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The prospective collection of clinical data can generate detailed information on heterogeneous populations. This article reviews the strengths and limitations of the collection of real-world data and provides insight into the feasibility of routine collection of high-quality evidence even in a resource-constrained setting. The acquisition of high-quality data to assess the clinical and psychosocial needs of young Mexican patients with breast cancer has been enhanced through the use of preplanned, standardized data definitions and instrumentation to provide internally and externally comparable results, optimization of data collection with web-based surveys, engagement of participants to minimize missing data, and routine review for data consistency. A similar approach by other research groups could improve the quality of real-world data and accomplish enhanced inference of information.
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Neoplasias de la Mama/epidemiología , Bases de Datos Factuales/estadística & datos numéricos , Investigación sobre Servicios de Salud/métodos , Almacenamiento y Recuperación de la Información/estadística & datos numéricos , Adaptación Psicológica , Adulto , Estudios de Cohortes , Femenino , Humanos , México , Estudios ProspectivosRESUMEN
BACKGROUND: Inherited epidermolysis bullosa (EB) is a genetic disorder characterized by skin fragility and unique oral features. AIMS: To provide (a) a complete review of the oral manifestations in those living with each type of inherited EB, (b) the current best practices for managing oral health care of people living with EB, (c) the current best practices on dental implant-based oral rehabilitation for patients with recessive dystrophic EB (RDEB), and (d) the current best practice for managing local anesthesia, principles of sedation, and general anesthesia for children and adults with EB undergoing dental treatment. METHODS: Systematic literature search, panel discussion including clinical experts and patient representatives from different centers around the world, external review, and guideline piloting. RESULTS: This article has been divided into five chapters: (i) general information on EB for the oral health care professional, (ii) systematic literature review on the oral manifestations of EB, (iii) oral health care and dental treatment for children and adults living with EB-clinical practice guidelines, (iv) dental implants in patients with RDEB-clinical practice guidelines, and (v) sedation and anesthesia for adults and children with EB undergoing dental treatment-clinical practice guidelines. Each chapter provides recommendations on the management of the different clinical procedures within dental practice, highlighting the importance of patient-clinician partnership, impact on quality of life, and the importance of follow-up appointments. Guidance on the use on nonadhesive wound care products and emollients to reduce friction during patient care is provided. CONCLUSIONS: Oral soft and hard tissue manifestations of inherited EB have unique patterns of involvement associated with each subtype of the condition. Understanding each subtype individually will help the professionals plan long-term treatment approaches.
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Anestesia Dental , Epidermólisis Ampollosa Distrófica , Epidermólisis Ampollosa , Adulto , Niño , Humanos , Salud Bucal , Guías de Práctica Clínica como Asunto , Calidad de VidaRESUMEN
The 2019 novel coronavirus disease (COVID-19) is a highly contagious zoonosis produced by SARS-CoV-2 that is spread human-to-human by respiratory secretions. It was declared by the WHO as a public health emergency. The most susceptible populations, needing mechanical ventilation, are the elderly and people with associated comorbidities. There is an important risk of contagion for anesthetists, dentists, head and neck surgeons, maxillofacial surgeons, ophthalmologists, and otolaryngologists. Health workers represent between 3.8% and 20% of the infected population; some 15% will develop severe complaints and among them, many will lose their lives. A large number of patients do not have overt signs and symptoms (fever/respiratory), yet pose a real risk to surgeons (who should know this fact and must therefore apply respiratory protective strategies for all patients they encounter). All interventions that have the potential to aerosolize aerodigestive secretions should be avoided or used only when mandatory. Health workers who are: pregnant, over 55 to 65 years of age, with a history of chronic diseases (uncontrolled hypertension, diabetes mellitus, chronic obstructive pulmonary diseases, and all clinical scenarios where immunosuppression is feasible, including that induced to treat chronic inflammatory conditions and organ transplants) should avoid the clinical attention of a potentially infected patient. Health care facilities should prioritize urgent and emergency visits and procedures until the present condition stabilizes; truly elective care should cease and discussed on a case-by-case basis for patients with cancer. For those who are working with COVID-19 infected patients' isolation is compulsory in the following settings: (a) unprotected close contact with COVID-19 pneumonia patients; (b) onset of fever, cough, shortness of breath, and other symptoms (gastrointestinal complaints, anosmia, and dysgeusia have been reported in a minority of cases). For any care or intervention in the upper aerodigestive tract region, irrespective of the setting and a confirmed diagnosis (eg, rhinoscopy or flexible laryngoscopy in the outpatient setting and tracheostomy or rigid endoscopy under anesthesia), it is strongly recommended that all health care personnel wear personal protective equipment such as N95, gown, cap, eye protection, and gloves. The procedures described are essential in trying to maintain safety of health care workers during COVID-19 pandemic. In particular, otolaryngologists, head and neck, and maxillofacial surgeons are per se exposed to the greatest risk of infection while caring for COVID-19 positive subjects, and their protection should be considered a priority in the present circumstances.
