RESUMO
Severe bacterial infections (SBI) have become less frequent in children with sickle cell disease (SCD) in the last decades. However, because of their potential risk of SBI, they usually receive empirical therapy with broad-spectrum antibiotics when they develop fever and are hospitalized in many cases. We performed a prospective study including 79 SCD patients with fever [median age 4.1 (1.7-7.5) years, 78.5% males; 17 of the episodes were diagnosed with SBI and 4 of them were confirmed] and developed a risk score for the prediction of SBI. The optimal score included CRP > 3 mg/dl, IL-6 > 125 pg/ml and hypoxemia, with an AUC of 0.91 (0.83-0.96) for the prediction of confirmed SBI and 0.86 (0.77-0.93) for possible SBI. We classified the patients in 3 groups: low, intermediate and high risk of SBI. Our risk-score-based management proposal could help to safely minimize antibiotic treatments and hospital admissions in children with SCD at low risk of SBI.
Assuntos
Anemia Falciforme , Infecções Bacterianas , Anemia Falciforme/complicações , Anemia Falciforme/tratamento farmacológico , Antibacterianos/uso terapêutico , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/tratamento farmacológico , Criança , Pré-Escolar , Feminino , Febre/tratamento farmacológico , Febre/etiologia , Humanos , Lactente , Masculino , Estudos Prospectivos , Fatores de RiscoRESUMO
BACKGROUND: Etiological diagnosis of fever in children with sickle cell disease (SCD) is often challenging. The aim of this study was to analyze the pattern of inflammatory biomarkers in SCD febrile children and controls, in order to determine predictors of severe bacterial infection (SBI). METHODS: A prospective, case-control study was carried out during 3 years, including patients younger than 18 years with SCD and fever (cases) and asymptomatic steady-state SCD children (controls). Clinical characteristics and laboratory parameters, including 10 serum proinflammatory cytokines (IL-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-17a, IFN-γ and TNF-α) and comparisons among study subgroups were analyzed. RESULTS: A total of 137 patients (79 cases and 58 controls) were included in the study; 78.5% males, median age 4.1 (1.7-7.5) years. Four cases were diagnosed with SBI, 41 viral infection (VI), 33 no proven infection (NPI) and 1 bacterial-viral coinfection (the latter excluded from the subanalyses). IL-6 was significantly higher in patients with SBI than in patients with VI or NPI (163 vs 0.7 vs 0.7 pg/ml, p < 0.001), and undetectable in all controls. The rest of the cytokines analyzed did not show any significant difference. The optimal cut-off value of IL-6 for the diagnosis of SBI was 125 pg/mL, with high PPV and NPV (PPV of 100% for a prevalence rate of 5, 10 and 15% and NPV of 98.7%, 97.3% and 95.8% for those prevalences rates, respectively). CONCLUSION: We found that IL-6 (with a cut-off value of 125 pg/ml) was an optimal marker for SBI in this cohort of febrile SCD children, with high PPV and NPV. Therefore, given its rapid elevation, IL-6 may be useful to early discriminate SCD children at risk of SBI, in order to guide their management.
Assuntos
Anemia Falciforme , Infecções Bacterianas , Anemia Falciforme/complicações , Infecções Bacterianas/diagnóstico , Biomarcadores , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Interleucina-6 , Masculino , Estudos ProspectivosRESUMO
The anti-PP1Pk is a rare antibody associated with recurrent miscarriages, mainly in the first half of pregnancy. There seems to be a direct correlation between the antibody titer and risk of miscarriage. As this is a rare entity, few case reports have been published. The most frequently proposed therapeutic approaches are double-filtration plasmapheresis and plasma exchange therapy. The rationale behind them is to remove the cytotoxic antibodies from maternal circulation. Here, we present the case of a 30-year-old woman with a history of two spontaneous miscarriages and a pre-conception anti-PP1Pk antibody titer of 1:4. As soon as she became pregnant, she was placed on prednisolone and low-molecular-weight heparin (LMWH). Biweekly antibody titers were performed throughout the entire gestation and remained below 1:16. As the titers were considered to be low, plasmapheresis was not performed. The pregnancy was uneventful and she delivered a healthy newborn child at 37 weeks of gestation, with no signs of anaemia.
