Infectious endotheliitis: a rare case of presumed mycotic origin.

PURPOSE: To report an interesting case of infectious endotheliitis of presumed mycotic origin. METHODS: A case report of a 56-year-old male farmer who sought medical attention after a month-long evolution of irritative symptoms in his right eye, accompanied by visual acuity (VA) impairment. The patient received topical and oral broad-spectrum antibiotic treatment with no improvement before being referred to a cornea specialist, where he was found to have VA of 20/150 and was noted on biomicroscopy to have endothelial feathery coalescent lesions. The patient was admitted to the hospital for an aqueous humor sample and intravenous voriconazole. RESULTS: The microbiological studies did not isolate any micro-organisms. However, clinical evidence of improvement was confirmed after 5 days of antimycotic intravenous therapy. Complete clinical resolution was achieved at 1 month after treatment completion with oral voriconazole, as evidenced by VA of 20/20 and disappearance of endothelial lesions. CONCLUSION: Endothelial involvement by fungi is a rare condition. In this case, no microbes were isolated, but the characteristic morphology of the lesions, the history of onychomycosis, and the spectacular response to voriconazole turn this case into a valid presumptive diagnosis.

Alimentar y nutrir a un niño con parálisis cerebral: una mirada desde las percepciones / Alimentar e nutrir a uma criança com paralisia cerebral: uma olhada desde as percepções / Feeding and nourishing a child with cerebral palsy: view from perceptions

Objetivo. Describir las percepciones y las rutinas del cuidador primario informal familiar frente a la alimentación y nutrición de niños con parálisis cerebral (PC). Metodología. Estudio cualitativo bajo perspectiva de etnografía enfocada. Los participantes fueron trece cuidadores de niños con PC residentes en Itagüí, Antioquia. La recolección de datos se hizo hasta la saturación de los mismos, mediante entrevistas semiestructuradas y observaciones. Para el procesamiento y análisis de la información se realizó codificación abierta, axial y selectiva, identificación de categorías, patrones recurrentes, atípicos y contradictorios con los que se construyeron taxonomías. Resultados. Los cuidadores perciben que alimentar y nutrir los niños con PC es difícil desde el nacimiento y que esta dificultad persiste durante el crecimiento del niño. Las rutinas de alimentación se construyen desde experiencias cotidianas, el sentir de la madre frente la discapacidad y la afección física y fisiológica del niño. Estas rutinas influyen en el consumo de alimentos, la nutrición y adquisición del niño de habilidades mínimas para autoalimentarse y transformar la vida personal, laboral, familiar y social del cuidador. Conclusión. El cuidado alimentario y nutricional del niño con PC es construido por su cuidador a partir de experiencias cotidianas. La asistencia permanente no posibilita desarrollar habilidades básicas para autoalimentarse en aquellos niños que pueden hacerlo, lo que genera una carga en el cuidador.

Objective. To describe perceptions and routines of the informal primary family caregiver towards feeding and nourishing children with cerebral palsy (CP). Methodology. Qualitative study under ethnography focused perspective. Thirteen caregivers of children with CP who lived in Itagui, Antioquia participated. Data collec- tion was performed until its saturation, through semi structured interviews and observation. For data processing and analysis an open, axial and selective coding was performed, category identification, recurrent, atypical and contradictory patterns from which taxonomies were built, were identified. Results. Caregivers perceive that feeding and nourishing children with CP is difficult from birth, and this difficulty stays during the child’s development. Feeding routines are constituted from daily experiences, mother’s feeling towards disability, physical and physiological handicaps of the child. These routines influence the kid’s food intake, nutrition and the acquisition of minimum abilities to eat by himself and it changes the personal, labor, social and family life of the caregiver. Conclusion. Alimentary and nutritional care of children with CP is built by their caregiver from daily experiences. Permanent assistance does not allow basic ability development to self nourish in those kids who can do it, what generates a load in the caregiver.