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Betacoronavirus , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Otolaringología , Pandemias/prevención & control , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , COVID-19 , Infecciones por Coronavirus/epidemiología , Humanos , Neumonía Viral/epidemiología , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina , SARS-CoV-2RESUMEN
BACKGROUND: Heavy episodic drinking (HED) can have health and social consequences. This study assesses the associations between HED and demographic, socioeconomic, motivation and effects indicators for people aged 18â»34 years old living in four cities in different regions of the world. METHOD: Multistage random sampling was consistent across the four cities (Ilorin (Nigeria), Wuhan (China), Montevideo (Uruguay) and Moscow (Russia)). The questionnaire was forward/back translated and face-to-face interviewing was undertaken. A total of 6235 interviews were undertaken in 2014. Separate univariable and multivariable modelling was undertaken to determine the best predictors of HED. RESULTS: HED prevalence was 9.0%. The best predictors differed for each city. The higher probability of HED in the final models included beliefs that they have reached adulthood, feeling relaxed as an effect of drinking alcohol, and forgetting problems as an effect of drinking alcohol. Lower probability of HED was associated with not being interested in alcohol as a reason for limiting alcohol, and the belief that drinking alcohol is too expensive or a waste of money. CONCLUSION: Although some indicators were common across the four cities, the variables included in the final models predominantly differed from city to city. The need for country-specific prevention and early intervention programs are warranted.
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Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/psicología , Población Urbana/estadística & datos numéricos , Adolescente , Adulto , China/epidemiología , Ciudades/estadística & datos numéricos , Femenino , Humanos , Masculino , Nigeria/epidemiología , Prevalencia , Federación de Rusia/epidemiología , Factores Socioeconómicos , Encuestas y Cuestionarios , Uruguay/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: To investigate the prospective associations between early childhood lead exposure and subsequent risk of attention deficit hyperactivity disorder (ADHD) in childhood and its potential effect modifiers. STUDY DESIGN: We analyzed data from 1479 mother-infant pairs (299 ADHD, 1180 neurotypical) in the Boston Birth Cohort. The child's first blood lead measurement and physician-diagnosed ADHD was obtained from electronic medical records. Graphic plots and multiple logistic regression were used to examine dose-response associations between lead exposure and ADHD and potential effect modifiers, adjusting for pertinent covariables. RESULTS: We found that 8.9% of the children in the Boston Birth Cohort had elevated lead levels (5-10 µg/dL) in early childhood, which was associated with a 66% increased risk of ADHD (OR, 1.66; 95% CI, 1.08-2.56). Among boys, the association was significantly stronger (OR, 2.49; 95% CI, 1.46-4.26); in girls, the association was largely attenuated (P value for sex-lead interaction = .017). The OR of ADHD associated with elevated lead levels among boys was reduced by one-half if mothers had adequate high-density lipoprotein levels compared with low high-density lipoprotein, or if mothers had low stress compared with high stress during pregnancy. CONCLUSIONS: Elevated early childhood blood lead levels increased the risk of ADHD. Boys were more vulnerable than girls at a given lead level. This risk of ADHD in boys was reduced by one-half if the mother had adequate high-density lipoprotein levels or low stress. These findings shed new light on the sex difference in ADHD and point to opportunities for early risk assessment and primary prevention of ADHD.
