RESUMO
BACKGROUND: The skin is a fundamental organ in the transition from intrauterine to extrauterine life. The newborn infant experiences physiological changes and often presents benign, transient skin characteristics that vary according to maternal, gestational, and neonatal factors. OBJECTIVES: To estimate the frequency of various dermatologic findings during the first 72hours of life and to identify their association with maternal, gestational, or neonatal factors. METHODS: Descriptive, observational, cross-sectional study from April to July 2015 and July to November 2017 in the maternity ward of Centro Hospitalario Pereira Rossell. We examined the skin of neonates within 72hours of birth. Proportions and 95% CI were calculated for all findings. Associations between findings and factors were analyzed. RESULTS: A total of 2811 neonates were included. We observed at least one neonatal skin finding in all of the neonates and found a median (interquartile range) of 8 (6-9) findings (minimum-maximum, 1-16). We observed 42 of the 46 possible characteristics we looked for; 99.9% of the findings were benign and transient. Among the findings were lanugo (98%; 95% CI, 97.7%-98.7%), physiological scaling (79.7%; 95% CI: 78.2%-81.1%), and sebaceous hyperplasia (73.3%; 95% CI: 71.6%-74.9%). Lanugo (P=.001), physiological scaling (P<.001), and erythema toxicum (P=.001) were observed significantly more often in full- and late-term neonates. Sebaceous hyperplasia (P=.001) and transient hyperpigmentation (P<.001) were found more often in newborn males. Erythema toxicum was more common after vaginal births (P=.008). Transient hyperpigmentation (P<.001) and dermal melanocytosis (P<.001) were seen more often in neonates of African descent. CONCLUSIONS: All neonates have skin characteristics that are part of their adaptation to extrauterine life. Most are benign and transient. Maternal age, type of delivery, and certain neonatal factors such as gestational age, birth weight, sex, and ethnicity are associated with specific findings.
Assuntos
Eritema , Causalidade , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Prevalência , Uruguai/epidemiologiaRESUMO
El déficit de alfa -1 Antitripsina (DAAT) es una enfermedad genética rara, asociada a un incremento a padecer enfisema pulmonar y hepatopatía crónicas en niños y adultos, frecuentemente subdiagnosticada, con largos retrasos entre el inicio de los síntomas y el diagnóstico definitivo. La alfa 1-antitripsina (AAT) es el inhibidor de proteasas más abundante en el organismo humano. Se considera déficit grave y es a lo que habitualmente se refiere la literatura científica a los siguientes fenotipos: SZ, ZZ y Null. Es necesario programas de cribado para su detección precoz, por lo que se ha descripto y validado un método sencillo y específico, mediante el cual se cuantifica el valor de AAT por nefelometría en muestras de gota de sangre en papel secante y se realiza genotipificación rápida de las variantes Z y S. Objetivos: Determinar la proporción de individuos con DAAT en una población de pacientes con enfermedades respiratorias crónicas. Identificar y caracterizar a aquellos con déficit de AAT. Materiales y Método: Estudio Observacional, Descriptivo de corte Transversal de cribado de déficit de AAT, entre el 2 de enero de 2014 a 30 de marzo de 2015. De 80 personas que cumplieron con los criterios de inclusión y que concurrieron de forma espontánea o por derivación al Servicio de Neumonología del Hospital Tránsito Cáceres de Allende, Córdoba, Argentina, se analizaron 62 pacientes que aceptaron realizarse el estudio. Se realizó dosaje de alfa1-antitripsina mediante gota de sangre en papel secante a los pacientes que cumplieron los criterios de inclusión. Se solicitó espirometría, Tomografía Computada de Tórax de Alta Resolución y genotipificación rápida solo a aquellos pacientes con valores de alfa 1-antitripsina < 1,8 mg/dL. Resultados: En el presente trabajo se estudió un total de 62 pacientes, 28 (45,2%) fueron de sexo femenino y 34 (54,8%) de sexo masculino, 37 (59,7%) tuvieron valores de alfa 1-antitripsina ≥ 1,8 mg/dL y 25 (40,3%) < 1,8 mg/dL. La obtención del genotipo por la técnica de gota seca a 25 (40,3%; 25:62) pacientes con valores < 1,8 mg/dL mostró que: 22 (88%; 22:25) fueron NoS NoZ, 2 (8%; 2:25) Heterocigoto para Z y 1 (4%; 1:25) Heterocigoto para S. El patrón espirométrico predominante según criterio de ATS/ERS fue el obstructivo (88%). El