissão de raios X medida em centigrays. Resultados A fixação das fraturas transtrocanterianas com PFN proporciona um menor tempo cirúrgico com uma diferença estatística significativa (p =0,013), quando comparada com as demais técnicas utilizadas entre os grupos envolvidos. Foi observada, também, uma menor exposição intraoperatória aos raios X (p =0,015), a qual foi estatisticamente relevante quando utilizado o DHS como método de fixação comparado com o gama nail e o PFN. Conclusão Apesar do PFN ter o menor tempo de cirurgia, a técnica do DHS se mostrou com menores níveis de exposição dentro da amostra estudada.


Subject(s)
Radiology , Surgical Procedures, Operative , X-Rays , Internal Fixators , Femoral Fractures , Operative Time , Neoplasms
4.
Rev. colomb. anestesiol ; 49(2): e500, Apr.-June 2021. graf
Article in English | LILACS, COLNAL | ID: biblio-1251502

ABSTRACT

Abstract Introduction Foreign body aspiration (FBA) is a potentially fatal paediatric emergency. Our objective was to highlight the importance of a multidisciplinary approach to difficult/doubtful diagnosis. Case report 34-month-old girl referred for urgent rigid bronchoscopy after suspected metallic blade ingestion (found chewing on it). She had a previous recurrent history of wheezing. The physical examination revealed face/lip wounds, traces of powder on her teeth but no breathing difficulty. The plain X-Ray revealed radiopaque images of the upper pulmonary field and gastric chamber. In the absence of FBA clinical signs but considering a previous history of bronchial hyperresponsiveness, a direct digital radiographic study was performed. There were no images compatible with foreign bodies: the results were interpreted as artefacts and no bronchoscopy was performed. Conclusions A careful pre-anaesthetic evaluation, a high level of suspicion and excellent multidisciplinary communication led to the recognition of false radiologic findings. A conservative approach was followed and invasive procedures in a remote location, with high anaesthetic risk for the paediatric population were avoided.


Resumen Introducción La aspiración de cuerpo extraño (ACE) es una emergencia pediátrica potencialmente fatal. La intención del presente artículo es resaltar la importancia de un abordaje multidisciplinario en caso de un diagnóstico difícil/dudoso. Reporte de caso Se trata de una paciente de 4 meses de edad remitida para broncoscopia rígida de urgencia, luego de la sospecha de ingestión de una hojilla metálica (se encontró a la bebé mordiéndola). La paciente tenía antecedentes de sibilancia. Al examen físico se encontraron heridas en la cara y los labios, rastros de polvo en los dientes, pero no había dificultad respiratoria. El examen de rayos-x mostraba imágenes radio opacas en el cuadrante superior derecho del pulmón y en la cámara gástrica. En virtud de la ausencia de signos clínicos de ACE en una paciente con antecedentes de hiperresponsividad bronquial, se realizó un estudio radiográfico digital. No hubo imágenes compatibles con cuerpos extraños: los resultados se interpretaron como artefactos y no se realizó la broncoscopia. Conclusiones Un cuidadoso examen pre-anestesia, el alto grado de sospecha y una excelente comunicación multidisciplinaria, permitieron el reconocimiento de hallazgos radiológicos falsos. Se siguió un abordaje conservador, evitando así procedimientos invasivos en lugares remotos con alto grado de riesgo para la población pediátrica.


Subject(s)
Humans , Male , Infant , Respiration , Respiratory Sounds , Eating , Emergencies , Foreign Bodies , Wounds and Injuries , X-Rays , Bronchoscopy , Risk , Artifacts , Absenteeism , Lung , Mastication
5.
Medisur ; 19(3): 524-529, 2021. graf
Article in Spanish | LILACS | ID: biblio-1287334

ABSTRACT

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


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


Subject(s)
Humans , Male , Adult , Prisoners/psychology , X-Rays , Costs and Cost Analysis , Foreign Bodies/complications , Physical Examination , Indicators of Morbidity and Mortality , Foreign Bodies/therapy
6.
Rev. Hosp. Ital. B. Aires (2004) ; 41(1): 15-20, mar. 2021. graf, tab
Article in Spanish | LILACS | ID: biblio-1178270

