RESUMO
INTRODUCTION AND OBJECTIVES: Food allergy is a highly prevalent disorder. Anaphylaxis is the most serious consequence, and reactions often occur in schools. In the event of anaphylactic reaction prompt treatment is key and should be initiated by school personnel. The aim of this study was to assess the level of knowledge of the management of anaphylaxis, and to determine if it improves after a training session among school staff. MATERIALS AND METHODS: Descriptive study carried out by means of a pre-and post-training questionnaire completed by participants before and after a training session held at the school. Data from the same participants before and after the educational session were compared using McNemar's test. RESULTS: Three schools were enrolled (with a total of 38 children with food allergy) and 53 participants (85% teachers, 15% canteen staff) were trained. In the pre-training surveys, 83% said they had a Student's Allergic Reaction Management Plan, 56% had met with parents, 83% recognised some symptoms of allergic reaction but only 41% recognised anaphylaxis, 16% knew when to use adrenaline, 15% knew how to use it and 19% knew how to act after administering it. In the post-training questionnaires, 100% were satisfied and believed they had improved their knowledge, 93% recognised anaphylaxis and 95% the treatment of choice. CONCLUSIONS: Prior to the intervention their knowledge was insufficient, but it improved considerably after simple training. It also increased the confidence of the staff, which will be decisive when responding to an anaphylactic reaction. We believe that a compulsory training programme should be implemented universally in all schools
No disponible
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Conhecimentos, Atitudes e Prática em Saúde , Hipersensibilidade Alimentar/complicações , Anafilaxia/etiologia , Anafilaxia/terapia , Serviços de Saúde Escolar , Inquéritos e QuestionáriosRESUMO
INTRODUCTION AND OBJECTIVES: Food allergy is a highly prevalent disorder. Anaphylaxis is the most serious consequence, and reactions often occur in schools. In the event of anaphylactic reaction prompt treatment is key and should be initiated by school personnel. The aim of this study was to assess the level of knowledge of the management of anaphylaxis, and to determine if it improves after a training session among school staff. MATERIALS AND METHODS: Descriptive study carried out by means of a pre-and post-training questionnaire completed by participants before and after a training session held at the school. Data from the same participants before and after the educational session were compared using McNemar's test. RESULTS: Three schools were enrolled (with a total of 38 children with food allergy) and 53 participants (85% teachers, 15% canteen staff) were trained. In the pre-training surveys, 83% said they had a Student's Allergic Reaction Management Plan, 56% had met with parents, 83% recognised some symptoms of allergic reaction but only 41% recognised anaphylaxis, 16% knew when to use adrenaline, 15% knew how to use it and 19% knew how to act after administering it. In the post-training questionnaires, 100% were satisfied and believed they had improved their knowledge, 93% recognised anaphylaxis and 95% the treatment of choice. CONCLUSIONS: Prior to the intervention their knowledge was insufficient, but it improved considerably after simple training. It also increased the confidence of the staff, which will be decisive when responding to an anaphylactic reaction. We believe that a compulsory training programme should be implemented universally in all schools.
Assuntos
Anafilaxia , Hipersensibilidade Alimentar , Educação em Saúde/métodos , Instituições Acadêmicas , Capacitação de Professores/métodos , Adulto , Anafilaxia/etiologia , Anafilaxia/terapia , Feminino , Hipersensibilidade Alimentar/complicações , Hipersensibilidade Alimentar/terapia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Professores EscolaresRESUMO
Descripción de la experiencia en la utilización de recursos médico-tecnológicas (consejo médico telefónico y por internet, el uso del chat médico, los mensajes SMS a móviles, la teledocumentación personalizada ) para la valoración y el cuidado de pacientes a distancia (AU)
No disponible
Assuntos
50230 , Comunicação em Saúde , Consulta Remota , Internet , Tecnologia da Informação , Telecomunicações , Gestão de Ciência, Tecnologia e Inovação em SaúdeRESUMO
Postraumatic lesions of the carotid artery are very unusual in the general population and are especially rare in children due to the elasticity of their vessels. Because clinical expression of these lesions is mild, diagnosis can be delayed until the development of neurological signs, which are frequently irreversible. Neurological signs can be those of Horner's syndrome, drop attack, headache, vertigo, visual disorders, aphasia or transitory ischemic accidents. Carotid arterial lesion should be ruled out when the patient shows injuries in the soft tissue of the neck, when the neurological examination is incompatible with the findings of computed tomography (CT), when late neurological deficits develop or when the patient has Horner's syndrome. The patient reported herein presented partial motor seizures and hemiplegia 3 days after trauma. The most sensitive diagnostic test is angiography. Because this technique is aggressive, it is performed when suspicion is based on the results of Doppler sonography, CT or angiomagnetic resonance imaging. Treatment must be individualized. Standard therapy is anticoagulation but when this is contraindicated or the patient is asymptomatic anti-aggregating drugs are used. Thrombolytic treatment is reserved for the first few hours after injury. Surgical repair is the treatment of choice in patients with pseudoaneurysm. Because inaccessibility is one of the major difficulties in this type of surgery, intravascular stents can be a good therapeutic alternative in lesions unresponsive to medical treatment.
