RESUMO
Persistent methicillin-resistant Staphylococcus aureus (MRSA) infection in cystic fibrosis (CF) patients has been associated with a more rapid decline in lung function, increased hospitalisation and mortality. The aim of this study was to evaluate the clonal relationships among 116 MRSA isolates from 12 chronically colonised CF pediatric patients over a 6-year period in a Rio de Janeiro CF specialist centre. Isolates were characterised by antimicrobial resistance, SCCmec type, presence of Panton-Valentine Leukocidin (PVL) genes and grouped according to DNA macrorestriction profile by pulsed-field gel electrophoresis (PFGE) and spa gene type. High resistance rates were detected for erythromycin (78%) and ciprofloxacin (50%) and SCCmec IV was the most common type (72.4%). Only 8.6% of isolates were PVL positive. High genetic diversity was evident by PFGE (39 pulsotypes) and of nine that were identified spa types, t002 (53.1%) and t539 (14.8%) were the most prevalent. We conclude that the observed homogeneity of spa types within patients over the study period demonstrates the persistence of such strain lineages throughout the course of chronic lung infection.
Assuntos
Fibrose Cística/microbiologia , Staphylococcus aureus Resistente à Meticilina/genética , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Brasil/epidemiologia , Portador Sadio , Criança , Humanos , Resistência a MeticilinaRESUMO
Acinetobacter spp. are important healthcare pathogens, being closely linked to antibiotic resistance and outbreaks worldwide. Although such species are rarely observed in patients with cystic fibrosis (CF), we describe the characteristics of 53 strains of Acinetobacter spp. isolated from the sputum of 39 Brazilian patients with CF. The species distribution was A. baumannii (n = 29), A. pittii (n = 13), A. nosocomialis (n = 8), A. seifertii (n = 1), A. soli (n = 1) and A. variabilis (n = 1) determined by partial rpoB gene sequencing. Sixteen strains (10 A. baumannii, 3 A. pittii and 3 A. nosocomialis) were multidrug-resistant (MDR) by disk diffusion test (30%) and eight MDR carbapenem-resistant A. baumannii strains harboured the bla OXA-23-like oxacillinase gene. Thirty-three sequence types (STs) were identified by multilocus sequence typing of which eight were novel (A. baumannii: 843, 844, 845, 847, 848; A. pitti: 643; A. nosocomialis: 862 and A. seifertii: 846); six STs (2 A. baumannii, 3 A. pittii and 1 A. nosocomialis) were found in more than one patient. Four strains of A. baumannii were assigned to two common clonal complexes (CCs), namely, CC1 (ST1, ST20 and ST160), and CC79 (ST79). This study underlines the extensive species diversity of Acinetobacter spp. strains in CF lung infections which may present difficulties for therapy due to significant antimicrobial resistance.
Assuntos
Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/microbiologia , Antibacterianos/farmacologia , Fibrose Cística/microbiologia , Farmacorresistência Bacteriana , Infecções por Acinetobacter/epidemiologia , Adulto , Algoritmos , Brasil/epidemiologia , Criança , Humanos , Testes de Sensibilidade Microbiana , Reação em Cadeia da Polimerase , Estudos Retrospectivos , Escarro/microbiologiaRESUMO
In this study, we report on the structural and hyperfine properties of Al-doped SnO2 nanoparticles synthesized by a polymer precursor method. The x-ray diffraction data analysis carried out using the Rietveld refinement method shows the formation of only rutile-type structures in all samples, with decreasing of the mean crystallite size as the Al content. A systematic study of the unit cell, as well as the vicinity of the interstitial position show strong evidence of two doping regimes in the rutile-type structure of SnO2. Below 7.5 mol% doping a dominant substitutional solution of Al(+3) and Sn(4+)-ions is determined. However, the occupation of both substitutional and interstitial sites is determined above 7.5 mol% doping. These findings are in good agreement with theoretical ab initio calculations.