ABSTRACT

Introducción: los estudios por imágenes (EPI) son de gran ayuda para el diagnóstico clínico, pero su uso irracional puede ocasionar daños. Objetivos: relevar las percepciones y expectativas sobre estudios por imágenes pediátricos en un grupo de padres de niños sanos. Evaluar los datos obtenidos en relación con el registro de EPI solicitados por Guardia durante el mismo período. Materiales y métodos: estudio exploratorio, descriptivo, cuali-cuantitativo mediante una encuesta en una muestra por conveniencia en un centro pediátrico ambulatorio, a lo largo de dos meses. Análisis retrospectivo de solicitud de EPI en el registro informatizado de historias clínicas de Guardia durante el mismo período. Resultados: respondieron 243 padres. El 93,4% refirió conocer métodos de EPI (la radiografía[Rx] fue el más conocido). Se había realizado al menos un EPI al 83,4% de los niños en los últimos doce meses. El estudio fue explicado en forma clara en el 96,4% de los casos. Un 47,7% de los padres refirieron conocer las consecuencias del uso repetitivo de EPI. El 81,6% acordó con que "ante cualquier traumatismo se debe realizar Rx para descartar fractura". Más del 60% consideró que debe realizarse Rx de tórax a todo niño con tos sin fiebre o con fiebre de más de dos días y 55% solicitarían Rx de senos paranasales si el niño elimina mocos verdes. El 49,8% opinó que los médicos piden EPI de menos (por falta de recursos, para trabajar menos o para ahorrar dinero). Durante el período estudiado se solicitó una radiografía al 5% de los pacientes que consultaron por Guardia; no se encontró justificación para solicitar el estudio en el 29% de los casos. Conclusión: un gran porcentaje de padres conoce los EPI; sin embargo, desconocen los riesgos asociados a su uso. Existen errores de concepto que generan expectativas desmedidas con respecto a la indicación de Rx. Se informó un exceso en las solicitudes de EPI por Guardia. Los padres consideran que los médicos solicitan EPI de menos. (AU)


Introduction: ediatric radiologic exams (PRE) are of great value for clinicians. It's over or misuse can lead to irreparable damage that can be prevented. Objective: to describe perceptions and expectations for the use of PRE among healthy children`s parents in an ambulatory center. To analyze these results in relation to the report of PRE performed in the emergency room during the same period. Methods: observational, cross sectional, quali- quantitative study using a survey on a convenience sample conducted in an outpatient pediatric center over a two months period. Retrospective analysis of medical records to evaluate PRE requested on the ER during the 2 months of the study. Results: 243 parents completed the survey. 93,4% were familiar with PRE (X-rays being the most popular among them). 83,4% of children in our sample had at least one PRE in the past 12 months. The need and utility of the study had been explained to the parents clearly in 96,4% of cases. 47,7% of parents knew about the side effects associated with repetitive use of PRE. 81,6% agreed with the statement "in the event that a child should suffer any trauma, an X-Ray should be performed to look for fractures". Over 60% think a chest X ray has to be obtained if the child has fever for over 48 hours and 55% would expect an X ray to be performed whenever a child has green nasal discharge. 49,8% respondents think that doctors order less than necessary (for lack of resources, unwillingness to work in or to save money). The analysis of clinical reports showed that X-Rays were performed to 5% of children at the emergency clinic. Among them, we found no reason for the study in 29% of the cases. Conclusion: we found that parents were very familiar with PRE, however less than half our sample knew of the potential risks related to their use. There are considerable misconceptions among parents regarding X-Ray use. Parents considered that doctors order too little PRE. (AU)


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Pediatrics/statistics & numerical data , Diagnostic Imaging/statistics & numerical data , Argentina , Radiation Injuries/etiology , Radiation, Ionizing , X-Rays , Diagnostic Imaging/adverse effects , Radiography/statistics & numerical data , Risk , Surveys and Questionnaires , Retrospective Studies
7.
San Salvador; MINSAL; feb. 04, 2021. 18 p. ilus, graf.
Non-conventional in Spanish | LILACS | ID: biblio-1177209

ABSTRACT

La Unidad de servicios de apoyo diagnostico tiene la finalidad de elaborar y actualizar la normativa técnica para la prestación de los servicios de apoyo diagnóstico: Laboratorio Clínico, Banco de Sangre, Patología, Imagenología y Rayos X, que contribuyen con el plan terapéutico del paciente en cualquiera de los establecimientos de salud de los tres niveles de atención del MINSAL. En este sentido y a fin de establecer la herramienta administrativa que sirva de guía para el desarrollo de las funciones de dicha Unidad, se ha elaborado el presente Manual que describe la estructura organizativa, objetivos, funciones y relaciones de trabajo que orientan y delimitan el campo de acción de los diferentes elementos que intervienen en esa Unidad