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Trastorno por Déficit de Atención con Hiperactividad/etiología , Exposición a Riesgos Ambientales/efectos adversos , Contaminantes Ambientales/toxicidad , Contaminación Ambiental/efectos adversos , Plomo/toxicidad , Estudios de Casos y Controles , Niño , Preescolar , Exposición a Riesgos Ambientales/análisis , Contaminantes Ambientales/sangre , Femenino , Estudios de Seguimiento , Humanos , Lactante , Plomo/sangre , Modelos Logísticos , Masculino , Embarazo , Efectos Tardíos de la Exposición Prenatal/etiología , Estudios Prospectivos , Factores de Riesgo , Factores SexualesRESUMEN
BACKGROUND: Alcohol consumption patterns are dependent upon culture and context. The aim of this study was to interview people aged 18-34 year old living in four cities in different regions of the world to explore differences in a range of alcohol measures to assist in determining culturally appropriate alcohol initiatives for this age group. METHOD: Multistage random sampling was consistent across the four cities (Ilorin (Nigeria), Wuhan (China), Montevideo (Uruguay) and Moscow (Russia)). The questionnaire was forward and back translated into relevant languages and face-to-face interviewing undertaken. The data were weighted to the population of each city. Uni-variable analysis (ever consumed, first time consumed, age when drunk for first time, number of days consumed, type consumed) and logistic regression modeling were undertaken. The final model for each city was adjusted for age, sex, marital status, highest education and employment status. In total 6235 interviews were undertaken (1391 in Ilorin, 1600 in Montevideo, 1604 in Moscow and 1640 in Wuhan). RESULTS: Alcohol was consumed by 96.4% in Montevideo, 86.1% in Moscow, 53.4% in Wuhan and 33.3% in Ilorin. There was very little difference by gender except Ilorin males were more likely to consume alcohol than females. Alcohol was consumed on more days for Ilorin males; Wuhan females consumed alcohol on the least number of days; Ilorin had the most abstainers; Montevideo and Moscow the highest proportion of light drinkers; Ilorin and Montevideo the highest proportion of heavy drinkers. Differences by type of alcohol were also apparent. The final logistic regression model provided different models including higher alcohol consumption rates for males, 25-34 years of age, divorced/separated marital status and employed part time for Ilorin respondents; males and higher educated for Montevideo; males, 25 to 29 years of age and higher educated for Moscow; and 25-29 years of age, non-married and vocationally trained for those in Wuhan. CONCLUSION: Alcohol consumption in these four cities does not increase with age as found in most high income countries. The alcohol consumption patterns during this stage of the life cycle are important to assess so that high level, as well as country-specific, planning and interventions can be implemented.
