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Introducción. La prueba de provocación oral (PPO) para el diagnóstico de alergia a las proteínas de la leche de la vaca (APLV) presenta riesgos y requiere de recursos. Nuestro objetivo fue evaluar condiciones y pruebas complementarias para identificar una alta probabilidad de APLV. Población y métodos. Análisis secundario sobre estudio de pacientes atendidos en una unidad de alergia entre 2015 y 2018. Se determinaron las probabilidades prepruebas asociadas a los síntomas y sus combinaciones, y las probabilidades pospruebas luego de realizadas pruebas cutáneas y determinación de inmunoglobulina E (IgE) sérica. Resultados. Se evaluó la información de 239 pacientes. Se observaron probabilidades mayores al 95 % en pacientes con angioedema y combinación de urticaria y vómitos. Usando puntos de corte propuestos por Calvani et al., la combinación de vómitos con rinitis, sin angioedema, también superó el 95 %. Conclusión. Se ofrece una metodología para identificar pacientes en los que puede diagnosticarse APLV sin realización de PPO.
Introduction. The oral food challenge (OFC) for the diagnosis of cow's milk protein allergy (CMPA) poses risks and requires resources. Our objective was to assess conditions and complementary tests used to identify a high probability of CMPA. Population and methods. Secondary analysis of a study of patients seen at a unit of allergy between 2015 and 2018. Pre-testing probabilities associated with symptoms and their combinations and post-testing probabilities after skin prick testing and serum immunoglobulin E (IgE) levels were determined. Results. The data from 239 patients were assessed. A probability greater than 95% was observed for angioedema and a combination of urticaria and vomiting. Based on the cut-off points proposed by Calvani et al., the combination of vomiting with rhinitis, without angioedema, also exceeded 95%. Conclusion. A methodology is provided to identify patients in whom CMPA may be diagnosed without an OFC.
Assuntos
Humanos , Animais , Lactente , Hipersensibilidade a Leite/diagnóstico , Hipersensibilidade a Leite/epidemiologia , Angioedema/complicações , Vômito , Bovinos , Testes Cutâneos/métodos , Proteínas do Leite/efeitos adversosRESUMO
Introduction. The oral food challenge (OFC) for the diagnosis of cow's milk protein allergy (CMPA) poses risks and requires resources. Our objective was to assess conditions and complementary tests used to identify a high probability of CMPA. Population and methods. Secondary analysis of a study of patients seen at a unit of allergy between 2015 and 2018. Pre-testing probabilities associated with symptoms and their combinations and post-testing probabilities after skin prick testing and serum immunoglobulin E (IgE) levels were determined. Results. The data from 239 patients were assessed. A probability greater than 95% was observed for angioedema and a combination of urticaria and vomiting. Based on the cut-off points proposed by Calvani et al., the combination of vomiting with rhinitis, without angioedema, also exceeded 95%. Conclusion. A methodology is provided to identify patients in whom CMPA may be diagnosed without an OFC.
Introducción. La prueba de provocación oral (PPO) para el diagnóstico de alergia a las proteínas de la leche de la vaca (APLV) presenta riesgos y requiere de recursos. Nuestro objetivo fue evaluar condiciones y pruebas complementarias para identificar una alta probabilidad de APLV. Población y métodos. Análisis secundario sobre estudio de pacientes atendidos en una unidad de alergia entre 2015 y 2018. Se determinaron las probabilidades prepruebas asociadas a los síntomas y sus combinaciones, y las probabilidades pospruebas luego de realizadas pruebas cutáneas y determinación de inmunoglobulina E (IgE) sérica. Resultados. Se evaluó la información de 239 pacientes. Se observaron probabilidades mayores al 95 % en pacientes con angioedema y combinación de urticaria y vómitos. Usando puntos de corte propuestos por Calvani et al., la combinación de vómitos con rinitis, sin angioedema, también superó el 95 %. Conclusión. Se ofrece una metodología para identificar pacientes en los que puede diagnosticarse APLV sin realización de PPO.