The Diagnostic Support Services Unit has the purpose of developing and updating the technical regulations for the provision of diagnostic support services: Clinical Laboratory, Blood Bank, Pathology, Imaging and X-rays, which contribute to the therapeutic plan of the patient in any of the health establishments of the three levels of MINSAL care. In this sense and in order to establish the administrative tool that serves as a guide for the development of the functions of said Unit, this Manual has been prepared that describes the organizational structure, objectives, functions and work relationships that guide and delimit the field of action of the different elements that intervene in that Unit


Subject(s)
Basic Health Services , Manuals as Topic , X-Rays , Blood Banks , Diagnosis , Laboratories
8.
Arq. bras. cardiol ; 116(1): 68-74, Jan. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1152967

ABSTRACT

Resumo Fundamento Cardiomegalia pela radiografia de tórax (RXT) é preditor independente de morte em indivíduos com cardiomiopatia crônica da doença de Chagas (CCDC). Contudo, a correlação entre o aumento do índice cardiotorácico (ICT) na RXT e do diâmetro telediastólico do ventrículo esquerdo (DDVE) pela ecocardiografia (ECO) nessa população não está bem definida. Objetivos Analisar a relação entre cardiomegalia pela RXT e DDVE pela ECO em pacientes com doença de Chagas (DC) e sua aplicabilidade ao escore de Rassi. Métodos Estudo retrospectivo incluiu 63 pacientes ambulatoriais com DC avaliados por RXT e ECO. Cardiomegalia na RXT foi definida como ICT > 0,5. DDVE foi avaliado como variável contínua. Curva ROC foi utilizada para avaliar o potencial do DDVE para identificação de cardiomegalia pela RXT, com ponto de corte definido pela maior somatória de sensibilidade e especificidade. Resultados Idade mediana = 61 anos [intervalo interquartil: 48-68], 56% mulheres. CCDC foi identificada em 58 pacientes; 5 tinham a forma indeterminada da DC. Cardiomegalia foi detectada em 28 indivíduos. A área sob a curva ROC do DDVE para identificação de cardiomegalia foi de 0,806 (IC 95%: 0,692-0,919). O ponto de corte ótimo para DDVE foi de 60 mm (sensibilidade = 64%, especificidade = 89%). O uso do DDVE pela ECO em substituição ao ICT pela RXT alterou o escore de Rassi em 14 pacientes, e em 10 deles houve redução do risco presumido. Conclusão DDVE pela ECO é parâmetro adequado e com alta especificidade para distinguir entre presença e ausência de cardiomegalia na RXT na DC. (Arq Bras Cardiol. 2021; 116(1):68-74)


Abstract Background Cardiomegaly on chest X-ray is an independent predictor of death in individuals with chronic Chagas cardiomyopathy (CCC). However, the correlation between increased cardiothoracic ratio (CTR) on chest X-ray and left ventricular end-diastolic diameter (LVEDD) on echocardiography is not well established in this population. Objectives To assess the relationship between chest X-ray and LVEDD on echocardiography in patients with Chagas disease and its applicability to the Rassi score. Methods Retrospective study on 63 Chagas disease outpatients who underwent chest X-ray and echocardiography. Cardiomegaly on chest X-ray was defined as a CTR>0.5. LVEDD was analyzed as a continuous variable. ROC curve was used to evaluate the ability of LVEDD in detecting cardiomegaly by chest X-ray, with a cut-off point defined by the highest sum of sensitivity and specificity. Results Median age 61 years [interquartile range 48-68], 56% were women. CCC was detected in 58 patients, five patients had the indeterminate form of Chagas disease. Cardiomegaly was detected in 28 patients. The area under the ROC curve for LVEDD was 0.806 (95%CI: 0.692-0.919). The optimal cut-off for LVEDD was 60 mm (sensitivity = 64%, specificity = 89%). The use of LVEDD on echocardiography as a surrogate for CTR on chest X-ray changed the Rassi score values of 14 patients, with a reduction in the presumed risk in 10 of them. Conclusion LVEDD on echocardiography is an appropriate, highly specific parameter to distinguish between the presence and absence of cardiomegaly on chest X-ray in Chagas disease. (Arq Bras Cardiol. 2021; 116(1):68-74)


Subject(s)
Humans , Male , Female , Echocardiography , Chagas Disease/diagnostic imaging , X-Rays , Retrospective Studies , Cardiomegaly/diagnostic imaging , Middle Aged
9.
Article in English | WPRIM | ID: wpr-887760