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Consumo de Bebidas Alcohólicas/epidemiología , Intoxicación Alcohólica/epidemiología , Adolescente , Adulto , Distribución por Edad , China , Ciudades , Etanol/efectos adversos , Femenino , Humanos , Masculino , Estado Civil , Nigeria , Federación de Rusia , Encuestas y Cuestionarios , Uruguay , Adulto JovenRESUMEN
Land use change and intensification in agricultural landscapes of the Andean highlands have resulted in widespread soil degradation and a loss in soil-based ecosystem services and biodiversity. This trend threatens the sustainability of farming communities in the Andes, with important implications for food security and biodiversity conservation throughout the region. Based on these challenges, we sought to understand the impact of current and future land use practices on soil fertility and biodiversity, so as to inform landscape planning and management decisions for sustainable agroecosystem management. We worked with local communities to identify and map dominant land uses in an agricultural landscape surrounding Quilcas, Peru. These land uses existed within two elevations zones (low-medium, 3200-3800 m, and high elevation, 3800-4300 m). They included three types of low-medium elevation forests (eucalyptus, alder, and mixed/native species), five pasture management types (permanent pasture, temporal pasture [in fallow stage], degraded pasture, high-altitude permanent pasture, and high-altitude temporal pasture [in fallow stage]) and six cropping systems (forage crops, maize/beans, and potato under four types of management). Soil fertility was evaluated in surface soils (0-20 cm) with soil physicochemical parameters (e.g., pH, soil organic matter, available nutrients, texture), while soil biological properties were assessed using the abundance and diversity of soil macrofauna and ground cover vegetation. Our results indicated clear impacts of land use on soil fertility and biological communities. Altitude demonstrated the strongest effect on soil physicochemical properties, but management systems within the low-mid elevation zone also showed important differences in soil biological communities. In general, the less-disturbed forest and pasture systems supported more diverse soil communities than the more intensively managed croplands. Degraded soils demonstrated the lowest overall soil fertility and abundance of soil macrofauna, but this may be reversible via the planting of alder forests. Our findings also indicated significant covariation between soil physicochemical parameters, soil macrofauna, and ground vegetation. This suggests that management for any one of these soil properties may yield unintended cascading effects throughout the soil subsystem. In summary, our findings suggest that shifts in land use across the landscape are likely to have important impacts on soil functioning and biodiversity.
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Agricultura/métodos , Biodiversidad , Bosques , Pradera , Suelo/química , Altitud , PerúRESUMEN
Yellow fever, a mosquito-borne disease, is an important viral hemorrhagic fever in Africa and South America where it is endemic. Detection of yellow fever virus (YFV) in Africa remains a challenge due to a lack of highly specific tests. The aim of this study was to develop and optimize a rapid detection reverse transcription loop-mediated isothermal amplification (RT-LAMP) for YFV. The RT-LAMP was done isothermally at 62 °C using a real-time turbidimeter that allowed detection within 1h. Specificity of the RT-LAMP was determined using RNA from flaviviruses and other related viruses where only YFV RNA was detected: West Nile virus, dengue viruses, Japanese encephalitis virus, Rift Valley fever virus, and chikungunya virus. In addition, equal sensitivity was also observed when the RT-LAMP and the real-time RT-PCR were compared using YFV-spiked human serum samples with a detection limit of 0.29 PFU/ml. Two Kenyan YFV wild strains showed an equal detection limit as the vaccine strain 17D in this study. The RT-LAMP reduced the time of reaction from 3h to 1h and increased sensitivity tenfold compared to RT-PCR. Therefore, this test offers a simple, rapid and reliable diagnostic tool for yellow fever when there are outbreaks of acute hemorrhagic fever in Kenya and other African countries.
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Técnicas de Amplificación de Ácido Nucleico/métodos , Fiebre Amarilla/diagnóstico , Virus de la Fiebre Amarilla/aislamiento & purificación , África , Humanos , Transcripción Reversa , Sensibilidad y Especificidad , América del Sur , Temperatura , Factores de Tiempo , Fiebre Amarilla/virologíaRESUMEN
OBJECTIVE: To assess the incidence of upper airway pathology in patients with junctional epidermolysis bullosa (JEB). STUDY DESIGN: We conducted a retrospective chart review of all patients with JEB who came to an interdisciplinary epidermolysis bullosa center at a tertiary care institution between 2004 and 2010. RESULTS: Twenty-five patients with JEB were identified, and 12 patients were seen in the otolaryngology clinic (age range, 2 months-15 years; 8 male, 4 female). Of the 12 patients, 8 underwent rigid laryngoscopy and bronchoscopy for upper respiratory tract symptoms; 7 of these patients displayed laryngeal pathology, and 5 of them underwent surgical intervention with successful resolution of symptoms. Furthermore, none of these patients had any short- or long-term complications from their surgery. A strict protocol and a precise problem-focused cold surgical technique were used in these cases to protect skin and mucus membranes. CONCLUSION: With appropriate precautions, endoscopic laryngeal surgery can be safe and effective in patients with JEB and larygnotracheal disease. Endoscopic laryngeal surgery is feasible when indicated for these patients.