RESUMO
No disponible
Assuntos
Humanos , Atenção Primária à Saúde/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Congressos como Assunto/estatística & dados numéricosRESUMO
BACKGROUND: The use of antifungals has expanded in pediatric hematology-oncology, and the need to develop pediatric-based surveillance and education activities is becoming crucial. The aims of this study were to evaluate the impact of a multidisciplinary protocol on the adequacy of antifungal prescription in a pediatric hematology-oncology unit and to assess the effect of an educational intervention to improve the knowledge of prescribing pediatricians over time. METHODS: A multidisciplinary team established a protocol for the management of invasive fungal disease (IFD). The use of antifungals before (January 2012-May 2013) and after the protocol (June 2013-December 2015) was evaluated. Prescribing pediatricians attended a training course on IFD and were evaluated before 0, 6, and 12 months after the intervention. RESULTS: During the study period, antifungal agents were used in 185 episodes (56 children, 39.3% females), and were administered as prophylaxis (58.9%), empiric (34.6%), or targeted therapy (6.5%). Antifungal prescriptions were inadequate in 7% of the episodes, related to drug selection (53.8%), dosage (38.5%) and route of administration (7.7%). After protocol implementation, inadequate prescriptions decreased 9.9% (15.2% vs 5.3%; P = .04). Following the educational activity, the percentage of adequate responses to the questionnaire improved significantly compared to baseline, and persisted over time (19.7% improvement at 0 months [P < .0001]; 21.1% at 6 months [P < .0001]; 16.6% at 12 months [P = .002]). CONCLUSIONS: The establishment of multidisciplinary protocols and education activities improved the quality of antifungal prescription and the knowledge of prescribers regarding antifungal therapy. Therefore, these activities may be important for the implementation of antifungal stewardship programs in pediatrics.
Assuntos
Antifúngicos/uso terapêutico , Hematologia/educação , Infecções Fúngicas Invasivas/tratamento farmacológico , Oncologia/educação , Pediatria/educação , Padrões de Prática Médica , Feminino , Humanos , MasculinoRESUMO
INTRODUCTION: The rate of bacterial infections in children with sickle cell disease (SCD) has decreased in recent years, mainly due to penicillin prophylaxis and vaccination. OBJECTIVES: To determine the rate of severe bacterial infection (SBI) in a cohort of children with SCD and to describe low-risk factors for confirmed SBI (CSBI) and acute chest syndrome (ACS). METHODS: This 11-year retrospective cohort study included children with febrile SCD admitted to a reference hospital in Spain. A case-control study was performed comparing patients diagnosed with SBI to those without SBI, and subanalyses for groups with CSBI and ACS were carried out. RESULTS: A total of 316 febrile episodes were analyzed; 69 (21.8%) had confirmed or possible SBI. Thirteen of those had CSBI (4.1%), eight urinary tract infection, and five bacteremia/sepsis. Among the cases of possible SBI, the majority had ACS (54/56; 96.4%). Age >3 years, absence of central venous catheter, hemodynamic stability, and procalcitonin <0.6 ng/ml were low-risk factors for CSBI, whereas normal oxygen saturation and C-reactive protein <3 mg/dl were low-risk factors for ACS, with negative predictive values (NPV) of 98.3%, 97.4%, 96%, 97.2%, 87.5%, and 85.8%, respectively. CONCLUSION: In this cohort of children with SCD who were well vaccinated and received adequate prophylaxis, we found a low rate of bacteremia and CSBI. We described several low-risk factors for CSBI and ACS, all of them with a high NPV. These findings may help to develop a risk score to safely select the patients that could be managed with a more conservative approach.