Assuntos
Lesões das Artérias Carótidas/diagnóstico , Traumatismos Craniocerebrais/diagnóstico , Acidentes de Trânsito , Adolescente , Angiografia Cerebral , Escala de Coma de Glasgow , Humanos , Masculino , Traumatismo Múltiplo , Lesões do Pescoço/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
Las lesiones postraumáticas de arteria carótida son muy raras en la población general, y más en la infancia por la elasticidad de los vasos. Su escasa expresión clínica inicial puede retrasar el diagnóstico hasta la aparición de signos neurológicos a menudo irreversibles. Se puede manifestar como síndrome de Horner, síncopes, cefalea, vértigo, cambios visuales, afasia y accidentes isquémicos transitorios. Se debe descartar una lesión ante: signos físicos de lesión de tejidos blandos del cuello, examen neurológico incompatible con los hallazgos de la tomografía computarizada (TC), desarrollo de déficit neurológicos tardíos y síndrome de Horner. El caso que se expone en esta nota clínica presentó una crisis parcial y hemiplejía a los 3 días del traumatismo. La técnica diagnóstica más sensible es la angiografía, aunque al ser agresiva se practica cuando hay sospecha por ecografía Doppler, TC o angiorresonancia. El tratamiento ha de ser individualizado. La anticoagulación constituye la terapia estándar y el tratamiento antiagregante está indicado en casos de contraindicación relativa para la anticoagulación y en pacientes asintomáticos, quedando el tratamiento trombolítico reservado para las primeras horas de evolución. La reparación quirúrgica constituye el tratamiento de elección en los seudoaneurismas y dado que la inaccesibilidad suele ser uno de los problemas principales de la cirugía, los stents intravasculares pueden constituir una buena alternativa terapéutica en las lesiones que no responden a tratamiento médico (AU)
Assuntos
Criança , Adolescente , Masculino , Humanos , Tomografia Computadorizada por Raios X , Escala de Coma de Glasgow , Traumatismo Múltiplo , Lesões das Artérias Carótidas , Lesões do Pescoço , Benzimidazóis , Anti-Helmínticos , Angiografia Cerebral , Acidentes de Trânsito , Hepatopatias Parasitárias , Fasciolíase , Traumatismos CraniocerebraisRESUMO
Primary varicella-zoster infection is very common during childhood and few patients develop complications. The most frequent complications are bacterial infection of the lesions, laryngitis and varicella pneumonia. In the nervous system it can produce encephalitis and especially cerebellitis. We describe a case of primary varicella-zoster induced rhabdomyolysis in a 5-year-old girl with mental retardation, microcephalia and mild diplegia who, in the context of varicella infection, presented extreme muscular weakness and prostration. Blood and urine tests showed high creatine phosphokinase concentrations and myoglobinuria. The patient received aggressive intravenous hydration. Evolution was favorable with no renal failure. Rhabdomyolysis can produce life-threatening complications such as renal failure, intravascular disseminated coagulation and hyperkaliemia. The disease can be precipitated by alcohol ingestion, compression injury and generalized seizures. Infectious etiology is less common. Few reports have been published on primary varicella-zoster induced rhabdomyolysis but, because creatine phosphokinase concentrations are not routinely performed in varicella infection, very mild cases might have been under-diagnosed. Despite its rarity, this disease should be considered in cases of infection, since early treatment with hyperhydration can prevent complications.