ABSTRACT

OBJECTIVES@#This study aimed to explore the short-term clinical efficacy and factors influencing low-dose superficial X-ray for treating infantile maxillofacial hemangioma.@*METHODS@#Retrospective analysis was conducted on 161 cases of infants with maxillofacial hemangioma treated with superficial X-ray in the Laser Center of Dermatology Department of Sichuan Provincial People's Hospital from January 2015 to December 2017. Clinical efficacy was analyzed by comparing the photos before and after treatment. Patients were further divided into groups according to different genders, age at the start of treatment, preterm birth or low birth weight, hemangioma site, longest diameter of hemangioma, and type of hemangioma to analyze whether differences existed in clinical efficacy and therapeutic dose between different groups.@*RESULTS@#Twelve months after the end of treatment, the overall cure rate was 93.8%, and the significant efficiency was 97.5%. The clinical efficacy was related to the age of children at the beginning of treatment and the type of hemangioma (@*CONCLUSIONS@#Low-dose superficial X-ray is safe and effective for the treatment of infantile maxillofacial hemangioma. Age and type of hemangioma at the time of treatment are the factors influencing therapeutic dose and clinical efficacy.


Subject(s)
Child , Female , Hemangioma , Humans , Infant , Infant, Newborn , Male , Pregnancy , Premature Birth , Retrospective Studies , Skin Neoplasms , Treatment Outcome , X-Rays
10.
Article in English | WPRIM | ID: wpr-880654

ABSTRACT

OBJECTIVES@#Clarifying the expression of breast cancer receptor is the key to clinical treatment for breast cancer. This study aims to explore the correlation between X-ray and clinical characteristics of 4 molecular subtypes and their receptor types of breast cancer.@*METHODS@#A total of 439 breast cancer patients who confirmed by pathology and performed X-ray examination were enrolled. The X-ray and clinical characteristics of 4 molecular subtypes and the expression of their receptors were analyzed.@*RESULTS@#Luminal A type showed the highest proportion of spiculate masses, and the lowest calcification score, showing significant difference with other 3 subtypes (all @*CONCLUSIONS@#Four molecular subtypes of breast cancer and their receptor expressions are correlated with X-ray and clinical characteristics, which can provide a basis for clinical diagnosis and treatment.


Subject(s)
Biomarkers, Tumor , Breast Neoplasms/genetics , Female , Humans , Receptor, ErbB-2/genetics , Receptors, Estrogen , Receptors, Progesterone , X-Rays
11.
REME rev. min. enferm ; 25: e1382, 2021. graf
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1340533

ABSTRACT

RESUMO Objetivo: relatar casos de cateteres nasoenterais mal posicionados, após inserção às cegas à beira leito. Método: são apresentados três casos, os quais ocorreram em uma instituição hospitalar localizada no estado de São Paulo. Os cateteres foram inseridos pelo enfermeiro conforme protocolo institucional, para posicionamento em nível entérico. Ausculta epigástrica e mensuração do pH foram os métodos empregados na confirmação do posicionamento dos cateteres e posteriormente foi realizado o exame de Raios-X, considerado exame de referência para confirmar o posicionamento de cateteres nasoenterais. Resultados: dos três cateteres mal posicionados, dois estavam com a extremidade distal projetada para a junção esofagogástrica e uma não foi visibilizada, apesar de a ausculta ter sido positiva e os valores de pH terem sido superiores a seis. Conclusão: os resultados revelaram importantes limitações de ambos os métodos na verificação do posicionamento de cateteres nasoenterais que foram inseridos recentemente às cegas à beira leito.


RESUMEN Objetivo: reportar casos de catéteres nasoenterales mal posicionados tras inserción ciega a pie de cama. Método: se presentan tres casos, ocurridos en un hospital ubicado en el estado de São Paulo. Los catéteres fueron insertados por el enfermero según protocolo institucional, para su colocación a nivel entérico. La auscultación epigástrica y la medición del pH fueron los métodos utilizados para confirmar la posición de los catéteres y posteriormente se realizó el examen de rayos X, considerado un examen de referencia para confirmar la posición de los catéteres nasoenterales. Resultados: de los tres catéteres mal posicionados, dos tenían el extremo distal proyectado a la unión esofagogástrica y uno no se visualizaba, a pesar de que la auscultación era positiva y los valores de pH superiores a seis. Conclusión: los resultados revelaron importantes limitaciones de ambos métodos para verificar la posición de los catéteres nasoenterales recientemente insertados a ciegas a la cabecera de la cama.


