RESUMEN
El plan de Prevención y Control de Enfermedades Transmitidas por Mosquito (ETM): Dengue, Fiebre Chikungunya, Amarilla, y Zika de la CABA establece cuatro escenarios teóricos de riesgo que orientan la implementación de las acciones de prevención y control. En el presente informe se presentan los estudios de foco investigados en nuestra Área Programática (AP) y su georreferencia, a fin de obtener un diagnóstico situacional local que permita la ejecución de intervenciones oportunas y eficaces a fin de limitar la aparición de nuevos casos en el contexto epidémico 2015-2016. El objetivo general fue estudiar la epidemia de ETM para su comprensión y abordaje en el Área Programática del Hospital General de Agudos Juan A. Fernández, y el objetivo específico, prevenir y limitar la aparición de nuevos casos de ETM. (AU)
Asunto(s)
Humanos , Animales , Fiebre Amarilla/prevención & control , Fiebre Amarilla/epidemiología , Áreas de Influencia de Salud , Diagnóstico de la Situación de Salud , Dengue/prevención & control , Dengue/epidemiología , Fiebre Chikungunya/prevención & control , Fiebre Chikungunya/epidemiología , Infección por el Virus Zika/prevención & control , Infección por el Virus Zika/epidemiología , Mosquitos Vectores/patogenicidad , Hospitales MunicipalesRESUMEN
BACKGROUND/OBJECTIVES: Vitamin A deficiency (VAD) is a world public health problem contributing to the increase in childhood morbidity and mortality in developing countries and severe deficiency of vitamin A may lead to xerophthalmia and blindness. The objective of this study was to determine the prevalence of VAD among Brazilian school-aged children attended at a primary health unit and to verify if some considered risk factor was associated with VAD in this group. SUBJECTS/METHODS: A descriptive prospective transverse study was conducted on 103 randomly selected children. A total of 54 boys and 49 girls aged 5.5-11 years had the relative dose-response (RDR) test performed on. Possible ocular alterations related to vitamin A and the status of anemia, serum zinc, some acute-phase proteins, and anthropometric situation were determinate by an analytic design. RESULTS: No child presented xerophthalmia. Serum retinol values lower than 1.05 and 0.7 micromol l(-1), respectively were found in 26.2 and 5.8% of the children. The prevalence of hypovitaminosis detected by RDR test was 20.4%. The following variables and their relationship with VAD were evaluated: sex (P=0.33; 95% confidence interval 0.61-4.34), weight and height (P> or =0.5), hemoglobin (P=0.15), C-reactive protein (P=0.56; 95% confidence interval 0.75-18.26), alpha-1-acid-glycoprotein (P=0.56; 95% confidence interval 0.15-15.42) and serum zinc (P=0.31). None of these variables was related to VAD. CONCLUSIONS: In this population, the prevalence of VAD detected could be considered a public health problem. School-aged children can be considered at risk for VAD mainly of a subclinical level, even without some associated risk factors.
Asunto(s)
Deficiencia de Vitamina A/epidemiología , Vitamina A/sangre , Vitaminas/sangre , Brasil/epidemiología , Niño , Preescolar , Femenino , Humanos , Masculino , Prevalencia , Deficiencia de Vitamina A/sangre , Xeroftalmia/epidemiologíaRESUMEN
Enfatizar en la correcta clasificación es aún una alta prioridad en la literatura ya persiste una gran desinformación al respecto. Nuevos progresos en la ciencia han permitido una mejor comprensión de estas lesiones. El avance en el diagnóstico precoz y la experiencia terapéutica han mejorado nuestra habilidad para tratar lesiones extensas y mejorar la calidad de vida de los pacientes.
Emphasis on correct classification is still a high priority in the literature and yet there remains a great deal of misinformation. Many new developments in the basic science of these lesions are allowing better understanding of why these lesions occur while improving our management in these patients. Advances in early diagnosis and therapeutic experience have improved our ability to treat extensive lesions and also improve patients' quality of life.