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Currently there is little doubt that the body mass index ( BMI) is not an appropriate tool to grant access to metabolic surgery, especially in type 2 diabetics (T2D). Several studies are pointing towards other parameters that should go along with BMI in the treatment decision tree in non morbidly obese diabetics. Insulin resistance, fat distribution among others are considered good tools to predict favorable outcomes in medically non controlled diabetics if sent to surgery. The bottom line in good T2D control is to decrease cardiovascular mortality. Using adequate tools to screen patients to the appropriate surgical treatment may favour patients that are not under control after lifestyle changes and best medical treatment, thus decreasing longterm cardiovascular mortality secondary to type 2 diabetes.
En la actualidad, existe poca duda de que el índice de masa corporal (IMC) no es una herramienta apropiada para garantizar el acceso a la cirugía metabólica, especialmente en los diabéticos tipo 2 (DT2). Diversos estudios apuntan a que otros parámetros deberían considerarse junto con el IMC en el árbol de decisión terapéutica de los diabéticos sin obesidad mórbida. La resistencia a la insulina y la distribución de la grasa, entre otros, se consideran buenas herramientas para predecir unos resultados favorables en pacientes diabéticos no controlados médicamente si se les deriva para cirugía. La idea de base en la DT2 bien controlada es disminuir la mortalidad cardiovascular. Utilizando las herramientas adecuadas para cribar a los pacientes para el tratamiento quirúrgico apropiado puede favorecer a los pacientes que no se controlan después de los cambios en el estilo de vida y el mejor tratamiento médico, disminuyendo así la mortalidad cardiovascular a largo plazo secundaria a la diabetes tipo 2.
Assuntos
Cirurgia Bariátrica/normas , Diabetes Mellitus Tipo 2/cirurgia , Humanos , Seleção de PacientesRESUMO
AIMS: To report Type 2 diabetes-related outcomes after the implantation of a duodenal-jejunal bypass liner device and to investigate the role of proximal gut exclusion from food in glucose homeostasis using the model of this device. METHODS: Sixteen patients with Type 2 diabetes and BMI <36 kg/m(2) were evaluated before and 1, 12 and 52 weeks after duodenal-jejunal bypass liner implantation and 26 weeks after explantation. Mixed-meal tolerance tests were conducted over a period of 120 min and glucose, insulin and C-peptide levels were measured. The Matsuda index and the homeostatic model of assessment of insulin resistance were used for the estimation of insulin sensitivity and insulin resistance. The insulin secretion rate was calculated using deconvolution of C-peptide levels. RESULTS: Body weight decreased by 1.3 kg after 1 week and by 2.4 kg after 52 weeks (P < 0.001). One year after duodenal-jejunal bypass liner implantation, the mean (sem) HbA(1c) level decreased from 71.3 (2.4) mmol/mol (8.6[0.2]%) to 58.1 (4.4) mmol/mol (7.5 [0.4]%) and mean (sem) fasting glucose levels decreased from 203.3 (13.5) mg/dl to 155.1 (13.1) mg/dl (both P < 0.001). Insulin sensitivity improved by >50% as early as 1 week after implantation as measured by the Matsuda index and the homeostatic model of assessment of insulin resistance (P < 0.001), but there was a trend towards deterioration in all the above-mentioned variables 26 weeks after explantation. Fasting insulin levels, insulin area under the curve, fasting C-peptide, C-peptide area under the curve, fasting insulin and total insulin secretion rates did not change during the duodenal-jejunal bypass liner implantation period or after explantation. CONCLUSIONS: The duodenal-jejunal bypass liner improves glycaemia in overweight and obese patients with Type 2 diabetes by rapidly improving insulin sensitivity. A reduction in hepatic glucose output is the most likely explanation for this improvement.
