RESUMO
Pediatric invasive fungal rhinosinusitis (PIFR) is a rapidly progressive, potentially fatal disease. Previous medical literature demonstrates that its early diagnosis significantly reduces the risk of mortality in these patients. This study aims to present an updated clinical algorithm for optimized diagnosis and management of PIFR. A comprehensive review was conducted with only original, full-text articles published in English and Spanish from Cochrane Library, Pub-Med/MEDLINE, Embase, Scopus, and Google Scholar between January 2010 and June 2022. Relevant information was extracted and then integrated to develop a clinical algorithm for a proper diagnosis and management of PIFR.
RESUMO
BACKGROUND: Antimicrobial resistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action. OBJECTIVES: To review AMR in Mexico and initiatives addressing it. Identifying any areas where more information is required will provide a call to action to minimize any further rises in AMR and to improve patient outcomes. METHODS: National AMR initiatives in Mexico, antibiotic use and prescribing, and availability of susceptibility data, particularly the key community-acquired respiratory tract infection (CA-RTI) pathogens Streptococcus pneumoniae and Haemophilus influenzae, were identified. National and international antibiotic prescribing guidelines commonly used in Mexico for specific CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) were also reviewed, along with local antibiotic availability. Insights from a local clinician were sought to contextualize this information. CONCLUSIONS: The Mexican national AMR strategy was published in 2018. This comprised similar objectives to the Global Action Plan from the World Health Assembly (2015) and was compulsory, requiring full compliance from members of the National Health System. Historically, antibiotic consumption in Mexico has been high, however, between 2000 and 2015, consumption fell, in sharp contrast to the majority of countries. Mexico lacks a national surveillance network for AMR, however there are several ongoing global surveillance studies providing local antibiotic susceptibility data. International and local antibiotic prescribing guidelines for CA-RTIs are used. A more standardized inclusive approach in developing local guidelines, using up-to-date local surveillance data of isolates from community-acquired infections, could make guideline use more locally relevant. This would pave the way for a higher level of appropriate antibiotic prescribing and improved adherence. This would, in turn, potentially limit AMR development in Mexico and improve patient outcomes.
Assuntos
COVID-19 , Infecções Comunitárias Adquiridas , Pneumonia , Infecções Respiratórias , Doença Aguda , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Acessibilidade aos Serviços de Saúde , Humanos , México/epidemiologia , Pneumonia/tratamento farmacológico , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/epidemiologiaRESUMO
OBJECTIVE: To evaluate the effectiveness of the chemically assisted dissection with sodium 2-mercaptoethanesulfonate (MESNA), in the reduction of residual and recurrent cholesteatoma after mastoidectomy in children with chronic cholesteatomatous otitis media (CCOM). STUDY DESIGN: Retrospective case-control study. SETTING: Tertiary referral center. POPULATION: One hundred forty mastoidectomies performed in patients under 18 years of age for the treatment of CCOM. INTERVENTIONS: Chemically assisted dissection (CAD) with MESNA compared with surgical dissection without MESNA. MAIN OUTCOME MEASURES: Recidivism of cholesteatoma (recurrence and residual disease), variations in the average of bone conduction threshold after treatment, and complications. RESULTS: Recidivism of cholesteatoma was significantly lower when CAD with MESNA was used (pâ<â0.0001). No difference was found in the mean variation of the average of bone conduction thresholds between the groups, confirming its safety profile regarding auditory function. Meatoplasty stenosis after surgery was more prevalent within CAD with MESNA group (p: 0.049). CONCLUSION: Recurrent and residual cholesteatoma remains a problem, especially in children and despite surgical techniques such as canal wall down mastoidectomy and endoscopic ear surgery. CAD with MESNA can be safe and effective to reduce recurrence rates. Multicenter and prospective studies with larger number of patients are needed to validate these findings. The higher rate of meatoplasty stenosis after CAD with MESNA merits additional clinical research to confirm these findings, as well as in vitro studies evaluating the effect of the drug on the activity of fibroblasts and other growth factors that may be involved.
Assuntos
Colesteatoma da Orelha Média/tratamento farmacológico , Colesteatoma da Orelha Média/cirurgia , Mastoidectomia/métodos , Mesna/uso terapêutico , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Colesteatoma da Orelha Média/etiologia , Dissecação/métodos , Feminino , Humanos , Masculino , Otite Média/complicações , Otite Média/cirurgia , Recidiva , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Juvenile recurrent respiratory papillomatosis (JRRP) is generally aggressive and with a high recurrence rate. Currently, there is no definite curative treatment for JRRP. Therefore, a greater understanding of the aspects that influence the severity and prognosis of the disease is required. OBJECTIVE: The aim of this study was to establish the clinical and socioeconomic characteristics of pediatric patients with JRRP and its relationship with the severity of the disease in a tertiary care pediatric hospital. RESULTS: A strong relationship was observed between the severity of the disease and the age at the time of diagnosis, and having a tracheostomy. A moderate association was found between the severity of the disease and the age at the time of the study, the area of origin and the recurrence rate. None of the socioeconomic statuses had a correlation with the severity of the JRRP. CONCLUSIONS: JRRP is associated with multiple surgeries due to the recurrence and aggressiveness of the disease. The socioeconomic status does not seem to influence the severity of the disease, whereas younger patients and users of tracheostomy should receive a more strict follow-up given the increased risk of severe disease.