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Hemangioma Capilar/diagnóstico , Hemangioma Capilar/terapia , Hemangioma Capilar/complicaciones , Hemangioma/clasificación , Hemangioma/epidemiología , Hemangioma/etiologíaRESUMEN
The purpose of this study was to analyze the levels of lead (Pb), cadmium (Cd), aluminum (Al), zinc (Zn), cooper (Cu) and chromium (Cr) in the water of drinking fountains distributed in the Campus of the University of São Paulo. Ribeirão Preto, Brazil. Thirty random samples were collected in different parts of the Campus that were analyzed by Atomic Absorption Spectrophotometry. According to WHO's Drinking Water Guidelines; lead, cadmium and zinc were found in concentrations higher than those recommended in 40 per cent, 20 per cent and 13 per cent of the samples, respectively. The results were analyzed considering nutritional and toxicological aspects related to the presence of essential and toxic elements for the human being. Reviewing the regulatory limits established in ten countries of America, authors focus in the necessity to find a consensus in the establishment of the higher levels of heavy metals in potable water. The tolerable daily intake, have to be the basis to assure the prevention of diseases associated with a long-term ingestion of these elements through foods.
Asunto(s)
Abastecimiento de Agua/análisis , Agua/química , Metales Pesados/análisis , Concentración Máxima AdmisibleRESUMEN
An epizootic outbreak of rabies occurred in 1995 in Ribeirão Preto, SP, with 58 cases of animal rabies (54 dogs, 3 cats and 1 bat) confirmed by the Pasteur Institute of São Paulo, and one human death. The need to provide care to a large number of people for the application of equine rabies immune globulin (ERIG) prevented the execution of the skin sensitivity test (SST) and often also the execution of desensitization, procedures routinely used up to that time at the Emergency Unit of the University Hospital of the Faculty of Medicine of Ribeirão Preto, University of São Paulo (EU-UHFMRP-USP), a reference hospital for the application of heterologous sera. In view of our positive experience of several years with the abolition of SST and of the use of premedication before the application of antivenom sera, we used a similar schedule for ERIG application. Of the 1489 victims of animal bites, 1054 (71%) received ERIG; no patient was submitted to SST and all received intravenously anti-histamines (anti-H1 + anti-H2) and corticosteroids before the procedure. The patients were kept under observation for 60 to 180 minutes and no adverse reaction was observed. On the basis of these results, since December 1995 ERIG application has been decentralized in Ribeirão Preto and has become the responsibility of the Emergency Unit of the University Hospital and the Central Basic Health Unit, where the same routine is used. Since then, 4216 patients have received ERIG (1818 at the Basic Health Unit and 2398 at the EU-UHFMRP), with no problems. The ideal would be the routine use of human rabies immune globulin (HRIG) in public health programs, but this is problematic, because of their high cost. However, while this does not occur, the use of SST is no longer justified at the time of application of ERIG, in view of the clinical evidence of low predictive value and low sensitivity of SST involving the application of heterologous sera. It is very important to point out that a negative SST result may lead the health team to a feeling of false safety that no adverse reaction will occur, but this is not true for the anaphylactoid reactions. The decision to use premedication, which is based on knowledge about anaphylaxis and on the pharmacology of the medication used, is left to the judgment of health professionals, who should always be prepared for eventual untoward events.
Asunto(s)
Inmunoglobulinas/efectos adversos , Premedicación , Rabia/prevención & control , Pruebas Cutáneas , Anafilaxia/prevención & control , Animales , Gatos , Quirópteros , Perros , Humanos , Inmunoglobulinas/administración & dosificación , Valor Predictivo de las Pruebas , Virus de la Rabia/inmunologíaRESUMEN
Los RNMBP constituye un grupo expuesto a recibir numerosas transfusiones de glóbulos rojos desplasmatizados (tr GRD). Objetivos: Para conocer la incidencia de tr GRD, los factores asociados a requerimiento transfusional y el número de donantes por receptor, se revisaron las fichas clínicas de todos los RNMBPN (n = 66), egresados vivos de Neonatología, Hospital Clínico Regional de Valdivia, entre junio 1995 y mayo 1997. Se consideraron características propias del grupo en estudio, patología concomitante, número de tr GRD y días de hospitalización. Los factores de riesgo asociados a mayor requerimiento de tr GRD se determinaron mediante odds ratio (OR). El 89,4 por ciento recibió 1 o más tr GRD: la media de transfusiones fue 4,1 ñ 3,9 con un rango de 1-17 tr GRD. Las características del grupo asociadas a mayor número de tr GRD fueron: peso de nacimiento con OR = 10,0 para el grupo de peso < 1 000 g: edad gestacional con OR = 7,9 para el grupo < 29 semanas y OR = 54 para los AEG. La patología asociada estuvo representada por: bronconeumonía OR = 46,5, hemorragias OR 25.0 y displasia broncopulmonar OR =16,4. Los receptores de tr GRD estuvieron expuestos a igual número de transfusiones y donantes. Conclusiones: Se confirma una alta frecuencia de requerimientos transfusionales de GRD en RNMBPN, especialmente en los menores de 1 000 g de peso al nacer, y una edad gestacional menor a 29 semanas. La patología que mostró una mayor asociación con requerimientos transfusionales fue la bronconeumonía seguida por las hemorragias y la displasia broncopulmonar