Assuntos
Varicela/complicações , Rabdomiólise/virologia , Pré-Escolar , Feminino , HumanosRESUMO
La primoinfección por virus de la varicela-zoster (VVZ) es muy frecuente durante la infancia y en pocos casos cursa con complicaciones. Las más frecuentes son la sobreinfección de las lesiones, la laringitis y la neumonía varicelosas y como complicaciones neurológicas la encefalitis con especial predominio de cerebelitis. Se describe un caso de rabdomiólisis como complicación de la varicela. Se trataba de una niña de 5 años de edad con retraso mental, microcefalia y diplejía leve que, en el contexto de una primoinfección con varicela, presentó debilidad muscular extrema y postración. Se practicaron determinaciones analíticas sanguíneas y de orina que mostraron hipercreatinfosfatemia y mioglobinuria. Se realizó sueroterapia inmediata y el cuadro mejoró progresivamente, sin signos de insuficiencia renal aguda. La rabdomiólisis puede presentar complicaciones importantes, que no se dieron en nuestra paciente, como insuficiencia renal aguda, coagulación intravascular diseminada (CID) e hiperpotasemia. Suele deberse a intoxicación etílica, traumatismo o crisis generalizadas, siendo otra causa menos frecuente las infecciones. La rabdomiólisis por virus de la varicela-zoster es rara, poco descrita en la bibliografía, aunque en grado leve puede pasar desapercibida ya que no se determinan las concentraciones de creatinfosfocinasa de manera sistemática. A pesar de su rareza, es importante tenerla en cuenta en el contexto de una infección ya que el abordaje terapéutico precoz con sueroterapia abundante evita complicaciones (AU)
Assuntos
Pré-Escolar , Feminino , Humanos , Rabdomiólise , VaricelaRESUMO
Advanced glycation end products (AGEs) and their cell surface receptor, RAGE, have been implicated in the pathogenesis of diabetic complications. Here, we studied the role of RAGE and expression of its proinflammatory ligands, EN-RAGEs (S100/calgranulins), in inflammatory events mediating cellular activation in diabetic tissue. Apolipoprotein E-null mice were rendered diabetic with streptozotocin at 6 weeks of age. Compared with nondiabetic aortas and kidneys, diabetic aortas and kidneys displayed increased expression of RAGE, EN-RAGEs, and 2 key markers of vascular inflammation, vascular cell adhesion molecule (VCAM)-1 and tissue factor. Administration of soluble RAGE, the extracellular domain of the receptor, or vehicle to diabetic mice for 6 weeks suppressed levels of VCAM-1 and tissue factor in the aorta, in parallel with decreased expression of RAGE and EN-RAGEs. Diabetic kidney demonstrated increased numbers of EN-RAGE-expressing inflammatory cells infiltrating the glomerulus and enhanced mRNA for transforming growth factor-beta, fibronectin, and alpha(1) (IV) collagen. In mice treated with soluble RAGE, the numbers of infiltrating inflammatory cells and mRNA levels for these glomerular cytokines and components of extracellular matrix were decreased. These data suggest that activation of RAGE primes cells targeted for perturbation in diabetic tissues by the induction of proinflammatory mediators.
Assuntos
Apolipoproteínas E/genética , Diabetes Mellitus Experimental/complicações , Receptores Imunológicos/fisiologia , Tromboplastina/biossíntese , Vasculite/metabolismo , Animais , Aorta/metabolismo , Rim/metabolismo , Complexo Antígeno L1 Leucocitário , Masculino , Glicoproteínas de Membrana/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , NF-kappa B/metabolismo , Moléculas de Adesão de Célula Nervosa/metabolismo , Receptor para Produtos Finais de Glicação Avançada , Molécula 1 de Adesão de Célula Vascular/metabolismo , Vasculite/complicaçõesRESUMO
Although hyperhomocysteinemia (HHcy) is a well-known risk factor for the development of cardiovascular disease, the underlying molecular mechanisms are not fully elucidated. Here we show that induction of HHcy in apoE-null mice by a diet enriched in methionine but depleted in folate and vitamins B6 and B12 increased atherosclerotic lesion area and complexity, and enhanced expression of receptor for advanced glycation end products (RAGE), VCAM-1, tissue factor, and MMP-9 in the vasculature. These homocysteine-mediated (HC-mediated) effects were significantly suppressed, in parallel with decreased levels of plasma HC, upon dietary supplementation with folate and vitamins B6/B12. These findings implicate HHcy in atherosclerotic plaque progression and stability, and they suggest that dietary enrichment in vitamins essential for the metabolism of HC may impart protective effects in the vasculature.