Assuntos
Angioedema , Hipersensibilidade a Leite , Feminino , Animais , Bovinos , Humanos , Lactente , Hipersensibilidade a Leite/diagnóstico , Hipersensibilidade a Leite/epidemiologia , Testes Cutâneos/métodos , Angioedema/complicações , Proteínas do Leite/efeitos adversos , VômitoRESUMO
Background: Recent data about clinical features, triggers and management of anaphylaxis in Latin America is lacking. Objective: To provide updated and extended data on anaphylaxis in this region. Method: An online questionnaire was used, with 67 allergy units involved from 12 Latin-American countries and Spain. Among data recorded, demographic information, clinical features, severity, triggering agents, and treatment were received. Results: Eight hundred and seventeen anaphylactic reactions were recorded. No difference in severity, regardless of pre-existing allergy or asthma history was found. Drug induced anaphylaxis (DIA) was most frequent (40.6%), followed by food induced anaphylaxis (FIA) (32.9%) and venom induced anaphylaxis (VIA) (12%). FIA and VIA were more common in children-adolescents. Non-steroidal anti-inflammatory drugs (NSAIDs) and beta-lactam antibiotics (BLA) were the most frequent drugs involved. Milk (61.1% of FIA) and egg (15.4% of FIA) in children, and shellfish (25.5% of FIA), fresh fruits (14.2% of FIA), and fish (11.3% of FIA) in adults were the most common FIA triggers. Fire ants were the most frequent insect triggers, and they induced more severe reactions than triggers of FIA and DIA (p < 0.0001). Epinephrine was used in 43.8% of anaphylaxis episodes. After Emergency Department treatment, epinephrine was prescribed to 13% of patients. Conclusions: Drugs (NSAIDs and BLA), foods (milk and egg in children and shellfish, fruits and fish in adults) and fire ants were the most common inducers of anaphylaxis. Epinephrine was used in less than half of the episodes emphasizing the urgent need to improve dissemination and implementation of anaphylaxis guidelines.
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Resumen Objetivo: Describir el grado de satisfacción y el impacto sociolaboral y medioambiental de los pacientes de un programa de seguimiento remoto de marcapasos. Método: Estudio observacional prospectivo que incluyó 160 pacientes del programa de seguimiento remoto entre 2016 y 2017. Se pasó una encuesta de satisfacción a dichos pacientes y se cuantificó la disminución del CO2 emitido al reducir el número de visitas. Resultados: Los pacientes acudían acompañados (86%) y en coche (66%) la mayoría de las veces, y mostraron un grado de satisfacción «bueno o excelente¼ en un 96%. Se estima un ahorro de emisión de CO2 de casi un 10% por ciclo de seguimiento. Conclusiones: El seguimiento remoto de marcapasos implantado en nuestra unidad de arritmias reduce el impacto sociolaboral, económico y medioambiental.
Abstract Objective: To describe the degree of satisfaction and social, occupational and environmental impact of patients on our remote pacemaker monitoring programme run. Method: Prospective observational study including 160 patients on the remote pacemaker monitoring programme between 2016 and 2017. We handed out a satisfaction survey and quantified the decrease in CO2 emitted by reducing the number of visits. Results: The patients attended visits accompanied (86%) and by car (66%) most of the time. 96% of respondents said their degree of satisfaction was "good or excellent". We estimated a saving in CO2 emissions of almost 10% for each remote monitoring cycle. Conclusions: The remote monitoring of pacemakers implemented by our arrhythmia unit reduces the social, occupational, financial and environmental impact.