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Recién Nacido de muy Bajo Peso , Transfusión de Eritrocitos/métodos , Enfermedades del Recién Nacido/terapia , Factores de RiesgoRESUMEN
OBJECTIVE: To estimate, semiquantitatively, the proteinuria of nephrotic patients by the use of the value of protein/creatinine ratio in single urine samples and determine its correlation with 24-hour proteinuria.METHODS: Analysis of 30 single urine samples and thirty 24-hour urine samples from 20 children with nephrosis followed up at the Division of Pediatric Nephrology of the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo. Proteinuria in single urine samples and 24-hour urine samples was measured by the turbidimetric method with 3% sulfosalicylic acid. Urinary creatinine concentration was measured by the method of Hare, modified by Haugen and Blegen, adapted to the microtechnique.RESULTS: An excellent correlation was observed between 24-hour proteinuria and the protein/creatinine ratio in single urine samples, by linear regression analysis before (r = 0.82; p < 0.001) and after logarithmic transformation (r = 0.93; p < 0.001). All patients with 24-hour proteinuria at physiological levels (less than 0.1 g/m(2)/day) had a protein/creatinine ratio of less than 0.1 (mg/mg) in single urine samples. All patients with nephrotic 24-hour proteinuria (more than 1.0 g/m(2)/day) had a protein/creatinine ratio of more than 1.0 (mg/mg). The patients with intermediate proteinuria (between 0.1 and 1.0 g/m(2)/day) had a protein/creatinine ratio distributed on the three levels.CONCLUSIONS: The protein/creatinine ratio in a single urine sample is a simple and reliable method for the evaluation of proteinuria and eliminates the errors due to inadequate 24-hour urine collection.
RESUMEN
We report and eight years old boy presenting with a pyogenic granuloma of the scalp, generalized alopecia, descamative plates in the neck, trunk and limbs and nail involvement. Cultures for fungus of all these lesions disclosed Microspore canis. The patient was treated with oral griseofulvin, miconazole and topical tolnaftate. Five years later and after several incomplete treatments, the patient returns with a fistulous mass of 12 x 8 cm in the dorsal area whose culture revealed Microspore canis. The mass was excised and oral ketoconazole was indicated. After three months of follow up, the patient was lost from control
Asunto(s)
Humanos , Masculino , Niño , Micetoma/microbiología , Microsporum/patogenicidad , Tolnaftato/uso terapéutico , Gentamicinas/uso terapéutico , Cloxacilina/uso terapéutico , Alopecia/microbiología , Griseofulvina/uso terapéutico , Micetoma/terapia , Miconazol/uso terapéutico , Granuloma Piogénico/cirugíaRESUMEN
We report 6 patients with Kerion Celsi due to trichophyton verrucosum. Five of the patients were hospiotalized with the diagnosis of Staphylococcal abscess. This confusion is due to that highly suppurative and inflammatory nature of the infection. Griseofulvin is the antimicrobial of choice for treatment, asociated with imidazolics and corticosteroids to prevent alopecia. The authors suggest that an adequate use of simple microbiological diagnosis tests in the diagnosis of pyodermitis in rural children, may prevent unnecessary hospitalizations and permanent hair loss
Asunto(s)
Humanos , Masculino , Femenino , Trichophyton/patogenicidad , Dermatomicosis/diagnóstico , Griseofulvina/administración & dosificación , Diagnóstico Diferencial , Tiña del Cuero Cabelludo/diagnóstico , Tiña del Cuero Cabelludo/tratamiento farmacológicoRESUMEN
Scorpion stings in Brazil are important not only because of their incidence but also for their potential ability to induce severe, and often fatal, clinical situations, especially among children. In this report we present the clinical and laboratory data of 4 patients victims of scorpion stings by T. serrulatus, who developed heart failure and pulmonary edema, with 3 of them dying within 24 hours of the sting. Anatomopathologic study of these patients revealed diffuse areas of myocardiocytolysis in addition to pulmonary edema. The surviving child presented enzymatic, electrocardiographic and echocardiographic changes compatible with severe cardiac involvement, which were reversed within 5 days. These findings reinforce the need for continuous monitoring of patients with severe scorpion envenoming during the hours immediately following the sting.