Assuntos
Arteriosclerose/etiologia , Hiper-Homocisteinemia/complicações , Vasculite/etiologia , Animais , Apolipoproteínas E/deficiência , Apolipoproteínas E/genética , Arteriosclerose/metabolismo , Arteriosclerose/patologia , Células Cultivadas , Dieta , Modelos Animais de Doenças , Ácido Fólico/administração & dosagem , Humanos , Hiper-Homocisteinemia/metabolismo , Imuno-Histoquímica , Masculino , Metaloproteinase 9 da Matriz/metabolismo , Metionina/administração & dosagem , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Piridoxina/administração & dosagem , Receptor para Produtos Finais de Glicação Avançada , Receptores Imunológicos/metabolismo , Tromboplastina/metabolismo , Molécula 1 de Adesão de Célula Vascular/metabolismo , Vasculite/metabolismo , Vasculite/patologia , Vitamina B 12/administração & dosagemRESUMO
OBJETIVO: Revisar la epidemiología, manifestaciones clínicas, manejo y complicaciones de las celulitis periorbitarias y orbitarias. Conocer la utilidad de las pruebas de imagen en la detección de dichas complicaciones. MÉTODOS: Estudio retrospectivo de los pacientes pediátricos afectos de celulitis periorbitaria u orbitaria ingresados desde enero de 1991hasta enero de 1999. RESULTADOS: Se incluyeron 107pacientes, con edad de máxima incidencia durante el segundo año de vida, sin predominio significativo en ninguno de los dos sexos y con mayor incidencia en invierno. En 68pacientes (63,6 por ciento) se identificó una sinusitis como causa de la celulitis. Los gérmenes más frecuentemente aislados fueron Staphylococcus aureus, Streptococcus pneumoniae y Streptococcus pyogenes. Mediante tomografía computarizada (TC) se detectó afectación retroseptal en 36pacientes, con 23abscesos subperiósticos, 3abscesos orbitarios y tres complicaciones intracraneales. El tratamiento instaurado al ingreso fue monoterapia antibiótica (cefotaxima, cefuroxima o amoxicilinaclavulánico) en el 69 por ciento de los casos y politerapia en le 31 por ciento de los pacientes. El 8,4 por ciento requirió cirugía. CONCLUSIÓN: La celulitis orbitaria es un proceso potencialmente grave y relativamente frecuente en la infancia. Para determinar el pronóstico es muy importante la prontitud con que se determine y la extensión de la afectación mediante pruebas de imagen, que determinarán la necesidad o no de drenaje quirúrgico (AU)
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Criança , Pré-Escolar , Adolescente , Masculino , Feminino , Humanos , Doenças Orbitárias , Celulite , Estudos RetrospectivosRESUMO
AIM: To report the epidemiology, clinical features, management and complications of orbital and periorbital cellulitis; to evaluate the use of imaging tests in the detection of complications. METHODS: Retrospective study of 107 pediatric patients admitted to the San Joan de Déu Pediatric Hospital with orbital or periorbital cellulitis from January 1991 to January 1999. RESULTS: The incidence of cellulitis was highest in the second year of life and during winter. No significant differences were found between the sexes. In 68 patients (63.6%) the cause of cellulitis was identified as sinusitis. The most frequently identified organisms were Staphylococcus aureus, Streptococcus pneumoniae and S. pyogenes. Computed tomography identified retroseptal damage in 36 patients with 23 super osteal abscesses, 3 orbital abscesses and 3 intracranial complications. Sixty nine percent of the patients were treated with a single antibiotic (cefotaxime, cefuroxime or amoxicillin clavulanic acid) while 31% underwent multiple antibiotic therapy. Only 8.4% required surgery. CONCLUSIONS: Orbital cellulitis is a relatively common and potentially serious disease in children. The early use of CT to assess the extent of damage is important in establishing prognosis and in assessing the need for surgical therapy.
Assuntos
Celulite (Flegmão) , Doenças Orbitárias , Adolescente , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/epidemiologia , Celulite (Flegmão)/terapia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/epidemiologia , Doenças Orbitárias/terapia , Estudos RetrospectivosRESUMO
Accelerated atherosclerosis in patients with diabetes is a major cause of their morbidity and mortality, and it is unresponsive to therapy aimed at restoring relative euglycemia. In hyperglycemia, nonenzymatic glycation and oxidation of proteins and lipids results in the accumulation of irreversibly formed advanced glycation endproducts. These advanced glycation endproducts engage their receptor in cells of the blood vessel wall, thereby activating mechanisms linked to the development of vascular lesions. We report here a model of accelerated and advanced atherosclerosis in diabetic mice deficient for apolipoprotein E. Treatment of these mice with the soluble extracellular domain of the receptor for advanced glycation endproducts completely suppressed diabetic atherosclerosis in a glycemia- and lipid-independent manner. These findings indicate interaction between the advanced glycation endproducts and their receptor is involved in the development of accelerated atherosclerosis in diabetes, and identify this receptor as a new therapeutic target in diabetic macrovascular disease.