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We report two cases of acute aseptic meningitis associated to mumps in middle-aged women, one pregnant. Both presented shortly after parotid gland enlargement. Neurological complications were suspected by headache, fever and meningeal signs and confirmed by CSF findings (mononuclear predominant pleocytosis) with negative results for alternative causes. Mumps were confirmed by positive IgM and IgG serology. Both patients were discharged with a favorable evolution and complete disappearance of symptoms. Cases were concurrent with a regional mumps outbreak. Conclusions: Aseptic meningitis is a rare mumps-associated neurological complication. Its diagnostic can be achieved by precedent parotid enlargement, mononuclear pleocytosis in the CSF and positive IgM and IgG serology or viral detection by PCR in urine or salivary samples. This complication would be more probably observed during mumps outbreaks.
Assuntos
Meningite Asséptica/virologia , Caxumba/complicações , Adulto , Distribuição por Idade , Chile/epidemiologia , Epidemias , Feminino , Humanos , Incidência , Meningite Asséptica/epidemiologia , Meningite Asséptica/patologia , Caxumba/epidemiologia , Caxumba/patologia , Fatores de Risco , Estações do Ano , Fatores de TempoRESUMO
Resumen Comunicamos dos casos de meningitis aséptica asociadas a parotiditis viral en mujeres de edad mediana, una de ellas embarazada. Ambas se presentaron pocos días después del aumento de volumen parotídeo, con cefalea, fiebre y signos meníngeos, pleocitosis de predominio mononuclear en el LCR y resultados negativos para otras causas. La parotiditis fue confirmada por serología IgG e IgM positiva. Las pacientes tuvieron una evolución favorable con desaparición total de sus síntomas. Ambos casos ocurrieron durante un brote regional de parotiditis. La meningitis aséptica es una complicación frecuente de las parotiditis. Su diagnóstico puede lograrse por el aumento de volumen glandular precedente, la pleocitosis de predominio mononuclear en el LCR y una serología IgM e IgG positiva o detección genómica por RPC en muestra urinaria o salival. Esta complicación es más probable que sea observada durante brotes de parotiditis viral.
We report two cases of acute aseptic meningitis associated to mumps in middle-aged women, one pregnant. Both presented shortly after parotid gland enlargement. Neurological complications were suspected by headache, fever and meningeal signs and confirmed by CSF findings (mononuclear predominant pleocytosis) with negative results for alternative causes. Mumps were confirmed by positive IgM and IgG serology. Both patients were discharged with a favorable evolution and complete disappearance of symptoms. Cases were concurrent with a regional mumps outbreak. Conclusions: Aseptic meningitis is a rare mumps-associated neurological complication. Its diagnostic can be achieved by precedent parotid enlargement, mononuclear pleocytosis in the CSF and positive IgM and IgG serology or viral detection by PCR in urine or salivary samples. This complication would be more probably observed during mumps outbreaks.
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Humanos , Feminino , Adulto , Meningite Asséptica/virologia , Caxumba/complicações , Estações do Ano , Fatores de Tempo , Chile/epidemiologia , Incidência , Fatores de Risco , Distribuição por Idade , Epidemias , Meningite Asséptica/patologia , Meningite Asséptica/epidemiologia , Caxumba/epidemiologiaRESUMO
Resumen Introducción: Los instrumentos de tamizaje de artritis psoriásica son una herramienta útil en la consulta dermatológica, para optimizar la remisión al reumatólogo. La herramienta Toronto Psoriatic Arthritis Screening Questionnaire (ToPAS) ha sido desarrollada y validada en Canadá. Objetivos: Traducir y aplicar algunas pruebas de validación de la escala ToPAS para ser utilizada en la consulta dermatológica en Colombia. Métodos: Estudio de traducción y validación de escalas. Resultados: Se llevó a cabo la traducción y validación del ToPAS con una metodología estandarizada, obteniendo un documento en español con el cual se realizó una prueba piloto del documento final en 20 pacientes con diagnóstico de psoriasis y artritis psoriásica, con el fin de evaluar los ítems en cuanto a aspectos como comprensión, ambigüedad y tiempo de respuesta. Posteriormente, el instrumento se aplicó a 108 pacientes, 65 (60,2%) eran hombres, 36 (33,3%) tenían diagnóstico de artritis psoriásica y 72 (66,6%) solo psoriasis. Se consideró como punto de corte un puntaje > 8 puntos, encontrando una sensibilidad del 75% y una especificidad del 92%, valor predictivo positivo del 82% y valor predictivo negativo del 88%. Para evaluar la confiabilidad test-retest se seleccionaron los últimos 25 participantes, calculándose el coeficiente de correlación de Pearson para evaluar la correlación entre la primera y la segunda aplicación del ToPAS; el valor de p fue de 0,94, valor que representa un alto nivel de correlación entre la primera y la segunda aplicación. Conclusiones: Se realizó la traducción, validación y evaluación de características operativas de la encuesta ToPAS para detección de artritis psoriásica, constituyéndose en una herramienta práctica para uso en la consulta dermatológica.