patrón en TCAR fue de enfisema en 22 pacientes (88%): 7 (31,8%) centrolobulillar, 8 (36,4%) paraseptal, 7 (31,8%) panlobulillar. Hubo 2 pacientes (8%) con bronquiectasias, y 1 (4%) fue normal. Conclusión: En una población seleccionada por síntomas y/o antecedentes se pueden identificar con el cribado con técnica de gota seca a pacientes con DAAT, que en su expresión grave es poco frecuente en la Argentina, probablemente subdiagnosticado, siendo superior el número de portadores heterocigotos PIS y PIZ. El diagnóstico precoz de DAAT es poco frecuente. Es difícil establecer conclusiones sobre el grupo de alfa 1-antitripsina <1,8 mg/dL sin ser deficiencias graves, en relación a las variables estudiadas en la muestra debido a la escases de estudios y bibliografía encontradas sobre el tema. Consideramos que los pacientes que presentan un genotipo No S No Z y los que presentan discordancia deben ser confirmados cuantitativamente y tener una caracterización del fenotipo en muestras de suero por Isoelectoenfoque y ocasionalmente el análisis molecular del gen para variantes alélicas poco frecuentes, nuevas o nulas.
Assuntos
Peneiramento de Líquidos , Deficiência de alfa 1-AntitripsinaRESUMO
Alpha-1-antitrypsin deficiency (AATD) is a rare genetic disease associated with an increased risk of suffering from pulmonary emphysema and chronic hepatopathy in children and adults alike. It is often underdiagnosed, with long periods elapsing between the onset of symptoms and a definite diagnosis. Alpha-1-antitrypsin (AAT) is the most abundant protease inhibitor in the human body. Scientific literature considers severe deficiency to be associated with the following phenotypes: SZ, ZZ and Null. Screening programs are required for early detection, this is why an easy and specific method has been described and validated. Through this method, AAT values are quantified using nephelometry in blood drop samples on blotting paper, then genotyping of the Z and S variants is quickly performed. Objectives: To determine the number of individuals with AATD within a population of patients with chronic respiratory diseases. To identify and define those with AAT deficiency. Materials and Method: Observational, descriptive and cross-sectional study of AAT deficiency screening, between January 2nd, 2014 and March 30th, 2015. Out of 80 individuals who fulfilled the inclusion criteria and who spontaneously attended or were referred to the Pneumonology Department of Hospital Tránsito Cáceres de Allende, Córdoba, Argentina, 62 patients who agreed to the study were analyzed. A test to determine the concentration of alpha-1-antitrypsin was performed to the patients who met all the inclusion criteria using blood drops on blotting paper. Only patients with alpha-1-antitrypsin levels < 1.8 mg/dL were requested a spirometry, a high-resolution computed tomography of the chest and quick genotyping tests. Results: A total of 62 patients was evaluated in this study, 28 (45.2%) were females and 34 (54.8%) were males, 37 (59.7%) had alpha-1-antitrypsin levels ≥ 1.8 mg/dL and 25 (40.3%) < 1.8 mg/dL. Genotype elicitation using the dried-droplet method in 25 (40.3%; 25:62) patients with values < 1.8 mg/dL showed that: 22 (88%; 22:25) were Non-S Non-Z, 2 (8%; 2:25) were heterozygote for Z and 1 (4%; 1:25) was heterozygote for S. According to ATS/ERS criteria, the predominant spirometric pattern was obstructive (88%). The HRCT pattern corresponded to emphysema in 22 patients (88%): 7 (31.8%) centrilobular, 8 (36.4%) paraseptal, 7 (31.8%) panlobular. There were 2 patients (8%) with bronchiectasis and 1 (4%) was normal. Conclusion: In a population selected by symptoms and/or history, patients with AATD can be identified using the dried-droplet method. Severe AATD is uncommon in Argentina, probably because it is underdiagnosed, and the amount of heterozygote PIS and PIZ carriers is higher. Early AATD diagnosis is uncommon. It is difficult to draw conclusions about the alpha-1-antitrypsin group below 1.8 mg/dL without severe deficiencies in connection with the variables analyzed in the sample due to the lack of studies and bibliography on this subject. We consider that patients with non-S non-Z genotypes and the ones with discrepancies must be quantitatively confirmed and their phenotype defined in serum samples using isoelectric focusing and, occasionally, they must have a molecular gene analysis to look for uncommon, new or null allelic variants.