Assuntos
Glicemia/metabolismo , Peptídeo C/sangue , Diabetes Mellitus Tipo 2/sangue , Derivação Gástrica , Hemoglobinas Glicadas/metabolismo , Obesidade/cirurgia , Área Sob a Curva , Remoção de Dispositivo , Diabetes Mellitus Tipo 2/cirurgia , Duodeno/cirurgia , Jejum , Feminino , Homeostase , Humanos , Insulina/metabolismo , Resistência à Insulina , Secreção de Insulina , Jejuno/cirurgia , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Estudos Prospectivos , Resultado do Tratamento , Redução de PesoRESUMO
Nanoparticles were prepared from a NdFeB-based alloy using the hydrogen decrepitation process together with high-energy ball milling and tested as heating agent for magnetic hyperthermia. In the milling time range evaluated (up to 10 h), the magnetic moment per mass at H = 1.59 MA m(-1) is superior than 70 A m(2) kg(-1); however, the intrinsic coercivity might be inferior than 20 kA m(-1). The material presents both ferromagnetic and superparamagnetic particles constituted by a mixture of phases due to the incomplete disproportionation reaction of Nd(2)Fe(14)BH(x) during milling. Solutions prepared with deionized water and magnetic particles exposed to an AC magnetic field (H(max) ~ 3.7 kA m(-1) and f = 228 kHz) exhibited 26 K ≤ ΔT(max) ≤ 44 K with a maximum estimated specific absorption rate (SAR) of 225 W kg(-1). For the pure magnetic material milled for the longest period of time (10 h), the SAR was estimated as ~2500 W kg(-1). In vitro tests indicated that the powders have acceptable cytotoxicity over a wide range of concentration (0.1-100 µg ml(-1)) due to the coating applied during milling.
Assuntos
Imãs/química , Nanopartículas/química , Nanotecnologia/métodos , Neodímio/química , Animais , Compostos de Boro/química , Linhagem Celular , Sobrevivência Celular/efeitos dos fármacos , Hipertermia Induzida/instrumentação , Compostos de Ferro/química , Campos Magnéticos , Imãs/toxicidade , Camundongos , Nanopartículas/toxicidade , Neodímio/toxicidade , Água/químicaRESUMO
We have performed molecular dynamics simulations using a shell model potential developed by fitting first-principles results to describe the behavior of the relaxor-ferroelectric (1 - x)PbMg(1/3)Nb(2/3)O(3)-xPbTiO(3) (PMN-xPT) as a function of concentration and temperature, using site occupancies within the random site model. In our simulations, PMN is cubic at all temperatures and behaves as a polar glass. As a small amount of Ti is added, a weak polar state develops, but structural disorder dominates, and the symmetry is rhombohedral. As more Ti is added the ground state is clearly polar and the system is ferroelectric, but with easy rotation of the polarization direction. In the high Ti content region, the solid solution adopts ferroelectric behavior similar to PT, with tetragonal symmetry. The ground state sequence with increasing Ti content is R-M(B)-O-M(C)-T. The high-temperature phase is cubic at all compositions. Our simulations give the slopes of the morphotropic phase boundaries, crucial for high-temperature applications. We find that the phase diagram of PMN-xPT can be understood within the random site model.
RESUMO
AIM: To evaluate the performance on automated perimetry (AP) after listening to a Mozart sonata in normal subjects naive to AP. METHODS: 60 naive normal subjects underwent AP (SITA 24-2). The study group (30 subjects) underwent AP after listening to Mozart's Sonata for Two Pianos in D Major and the control group (30 subjects) underwent AP without previous exposure to the music. RESULTS: The study group had significantly less fixation loss, false positive, and false negative rates compared to controls (p < 0.05). CONCLUSION: Listening to Mozart seems to improve AP performance in normal naive subjects.
