RESUMO
The management of patients with mycetoma depends on accurate identification of the causative organisms and of the extent of disease involvement along the different tissue planes. Disease involvement cannot accurately be assessed with the available diagnostic tools, so in this study we set out to evaluate the effectiveness of MRI in the diagnosis and management of mycetoma. Forty-two patients with confirmed mycetoma had MRI examination of the affected parts. A grading system, The Mycetoma Skin, Muscle, Bone Grading System (MSMBS), was used to describe and grade disease severity on the basis of MRI findings. The logistic regression test was used to correlate the clinical and MRI findings. The study showed that MRI can help in the diagnosis and management of mycetoma patients. The dot-in-circle sign, conglomerated foci with low signal intensity and macro- and micro-abscesses on a background of a hypointense matrix are all diagnostic of mycetoma. In patients with mycetoma, the MSMBS can grade disease severity, compare patients and help to manage them. Further studies are needed to determine to what extent the grading system can be used to determine a patient's prognosis.
Assuntos
Doenças do Pé/diagnóstico , Micetoma/diagnóstico , Índice de Gravidade de Doença , Adolescente , Adulto , Idoso , Biópsia , Doenças Ósseas/diagnóstico , Doenças Ósseas/patologia , Feminino , Doenças do Pé/patologia , Mãos/patologia , Humanos , Modelos Logísticos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Micetoma/patologia , Estudos Prospectivos , Sudão , Coxa da Perna/patologia , Adulto JovemRESUMO
A prospective study was carried out in an area of unstable malaria transmission in central Sudan to determine the efficacy and toxicity of quinine in pregnancy. Thirty-three pregnant women with severe Plasmodium falciparum malaria at mean 28.8 weeks gestational age were treated with quinine for 7 days. The mean body temperature on presentation for 3 patients who delivered prematurely was significantly higher than for those who delivered at term (39.2 +/- 0.7 degrees C versus 38.7 +/- 1.3 degrees C). There were no significant difference between the 2 groups in other clinical or biochemical parameters. There were no clinically detectable congenital malformations and no auditory, visual or other neurological deficits in the babies at birth or 6 months later. Quinine may be safe in the treatment of severe falciparum malaria during pregnancy.
Assuntos
Antimaláricos/uso terapêutico , Malária Falciparum/tratamento farmacológico , Complicações Parasitárias na Gravidez/tratamento farmacológico , Quinina/uso terapêutico , Administração Oral , Adulto , Temperatura Corporal , Esquema de Medicação , Feminino , Idade Gestacional , Humanos , Infusões Intravenosas , Malária Falciparum/epidemiologia , Malária Falciparum/transmissão , Gravidez , Complicações Parasitárias na Gravidez/epidemiologia , Resultado da Gravidez , Cuidado Pré-Natal/métodos , Estudos Prospectivos , Segurança , Estações do Ano , Índice de Gravidade de Doença , Sudão/epidemiologia , Resultado do TratamentoRESUMO
A prospective study was carried out in an area of unstable malaria transmission in central Sudan to determine the efficacy and toxicity of quinine in pregnancy. Thirty-three pregnant women with severe Plasmodium falciparum malaria at mean 28.8 weeks gestational age were treated with quinine for 7 days. The mean body temperature on presentation for 3 patients who delivered prematurely was significantly higher than for those who delivered at term [39.2 +/- 0.7 degrees C versus 38.7 +/- 1.3 degrees C]. There were no significant difference between the 2 groups in other clinical or biochemical parameters. There were no clinically detectable congenital malformations and no auditory, visual or other neurological deficits in the babies at birth or 6 months later. Quinine may be safe in the treatment of severe falciparum malaria during pregnancy