Assuntos
Peneiramento de Líquidos , Deficiência de alfa 1-AntitripsinaRESUMO
BACKGROUND: Melanocytic nevi are frequently found on acral volar skin. Differentiation between nevi and melanoma is essential and sometimes difficult, although dermoscopy has enabled a more specific diagnosis of pigmented lesions. Dermoscopic patterns of lesions on acral volar skin have mostly been described in European and Asian populations. The Latin American population is heterogeneous, and particularly so in the case of Uruguayans, who largely descend from 3 distinct populations. OBJECTIVE: To describe dermoscopic patterns of acral melanocytic nevi and evaluate their applicability in a Latin American population in Uruguay. PATIENTS AND METHODS: This was an observational, descriptive, cross-sectional study conducted by 2 dermatologists from 4 dermatology clinics in Uruguay. Uruguayan patients older than 18 years with acral melanocytic nevi were included. Digital dermoscopic images were captured and jointly analyzed by 2 investigators. RESULTS: A total of 158 acral volar nevi in 80 patients were analyzed. The most-prevalent pattern was the parallel furrow pattern (51.3% of nevi), followed by the latticelike pattern (13.3%), the homogeneous pattern (12.7%), the globular pattern (9.5%), the fibrillar pattern (7%), the globulostreaklike pattern (3.8%), and the nontypical pattern (2.5%). The reticular and transition patterns were not observed in our population. CONCLUSIONS: The parallel furrow pattern, followed by the latticelike and homogeneous patterns, was the most-prevalent pattern in acral melanocytic nevi in the Uruguayan population. The fibrillar pattern was found exclusively on the soles. No new dermoscopic patterns were observed. The patterns described in Asian and European literature apply to our population.
Assuntos
Dermoscopia , Doenças do Pé/patologia , Mãos/patologia , Nevo Pigmentado/patologia , Neoplasias Cutâneas/patologia , Adulto , Estudos Transversais , Dermatoglifia , Diagnóstico Diferencial , Feminino , Dedos/patologia , Humanos , Masculino , Melanoma/diagnóstico , Pessoa de Meia-Idade , Nevo Pigmentado/diagnóstico , Nevo Pigmentado/epidemiologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/epidemiologia , Dedos do Pé/patologia , Uruguai/epidemiologia , Adulto JovemRESUMO
Allele frequencies and haplotype analysis have been performed for eight Y-chromosome STRs (DYS19, DYS385 I and II, DYS389 I and II, DYS390, DYS391, DYS392, DYS393). Population data was obtained from a sample of 400 unrelated individuals living in Antioquia (Colombia). A total of 270 different haplotypes were found, and the haplotype diversity was 0.989. The first and second most frequent haplotypes where shared by 8 and 6% of the individuals, respectively.