Asunto(s)
Antivenenos/uso terapéutico , Picaduras de Escorpión/fisiopatología , Venenos de Escorpión/envenenamiento , Animales , Cardiomiopatías/etiología , Niño , Preescolar , Resultado Fatal , Femenino , Humanos , Masculino , Edema Pulmonar/etiología , Picaduras de Escorpión/patología , Picaduras de Escorpión/terapia , EscorpionesRESUMEN
Severe scorpion envenoming is characterized by cardiocirculatory failure which may lead to pulmonary oedema. These are the major causes of death among victims of scorpion stings. Involvement of the heart has been attributed to the massive release of catecholamines and/or to a direct toxic effect of the venom on cardiac fibres, while pulmonary oedema has been considered to be of cardiogenic or non-cardiogenic origin. We present here the clinical, laboratory, electrocardiographic and echocardiographic data of 12 victims of severe Tityus serrulatus stings. These patients had important echocardiographic evidence of moderate to severe left ventricular (LV) dysfunction with diffuse LV hypokinesia and reduced ejection fraction. Seven developed pulmonary oedema. The clinical course of all the patients was satisfactory and the laboratory, electrocardiographic and echocardiographic changes returned to normal, usually within 1 week of the sting. The important alterations detected by echocardiography as early as during the 1st few hours after the sting, taken together with the enzymatic and electrocardiographic data, confirm that LV dysfunction is responsible, either alone or in combination with other factors, for the cardiac insufficiency and pulmonary oedema encountered in scorpion envenoming.
Asunto(s)
Edema Pulmonar/inducido químicamente , Picaduras de Escorpión/fisiopatología , Venenos de Escorpión/envenenamiento , Función Ventricular Izquierda/efectos de los fármacos , Adolescente , Amilasas/sangre , Animales , Antivenenos/uso terapéutico , Niño , Preescolar , Creatina Quinasa/sangre , Ecocardiografía , Electrocardiografía , Femenino , Corazón/efectos de los fármacos , Corazón/fisiopatología , Humanos , Masculino , Edema Pulmonar/fisiopatología , Picaduras de Escorpión/terapia , Escorpiones , Taquicardia/inducido químicamente , Taquicardia/fisiopatologíaRESUMEN
La tromboastenia de Glanzmann es un trastorno hemorrágico de herencia autosómica recesiva, caracterizado por la ausencia o déficit de complejo glicoproteico IIb/IIIa de la membrana de las plaquetas, que se traduce en alteración de la agregación plaquetaria y sangramientos. Se describre el caso clínico de una niña de tres años de edad con síndrome purpúrico-equimótico y antecedente de hemorragias desde el año de vida, con recuento y morfología plaquetaria normales, tiempo de sangría prolongado, modificación en la retracción del coágulo, ausencia de agregación plaquetaria frente a ADP, colágeno, araquinodato de Na, epinefrina, ionóforo A23187 y agregación subnormal con ristocetina. Mediante técnicas de inmunofluorescencia y anticuerpos monoclonales se confirmó disminución del complejo GP IIb/IIIa de la membrana plaquetaria y reducción en el número de sitios de fijación de este complejo por plaqueta, lo que permite catalogar a la paciente como una variante de tromboastenia de Glanzmann
Asunto(s)
Preescolar , Humanos , Femenino , Glicoproteínas de Membrana/deficiencia , Trombocitemia Esencial/diagnóstico , Agregación Plaquetaria , Púrpura , Pruebas de Función PlaquetariaRESUMEN
At the Hospital of Clinics of the Faculty of Medicine of Ribeirão Preto/USP during the years 1980-1989 21 children have been attended after rattlesnake bite: 16 severe and 5 with moderate envenomation. Four (20%) developed acute tubular necrosis 2 necessitating dialysis. One patient died 13 days after the bite and grave complications including digestive hemorrhage and acute respiratory insufficiency. All patients preserved clinical laboratory and epidemiological characteristics of Crotalus durissus terrificus envenomation. We also comment on the correct management of such patients specially related to antivenin dosage and the prevention of acute tubular the most serious complication of such an accident.
