ABSTRACT
INTRODUCCIÓN: Los exámenes habituales de coagulación evalúan distintos elementos de la hemostasia en forma par cial, y no traducen las interacciones celulares, lo que es especialmente sensible en pacientes críticos. Las técnicas viscoelásticas, como el tromboelastograma (TEG) muestran el proceso de coagulación completo, y están siendo evaluadas como exámenes de la coagulación global. OBJETIVO: determinar la correlación de los exámenes habituales de coagulación con los valores del TEG, en niños atendidos en una unidad de cuidados intensivos (UCI). PACIENTES Y MÉTODO: Se revisaron 238 TEG de pacientes <18 años, con evidencia de alteración de coagulación clínica y/o de laboratorio, hospitalizados en UCI. Se correlacionaron los valores de los parámetros del TEG con cada uno de los valores de los exámenes habituales de coagulación. Los exámenes se obtuvieron según protocolo, utilizando una muestra de sangre de 4,5 ml para TEG con equipo TEG® 5000 Thrombelastograph Hemostasis Sys tem, mediante un transductor electromagnético que permite la medición de la resistencia durante la formación y lisis del coágulo. El recuento de plaquetas se obtuvo utilizando método automatizado o microscopía con contraste de fase; el fibrinógeno, tiempo de protrombina y de tromboplastina parcial activada por métodos nefelométricos. RESULTADOS: 201 TEGs correspondientes a 59 pacientes. Se evidenció una correlación moderada a baja en todos los parámetros medidos. No se encontró co rrelación entre porcentaje de lisis del coágulo, ni firmeza del coágulo. CONCLUSIONES: Existe una baja correlación entre la información entregada por TEG y los exámenes de coagulación habituales, esto sugiere que el TEG aporta información diferente acerca del estado de coagulación de los pacientes críticos evaluados.
INTRODUCTION: Usual coagulation tests partially evaluate different elements of hemostasis, and do not translate cell interactions, which is an especially sensitive issue in critically ill patients. Viscoelastic measurement techniques, such as thromboelastogram (TEG) show the complete coagulation pro cess and are being evaluated as global coagulation tests. OBJECTIVE: To determine the correlation of the usual coagulation tests with the TEG values, in children treated in an intensive care unit (ICU). PATIENTS AND METHOD: We reviewed 238 TEGs of patients under 18 years of age, with evidence of clinical and/or laboratory coagulation alterations, who were hospitalized in the ICU. The TEG para meter values were correlated with each of the usual coagulation test values. The tests were obtained according to the protocol, using a 4.5 ml blood sample for TEG with TEG® 5000 Thrombelastograph Hemostasis System, through an electromagnetic transducer that allows the measurement of resis tance during the clot formation and lysis. Platelet count was obtained using an automated method or phase-contrast microscopy, and fibrinogen levels, prothrombin time, and partial thromboplastin time activated by nephelometric methods. RESULTS: 201 TEGs corresponding to 59 patients were re viewed. A moderate to low correlation was observed in all the measured parameters. No correlation was found between the percentages of clot lysis or clot firmness. CONCLUSIONS: There is a low corre lation between the information provided by TEG and the usual coagulation tests. This suggests that the TEG provides different information about the coagulation status of the evaluated critical patients.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Thrombelastography/methods , Critical Illness , Platelet Count , Reaction Time , Time Factors , Blood Coagulation , Blood Coagulation Tests , Intensive Care Units, Pediatric , Retrospective StudiesABSTRACT
INTRODUCTION: Usual coagulation tests partially evaluate different elements of hemostasis, and do not translate cell interactions, which is an especially sensitive issue in critically ill patients. Viscoelastic measurement techniques, such as thromboelastogram (TEG) show the complete coagulation pro cess and are being evaluated as global coagulation tests. OBJECTIVE: To determine the correlation of the usual coagulation tests with the TEG values, in children treated in an intensive care unit (ICU). PATIENTS AND METHOD: We reviewed 238 TEGs of patients under 18 years of age, with evidence of clinical and/or laboratory coagulation alterations, who were hospitalized in the ICU. The TEG para meter values were correlated with each of the usual coagulation test values. The tests were obtained according to the protocol, using a 4.5 ml blood sample for TEG with TEG® 5000 Thrombelastograph Hemostasis System, through an electromagnetic transducer that allows the measurement of resis tance during the clot formation and lysis. Platelet count was obtained using an automated method or phase-contrast microscopy, and fibrinogen levels, prothrombin time, and partial thromboplastin time activated by nephelometric methods. RESULTS: 201 TEGs corresponding to 59 patients were re viewed. A moderate to low correlation was observed in all the measured parameters. No correlation was found between the percentages of clot lysis or clot firmness. CONCLUSIONS: There is a low corre lation between the information provided by TEG and the usual coagulation tests. This suggests that the TEG provides different information about the coagulation status of the evaluated critical patients.