Assuntos
Cromossomos Humanos Y , Genética Populacional , Haplótipos , Sequências de Repetição em Tandem , Colômbia , Impressões Digitais de DNA , Frequência do Gene , Humanos , Reação em Cadeia da PolimeraseRESUMO
There are no standards accepted by all the countries to fix top concentrations of microbiological indicators in recreational waters. Even now there is still a considerable discussion either in USA as in Europe. The universal application of a bacteriological quality criterion is hard due to several environmental factors that affect the relation between the indicator, the exposition and the health risks. Our purpose was to present a case study as an example of the influence of the climatic conditions in the application of the most known standards (Environmental Protection Agency of USA, Council of European Communities, World Organization of Health, and others from Canada, South Africa and Hong Kong). The pluvial rainfall increased the number of E. coli, thermotolerant coliforms (C Te), and total coliforms (CT) 6-10 fold, in comparison to the number registered during the steady-state conditions of the system. However, not all the standards included that factor. In Summer, hourly, daily and weekly variations were proved, therefore the standards that suggest fortnightly sampling frequencies would not be convenient in that system. Although the main source of variation was time, spatial variability was also detected. The percentage of E. coli among the C Te was very variable, but the average resulted low (26%) compared to the levels in temperate regions of other countries (> 90%). According to the directives proposed by the Commission of European Communities, the parameter has been changed (C Te for E. coli), but the standard has remained (2000/100 ml). Thus, the directive would be more permissive.
Assuntos
Enterobacteriaceae/isolamento & purificação , Água Doce/microbiologia , Microbiologia da Água , Argentina , Escherichia coli/isolamento & purificação , Controle de Qualidade , Recreação , Estados Unidos , United States Environmental Protection Agency , Organização Mundial da SaúdeRESUMO
There are no standards accepted by all the countries to fix top concentrations of microbiological indicators in recreational waters. Even now there is still a considerable discussion either in USA as in Europe. The universal application of a bacteriological quality criterion is hard due to several environmental factors that affect the relation between the indicator, the exposition and the health risks. Our purpose was to present a case study as an example of the influence of the climatic conditions in the application of the most known standards (Environmental Protection Agency of USA, Council of European Communities, World Organization of Health, and others from Canada, South Africa and Hong Kong). The pluvial rainfall increased the number of E. coli, thermotolerant coliforms (C Te), and total coliforms (CT) 6-10 fold, in comparison to the number registered during the steady-state conditions of the system. However, not all the standards included that factor. In Summer, hourly, daily and weekly variations were proved, therefore the standards that suggest fortnightly sampling frequencies would not be convenient in that system. Although the main source of variation was time, spatial variability was also detected. The percentage of E. coli among the C Te was very variable, but the average resulted low (26) compared to the levels in temperate regions of other countries (> 90). According to the directives proposed by the Commission of European Communities, the parameter has been changed (C Te for E. coli), but the standard has remained (2000/100 ml). Thus, the directive would be more permissive.(AU)
Assuntos
RESEARCH SUPPORT, NON-U.S. GOVT , Enterobacteriaceae/isolamento & purificação , Água Doce/microbiologia , Microbiologia da Água , Argentina , Escherichia coli/isolamento & purificação , Controle de Qualidade , Recreação , Estados Unidos , United States Environmental Protection Agency , Organização Mundial da SaúdeRESUMO
There are no standards accepted by all the countries to fix top concentrations of microbiological indicators in recreational waters. Even now there is still a considerable discussion either in USA as in Europe. The universal application of a bacteriological quality criterion is hard due to several environmental factors that affect the relation between the indicator, the exposition and the health risks. Our purpose was to present a case study as an example of the influence of the climatic conditions in the application of the most known standards (Environmental Protection Agency of USA, Council of European Communities, World Organization of Health, and others from Canada, South Africa and Hong Kong). The pluvial rainfall increased the number of E. coli, thermotolerant coliforms (C Te), and total coliforms (CT) 6-10 fold, in comparison to the number registered during the steady-state conditions of the system. However, not all the standards included that factor. In Summer, hourly, daily and weekly variations were proved, therefore the standards that suggest fortnightly sampling frequencies would not be convenient in that system. Although the main source of variation was time, spatial variability was also detected. The percentage of E. coli among the C Te was very variable, but the average resulted low (26) compared to the levels in temperate regions of other countries (> 90). According to the directives proposed by the Commission of European Communities, the parameter has been changed (C Te for E. coli), but the standard has remained (2000/100 ml). Thus, the directive would be more permissive.