Abstract Introduction: Psoriatic arthritis screening tools are useful for the rheumatologist in optimising referrals to the dermatology clinic. The Toronto Psoriatic Arthritis Screening Questionnaire (ToPAS) is a tool that has been developed and validated in Canada. Objectives: To translate, and perform some validation tests on TOPAS for use in dermatology clinics in Colombia. Methods: Translation and validation of scales. Results: ToPAS was translated using standardised methodology. A pilot test was conducted on 20 patients diagnosed with psoriasis and psoriatic arthritis using the final version of the document translated into Spanish, in order to evaluate items of aspects such as understanding, ambiguity, and response time. The tool was then used on 108 patients, including 65 (60.2%) males, with 36 (33.3%) cases with a diagnosis of psoriatic arthritis, and 72 (64.7%) with psoriasis only. Using a cut-off score > 8 points, it showed a sensitivity of 75% and specificity 92%, positive predictive value 82% and negative predictive value of 88%. To assess the reliability test re-test, 25 participants were selected and Pearson correlation coefficient was calculated to evaluate the correlation between the first and second application of ToPAS, which gave a value of P = .94, which represents a high level of correlation between the first and second application. Conclusions: A translation, validation and evaluation of operational characteristics of the ToPAS questionnaire was conducted, being a practical tool for use in the dermatology clinic.
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Humanos , Artrite Psoriásica , Inquéritos e Questionários , Encaminhamento e Consulta , Dermatopatias , Canadá , Programas de Rastreamento , DiagnósticoRESUMO
La terapia antifactor de necrosis tumoral se ha convertido en los últimos años en uno de los pilares fundamentales para el tratamiento de la artritis reumatoide. El adalimumab es un anticuerpo monoclonal humanizado empleado en el tratamiento de la artritis reumatoide. Se describe un caso de lupus cutáneo inducido por adalimumab.
Tumor necrosis factor inhibitors have become one of the most important treatments of rheumatoid arthritis. Adalimumab is a monoclonal antibody used for the treatment of this condition. A case is described of adalimumab induced cutaneous lupus.
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Humanos , Artrite Reumatoide , Lúpus Eritematoso SistêmicoRESUMO
A thin fiber-less sponge from Caribbean reefs (Bocas del Toro, Panama) with close genetic affinities (based on 18S and 28S nuclear ribosomal RNA gene sequences) to large fan-shaped fiber-bearing sponges (Ianthella and Anomoianthella) from the Indo-Pacific Ocean is here presented. We describe its overall external morphology, histological features, and ultrastructure. Its genetic distance from the only previously known fiber-less verongid genus, Hexadella, prompted the need to erect a new genus to classify this species. This novel species constitutes the first record for a member of the family Ianthellidae in the Caribbean. The characterization of the family Ianthellidae (sensu Cook and Bergquist, 2000) is here modified by: i) highlighting the cavernous nature of the choanosome, with many lacunae and channels reported for all genera included in the family; ii) extending the family distribution to the Caribbean; and iii) adding a fourth genus to the group of verongids with eurypylous chambers. The possession of a cellularized cortex (10-300 µm in thickness) is here proposed as a potential synapomorphic character of the Ianthella-Anomoianthella-Vansoestia clade. The main issues regarding the suprageneric classification of verongids are discussed.