Objetivo. Descrever as percepções e as rotinas do responsável primário informal familiar frente à alimentação e nutrição de crianças com paralisia cerebral (PC). Metodologia. Estudo qualitativo sob perspectiva de etnografia enfocada. Os participantes foram treze responsáveis de crianças com PC residentes em Itagüí, Antioquia. A recolha de dados se fez até a saturação dos mesmos, mediante entrevistas semi-estructuradas e observações. Para o processamento e análise da informação se realizaram codificação aberta, axial e seletiva, identificação de categorias, padrões recorrentes, atípicos e contraditórios com os que se construíram taxonomias. Resultados. Os responsáveis percebem que alimentar e nutrir as crianças com PC é difícil desde o nascimento, e que esta dificuldade persiste durante o crescimento da criança. As rotinas de alimentação se constroem desde experiências cotidianas, o sentir da mãe frente à incapacidade e a afecção física e fisiológica da criança. Estas rotinas influem no consumo de alimentos, a nutrição e aquisição da criança de habilidades mínimas para auto-alimentação e transforma a vida pessoal, trabalhista, familiar e social do responsável Conclusão. O responsável da alimentação e nutrição da criança com PC é construído por seu responsável a partir de experiências cotidianas. A assistência permanente não possibilita desenvolver habilidades básicas para auto-alimentar naquelas crianças que podem fazê-lo, o que gera um ônus no responsável.

La alimentación del niño con parálisis cerebral un reto para el nutricionista dietista: perspectivas desde una revisión / Nutrition for children having cerebral paralysis is challenging for dietitians: review

Antecedentes: la parálisis cerebral es un término usado para describir el síndrome producido por lesión o daño del sistema nervioso central durante períodos críticos del desarrollo. Los niños con parálisis cerebral presentan diferentes manifestaciones clínicas, pero todos presentan deterioro de la función neurológica. Esta enfermedad, considerada altamente incapacitante, presenta una incidencia de 2,5 por cada mil nacidos vivos en países en desarrollo y de 2,0 en países desarrollados. Objetivo: identificar características alimentarias y nutricionales de los niños con parálisis cerebral para orientar a los profesionales de la salud con recomendaciones que contribuyan a la intervención efectiva de este grupo. Materiales y métodos: se realizó una búsqueda sistemática de artículos publicados en los últimos 10 años en bases de datos nacionales e internacionales. Resultados: la parálisis cerebral afecta el desarrollo de los diferentes sistemas reguladores de las funciones vitales del organismo: succión, masticación, deglución y respiración, que comprometen los procesos de alimentación y el estado nutricional de los niños que la padecen.Conclusiones: la atención alimentaria y nutricional de niños con parálisis cerebral, requiere que el nutricionista dietista, de forma interdisciplinaria, desarrolle modificaciones dietéticas acordes a las características del paciente para favorecer el consumo de alimentos y mejorar su estado nutricional.

Cerebral paralysis defined the syndrome for damage of nervous system, it could happen during critical periods of child development. Children having cerebral paralysis present different clinical manifestations, but all present damage of neurological function. Cerebral paralysis is an extremely disable disease, the world incidence is 2,5 per 1000 newborns in developing countries and 2,0 per 1000 newborns in developed nations. Objective: to identify feeding and nutritional characteristics in children having cerebral paralysis in order to develop guidelines for health professionals working with these children. Methods: a systematic search of articles published the last 10 years related to the topic was done, looking in scientific national and international data base. Results: cerebral paralysis affects physiological functions like suction, mastication, swallowing and breading system, that affect feeding process and nutritional status of children. Conclusion: the main purpose of this review was to understand the impact of cerebral paralysis on nutritional status in children having this syndrome, also this review provides information about recommendations that health professionals should apply to improve the quality of life for this population.

Sjögren keratoconjunctivitis sicca treated with rituximab.

PURPOSE: To report two clinical cases of patients having severe keratoconjunctivitis sicca refractive to conventional treatment that received rituximab, a chimeric monoclonal antibody specific for human CD20 that targets B lymphocytes. METHODS: Clinical description and review of the literature. RESULTS: After treatment with rituximab, there was a marked improvement in their keratoconjunctivitis sicca and in other systemic manifestations of the disease. The patients also report a better quality of life in regard to sicca symptoms. B cells seem to play an important role in the pathogenesis of Sjögren syndrome. Rituximab produces immunoablation and has been used in various autoimmune diseases and cancer with a secure profile. CONCLUSION: We demonstrate improvement in Schirmer test values, tear film breakup time, visual acuity, symptomatology, and vital staining in two patients with refractory queratoconjunctivitis sicca secondary to Sjögren syndrome. It is probable that drugs like rituximab could be of help in patients in unresponsive cases of keratoconjunctivitis sicca secondary to Sjögren syndrome. This case report serves as the basis to justify a multicenter, randomized, placebo-controlled clinical trial.