ABSTRACT Objective: to report cases of poorly positioned nasoenteral catheters after blind insertion at the bedside. Method: three cases are presented, which occurred in a hospital located in the state of São Paulo. The catheters were inserted by the nurse according to institutional protocol, for placement at the enteric level. Epigastric auscultation and pH measurement were the methods used to confirm the positioning of the catheters and subsequently the X-Ray exam was performed, considered a reference exam to confirm the positioning of nasoenteral catheters. Results: of the three poorly positioned catheters, two were with the distal end projected to the esophagogastric junction and one was not visualized, despite the auscultation being positive and the pH values being higher than six. Conclusion: the results revealed important limitations of both methods in verifying the positioning of nasoenteral catheters that were recently inserted blindly at the bedside.


Subject(s)
Humans , Catheters , Patient Care , Intubation, Gastrointestinal/methods , X-Rays , Enteral Nutrition , Hydrogen-Ion Concentration
13.
Article in Portuguese | LILACS | ID: biblio-1254158

ABSTRACT

Mulher de 18 anos com histórico de síncope, angina e palpitações há um ano. Uma indicação crucial era artéria coronária direita dilatada na ecocardiografia transtorácica. Os achados da tomografia computadorizada resultaram no diagnóstico da origem anômala da artéria coronariana esquerda proveniente da síndrome da artéria pulmonar.(AU)


Subject(s)
Humans , Female , Adolescent , Pulmonary Artery/physiopathology , Coronary Artery Disease/surgery , Coronary Vessels/diagnostic imaging , Bland White Garland Syndrome/pathology , Bland White Garland Syndrome/diagnostic imaging , X-Rays , Echocardiography , Magnetic Resonance Spectroscopy/methods , Electrocardiography, Ambulatory/methods , Creatine Kinase/blood , Electrocardiography , Computed Tomography Angiography/methods
14.
Arq. odontol ; 57: 46-56, jan.-dez. 2021. ilus, tab
Article in Portuguese | LILACS, BBO | ID: biblio-1223620

ABSTRACT

Objetivo: Avaliar a prevalência de erros radiográficos em radiografias periapicais de uma clínica de Odontopediatria em uma instituição de ensino superior de Teresina-Piauí. Métodos: Tratou-se de estudo transversal retrospectivo. Foram coletados dados sociodemográficos e radiográficos (localização e presença de erros de técnica radiográfica, processamento e armazenamento). As radiografias foram analisadas por um único examinador calibrado (kappa > 0,80). Foi realizada análise descritiva dos dados, teste Qui-Quadrado, razão de prevalência não-ajustadas (RPnãoajust) e intervalos de confiança (IC 95%). Considerou-se significativo valor de p < 0,05. Resultados: Das 208 radiografias analisadas, 187 (89,9%) possuíam algum tipo de erro. O erro mais prevalente foi de técnica radiográfica (n = 115; 55,3%). Entre esses, a radiografia tremida foi o mais frequente (n = 57; 28,4%). O erro de processamento mais frequente foi presença de digitais (n = 37; 17,8%). Todos os erros de armazenamento (n = 89; 100%) estavam relacionados a não identificação do paciente. O erro de técnica esteve associado com os pacientes de idade menor que 5 anos (RPnãoajus = 1,2 IC95% 1,1-1,3) comparando com idade entre 6 e 10 anos. Não houve associação entre tipo de erro radiográfico e a dentição avaliada nas radiografias (p > 0,05). Conclusão: A quantidade de erros detectados neste estudo foi alta e o mais frequente foi quanto à técnica radiográfica mal executada. Todos os erros de armazenamento observados foram devido a não identificação do paciente. Há uma maior frequência de erros de técnica radiográfica em pacientes com menos de 5 anos se comparados aos de 6 a 10 anos.


Aim: To evaluate the prevalence of radiographic errors in periapical radiographs of a pediatric dentistry clinic in a higher education institution in Teresina, Piauí, Brazil. Methods: This work is a retrospective cross-sectional study. Sociodemographic and radiographic data (location and presence of radiographic technique errors, processing, and storage) were collected. The radiographs were analyzed by a single calibrated examiner (kappa > 0.80). Descriptive analysis of the data, chi-square test, unadjusted prevalence ratio (PRnon-adjusted), and confidence intervals (95% CI) were performed. A p-value < 0.05 was considered significant. Results: Of the 208 radiographs analyzed in this study, 187 (89.9%) presented some type of error. The most prevalent error was the radiographic technique (n = 115; 55.3%). Among these, shaky radiography was the most frequent (n = 57; 28.4%). The most frequent processing error was the presence of fingerprints (n = 37; 17.8%). All storage errors (n = 89; 100%) were related to failure to identify the patient. The technical error was associated with patients younger than 5 years of age (PRnon-adjusted = 1.2; 95% CI 1.1-1.3) compared with 6 to 10 years of age. No association was observed between the type of radiographic error and the dentition assessed on the radiographs (p > 0.05). Conclusion: The number of errors detected in this study was high and the most frequent concerned the poorly performed radiographic technique. All storage errors observed in this study were due to the failure to identify the patients. Children under 5 years of age proved to be more prone to technical radiographic errors than those of 6 to 10 years of age.