Assuntos
Síndrome Torácica Aguda/diagnóstico , Anemia Falciforme/complicações , Bactérias/isolamento & purificação , Infecções Bacterianas/diagnóstico , Síndrome Torácica Aguda/epidemiologia , Síndrome Torácica Aguda/etiologia , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/etiologia , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologiaRESUMO
INTRODUCTION: PFAPA syndrome is an autoinflammatory disease whose diagnosis is mainly clinical. Several treatments have been proposed; among them, tonsillectomy could be an effective one. MATERIAL AND METHODS: Retrospective multicenter study. Patients included were diagnosed with PFAPA syndrome, according to the Thomas criteria, in 3 hospitals in Madrid between 2009-2013. RESULTS: Thirty-two cases were included. Median age at onset and at diagnosis were 32 months (IQR 24-44) and 47.5 months (IQR 37-60), respectively. There were increases in leukocytes (13,580/µL [IQR 8,200-16,600] vs. 8,300/µL [IQR 7,130-9,650], P=.005), neutrophils (9,340/µL [IQR 5,900-11,620] vs. 3,660/µL [IQR 2,950-4,580], P=.002) and C-reactive protein (11.0mg/dL [IQR 6.6-12.7] vs. 0.2mg/dL [IQR 0.1-0.6], P=.003) during febrile episodes. In all, 80.8% of patients reported remission of symptoms within 24h after oral corticosteroid therapy. Fourteen patients were tonsillectomized. In 11, the febrile episodes stopped while, in 3, the frequency was reduced; there were 2 cases of postoperative bleeding. The disease was resolved in 56.3% of the patients, at a median age of 60 months (IQR 47-95), with similar duration in patients who were tonsillectomized and those who were not. CONCLUSIONS: We present a large cohort of children with PFAPA syndrome, with clinical and analytical features similar to those described in the literature, and a good response to corticosteroids and a high resolution rate of symptoms after tonsillectomy.
Assuntos
Febre/diagnóstico , Febre/epidemiologia , Linfadenite/diagnóstico , Linfadenite/epidemiologia , Faringite/diagnóstico , Faringite/epidemiologia , Estomatite Aftosa/diagnóstico , Estomatite Aftosa/epidemiologia , Pré-Escolar , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , Masculino , Estudos Retrospectivos , Espanha/epidemiologia , Síndrome , Saúde da População UrbanaRESUMO
RATIONALE/AIM: Despite the increasing efficacy of recanalization therapies for acute ischemic stroke, a large number of patients are left with long-term functional impairment, devoid of efficacious treatments. CD34+ cells comprise a subset of bone marrow-derived mononuclear cells with the capacity to promote angiogenesis in ischemic lesions and have shown promising results in observational and in vitro studies. In this study, we aim to assess the efficacy of an autotransplant of CD34+ cells in acute ischemic stroke. SAMPLE SIZE ESTIMATES: 30 patients will be randomized for a power of 90% and alpha of 0.05 to detect a difference in 3 months infarct volume. METHODS AND DESIGN: We will screen 18-80 years old patients with acute ischemic stroke due to occlusion of a middle cerebral artery (MCA) for randomization. Persistent arterial occlusions, contra-indications to magnetic resonance imaging (MRI), premorbid dependency, or other severe diseases will be excluded. Treatment will involve bone marrow aspiration, selection of CD34+ cells, and their administration intra-arterially in the symptomatic MCA by angiography. Patients will be randomized for treatment at 7 (±2) days, 20 (±5 days) or sham procedure, 10 in each group. STUDY OUTCOMES: The primary outcome will be infarct volume in MRI performed at 3 months. Secondary outcomes will include adverse events and multidimensional functional and neurological measures. DISCUSSION/CONCLUSION: STROKE34 is a PROBE design phase IIa clinical trial to assess the efficacy of intra-arterial administration of CD34+ cells 7 and 20 days after acute ischemic stroke. TRIAL REGISTRATION EU CLINICAL TRIALS REGISTER: 2017-002456-88.
RESUMO
The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV- AEP) annually publishes the immunisation schedule which, in our opinion, is considered optimal for children resident in Spain, taking into account the evidence available on current vaccines. Pneumococcal and varicella immunisation in early childhood is already included in all funded vaccines present in the regional immunisation programmes. Furthermore, this committee establishes recommendations on vaccines not included in official calendars (non-funded immunisations), such as rotavirus, meningococcal B, and meningococcal ACWY. As regards funded immunisations, 2+1 strategy (2, 4, 11-12 months) with hexavalent (DTaP-IPV-Hib-HB) and 13-valent pneumococcal vaccines is recommended. Administration of the 6-year booster dose with DTaP is recommended, as well as a poliomyelitis dose for children who had received the 2+1 scheme, with the Tdap vaccine for adolescents and pregnant women between 27 and 32 weeks gestation. The two-dose scheme should be used for MMR (12 months and 2-4 years) and varicella (15 months and 2-4 years). Coverage of human papillomavirus vaccination in girls aged 12 with a two-dose scheme (0, 6 months) should be improved. Information and recommendations for male adolescents about potential beneficial effects of the tetravalent HPV vaccine should also be provided. ACWY meningococcal vaccine is the optimal choice in adolescents. For recommended unfunded immunisations, the CAV-AEP recommends the administration of meningococcal B vaccine, due to the current availability in Spanish community pharmacies, with a 3+1 scheme. CAV-AEP requests the incorporation of this vaccine in the funded unified schedule. Vaccination against rotavirus is recommended in all infants.