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Poríferos/classificação , Distribuição Animal , Estruturas Animais/anatomia & histologia , Estruturas Animais/crescimento & desenvolvimento , Animais , Tamanho Corporal , DNA Ribossômico/genética , Tamanho do Órgão , Oceano Pacífico , Panamá , Filogenia , Poríferos/anatomia & histologia , Poríferos/genética , Poríferos/crescimento & desenvolvimentoAssuntos
Anti-Inflamatórios/efeitos adversos , Antirreumáticos/efeitos adversos , Artrite Reumatoide/tratamento farmacológico , Meningite Criptocócica/induzido quimicamente , Meningoencefalite/induzido quimicamente , Meningoencefalite/microbiologia , Metotrexato/efeitos adversos , Prednisona/efeitos adversos , Anti-Inflamatórios/uso terapêutico , Antirreumáticos/uso terapêutico , Feminino , Humanos , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Prednisona/uso terapêuticoRESUMO
The highly collaborative research sponsored by the NSF-funded Assembling the Porifera Tree of Life (PorToL) project is providing insights into some of the most difficult questions in metazoan systematics. Our understanding of phylogenetic relationships within the phylum Porifera has changed considerably with increased taxon sampling and data from additional molecular markers. PorToL researchers have falsified earlier phylogenetic hypotheses, discovered novel phylogenetic alliances, found phylogenetic homes for enigmatic taxa, and provided a more precise understanding of the evolution of skeletal features, secondary metabolites, body organization, and symbioses. Some of these exciting new discoveries are shared in the papers that form this issue of Integrative and Comparative Biology. Our analyses of over 300 nearly complete 28S ribosomal subunit gene sequences provide specific case studies that illustrate how our dataset confirms new hypotheses of sponge evolution. We recovered monophyletic clades for all 4 classes of sponges, as well as the 4 major clades of Demospongiae (Keratosa, Myxospongiae, Haploscleromorpha, and Heteroscleromorpha), but our phylogeny differs in several aspects from traditional classifications. In most major clades of sponges, families within orders appear to be paraphyletic. Although additional sampling of genes and taxa are needed to establish whether this pattern results from a lack of phylogenetic resolution or from a paraphyletic classification system, many of our results are congruent with those obtained from 18S ribosomal subunit gene sequences and complete mitochondrial genomes. These data provide further support for a revision of the traditional classification of sponges.
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Filogenia , Poríferos/classificação , Poríferos/genética , RNA Ribossômico 28S/genética , Animais , Sequência de Bases , Teorema de Bayes , Primers do DNA/genética , Funções Verossimilhança , Modelos Genéticos , Dados de Sequência Molecular , Panamá , Alinhamento de Sequência , Análise de Sequência de DNA , Especificidade da Espécie , Espectrofotometria UltravioletaRESUMO
Exploring marine sponges from shallow tropical reefs of the Caribbean and western Central Pacific, as part of large biodiversity (Moorea Biocode Project) and evolutionary (Porifera Tree of Life) research projects, we encountered 13 skeleton-less specimens, initially divided in two morphological groups, which had patterns of coloration and oxidation typical of taxa of the order Verongida (Demospongiae). The first group of samples inhabited open and cryptic habitats of shallow (15-20 m) Caribbean reefs at Bocas del Toro Archipelago, Panama. The second group inhabited schiophilous (e.g., inner coral framework and crevices) habitats on shallow reefs (0.5-20 m deep) in Moorea Island, French Polynesia. We applied an integrative approach by combining analyses of external morphology, histological observations, 18S rDNA, and mtCOI to determine the identity and the relationships of these unknown taxa within the order Verongida. Molecular analyses revealed that none of the species studied belonged to Hexadella (Ianthellidae, Verongida), the only fibreless genus of the Order Verongida currently recognized. The species from the Caribbean locality of Bocas del Toro (Panama) belong to the family Ianthellidae and is closely related to the Pacific genera Ianthella and Anomoianthella, both with well-developed fiber reticulations. We suggest the erection of a new generic denomination to include this novel eurypylous, fibreless ianthellid. The species collected in Moorea were all diplodal verongid taxa, with high affinities to a clade containing Pseudoceratina, Verongula, and Aiolochroia, a Pacific and two Caribbean genera, respectively. These unknown species represented at least three different taxa distinguished by DNA sequence analysis and morphological characteristics. Two new genera and a new species of Pseudoceratina are here proposed to accommodate these novel biological discoveries. The evolutionary and ecological meaning of having or lacking a fiber skeleton within Verongida is challenged under the evidence of the existence of fibreless genera within various verongid clades. Furthermore, the discovery of a fibreless Peudoceratina suggests that the possession of a spongin-chitin fiber reticulation is an "ecological" plastic trait that might be lost under certain conditions, such us growing within another organism's skeletal framework. These results raise new questions about the ecological and evolutionary significance of the development of a fiber skeleton and of sponges' adaptability to various environmental conditions.