Assuntos
Percepção Auditiva , Música , Desempenho Psicomotor , Estudantes/psicologia , Adulto , Estudos de Casos e Controles , Humanos , Psicofísica , Estatísticas não Paramétricas , Fatores de Tempo , Testes de Campo Visual/métodos , Campos VisuaisRESUMO
BACKGROUND: Bariatric surgery is growing worldwide. An increasing number of patients will require revisional procedures because of inadequate weight control, complications, or loss of quality of life. METHODS: From August 1999 to September 2003, 62 patients were submitted to laparoscopic revisional surgery. RESULTS: The primary operations consisted of laparoscopic adjustable gastric banding in 39 cases, banded and nonbanded Roux-en-Y gastric bypass (RYGB) in 17 cases, vertical banded gastroplasty in 4 cases, and biliopancreatic diversion in 2 cases. Although technically demanding, laparoscopic conversion to RYGB was possible in all cases. Mean operative time was 100 min. Mean hospital stay was 77 h. There were no intraoperative or postoperative complications. A good body mass index reduction after the revisional procedure was observed with a 24 month follow-up period. CONCLUSIONS: Laparoscopic revisional bariatric surgery is safe and effective. However, it should be performed only by experienced bariatric and laparoscopic surgeons.
Assuntos
Cirurgia Bariátrica , Laparoscopia , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos RetrospectivosRESUMO
OBJECTIVE: The objective was to study the effects of iron supplementation on hemoglobin and iron status in 2 different populations. STUDY DESIGN: In a randomized, placebo-controlled, masked clinical trial, we assigned term Swedish (n = 101) and Honduran (n = 131) infants to 3 groups at 4 months of age: (1) iron supplements, 1 mg/kg/d, from 4 to 9 months, (2) placebo, 4 to 6 months and iron, 6 to 9 months, and (3) placebo, 4 to 9 months. All infants were breast-fed exclusively to 6 months and partially to 9 months. RESULTS: From 4 to 6 months, the effect of iron (group 1 vs 2 + 3) was significant and similar in both populations for hemoglobin, ferritin, and zinc protoporphyrin. From 6 to 9 months, the effect (group 2 vs group 3) was significant and similar at both sites for all iron status variables except hemoglobin, for which there was a significant effect only in Honduras. In Honduras, the prevalence of iron deficiency anemia at 9 months was 29% in the placebo group and 9% in the supplemented groups. In Sweden, iron supplements caused no reduction in the already low prevalence of iron deficiency anemia at 9 months (<3%). CONCLUSION: Iron supplementation from 4 to 9 months or 6 to 9 months significantly reduced iron deficiency anemia in Honduran breast-fed infants. The unexpected hemoglobin response at 4 to 6 months in both populations suggests that regulation of hemoglobin synthesis is immature at this age.
Assuntos
Anemia Ferropriva/prevenção & controle , Suplementos Nutricionais , Ferro/uso terapêutico , Fatores Etários , Anemia Ferropriva/epidemiologia , Aleitamento Materno , Hemoglobinas/metabolismo , Honduras/epidemiologia , Humanos , Lactente , Ferro/sangue , Deficiências de Ferro , Prevalência , Suécia/epidemiologia , Resultado do TratamentoRESUMO
To examine whether the duration of exclusive breastfeeding affects maternal nutrition or infant motor development, we examined data from two studies in Honduras: the first with 141 infants of low-income primiparous women and the second with 119 term, low birth weight infants. In both studies, infants were exclusively breastfed for 4 mo and then randomly assigned to continue exclusive breastfeeding (EBF) until 6 mo or to receive high-quality, hygienic solid foods (SF) in addition to breast milk between 4 and 6 mo. Maternal weight loss between 4 and 6 mo was significantly greater in the exclusive breastfeeding group (EBF) group than in the group(s) given solid foods (SF) in study 1 (-0.7 +/- 1.5 versus -0.1 +/- 1.7 kg, P < 0.05) but not in study 2. The estimated average additional nutritional burden of continuing to exclusively breastfeed until 6 mo was small, representing only 0.1-6.0% of the recommended dietary allowance for energy, vitamin A, calcium and iron. Women in the EBF group were more likely to be amenorrheic at 6 mo than women in the SF group, which conserves nutrients such as iron. In both studies, few women (10-11%) were thin (body mass index <19 kg/m(2)), so the additional weight loss in the EBF group in study 1 was unlikely to have been detrimental. Infants in the EBF group crawled sooner (both studies) and were more likely to be walking by 12 mo (study 1) than infants in the SF group. Taken together with our previous findings, these results indicate that the advantages of exclusive breastfeeding during this interval appear to outweigh any potential disadvantages in this setting.