Assuntos
Esquemas de Imunização , Adolescente , Criança , Pré-Escolar , Humanos , LactenteRESUMO
Dendritic cells (DCs) hold promise for anti-cancer immunotherapy. However, clinically, their efficiency is limited and novel strategies to improve DC-mediated anti-tumor responses are needed. Human DCs display high content of sialic acids, which inhibits their maturation and co-stimulation capacity. Here, we aimed to understand whether exogenous desialylation of DCs improves their anti-tumor immunity. Compared to fully sialylated DCs, desialylated human DCs loaded with tumor-antigens showed enhanced ability to induce autologous T cells to proliferate, to secrete Th1 cytokines, and to specifically induce tumor cell apoptosis. Desialylated DCs showed an increased expression of MHC-I and -II, co-stimulatory molecules and an augmented secretion of IL-12. Desialylated HLA-A*02:01 DCs pulsed with gp100 peptides displayed enhanced peptide presentation through MHC-I, resulting in higher activation ofgp100280-288 specific CD8+ cytotoxic T cells. Desialylated murine DCs also exhibited increased MHC and co-stimulatory molecules and higher antigen cross-presentation via MHC-I. These DCs showed higher ability to activate antigen-specific CD4+ and CD8+ T cells, and to specifically induce tumor cell apoptosis. Collectively, our data demonstrates that desialylation improves DCs' ability to elicit T cell-mediated anti-tumor activity, due to increased MHC-I expression and higher antigen presentation via MHC-I. Sialidase treatment of DCs may represent a technology to improve the efficacy of antigen loaded-DC-based vaccines for anti-cancer immunotherapy.
Assuntos
Apresentação de Antígeno/imunologia , Antígenos de Neoplasias/imunologia , Apresentação Cruzada/imunologia , Células Dendríticas/imunologia , Células Dendríticas/metabolismo , Ácido N-Acetilneuramínico/metabolismo , Neoplasias/terapia , Animais , Vacinas Anticâncer/imunologia , Vacinas Anticâncer/uso terapêutico , Células Cultivadas , Feminino , Humanos , Imunoterapia/métodos , Células MCF-7 , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Neoplasias/imunologia , Linfócitos T Citotóxicos/imunologiaRESUMO
Morcela de Arroz (MA) is a ready-to-eat blood and rice cooked sausage produced with pork, blood, rice, and seasonings, stuffed in natural casing and cooked above 90 °C/30 min. It is commercialized whole, not packed, with a restricted shelf life (1 wk/0 to 5 °C). The objective of this work was to establish sliced MA shelf life considering both the behavior of L. monocytogenes through a microbiological challenge test (MCT) and the consumer acceptability of MA stored: vacuum packed (VP), modified atmosphere packed (MAP: 80% CO2/20% N2 ), and aerobic packed (AP). The MCT was conducted inoculating ±3 log CFU/g of L. monocytogenes cell suspension on the MA slices. Packaged samples were stored at 3 ± 1 °C and 7 ± 1 °C until 20 d. At 3 ± 1 °C, L. monocytogenes behavior was not affected by packaging or storage time. At 7 ± 1 °C, the pathogen increased nearly 1 log CFU/g in the first 4 d. L. monocytogenes populations in AP were higher (P < 0.05) than in MAP. The pathogen may grow to hazardous levels in the 1st days if a temperature abuse occurs. Considering the acceptability by the consumers, the shelf life of MA stored at 3 ± 1 °C was 4.4 d for AP, 8.1 d for VP, and 10.4 d for MAP. The sensory shelf life established based on sensory spoilage is shorter than the shelf life to maintain the population of L. monocytogenes in safe levels.