Assuntos
Água Doce/microbiologia , Enterobacteriaceae , Microbiologia da Água , Argentina , Escherichia coli , Controle de Qualidade , Recreação , Estados Unidos , United States Environmental Protection Agency , Organização Mundial da SaúdeRESUMO
There are no standards accepted by all the countries to fix top concentrations of microbiological indicators in recreational waters. Even now there is still a considerable discussion either in USA as in Europe. The universal application of a bacteriological quality criterion is hard due to several environmental factors that affect the relation between the indicator, the exposition and the health risks. Our purpose was to present a case study as an example of the influence of the climatic conditions in the application of the most known standards (Environmental Protection Agency of USA, Council of European Communities, World Organization of Health, and others from Canada, South Africa and Hong Kong). The pluvial rainfall increased the number of E. coli, thermotolerant coliforms (C Te), and total coliforms (CT) 6-10 fold, in comparison to the number registered during the steady-state conditions of the system. However, not all the standards included that factor. In Summer, hourly, daily and weekly variations were proved, therefore the standards that suggest fortnightly sampling frequencies would not be convenient in that system. Although the main source of variation was time, spatial variability was also detected. The percentage of E. coli among the C Te was very variable, but the average resulted low (26
) compared to the levels in temperate regions of other countries (> 90
). According to the directives proposed by the Commission of European Communities, the parameter has been changed (C Te for E. coli), but the standard has remained (2000/100 ml). Thus, the directive would be more permissive.
RESUMO
A randomized clinical trial was completed to compare the efficacy of a mixed diet composed of locally available foods versus a lactose-free, soy-based formula for the management of young Mexican children with acute diarrhea and dehydration. A total of 87 patients between 5 and 36 months of age received either a blended mixed diet containing rice, chicken, carrots, beans, and vegetable oil (group MD) or a soy formula (group SF) immediately after standard oral rehydration therapy. The initial clinical characteristics of the patients in each group were similar, as were their stool outputs during the first 6-hour period of rehydration before the diets were offered. There were six treatment failures, all of which were in group SF (p < 0.01). The stool outputs of children in group MD and in group SF were 82 +/- 55 versus 112 +/- 88 gm/kg per day, respectively, on day 1 (p = 0.037), and 48 +/- 33 versus 66 +/- 55 gm/kg per day on day 2 (p = 0.109). The duration of diarrhea among those in group MD was significantly reduced compared with those in group SF (29 vs 67 hours; p < 0.001). We conclude that the mixed diet resulted in improved clinical outcomes compared with the lactose-free, soy protein isolate formula.
Assuntos
Diarreia/dietoterapia , Proteínas Alimentares/administração & dosagem , Hidratação , Alimentos Fortificados , Glycine max , Alimentos Infantis , Oryza , Administração Oral , Peso Corporal , Pré-Escolar , Terapia Combinada , Diarreia/microbiologia , Diarreia/fisiopatologia , Diarreia/terapia , Diarreia Infantil/dietoterapia , Diarreia Infantil/microbiologia , Diarreia Infantil/fisiopatologia , Diarreia Infantil/terapia , Humanos , Lactente , Masculino , Soluções para Reidratação/uso terapêutico , Índice de Gravidade de Doença , Fatores de Tempo , Aumento de PesoRESUMO
80 autopsy cases with the diagnosis of infectious endocarditis were reviewed from the Department of Pathology of the Instituto Nacional de Cardiología. Cases included were those who had history of conduction abnormalities. 5% of cases had conduction abnormality due to infectious endocarditis. In 12% of cases, this was attributed to some other cause independent of IE. Only 2 cases had complete AV block and in one of them (1.25%) there was a ventricular septal lesion. It was concluded that abnormalities are a least frequent complication in the natural history of IE. Generally it is due to the extension of the infectious process in the aortic valve towards the ventricular septum and when present carries a bad prognosis.