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Distribuição Animal/fisiologia , Filogenia , Poríferos/anatomia & histologia , Poríferos/classificação , Poríferos/genética , Animais , Sequência de Bases , Complexo IV da Cadeia de Transporte de Elétrons/genética , Funções Verossimilhança , Modelos Genéticos , Dados de Sequência Molecular , Panamá , Polinésia , RNA Ribossômico 18S/genética , Análise de Sequência de DNA , Especificidade da EspécieRESUMO
Gout is a disease characterized by acute episodes of pain, which occurs as the result of monosodic urate crystal deposit in the joint and periarticular tissue. In some cases, gout behaves as a severe inflammatory arthopathy that is difficult to manage, generating structural joint damage and functional impairment. We report the case of a 44 years old man with gouty arthritis for 12 years, not responding to NSAIDs, alopurinol, colchicine or corticosteroids. Tocilizumab was started with favorable clinical and laboratory results after treatment.
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Anticorpos Monoclonais Humanizados/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Gotosa/tratamento farmacológico , Adulto , Humanos , MasculinoRESUMO
Hypertension can start at an early age, however there are few data about blood pressure control in rural students in Argentina. Proyecto Vela is a survey about cardiovascular risk factors in the rural population of Maria Ignacia Vela, Argentina. We evaluated blood pressure levels, prevalence of arterial hypertension, sedentary lifestyle, overweight, and obesity in 331 children and adolescent students. In 70% of the subjects the blood pressure was measured for the first time. Prevalence of arterial hypertension was 4.3% in adolescents. Pre-hypertension was detected in 1.9% and 1.7% of children and adolescents, respectively. The prevalence of smoking, sedentary lifestyle, overweight or obesity was 2.4%, 50% and 23.8% respectively. There was association (p <0.05) between hypertension and sedentary lifestyle. In our population the evaluation of blood pressure in adolescents is not a routine procedure. Prevalence of hypertension was low but these data show the importance of blood pressure controls and the need of official programs to modify sedentary lifestyle.
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Hipertensão/epidemiologia , Adolescente , Argentina , Pressão Sanguínea , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Prevalência , Estudos Prospectivos , Saúde da População RuralRESUMO
La hipertensión arterial puede iniciarse a temprana edad. Existen pocos datos sobre el control de la presión arterial en poblaciones escolares rurales argentinas. Proyecto Vela es un estudio epidemiológico que evalúa la prevalencia de factores de riesgo cardiovascular en la población rural de María Ignacia Vela, Argentina. Se midieron niveles de presión arterial, prevalencia de hipertensión arterial, sedentarismo y sobrepeso en 331 niños y adolescentes escolares. En el 70 por ciento, la presión arterial se midió por primera vez. La prevalencia de hipertensión fue 4,3 por ciento y la de prehipertensión 1,9 por ciento en niños y 1,7 por ciento en adolescentes. Las prevalencias de tabaquismo, sedentarismo y sobrepeso fueron 2,4 por ciento, 50 por ciento y 23,8 por ciento, respectivamente. Hubo asociación entre sedentarismo e hipertensión arterial (p menor 0,05). La prevalencia de hipertensión fue baja, pero destacamos la importancia de medir la presión arterial desde edades tempranas e implementar programas oficiales para modificar el sedentarismo.