Assuntos
Comportamento do Consumidor , Culinária , Conservação de Alimentos/métodos , Armazenamento de Alimentos/métodos , Listeria monocytogenes/crescimento & desenvolvimento , Produtos da Carne/microbiologia , Temperatura , Animais , Atmosfera , Contagem de Colônia Microbiana , Qualidade de Produtos para o Consumidor , Microbiologia de Alimentos , Embalagem de Alimentos/métodos , Humanos , Suínos , Paladar , VácuoRESUMO
Microbial flora of portuguese chouriço (Alentejano (A) and Ribatejano (R)) with abnormal sensorial characteristics along shelf life was studied. Mesophilic anaerobic bacteria, enterococci, mesophilic sporeformers, coliforms, coagulase-positive staphylococci, sulphite reducing clostridia, Clostridium perfringens, moulds and yeasts were the most representative in both types of chouriço.
RESUMO
El Comité Asesor de Vacunas de la Asociación Española de Pediatría (CAV-AEP) actualiza anualmente el calendario de vacunaciones teniendo en cuenta tanto aspectos epidemiológicos, como de seguridad, efectividad y eficiencia de las vacunas. El presente calendario incluye grados de recomendación. Se han considerado como vacunas sistemáticas aquellas que el CAV-AEP estima que todos los niños deberían recibir; como recomendadas las que presentan un perfil de vacuna sistemática en la edad pediátrica y que es deseable que los niños reciban, pero que pueden ser priorizadas en función de los recursos para su financiación pública; y dirigidas a grupos de riesgo aquellas con indicación preferente para personas en situaciones de riesgo. Los calendarios de vacunaciones tienen que ser dinámicos y adaptarse a los cambios epidemiológicos que vayan surgiendo. El CAV-AEP considera como objetivo prioritario la consecución de un calendario de vacunación único para toda España. Teniendo en cuenta los últimos cambios en la epidemiología de las enfermedades, el CAV-AEP mantiene las novedades propuestas la temporada anterior, como la administración de las primeras dosis de las vacunas triple vírica y varicela a los 12 meses y las segundas dosis a los 2-3 años, así como la administración de la vacuna Tdpa a los 4-6 años, siempre acompañada de otra dosis a los 11-14 años, con preferencia a los 11-12 años. El CAV-AEP estima que deben incrementarse las coberturas de vacunación frente al papilomavirus humano en las niñas de 11 a 14 años, con preferencia a los 11-12 años. Se reafirma en la recomendación de incluir la vacunación frente al neumococo en el calendario de vacunación sistemático. La vacunación universal frente a la varicela en el segundo año de vida es una estrategia efectiva y, por tanto, un objetivo deseable. La vacunación frente al rotavirus, dadas la morbilidad y la elevada carga sanitaria, es recomendable en todos los lactantes. Se insiste en la necesidad de vacunar frente a la gripe y a la hepatitis A a todos los que presenten factores de riesgo para dichas enfermedades. Finalmente, se insiste en la necesidad de actualizar las vacunaciones incompletas con las pautas de vacunación acelerada (AU)
The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) updates the immunisation schedule every year, taking into account epidemiological data as well as evidence on the safety, effectiveness and efficiency of vaccines. The present schedule includes levels of recommendation. We have graded as routine vaccinations those that the CAV-AEP consider all children should receive; as recommended those that fit the profile for universal childhood immunisation and would ideally be given to all children, but that can be prioritised according to the resources available for their public funding; and as risk group vaccinations those that specifically target individuals in situations of risk. Immunisation schedules tend to be dynamic and adaptable to ongoing epidemiological changes. Nevertheless, the achievement of a unified immunisation schedule in all regions of Spain is a top priority for the CAV-AEP. Based on the latest epidemiological trends, CAV-AEP follows the innovations proposed in the last year's schedule, such as the administration of the first dose of the MMR and the varicella vaccines at age 12 months and the second dose at age 2-3 years, as well as the administration of the Tdap vaccine at age 4-6 years, always followed by another dose at 11-14 years of age, preferably at 11-12 years. The CAV-AEP believes that the coverage of vaccination against human