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Epidermólisis Ampollosa de la Unión/complicaciones , Enfermedades de la Laringe/etiología , Enfermedades de la Tráquea/etiología , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Enfermedades de la Laringe/terapia , Laringoscopía , Masculino , Estudios Retrospectivos , Enfermedades de la Tráquea/terapiaRESUMEN
OBJECTIVES: To evaluate the utility of rapid antigen detection testing (RADT) for the diagnosis of group A streptococcal (GAS) pharyngitis in pediatric outpatient clinics in four countries with varied socio-economic and geographic profiles. METHODS: We prospectively evaluated the utility of a commercial RADT in children aged 2-12 years presenting with symptoms of pharyngitis to urban outpatient clinics in Brazil, Croatia, Egypt, and Latvia between August 2001 and December 2005. We compared the performance of the RADT to culture using diagnostic and agreement statistics, including sensitivity, specificity, and positive and negative predictive values. The Centor scores for GAS diagnosis were used to assess the potential effect of spectrum bias on RADT results. RESULTS: Two thousand four hundred and seventy-two children were enrolled at four sites. The prevalence of GAS by throat culture varied by country (range 24.5-39.4%) and by RADT (range 23.9-41.8%). Compared to culture, RADT sensitivity ranged from 72.4% to 91.8% and specificity ranged from 85.7% to 96.4%. The positive predictive value ranged from 67.9% to 88.6% and negative predictive value ranged from 88.1% to 95.7%. CONCLUSIONS: In limited-resource regions where microbiological diagnosis is not feasible or practical, RADTs should be considered an option that can be performed in a clinic and provide timely results.
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Antígenos Bacterianos/análisis , Faringitis/diagnóstico , Áreas de Pobreza , Juego de Reactivos para Diagnóstico , Streptococcus pyogenes/aislamiento & purificación , Brasil , Niño , Preescolar , Croacia , Medios de Cultivo , Egipto , Femenino , Humanos , Letonia , Masculino , Faringitis/microbiología , Faringe/microbiología , Valor Predictivo de las Pruebas , Prevalencia , Sensibilidad y Especificidad , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/microbiología , Streptococcus pyogenes/inmunología , Factores de TiempoRESUMEN
OBJECTIVE: To prospectively evaluate a cohort of patients with infantile hemangioma in the midline lumbosacral region for spinal anomalies to determine the positive predictive value of infantile hemangioma for occult spinal anomalies and to make evidence-based recommendations for screening. STUDY DESIGN: A multicenter prospective cohort study was performed at 9 Hemangioma Investigator Group sites. RESULTS: Intraspinal abnormalities were detected in 21 of 41 study participants with a lumbosacral infantile hemangioma who underwent a magnetic resonance imaging evaluation. The relative risk for all patients with lumbosacral infantile hemangiomas for spinal anomalies was 640 (95% confidence interval [CI], 404-954), and the positive predictive value of infantile hemangioma for spinal dysraphism was 51.2%. Ulceration of the hemangioma was associated with a higher risk of having spinal anomalies. The presence of additional cutaneous anomalies also was associated with a higher likelihood of finding spinal anomalies; however, 35% of the infants with isolated lumbosacral infantile hemangiomas had spinal anomalies, with a relative risk of 438 (95% CI, 188-846). The sensitivity for ultrasound scanning to detect spinal anomalies in this high-risk group was poor at 50% (95% CI, 18.7%-81.3%), with a specificity rate of 77.8% (95% CI, 40%-97.2%). CONCLUSIONS: Infants and children with midline lumbosacral infantile hemangiomas are at increased risk for spinal anomalies. Screening magnetic resonance imaging is recommended for children with these lesions.