Subject(s)
Child , Quality Control , X-Rays , Radiography, Dental , Child , Outcome Assessment, Health Care , Pediatric Dentistry , Dental Care for Children , Cross-Sectional Studies
15.
Article in Portuguese | LILACS | ID: biblio-1254149

ABSTRACT

Tumores cardíacos primários consistem em patologia rara, sendo encontrados em até 0,03% das autópsias e a maioria benigna. Dentre os benignos, os lipomas apresentam incidência de 8,5%, localizando-se mais frequentemente no septo interatrial. Quando localizado no septo interventricular, é considerado patologia ainda mais incomum, com prevalência real desconhecida. Na maioria dos casos, o diagnóstico ocorre de forma incidental, por exame de imagem cardiovascular, e pode ser confirmado por exame histopatológico. Apresentam-se mais comumente de forma assintomática ou com sintomas inespecíficos, mas podem evoluir com arritmias, disfunção valvar, insuficiência cardíaca e óbito, o que ressalta a importância dos métodos de imagem cardiovascular no diagnóstico diferencial e na orientação da terapêutica adequada. O presente trabalho relata o caso de um paciente com achado ecocardiográfico incidental de massa cardíaca localizada no septo interventricular, seguindo da realização de ressonância magnética cardíaca, para melhor caracterização da lesão e demonstração de características compatíveis com lipoma.(AU)


Subject(s)
Humans , Female , Aged , Pulmonary Disease, Chronic Obstructive/complications , Ventricular Septum/pathology , Heart Ventricles/pathology , Lipoma/etiology , Lipoma/diagnostic imaging , X-Rays , Biopsy/methods , Echocardiography/methods , Magnetic Resonance Spectroscopy/methods , Comorbidity , Electrocardiography
17.
Curitiba; s.n; 20200902. 100 p. ilus.
Thesis in Portuguese | LILACS, BDENF | ID: biblio-1151237

ABSTRACT

A segurança do paciente no momento da realização do exame de raio-x no leito em pacientes críticos é fundamental, o que exige a implementação de um protocolo de cuidados para esta prática que contemple as ações que os profissionais envolvidos devem executar antes, durante e após o exame. Assim, o objetivo dessa pesquisa é implementar um protocolo de cuidados para realização segura de raio-x no leito em pacientes críticos na Unidade de Terapia Intensiva em um hospital público. Realizou-se uma Pesquisa Convergente Assistencial (PCA), desenvolvida em unidade de terapia intensiva e unidade de diagnóstico por imagem, de um Hospital de Ensino do Sul do Brasil, no período de julho de 2019 a julho de 2020, com enfermeiros, técnicos de enfermagem e técnicos de radiologia, envolvidos na realização do exame de raio-x no leito. Na fase de concepção da PCA, em decorrência da atuação profissional da pesquisadora em unidade de terapia intensiva, despertou-se interesse em implementar um protocolo já existente para realização desses exames. Na fase de instrumentação definiu-se o local e os participantes da pesquisa. A fase de perscrutação foi dividida em cinco etapas: na primeira, observou-se a realização do exame de raio-x no leito o que permitiu identificar fragilidades e potencialidades da prática; na segunda etapa, ocorreu a divulgação do protocolo a ser implementado por meio de flayers e cartões com o intuito de despertar curiosidade e interesse nos profissionais; na terceira etapa, os profissionais foram capacitados para implementação do protocolo, com utilização de vídeo didático que possibilitou um maior envolvimento das equipes; na quarta etapa, os participantes foram convidados a dialogar com a pesquisadora sobre a prática da realização do exame e na quinta etapa os profissionais responderam a um formulário de quais ações começaram a realizar após a implementação do protocolo. Na fase de análise os dados foram agrupados por similaridade e analisados com literatura correlata. Esta pesquisa foi aprovada em Comitê de Ética e Pesquisa com parecer número 3.182.887 e CAAE: 64812117.0.0000.0096. Após análise dos dados, foi possível apontar oito aspectos que foram base para discussão da implementação do protocolo, a citar: a importância de um protocolo para a realização segura de raio-x no leito; a capacitação ao implementar novos cuidados para garantir uma prática segura; a comunicação entre setores, profissionais e paciente no momento da realização do exame; o fechamento da sonda enteral antes do exame; a desinfecção das mãos e equipamentos; o papel da enfermagem durante o exame, exposição corporal desnecessária do paciente e cuidados com diferentes dispositivos. Concluiu-se que é importante padronizar as ações desenvolvidas pelos profissionais com a implementação de um protocolo, trazendo como recomendação a necessidade constante de atualização da equipe de saúde, olhar humanizado dos profissionais e a valorização do uso de protocolos pelas instituições.