papillomavirus in girls aged 11-14 years, preferably at 11-12 years, must increase. It reasserts its recommendation to include vaccination against pneumococcal disease in the routine immunisation schedule. Universal vaccination against varicella in the second year of life is an effective strategy and therefore a desirable objective. Vaccination against rotavirus is recommended in all infants due to the morbidity and elevated healthcare burden of the virus. The Committee stresses the need to vaccinate population groups considered at risk against influenza and hepatitis A. Finally, it emphasizes the need to bring incomplete vaccinations up to date following the catch-up immunisation schedule (AU)
Assuntos
Humanos , Esquemas de Imunização , Controle de Doenças Transmissíveis/organização & administração , Controle de Doenças Transmissíveis/métodos , Poliomielite/prevenção & controle , Hepatite A/prevenção & controle , Hepatite B/prevenção & controle , Difteria/prevenção & controle , Tétano/prevenção & controle , Coqueluche/prevenção & controle , Haemophilus influenzae tipo b/imunologia , Neisseria meningitidis Sorogrupo B/imunologia , Neisseria meningitidis Sorogrupo C/imunologia , /prevenção & controle , Sarampo/prevenção & controle , Rubéola (Sarampo Alemão)/prevenção & controle , Infecções por Rotavirus/prevenção & controle , Varicela/prevenção & controleRESUMO
INTRODUCTION: HELLP syndrome is characterized by hemolysis with a microangiopathic blood smear, elevated liver enzymes, and low platelet count. It develops in 10-20% of women with severe preeclampsia/eclampsia. The syndrome is associated with maternal morbidities - DIC, renal failure, pulmonary edema and hepatic hematoma/rupture. Some need transfusions and others require laparotomies for intraabdominal bleeding. OBJECTIVES: Study the incidence and related risk factors of HELLP syndrome in Pregnancy, as well as the maternal/fetal outcome. METHODS: A retrospective study of admissions for HELLP syndrome in 2012.The statistical analysis was based on Excel 2007. RESULTS: In 55 admissions for hypertensive complications in pregnancy, 3 women had HELLP syndrome - 2 were black race and 1 was caucasian. The average maternal age was 29. None had relevant medical history. 2 of the women developed HELLP syndrome after severe preeclampsia. The fetal/neonatal outcomes were prematurity in 2 cases, birth weight average was 1798g and none had apgar-index below 7. There was no fetal death. Premature delivery occurred in 2 cases and all were by cesarean. Maternal complications that determined Intensive Care Unit Admission was recorded in one case - laparotomy for internal bleeding and transfusions were needed. No maternal death occured. CONCLUSIONS: HELLP syndrome is associated with many morbidities which risk increases with severity of symptoms/lab results. We had no aggresive/fatal outcomes.
RESUMO
INTRODUCTION: There are major hypertensive disorders related to pregnancy-preeclampsia,eclampsia and HELLP syndrome. These women are at an increased risk for placental abruption,renal failure, cerebral hemorrhage,hepatic failure/rupture,pulmonary edema, DIC and of long-term cardiovascular disease. OBJECTIVES: Study the incidence, risk factors, maternal/fetal outcome of hypertensive complications that determined Intensive Care Unit admission. METHODS: A retrospective study of admissions in Intensive Care Unit for preeclampsia, HELLP syndrome and eclampsia in 2011-2012. RESULTS: There were 8 admissions in Intensive Care - 88% black women, average age was 20 years and all were nulliparous. 1 had an hypertension induced by pregnancy, but 63% had increased blood pressure in hospital admission. 50% had elevated liver enzymes, 25% proteinuria, 1 low platelet count and 1 had normal blood results. 50% of the admissions were due to eclampsia, 38% due to severe preeclampsia and 1 due to HELLP. Fetal/neonatal outcomes were prematurity in 25%, birth weight average was 2759g and none had apgar below 7. There was no fetal death. Vaginal delivery occurred in 25% and caesarian in 75%. Maternal complications were elevated blood pressure (75%), cardiorespiratory disorders (38%), encephalopathy (25%), renal disorder (13%) and convulsions (13%). There was no maternal death. CONCLUSION: The risk of adverse outcome increases with the severity of hypertension and organ damage. Early detection and appropriate management are essential.