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Humanos , Masculino , Adolescente , Criança , Feminino , Pressão Sanguínea , Doenças Cardiovasculares , Hipertensão , Sobrepeso , Fatores de Risco , População Rural , Tabagismo , Estudos Transversais , Estudos Epidemiológicos , ProjetosRESUMO
La hipertensión arterial puede iniciarse a temprana edad. Existen pocos datos sobre el control de la presión arterial en poblaciones escolares rurales argentinas. Proyecto Vela es un estudio epidemiológico que evalúa la prevalencia de factores de riesgo cardiovascular en la población rural de María Ignacia Vela, Argentina. Se midieron niveles de presión arterial, prevalencia de hipertensión arterial, sedentarismo y sobrepeso en 331 niños y adolescentes escolares. En el 70 por ciento, la presión arterial se midió por primera vez. La prevalencia de hipertensión fue 4,3 por ciento y la de prehipertensión 1,9 por ciento en niños y 1,7 por ciento en adolescentes. Las prevalencias de tabaquismo, sedentarismo y sobrepeso fueron 2,4 por ciento, 50 por ciento y 23,8 por ciento, respectivamente. Hubo asociación entre sedentarismo e hipertensión arterial (p menor 0,05). La prevalencia de hipertensión fue baja, pero destacamos la importancia de medir la presión arterial desde edades tempranas e implementar programas oficiales para modificar el sedentarismo.(AU)
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Humanos , Masculino , Adolescente , Criança , Feminino , Pressão Sanguínea , Fatores de Risco , Hipertensão , Tabagismo , Sobrepeso , Doenças Cardiovasculares , População Rural , Projetos , Estudos Epidemiológicos , Estudos TransversaisRESUMO
Objetivo: Describir las características clínicas, paraclínicas y manejo de la enfermedad de Still del adulto (E.S.A.). Métodos: Análisis retrospectivo de una cohorte de 24 pacientes. Resultados: Las características clínicas fueron: fiebre (100%), rash (79.1%) y artritis (66.66%). Leucocitosis (75%) fue la alteración paraclínica más frecuente, seguida por un incremento de la PCR, VSG y ferritina en 70.8%, 66.65% y 62.5%, respectivamente. El 50% de los pacientes presentaron un curso monocíclico; el 33%, policíclico sistémico y el 17%, policíclico articular. No se presentaron casos de monocíclico poliarticular. Se evidenciaron manifestaciones inusuales de enfermedad tales como: urticaria en 7 pacientes (29%); enfermedad pulmonar intersticial, en 6 pacientes (25%); meningitis aséptica, 4 pacientes (16.6%) y SDRA, en 4 pacientes (16.6%). Por su parte, todos los pacientes recibieron esteroides y 9 de ellos (37.5%) necesitaron tratamiento con pulsos de metilprednisolona. Dentro de las drogas modificadoras, el metotrexate fue el medicamento más usado en 15 casos (62.5%), seguido por cloroquina sola o combinada en 11 pacientes (45.8%). Además, 3 pacientes (12.5%), requirieron tratamiento con terapia anti TNF por pobre respuesta a la terapia convencional. Fallecieron 2 pacientes (8.4%) asociados a cuadros de SDRA. Conclusiones: La ESA tiene un amplio y difícil diagnóstico diferencial a pesar de manifestaciones clásicas. La presencia de expresiones clínicas poco usuales puede retardar el diagnóstico y tratamiento de ESA. La ESA no es una enfermedad benigna y puede cursar con alta mortalidad cuando se asocia a manifestaciones pulmonares severas.