Assuntos
Aleitamento Materno , Desenvolvimento Infantil , Recém-Nascido/crescimento & desenvolvimento , Destreza Motora/fisiologia , Fenômenos Fisiológicos da Nutrição , Estado Nutricional , Amenorreia , Feminino , Honduras , Humanos , Lactente , Alimentos Infantis , Fenômenos Fisiológicos da Nutrição do Lactente , Lactação/fisiologia , Masculino , Necessidades Nutricionais , Período Pós-Parto/fisiologia , Fatores de Tempo , Redução de PesoRESUMO
Artemia brine shrimps are commercially important and they have been extensively studied. This branchiopod crustacean is extensively used in aquaculture and other commercial and applied practices. The genus also awakes an increasing interest worldwide as an experimental model in other basic areas of research such as evolution and cytogenetics. In the present work adult male meiosis and nauplii mitotic cells in two Artemia populations from Argentina (Mar Chiquita and Las Tunas, Córdoba Province) are analyzed and compared to the reference strains A. franciscana (Great Salt Lake, Utah, USA) and A. persimilis (Salinas Grandes de Hidalgo, La Pampa Province, Argentina). The Mar Chiquita population shows the diploid and haploid numbers characteristic of A. franciscana, and a regular male meiosis. In the Las Tunas population diverse diploid and haploid numbers are encountered, and an irregular meiosis is observed in some individuals. Fluorescent DAPI and CMA banding shows bright chromocenters of intermediate size and number in both populations. Cytogenetic and phenotypic data show that the population of Mar Chiquita could be assigned to A. franciscana; the variation found in chromocenter size and number reflects an heterochromatin polytypism already observed in this species. The cytogenetic and morphological traits in Las Tunas population suggest an occasional hybridization between A. franciscana and A. persimilis.
Assuntos
Artemia/classificação , Artemia/genética , Genética Populacional , Animais , Argentina , Diploide , Feminino , Cariotipagem , Masculino , Meiose , PoliploidiaRESUMO
Prospective and retrospective data on maternal attitudes and obstacles to exclusive breastfeeding (EBF) were collected from Honduran mothers of low birthweight (1500-2500 g), term infants who were enrolled in an intervention study to compare infant outcomes in those who were randomly assigned to breastfeed exclusively for either 4 or 6 months. Perceived advantages of EBF were that it was easier, more practical and economical, and resulted in better infant health and growth. Disadvantages included the perceived time demand, concerns that the infant would accept solids less readily, and fears that breast milk alone was insufficient. The majority of study participants said that they would choose to exclusively breastfeed their next infant to 6 months. Although there were many obstacles to EBF, particularly in the first few weeks, women who persevered became enthusiastic proponents of EBF. Messages to promote EBF need to target the entire community, not just mothers, and should focus on addressing common misconceptions and alerting women to potential problems before they occur.