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Hemangioma/complicaciones , Neoplasias Cutáneas/complicaciones , Columna Vertebral/anomalías , Preescolar , Anomalías Congénitas/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Región Lumbosacra , Masculino , Estudios ProspectivosRESUMEN
Epidermolysis bullosa (EB) has become recognized as a multisystem disorder that poses a number of pre-, intra-, and postoperative challenges. While anesthesiologists have long appreciated the potential difficult intubation in patients with EB, other systems can be affected by this disorder. Hematologic, cardiac, skeletal, gastrointestinal, nutritional, and metabolic deficiencies are foci of preoperative medical care, in addition to the airway concerns. Therefore, multidisciplinary planning for operative care is imperative. A multinational, interdisciplinary panel of experts assembled in Santiagio, Chile to review the best practices for perioperative care of patients with EB. This paper presents guidelines that represent a synthesis of evidence-based approaches and the expert consensus of this panel and are intended to aid physicians new to caring for patients with EB when operative management is indicated. With proper medical optimization and attention to detail in the operating room, patients with EB can have an uneventful perioperative course.
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Epidermólisis Ampollosa/complicaciones , Atención Perioperativa , Anestesia por Inhalación , Epidermólisis Ampollosa/patología , Epidermólisis Ampollosa/terapia , Humanos , Quirófanos , Dolor Postoperatorio/terapia , Cuidados Posoperatorios , Sistema Respiratorio/patologíaRESUMEN
We review the current state of multiphoton microscopy. In particular, the requirements and limitations associated with high-speed multiphoton imaging are considered. A description of the different scanning technologies such as line scan, multifoci approaches, multidepth microscopy, and novel detection techniques is given. The main nonlinear optical contrast mechanisms employed in microscopy are reviewed, namely, multiphoton excitation fluorescence, second harmonic generation, and third harmonic generation. Techniques for optimizing these nonlinear mechanisms through a careful measurement of the spatial and temporal characteristics of the focal volume are discussed, and a brief summary of photobleaching effects is provided. Finally, we consider three new applications of multiphoton microscopy: nonlinear imaging in microfluidics as applied to chemical analysis and the use of two-photon absorption and self-phase modulation as contrast mechanisms applied to imaging problems in the medical sciences.
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Microscopía de Fluorescencia por Excitación Multifotónica/métodos , Absorción , Algoritmos , Animales , Fluorescencia , Humanos , Microscopía de Fluorescencia por Excitación Multifotónica/instrumentación , Modelos Teóricos , Dinámicas no Lineales , Óptica y Fotónica/instrumentación , Óptica y Fotónica/métodos , Fotoblanqueo , Fotones , Factores de TiempoRESUMEN
OBJECTIVE: To examine the efficacy and safety of MAS063DP (Atopiclair) cream in the management of mild to moderate atopic dermatitis in infants and children. STUDY DESIGN: One hundred forty-two patients aged 6 months to 12 years were administered MAS063DP (n = 72) or vehicle (n = 70) cream 3 times per day to affected areas and sites prone to develop atopic dermatitis. The primary endpoint for efficacy was the Investigator's Global Assessment at day 22. Secondary endpoints included Investigator's Global Assessment at other time-points, patient's/caregiver's assessment of pruritus, onset, duration of itch relief, Eczema Area and Severity Index, subject's/caregiver's assessment of global response, and need for rescue medication in the event of an atopic dermatitis flare. RESULTS: MAS063DP cream was statistically more effective (P < .0001) than vehicle cream for the primary endpoint and all secondary endpoints. Treatment discontinuation as a result of an adverse event occurred in 9.9% of patients using MAS063DP cream and 16% of patients using vehicle cream. CONCLUSION: MAS063DP cream is effective and safe as monotherapy for the treatment of symptoms of mild to moderate atopic dermatitis in infants and children.