Asunto(s)
Venenos de Crotálidos , Mordeduras de Serpientes , Adolescente , Brasil , Niño , Preescolar , Femenino , Humanos , Masculino , Mordeduras de Serpientes/sangre , Mordeduras de Serpientes/diagnóstico , Mordeduras de Serpientes/epidemiología , Mordeduras de Serpientes/terapiaRESUMEN
Foram admitidos no Hospital das Clinicas da FMRPUSP, durante os anos de 1983 a 1988, 494 pacientes vitimas de acidentes ofidicos e escorpionicos que receberam soro antiveneno (SAV) e nos quais foi avaliada a frequencia e tipo das manifestacoes imediatas, bem como o valor prognostico do teste de sensibilidade. Do total de pacientes vitimas de ofidismo, 82 (25,6 por cento) apresentaram reacoes imediatas, das quais as mais comuns foram as cutaneas, isoladas (40 por cento) ou associadas com sintomas respiratorios (19 por cento), seguidas de manifestacoes gastrintestinais (17 por cento). Choque anafilatico foi detectado em 10 pacientes (12 por cento). Em relacao aos acidentes escorpionicos, reacoes imediatas foram observadas em 13 pacientes (7,5 por cento), tambem com predominio de lesoes cutaneas. Sintomatologia cardiocirculatoria foi detectada em apenas 1 paciente. Devido ao baixo valor preditivo positivo (31,8 por cento) e a baixa sensibilidade (54,6 por cento), propomos que o teste de sesibilidade intradermico seja abolido da rotina de atendimento de urgencia aos pacientes vitimas de acidentes por animais peconhentos. Anti-histaminicos (bloqueadores dos receptores "H IND. 1" e "H IND. 2") e corticosteroides devem ser administrados por via parenteral anteriormente a soroterapia, no sentido de prevenir...
Asunto(s)
Animales , Humanos , Antivenenos/efectos adversos , Mordeduras y Picaduras/terapia , Hipersensibilidad Inmediata/inducido químicamente , Infusiones Intravenosas , Pruebas Intradérmicas , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Escorpiones , Mordeduras de Serpientes/terapia , Picaduras de Arañas/terapiaRESUMEN
The frequency and class of immediate-type hypersensitivity manifestations were studied in 494 snakebitten and scorpion stung patients who were treated with intravenous injections of antivenom sera. These patients were admitted to HC-FMRPUSP from 1983 to 1988. The effectiveness of a hypersensitivity skin test was also investigated. Eighty two out of 320 patients admitted following snake bites (25.6%) had immediate-type reactions consisting of isolated skin lesions (40%), skin lesions plus respiratory manifestations (19%) and gastrointestinal involvement (17%). Anaphylactic shock occurred in ten patients (12%). Thirteen out of 174 patients admitted following scorpion stings had immediate-type reactions (7.5%). There was also a preponderance of skin reactions. Anaphylactic shock was observed in one patient. The positive predictive value of hypersensitivity skin test was 31.8% and its sensibility was 54.8%. These data show that a hypersensitivity skin test is ineffective in predicting immediate-type hypersensitivity manifestations in patients given snake and scorpion antivenom. Considering these results, this test should be eliminated as a routine procedure when treating victims of poisonous animals. These studies indicate that prior to the administration of antivenom anti-histamine (H1- and H2-antagonists) as well corticosteroids should be given by i.v. route in order to prevent or reduce hypersensitivity reactions. Antivenom sera must always be given under continuous medical surveillance by an intravenous route, without dilution, drop by drop for 15-30 minutes.
Asunto(s)
Antivenenos/efectos adversos , Mordeduras y Picaduras/terapia , Hipersensibilidad Inmediata/inducido químicamente , Adolescente , Adulto , Animales , Antivenenos/administración & dosificación , Niño , Humanos , Infusiones Intravenosas , Pruebas Intradérmicas , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Picaduras de Escorpión/terapia , Escorpiones , Mordeduras de Serpientes/terapiaRESUMEN
The clinical signs and symptoms of Crotalus durissus terrificus envenoming are due to the neurotoxic, myotoxic systemic and thrombin-like coagulating effects of the venom. The rhabdomyolysis observed after envenoming caused by snakes, the venom of which has a systemic myotoxic activity, has been limited thus far to skeletal muscle, with no reports of myocardial damage. In the present paper we report serial measurements of serum creatine kinase (CK), lactic dehydrogenase (LD) and of CK-MB and LD1 isoenzymes in human victims of Crotalus bites. The results were similar to those reported for acute myocardial infarction even though the clinical evolution, electrocardiogram and echocardiogram findings did not show any involvement of cardiac muscle. The enzymatic profile detected, as well as the pattern of focal involvement observed in muscle biopsies obtained from these patients, suggest that there may be a type of skeletal muscle fibre that is preferentially damaged by C. durissus terrificus venom, i.e., type I and/or IIa fibres, the composition of which is richer in CK-MB and LD1, and is similar to that of cardiac fibres.