RESUMO
OBJECTIVES: To investigate the etiopathogenic role of sinus inflammatory disease in primary acquired dacryocystitis and other chronic obstructive diseases of the lachrymal drainage system. STUDY DESIGN: Noninterventional controlled study. SETTING: Tertiary care center. SUBJECTS AND METHODS: Sixty consecutive patients with primary acquired dacryocystitis and other chronic obstructive diseases of the lachrymal drainage system, selected for endoscopic endonasal dacryocystorhinostomy (DCR) and who had been ordered a preoperative sinus CT scan, had their sinus scans assessed for inflammatory naso-sinusal disease extension, using the modified Lund-Mackay system. A control group of 40 subjects was simultaneously enrolled, as a way to assess the prevalence of sinus disease in the general population. RESULTS: Chronic inflammatory sinus disease was found to be no more frequent or more extensive in DCR patients than in controls. CONCLUSION: Chronic sinusitis alone does not seem to be a causative factor to primary acquired chronic obstructive diseases of the lachrymal drainage system.
Assuntos
Dacriocistite/etiologia , Obstrução dos Ductos Lacrimais/etiologia , Sinusite/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Doença Crônica , Dacriocistite/diagnóstico por imagem , Dacriocistite/cirurgia , Dacriocistorinostomia , Feminino , Humanos , Obstrução dos Ductos Lacrimais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
Microbial flora of portuguese chouriço (Alentejano (A) and Ribatejano (R)) with abnormal sensorial characteristics along shelf life was studied. Mesophilic anaerobic bacteria, enterococci, mesophilic sporeformers, coliforms, coagulase-positive staphylococci, sulphite reducing clostridia, Clostridium perfringens, moulds and yeasts were the most representative in both types of chouriço.
RESUMO
Este trabalho objetivou analisar a identidade social de catadores de material reciclável, ligada às posições que ocupam na sociedade, decorrentes de suas pertenças sociais. Realizaram-se grupos focais com catadores de depósitos e de associações. Os discursos mostram que os catadores reconhecem os estigmas atribuídos à sua atividade e que permanecem nela por falta de outras oportunidades de trabalho. Nos catadores associados destaca-se uma visão mais crítica acerca do papel que desempenham na sociedade, pois sua participação nessa organização torna possível a mudança da realidade social e de como são percebidos. Conclui-se que os catadores não conseguem vislumbrar uma identidade social própria, escolhida, mas sim uma identidade cuja construção decorre da consciência de integrarem uma categoria de trabalhadores
This work analyzes the recyclable material collectors' social identity, linked to the position they occupy in society as a consequence of their social membership. Focus groups took place with collectors from associations and deposits. Their discourse shows recognition of the stigmas attached to their activity and also that they persist as collectors for lack of other employment opportunities. Associated collectors have a more critical view about their role in society: being an associated collector makes it possible to change their social reality and also the way they are perceived by others. We conclude that collectors cannot envision a chosen, particular social identity, but an identity built from the awareness of belonging to a professional category
Assuntos
Humanos , Masculino , Feminino , Adulto , Identificação Social , Catadores , Uso de Resíduos SólidosRESUMO
Este trabalho objetivou analisar a identidade social de catadores de material reciclável, ligada às posições que ocupam na sociedade, decorrentes de suas pertenças sociais. Realizaram-se grupos focais com catadores de depósitos e de associações. Os discursos mostram que os catadores reconhecem os estigmas atribuídos à sua atividade e que permanecem nela por falta de outras oportunidades de trabalho. Nos catadores associados destaca-se uma visão mais crítica acerca do papel que desempenham na sociedade, pois sua participação nessa organização torna possível a mudança da realidade social e de como são percebidos. Conclui-se que os catadores não conseguem vislumbrar uma identidade social própria, escolhida, mas sim uma identidade cuja construção decorre da consciência de integrarem uma categoria de trabalhadores (AU)
This work analyzes the recyclable material collectors' social identity, linked to the position they occupy in society as a consequence of their social membership. Focus groups took place with collectors from associations and deposits. Their discourse shows recognition of the stigmas attached to their activity and also that they persist as collectors for lack of other employment opportunities. Associated collectors have a more critical view about their role in society: being an associated collector makes it possible to change their social reality and also the way they are perceived by others. We conclude that collectors cannot envision a chosen, particular social identity, but an identity built from the awareness of belonging to a professional category (AU)