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Atitude Frente a Saúde , Aleitamento Materno , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/métodos , Mães , Adulto , Atitude Frente a Saúde/etnologia , Aleitamento Materno/etnologia , Aleitamento Materno/psicologia , Aleitamento Materno/estatística & dados numéricos , Feminino , Grupos Focais , Honduras , Humanos , Mães/educação , Mães/psicologia , Estudos Prospectivos , Estudos RetrospectivosRESUMO
BACKGROUND: Previous research has suggested that there may be significant within-subject variability, both site-to-site and over time, in hemoglobin concentrations in capillary blood. OBJECTIVE: This study examined the reliability of the portable hemoglobinometer (PHM) system with use of capillary blood and the implications of errors of the magnitude found for the classification of anemia status in individuals and population groups. The precision and accuracy of the method with use of venous blood were also tested. DESIGN: Three empirical data sets were used to measure reliability, precision, and accuracy of the PHM system [2 from Honduras (n = 87 and 141); 1 from Bangladesh (n = 73)]. Simulation data were used to assess the implications of errors for screening individuals for anemia and to estimate anemia prevalence. RESULTS: High within-subject variability (unreliability) was identified when capillary blood from the left hand was compared with that from the right hand (CV: 6.3%) and when measurements were taken on 4 consecutive days (CV: 7.0%). Reliability was only 69% and 50%, respectively. Precision and accuracy, however, were very high (concordance coefficients of 0.99 and 0.98 and CV < 1%). CONCLUSIONS: The simulation data showed that errors of the magnitude found due to unreliability can lead to misclassification of anemia status in individuals and small biases in anemia prevalence estimates. We recommend replicate sampling to reduce the influence of unreliability in the use of the PHM system with capillary blood.
Assuntos
Anemia/diagnóstico , Hemoglobinas/análise , Adolescente , Adulto , Anemia/sangue , Anemia/classificação , Anemia/epidemiologia , Bangladesh/epidemiologia , Viés , Análise Química do Sangue , Capilares , Criança , Falha de Equipamento , Feminino , Hemoglobinometria/instrumentação , Honduras/epidemiologia , Humanos , Lactente , Pessoa de Meia-Idade , Prevalência , Reprodutibilidade dos TestesRESUMO
Objetivo: Este estudo tem como objetivo de avaliar a confiabilidade do exame ecográfico na avaliaçäo de escavaçöes do nervo óptico menores ou iguais a 0.3 e maiores ou iguais a 0.9. Material e métodos: Foram analisados 53 olhos, de 30 pacientes, com meios ópticos transparentes, submetidos à ecografia ocular modo B para avaliaçäo da escavaçäo do disco óptico. A biomicroscopia, 26 possuíam escavaçäo pequena (grupo 1) e 27 escavaçäo grande (grupo 2). Resultados: Os exames impressos foram avaliados por dois observadores, e a ecografia ocular se mostrou confiável com índice Kappa de 0.77(mais ou menos 0.14). A sensibilidade e a especificidade, com intervalo de confiança de 95 por cento, foram de 71.4 por cento (53.4 - 81.1)e de 96.2 por cento (59.6 - 90.1). Conclusäo: A ecografia é método confiável para avaliaçäo da escavaçäo do disco óptico permitindo a distinçäo entre grupo <= 0.3 e o grupo >= 0.9. No entanto, como método de ''screening'' seria mais importante nos resultados negativo.
Assuntos
Humanos , Pessoa de Meia-Idade , Glaucoma , Nervo ÓpticoRESUMO
BACKGROUND: The optimal age at which to introduce complementary foods is a topic of considerable debate. OBJECTIVE: This study was designed to evaluate this issue in a nutritionally vulnerable population in Honduras. DESIGN: Mothers of low-birth-weight (1500-2500 g) term (ie, small-for-gestational-age) infants were recruited in the hospital and assisted with exclusive breast-feeding during the first 4 mo. At 4 mo, mothers were randomly assigned to either continue exclusive breast-feeding to 6 mo (EBF; n = 59) or to feed complementary solid foods (jarred rice cereal, chicken, and fruit and vegetables) twice daily from 4 to 6 mo while continuing to breast-feed at their initial frequency (SF; n = 60). At 4 and 6 mo, breast milk and total energy intake were measured for a nonrandom subsample (those who could stay overnight in a central unit: 32 EBF and 31 SF). RESULTS: At 4 mo, breast milk intake in the subsample was not significantly different between groups (EBF: 729 +/- 135 g/d; SF: 683 +/- 151 g/d: P >0.2); from 4 to 6 mo it increased (by 28 g/d) in the EBF group but decreased (by 39 g/d) in the SF group (P < 0.005). Nonetheless, total energy intake (including solid foods) increased more from 4 to 6 mo in the SF than in the EBF group. However, there were no significant differences between groups in weight or length gain during the intervention or subsequently (6-12 mo). CONCLUSION: There was no growth advantage of complementary feeding of small-for-gestational-age, breast-fed infants between 4 and 6 mo of age.