The patient safety at the moment an x-ray examination in bed in critically ill patients is essential, it must indicate the most appropriate practice, contemplating the care actions that the professionals involved must perform before, during and after the examination, which requires the implementation of a care protocol for this practice. Therefore, the objective of this research is to implement a care protocol for safely performing x-ray in bed in critically ill patients in the Intensive Care Unit in a public hospital. A Convergent Care Research (PCA) was carried out, developed in an intensive care unit and diagnostic imaging unit, of a Teaching Hospital in the South of Brazil, from July 2019 to July 2020, with nurses, technicians from nursing and radiology technicians, involved in performing the bed x-ray examination. In the PCA design phase, as a result of the researcher's professional performance in an intensive care unit, interest was aroused in implementing an already existing protocol for carrying out these exams. In the instrumentation phase, the location and research participants were defined. The screening phase was divided into five stages: in the first, the x-ray examination in bed was observed, which allowed the identification of weaknesses and potentialities of the practice; in the second stage, there was the disclosure of the protocol to be implemented through flayers and cards in order to arouse curiosity and interest in the professionals; in the third stage, the professionals were trained to implement the protocol, using didactic video that enabled greater involvement of the teams; in the fourth stage, the participants were invited to talk with the researcher about the practice of taking the exam and in the fifth stage, the professionals responded to a form of what actions they started to perform after the protocol implementation. In the analysis phase, data were grouped by similarity and analyzed with related literature. This research was approved by the Ethics and Research Committee with opinion number 3,182,887 and CAAE: 64812117.0.0000.0096. After analyzing the data, it was possible to point out eight aspects that were the basis for discussing the implementation of the protocol, to mention: the importance of a protocol for the safe performance of xrays in bed; training in implementing new care to ensure safe practice; communication between sectors, professionals and the patient at the time of the exam; closing the enteral tube before the exam; disinfection of hands and equipment; the role of nursing during the examination, unnecessary body exposure of the patient and care for different devices. It was concluded that it is important to standardize the actions developed by the professionals with the implementation of a protocol, bringing as a recommendation the constant need for updating the health team, a humanized view of the professionals and the valorization of the use of protocols by institutions.


Subject(s)
Humans , Male , Female , X-Rays , Protocols , Patient Safety , Intensive Care Units , Nursing Care , Patient Care Team , Nursing , Professional Training
19.
Rev. argent. reumatolg. (En línea) ; 31(2): 10-17, jun. 2020. ilus, graf, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1143926

ABSTRACT

Existen diversos índices capaces de valorar el daño radiográfico en pacientes con artritis psoriásica (APs), sin embargo la mayoría fueron creados para su uso en Artritis Reumatoidea y luego modificados para APs, por lo tanto no valoran lesiones características como la osteoproliferación. El objetivo de este estudio fue validar el Reductive X-Ray Score for Psoriatic Arthritis (ReXSPA), el cual fue recientemente desarrollado para su uso en cohortes observacionales. Material y métodos: Estudio de corte transversal, en el cual se incluyeron pacientes ≥18 años de edad, en forma consecutiva, con diagnóstico de APs según criterios CASPAR. A todos los pacientes se les realizaron radiografías de manos y pies en proyección anteroposterior. Dos lectores ciegos para las características clínicas de los pacientes y previamente entrenados, analizaron las mismas por medio de los índices Sharp van der Heijde modificado para APs (SvdHmAPs) y ReXSPA. Se midió el tiempo empleado para la lectura de los índices radiográficos y para el cálculo de los mismos. Resultados: Se incluyeron 66 pacientes, 50% mujeres, con tiempo de evolución de la APs mediano de 8 años (RIC: 4-14.3). 132 radiografías fueron evaluadas según los índices SvdHmAPs [m 35 (RIC: 16.3-72.5)] y el ReXSPA [m 22 (RIC: 7-46.3)]. El tiempo para la lectura radiográfica fue significativamente menor para ReXSPA comparado con SvdHmAPs [media 5.8±2.1 vs media 7.5±2.5 minutos, p<0.0001], al igual que el tiempo para calcularlo [media 26.5±14.7 vs media 55.3±38.3 segundos, p<0.0001]. La correlación entre estos últimos fue excelente (Rho: 0.93). En el análisis multivariado se observó asociación de ambos índices con el tiempo de evolución de la enfermedad y en el caso de ReXSPA también con la edad. Conclusión: El índice ReXSPA ha demostrado validez y una excelente correlación con el índice SvdHmAPs, con menor tiempo para su lectura y cálculo. Evaluaciones longitudinales posteriores permitirán demostrar la validez de estos hallazgos.