Assuntos
Arteriosclerose/tratamento farmacológico , Diabetes Mellitus Experimental/complicações , Angiopatias Diabéticas/tratamento farmacológico , Produtos Finais de Glicação Avançada/metabolismo , Receptores Imunológicos/uso terapêutico , Animais , Arteriosclerose/etiologia , Linhagem Celular , Diabetes Mellitus Experimental/fisiopatologia , Humanos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Receptor para Produtos Finais de Glicação Avançada , Receptores Imunológicos/metabolismo , Proteínas Recombinantes de Fusão/metabolismo , Solubilidade , Spodoptera , EstreptozocinaRESUMO
An important component of amyloid fibrils in dialysis-related amyloidosis is a form of beta2microglobulin modified with advanced glycation end products (AGEs) of the Maillard reaction, known as AGE-beta2M. We demonstrate here that the interaction of AGE-beta2M with mononuclear phagocytes (MPs), cells important in the pathogenesis of the inflammatory arthropathy of dialysis-related amyloidosis, is mediated by the receptor for AGEs, or RAGE. 125I-AGE-beta2M bound to immobilized RAGE or to MPs in a specific, dose-dependent manner (Kd approximately 53.5 and approximately 81.6 nM, respectively), a process inhibited in the presence of RAGE blockade. AGE-beta2M-mediated monocyte chemotaxis was prevented by excess sRAGE or anti-RAGE IgG. Induction of tumor necrosis factor-alpha (TNF) expression by MPs exposed to AGE-beta2M resulted from engagement of RAGE, as appearances of TNF transcripts and TNF antigen release into culture supernatants were prevented by addition of sRAGE, a process mediated, at least in part, by oxidant stress. AGE-beta2M reduced cytochrome c and the elaboration of TNF by MPs was inhibited by N-acetylcysteine. Consistent with these data, immunohistochemical studies of AGE-laden amyloid deposits of a long-term hemodialysis patient revealed positive staining for RAGE in the MPs infiltrating these lesions. These data indicate that RAGE is a central binding site for AGEs formed in vivo and suggest that AGE-beta2M-MP-RAGE interaction likely contributes to the initiation of an inflammatory response in amyloid deposits of long-term hemodialysis patients, a process which may ultimately lead to bone and joint destruction.
Assuntos
Amiloidose/etiologia , Produtos Finais de Glicação Avançada/metabolismo , Artropatias/etiologia , Leucócitos Mononucleares/metabolismo , Fagócitos/metabolismo , Receptores Imunológicos/metabolismo , Microglobulina beta-2/metabolismo , Antígenos CD/isolamento & purificação , Antígenos de Diferenciação Mielomonocítica/isolamento & purificação , Movimento Celular , Humanos , Oxirredução , Estresse Oxidativo , Ligação Proteica , Receptor para Produtos Finais de Glicação Avançada , Diálise Renal/efeitos adversos , Transdução de Sinais , Pele/patologia , Fator de Necrose Tumoral alfa/biossínteseRESUMO
The essential objective of this work is the care provided at Santa Clara Heart Center to a total of 170 patients who underwent Cardiovascular surgery from October 1986 to December 1987. Data were collected from the record book of the Surgical Intensive Care Unit of the Heart Center, taking into account the following variables: sex, age, place of residence, frequency of extracorporeal and closed surgery applied, as well as the causes of the repeated surgery performed. It was found that extracorporeal surgery was performed in 82.2% of patients, who underwent mostly elective cardiovascular surgery. There was a prevalence of acquired diseases. The most frequent causes for repeated surgery were mediastinitis (wound sepsis) and postoperative bleeding. Surgical mortality was 5.8% (112 patients).
Assuntos
Institutos de Cardiologia/estatística & dados numéricos , Hospitais Especializados/estatística & dados numéricos , Fatores Etários , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/enfermagem , Doenças Cardiovasculares/cirurgia , Cuba/epidemiologia , Próteses Valvulares Cardíacas/estatística & dados numéricos , Humanos , Reoperação/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Fatores SexuaisRESUMO
Due to the importance of guided studies in training and improvement of workers hoping to reach the higher learning level, this new teaching modality is analyzed in the Higher Institute of Medical Sciences in Villa Clara in the discipline of Baccalaureate Nursing. Its advantages are described; the methodologic structure of the encounter course (as it is named from 1981 on as a result of the improvement of the teaching-educational process) is reported. Among these advantage the close association between teacher and student and self-training, which allows to develop the independent skills of the student are mentioned.