Purpose: describe the clinical and laboratory finding, as well as the treatment, of adult still's disease (ASD). Methods: retrospective analysis of a 24 patients cohort. Results: clinical features were: fever (100%), rash (79.1%) and arthritis (66.6%). Most frequent laboratory alterations were: leukocytosis (75%), followed by increased PCR, VSG and ferritin, 70.8%, 66.65% and 62.5% respectively. 50% of the patients showed a monocyclic course, while 33% showed polycyclic systemic and 17% joint polycyclic. No joint monocyclic cases were found. Besides, some unusual manifestations such urticaria in 7 patients (29%); interstitial lung disease in 6 patients (25%); aseptic meningitis in 4 patients (16.6%) and SDRA in 4 patients (16.6%) were found. All the patients received steroid and 9 of them (37.5%) required therapy with IV methilprednisolone. Methotrexate was the most used medication between all; DMARD in 15 cases (62.5%), followed by chloroquine, alone or in combination, in 11 patients (45.8%). Besides, 3 patients (12.5%) required treatment with anti TNF due to poor response to conventional therapy. 2 patients died (8.4%) due to adult respiratory distress syndrome. Conclusions: ASD has a broad and difficult differential diagnosis despite classical features. The presence of unusual manifestations may delay the diagnosis and treatment of this disease. ASD in not a benign disease and may appear with high mortality when it is associated with severe lung involvement.
Assuntos
Humanos , Estudos de Coortes , Doença de Still de Início Tardio , Sinais e Sintomas , Administração dos Cuidados ao Paciente , Gerenciamento Clínico , DiagnósticoRESUMO
BACKGROUND: An increase in the frequency of resistant strains to antifungal drugs has been detected in the last decade. AIM: To report the minimal inhibitory concentration (MIC) to amphotericin B, fluconazole, ketoconazole and itraconazole. To compare the MIC obtained with 80% and 50% of growth inhibition to the azoles. MATERIAL AND METHODS: Fifty yeast strains isolated between 1998 and 1999, from 17 adults and 33 children with invasive mycosis were studied. Susceptibility was determined by broth microdilution method with RPMI 1640 plus glucose 2% according to the National Committee for Clinical Laboratory Standards (1997). RESULTS: The most frequently isolated strains were C albicans in 27 cases and C parapsilosis in 12. All isolates were susceptible to amphotericin B. According to the MICs obtained with 80% of inhibition, 12 strains had MICs considered as resistant to azoles. Five strains were resistant both to fluconazole and itraconazole. Considering MICs obtained with 50% of inhibition, only five strains were found resistant to azoles (p < 0.05). Using this criterion, only one C glabrata strain was found to be simultaneously resistant to fluconazole and itraconazole. CONCLUSIONS: Similar results in the pattern of susceptibility of Candida spp to azoles, to those reported abroad, are obtained when the MIC is calculated using 50% inhibition.
Assuntos
Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Adulto , Anfotericina B/farmacologia , Candida/crescimento & desenvolvimento , Candidíase/microbiologia , Criança , Fluconazol/farmacologia , Inibidores do Crescimento/farmacologia , Humanos , Itraconazol/farmacologia , Cetoconazol/farmacologia , Testes de Sensibilidade MicrobianaRESUMO
Con el objetivo de conocer las características y establecer la frecuencia de la masturbación en adolescentes femeninas de tres (3) Liceos públicos de la ciudad de Santo Domingo, realizamos un estudio prospectivo longitudinal con 601 estudiantes del sexo femenino de 13-19 años de edad. La frecuencia masturbatorio osciló en un 77.3 (por ciento), que excede de la relación genital heterosexual (26 por ciento) y homosexual (17.3 pro ciento) coincidiendo su mayor pico a los 16-17 años de edad. Se destacan los porcentajes de las que se masturban para liberal tensiones emocionales, las que no logran orgasmo y las que tienen sentimientos de culpa y verguenza