Subject(s)
Critical Illness , Thrombelastography/methods , Adolescent , Blood Coagulation , Blood Coagulation Tests , Child , Child, Preschool , Female , Humans , Infant , Intensive Care Units, Pediatric , Male , Platelet Count/methods , Reaction Time , Retrospective Studies , Time FactorsABSTRACT
The prevalence of antibodies to Chlamydia was determined in 9 population groups with different risk levels for sexually transmitted diseases in Belém, Pará state, Brazil. 583 serum samples were examined by the indirect immunofluorescence test. The prevalence rates varied from 33.3% in patients attending a sexually transmitted disease clinic to 97.1% in Parakana Indians. One or more pathogens were found in 55 of 86 patients presenting a clinical picture of urethritis; C. trachomatis was isolated from 11% (6/55) of these cases by inoculation to McCoy cell cultures, accounting for 30% (6/20) of the cases of non-gonococcal urethritis. C. trachomatis was isolated from one of 28 female patients (3.6%) attending gynaecology and obstetrics outpatient clinics. The positive patients had no symptom or complaint that would have suggested the diagnosis.
Subject(s)
Antibodies, Viral/blood , Chlamydia Infections/epidemiology , Chlamydia trachomatis/immunology , Adolescent , Adult , Aged , Brazil/epidemiology , Child , Chlamydia Infections/blood , Chlamydia trachomatis/isolation & purification , Female , Humans , Male , Middle Aged , Prevalence , Rural Health , Urban HealthABSTRACT
From 1954 to 1990 granuloma inguinale was diagnosed in 259 patients al the dermatology service of the Universidade Federal do Pará in Belém, Brazil. Among them, 56 cases had occurred in the twenty-year period 1954-1974 and as many as 133 cases were seen during the last five years only. Greater sexual liberty, poor social and economic conditions, and especially increasing homosexual behavior were implicated by the authors as chief determinants for this augmented incidence of the disease.
Subject(s)
Granuloma Inguinale/epidemiology , Brazil/epidemiology , HumansABSTRACT
Neste estudo foram incluidos 148 doentes, sendo 65 com pitiriase versicolor e 83 com dermatofitoses, submetidos a tratamento com ketoconazole por via oral. A dose diaria foi de 200mg (um comprimido) durante duas a quatro semanas para os casos de pitiriase versicolor e de quatro a oito semanas para os de dermatofitoses. O tratamento determinou, nos doentes de pitiriase versicolor, cura clinica e micologica em 50 (78,1%), apenas cura clinica em dois (3,1%) e cura micologica em um (1,6%). Nos doentes com dermatofitoses, em 69 (84,1%) houve cura clinica e micologica, quatro (4,9%) apresentaram cura micologica e cinco (6,1%) tiveram apenas cura clinica. Efeitos colaterais foram observados em 11 doentes (7,4%), sendo que dois necessitaram abandonar o tratamento por intolerancia (um teve nauseas de grau moderado e outro, nauseas, vomitos e tonturas de grau moderado, ambos no 1o. dia de tratamento).O ketoconazole por via oral demonstrou ser bastante eficaz no tratamento de pitiriase versicolor e de dermatofitoses