Assuntos
Aleitamento Materno , Alimentos Infantis , Recém-Nascido Pequeno para a Idade Gestacional/crescimento & desenvolvimento , Adulto , Fatores Etários , Peso ao Nascer , Ingestão de Energia , Feminino , Nível de Saúde , Honduras , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Masculino , Classe SocialRESUMO
OBJECTIVE: To evaluate the efficacy of cisapride in the treatment of uncomplicated gastroesophageal reflux in children younger than 36 months of age. STUDY DESIGN: A total of 95 patients satisfied the entry criteria and were randomly assigned to double-blind treatment with either cisapride (n = 50), 0.2 mg/kg 4 times daily, or placebo (n = 45) for 2 weeks. At the end of the 2-week treatment period, symptom diary and parental evaluation with repeat 24-hour pH study were performed. RESULTS: Sixty-eight patients completed the trial (38 in the cisapride group and 30 in the placebo group). There were no significant differences in the symptoms of crying, vomiting, or gagging; the overall symptom intensity score; or parental global evaluations. There was a significant difference (P <.03) in the percent time pH <4, the number of reflux episodes lasting more than 5 minutes, and the duration of the longest episode. No significant difference was demonstrated for the number of episodes with pH <4 or the reflux score. CONCLUSIONS: Cisapride was no better than placebo for relief of symptoms in children with uncomplicated gastroesophageal reflux. A beneficial effect was demonstrated in the cisapride group in relation to the measured parameters for esophageal acid exposure time.
Assuntos
Cisaprida/uso terapêutico , Refluxo Gastroesofágico/tratamento farmacológico , Fármacos Gastrointestinais/uso terapêutico , Administração Oral , Austrália , Distribuição de Qui-Quadrado , Cisaprida/efeitos adversos , Método Duplo-Cego , Esôfago/fisiopatologia , Feminino , Refluxo Gastroesofágico/diagnóstico , Fármacos Gastrointestinais/efeitos adversos , Humanos , Concentração de Íons de Hidrogênio , Lactente , Masculino , Placebos , Estatísticas não Paramétricas , Falha de TratamentoRESUMO
Enthusiasm about the application of videolaparoscopy to oncologic diseases has been limited by the growing number of port site implants. Adult Wistar rats were submitted to 6-7 mm Hg carbonic gas pneumoperitoneum. Rats were randomly divided into two groups: group I rats with tumor (200,000 viable cells of Walker tumor) and group 11 rats with no tumor. The pneumoperitoneum was deflated after 30 min. Group I was further randomized into five groups: no treatment; or abdominal irrigation with saline, heparin, chemotherapy (doxorubicin), or chemotherapy associated with heparin. After a period lasting no more than 18 days, the abdominal wall and intraperitoneal organs macroscopically affected were studied histologically. Chemotherapy groups had no port site implants and were significantly different (p < 0.05) than the no treatment, saline, and heparin solution groups, which had incisional implants at frequencies of 100%, 85.7%, and 82.5%, respectively. Intraperitoneal irrigation with chemotherapy solution was effective in preventing incisional implants in this animal model.