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Dermatitis Atópica/tratamiento farmacológico , Grasas de la Dieta/uso terapéutico , Ácido Glicirretínico/uso terapéutico , Extractos Vegetales/uso terapéutico , Niño , Preescolar , Formas de Dosificación , Método Doble Ciego , Femenino , Humanos , Lactante , Masculino , Vehículos Farmacéuticos , Índice de Severidad de la EnfermedadRESUMEN
We conducted a cross-sectional study from September 2001 to August 2003 during which children between 2 and 12 years of age presenting with complaint of sore throat were recruited from urban pediatric clinics in Brazil, Croatia, Egypt and Latvia. The objective of the study was to compare clinical signs and symptoms of children presenting to urban pediatric clinics with sore throat in and between countries and to identify common clinical criteria predicting group A beta hemolytic streptococcal (GAS) pharyngitis. Using a single standard protocol in all four sites, clinical data were recorded and throat swabs obtained for standard GAS culture in 2040 children. Signs and symptoms were tested for statistical association with GAS positive/negative pharyngitis, and were compared using chi(2) tests, ANOVA and Odds Ratios. Clinical signs of GAS pharyngitis in children presenting to clinics varied significantly between countries, and there were few signs or symptom that could statistically be associated with GAS pharyngitis in all four countries, though several were useful in two or three countries. Our results indicate that the clinical manifestations of pharyngitis in clinics may vary by region. It is therefore critical that clinical decision rules for management of pharyngitis should have local validation.
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Faringitis/diagnóstico , Faringitis/microbiología , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/diagnóstico , Streptococcus pyogenes/aislamiento & purificación , Análisis de Varianza , Brasil , Distribución de Chi-Cuadrado , Niño , Preescolar , Tos/microbiología , Croacia , Estudios Transversales , Egipto , Femenino , Fiebre/microbiología , Humanos , Letonia , Masculino , Oportunidad Relativa , Sensibilidad y Especificidad , Infecciones Estreptocócicas/microbiología , Población UrbanaAsunto(s)
Epidermólisis Ampollosa/terapia , Animales , Trasplante de Médula Ósea , Modelos Animales de Enfermedad , Epidermólisis Ampollosa/complicaciones , Epidermólisis Ampollosa/diagnóstico , Epidermólisis Ampollosa/tratamiento farmacológico , Epidermólisis Ampollosa/cirugía , Terapia Genética , Indicadores de Salud , Humanos , Diagnóstico Prenatal , Trasplante de Células Madre , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
OBJECTIVE: To identify clinical features of infants with ulcerated infantile hemangiomas. STUDY DESIGN: Cross-sectional analysis was conducted within a prospective cohort study of children with infantile hemangiomas. Children younger than 12 years of age were recruited. Demographic and prenatal/perinatal information was collected. Hemangioma size, location, subtype, course, complications, and treatments were recorded. RESULTS: One thousand ninety-six patients were enrolled, and 173 (15.8%) patients experienced ulceration. Ulceration occurred in 192 (9.8%) of 1960 [corrected] total hemangiomas. Hemangiomas with ulcerations were more likely large, mixed clinical type, segmental morphologic type, and located on the lower lip, neck, or anogenital region. Ulceration occurred at a median age of 4 months, most often during the proliferative phase. Children with ulcerated hemangiomas were more likely to present to a pediatric dermatologist at a younger age and to require treatment. Bleeding occurred in 41% of ulcerated lesions but was rarely of clinical significance. Infection occurred in 16%. CONCLUSIONS: Ulceration occurs in nearly 16% of patients with infantile hemangiomas, most often by 4 months of age, during the proliferative phase. Location, size, and clinical and morphologic type are associated with an increased risk for development of ulceration.