There are many scores available to measure radiographic joint damage in patients with Psoriatic Arthritis (PsA), but most of them were developed for Rheumatoid Arhtritis and then modified for PsA. These scores do not evaluate juxtaarticular bone proliferation. The aim of our study was to validate the Reductive X-Ray Score for Psoriatic Arthritis (ReXSPA), which was recently developed to be used in observational cohorts. Methods: A cross-sectional study was carried out. Consecutive patients ≥18 years old with PsA according to CASPAR criteria were included. All patients underwent X-rays of the hands and feet in an anteroposterior view. Two blind readers for the clinical characteristics of the patients and previously trained, scored them by Sharp van der Heijde modified for PsA (PsA-SvdH) and ReXSPA indexes. Time to read and calculate both scores were measured. Results: A total of 66 patients were included, half of them were female, median (m) disease duration of 8 years (IQR: 4-14.3). 132 X-Rays were scored according to PsA-SvdH [m 35 (IQR: 16.3-72.5)] and ReXSPA [m 22 (IQR: 7-46.3)]. Time to read was significantly shorter for ReXSPA than PsA-SvdH [mean 5.8±2.1 vs mean 7.5±2.5 minutes, p<0.0001], as well as, time to calculate them [mean 26.5±14.7 vs mean 55.3±38.3 seconds, p<0.0001]. The correlation between both indexes was excellent (Rho: 0.93). In the multivariate analysis, using both radiographic scores as dependent variable, association of each of the indices with disease duration was observed, and ReXSPA also had association with age. Conclusion: The ReXSPA index has shown validity and a very good correlation with PsA-SvdH. It is quicker to read and to calculate than PsA-SvdH. Subsequent longitudinal evaluations will allow demonstrating the validity of these findings.


Subject(s)
Humans , Arthritis, Psoriatic , X-Rays , Disease , Cross-Sectional Studies , Diagnosis
20.
Rev. chil. radiol ; 26(2): 40-45, jun. 2020. graf
Article in Spanish | LILACS | ID: biblio-1126192

ABSTRACT

Resumen: La protección gonadal ha sido durante largo tiempo un importante factor para abordar el requisito "tan bajo como sea razonablemente posible" ALARA. El presente artículo realiza una revisión sistemática sobre la utilidad de la protección gonadal en la radiografía de pelvis en la cual se han destacado los factores que tienen que ver con su realización diaria, es decir, la dosis de radiación involucrada, la radiosensibilidad de las gónadas, la posición del protector gonadal y el factor psicológico de la población en relación con su uso. La incorporación de equipamientos modernos, con dosis y protocolo optimizados, transforma el beneficio de la protección en un tema al menos debatible. Mientras algunos siguen respaldando la medida, otros organismos y autores ya no la respaldan. Es necesario reconsiderar prácticas actuales fundadas en consensos científicos que pueden estar obsoletos y considerar el factor de cambio cultural basados en estos nuevos consensos para su implementación, sin generar mayor preocupación en la población.


Abstract: Gonadal protection has long been an important factor in addressing the ALARA "as low as reasonably possible" requirement. This article performs a systematic review on the usefulness of gonadal protection in pelvic radiography, in which the factors that have to do with its daily performance have been highlighted, that is, radiation dose involved, the radiosensitivity of the gonads, the position of the gonadal shielding and the psychological factor of the population in relation to its use. The incorporation of modern equipment, with optimized dose and protocols, transforms the benefit of gonad shielding into an issue that is at least debatable. While some continue to support the measure, other agencies and authors no longer support it. It is necessary to reconsider current practices based on scientific consensus that may be obsolete and consider the factor of cultural change based on these new consensus for its implementation, without generating major concern in the population.


Subject(s)
Humans , Child , Pelvis/diagnostic imaging , Radiation Protection/methods , Gonads/radiation effects , Radiation Dosage , X-Rays , Radiography
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