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Antineoplásicos/administração & dosagem , Carcinossarcoma/terapia , Heparina/administração & dosagem , Laparoscopia/efeitos adversos , Inoculação de Neoplasia , Neoplasias Peritoneais/terapia , Animais , Carcinossarcoma/mortalidade , Modelos Animais de Doenças , Masculino , Distribuição Aleatória , Ratos , Ratos Wistar , Valores de Referência , Análise de Sobrevida , Gravação em VídeoRESUMO
BACKGROUND: All but 2 of the 15 published trials have failed to show a difference in efficacy between short (3 to 5 days) and standard (7 to 10 days) antibiotic regimens for acute otitis media (AOM). These studies involved relatively few patients under 2 years of age, who are at a higher risk for treatment failure. METHODS: In a prospective, comparative, double-blind, randomized, multicenter trial, we compared amoxicillin/clavulanate in 3 divided doses for 10 days with an identical 5-day regimen, followed by a 5-day placebo period. RESULTS: Between February 1995 and May 1996, 385 children (mean age, 13.3 months) were enrolled, 194 in the 5-day treatment group and 191 in the 10-day treatment group. In the per protocol analysis, clinical success was obtained on days 12 to 14 after the beginning of treatment (main analysis) in 125 (76.7%) of the 163 children receiving the 5-day regimen and 148 (88.1%) of the 168 receiving the 10-day regimen (P = .006). Clinical success persisted on days 28 to 42 among 57 (40.4%) of the 141 assessable patients in the 5-day group and 64 (46%) of the 139 assessable patients in the 10-day group. (P = .34). Multivariate analysis showed that the 10-day course was statistically superior only among children cared for outside their homes (86.8% vs 70.8%; P = .008). CONCLUSIONS: When assessed on days 12 to 14 after the outset of treatment, a 5-day regimen is not equivalent to a 10-day regimen among young children with AOM.
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Amoxicilina/administração & dosagem , Ácido Clavulânico/administração & dosagem , Otite Média/tratamento farmacológico , Doença Aguda , Amoxicilina/efeitos adversos , Pré-Escolar , Ácido Clavulânico/efeitos adversos , Relação Dose-Resposta a Droga , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Lactente , Masculino , Estudos ProspectivosRESUMO
Laparoscopic repair of inguinal hernias follows some principles that have already proven its efficiency, as a posterior approach and the prosthetic repair that allows a "tension-free" repair with consequent early return to work and low recurrence rate. To determine the most appropriate laparoscopic repair, we compared the transabdominal preperitoneal (TAPP) and the totally extraperitoneal (TEP) approach. Patients undergoing TAPP and TEP were compared regarding technical feasibility and difficulties, time until return to work and follow-up, including intraoperative and postoperative complications. Seventy-eight patients (108 hernias) were submitted to TAPP and 67 (100 hernias) were repaired through TEP. All data were analyzed by Yates-corrected chi-square test to qualitative analysis of each group and p < or = 0.05 was considered significant. Both procedures were indicated mainly for bilateral and/or recurrent hernias (68%). The operative time was shorter in TAPP (not statistically significant). Surgeons complained of more technical difficulties while performing the TEP approach (70% complaints of difficulty in TEP--four conversions to TAPP). There was no difference in hospital stay (mean of 30 h) and return to work (TAPP 7 days and TEP 5.5 days). Regarding the complication rate (TAPP = 20.5% and TEP = 13.5%; not significant), none were related to the pneumoperitoneum technique or its systemic effects. In the TAPP approach, two trocar site hernias occurred, and in the TEP approach, one severe cellulitis occurred, which was managed without surgical intervention. The mean follow-up period for each procedure was not the same, so the recurrence rates are not comparable statistically (rate of 1.85% in TAPP and 0 in TEP). Both techniques are safe and have the same advantages, but TAPP is easier: a better view of the anatomy is achieved, shortening the learning curve. We suggest that TAPP can be an adequate laparoscopic approach to groin hernias. A longer follow-up period and more cases are needed to determine recurrence rates.