Assuntos
Infecções por Papillomavirus/epidemiologia , Infecções Respiratórias/epidemiologia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Hospitais Pediátricos , Humanos , Laringoscopia/estatística & dados numéricos , Masculino , Infecções por Papillomavirus/terapia , Prognóstico , Recidiva , Infecções Respiratórias/terapia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Classe Social , Atenção Terciária à Saúde , Traqueostomia/estatística & dados numéricosRESUMO
El bebé colodión se caracteriza por la presencia de una membrana que cubre la totalidad de la piel del recién nacido. La mayoría de los niños que presenta esta membrana desarrolla ictiosis, siendo la eritrodermia ictiosiforme congénita no ampollar la forma más frecuente, seguida de la ictiosis lamelar y la ictiosis vulgar. No existen características clínicas ni histológicas que sirvan de guía para predecir el diagnóstico final. Estos niños presentan complicaciones debido a las alteraciones de la función de barrera de la piel, como deshidratación hipernatrémica, hipotermia e infecciones cutáneas y sistémicas. Sin embargo el pronóstico de este cuadro ha mejorado en los últimos años debido a los mejores cuidados intensivos neonatales. Presentamos tres casos de bebé colodión evaluados en el servicio de Dermatología del Complejo Hospitalario de Pontevedra (España) y describimos sus características clínicas, tratamientos, complicaciones, pruebas complementarias realizadas y diagnóstico final. A pesar de que el bebé colodión es un fenotipo infrecuente, destacamos la importancia de conocer su tratamiento, así como los diferentes procesos a los que puede dar lugar...(AU)
Collodion baby consists on a membrane covering the whole body surface of a newborn. Most children born as collodion baby develop ichthyosis, being the most frequent the non-bullous congenital ichthyosiform erythroderma, followed by lamellar ichthyosis and ichthyosis vulgaris. There are no distinctive clinical or histological features that can be used to predict the final diagnosis. These children have complications due to the impaired barrier function, such as hypernatraemic dehydration, hypothermia, or cutaneous and systemic infections. However the prognosis has dramatically improved over time with the development of neonatal intensive care. We present three cases of collodion baby seen at the Dermatology Service of the Pontevedra Hospital Complex (Spain) and describe their clinical characteristics, treatments, complications, diagnostic procedures and final diagnoses. Despite collodion baby is an uncommon entity, we highlight the importance of knowing its treatment and the different processes that may arise from it...(AU)
Assuntos
Humanos , Masculino , Lactente , Ictiose Lamelar , Eritrodermia Ictiosiforme CongênitaRESUMO
El bebé colodión se caracteriza por la presencia de una membrana que cubre la totalidad de la piel del recién nacido. La mayoría de los niños que presenta esta membrana desarrolla ictiosis, siendo la eritrodermia ictiosiforme congénita no ampollar la forma más frecuente, seguida de la ictiosis lamelar y la ictiosis vulgar. No existen características clínicas ni histológicas que sirvan de guía para predecir el diagnóstico final. Estos niños presentan complicaciones debido a las alteraciones de la función de barrera de la piel, como deshidratación hipernatrémica, hipotermia e infecciones cutáneas y sistémicas. Sin embargo el pronóstico de este cuadro ha mejorado en los últimos años debido a los mejores cuidados intensivos neonatales. Presentamos tres casos de bebé colodión evaluados en el servicio de Dermatología del Complejo Hospitalario de Pontevedra (España) y describimos sus características clínicas, tratamientos, complicaciones, pruebas complementarias realizadas y diagnóstico final. A pesar de que el bebé colodión es un fenotipo infrecuente, destacamos la importancia de conocer su tratamiento, así como los diferentes procesos a los que puede dar lugar...
Collodion baby consists on a membrane covering the whole body surface of a newborn. Most children born as collodion baby develop ichthyosis, being the most frequent the non-bullous congenital ichthyosiform erythroderma, followed by lamellar ichthyosis and ichthyosis vulgaris. There are no distinctive clinical or histological features that can be used to predict the final diagnosis. These children have complications due to the impaired barrier function, such as hypernatraemic dehydration, hypothermia, or cutaneous and systemic infections. However the prognosis has dramatically improved over time with the development of neonatal intensive care. We present three cases of collodion baby seen at the Dermatology Service of the Pontevedra Hospital Complex (Spain) and describe their clinical characteristics, treatments, complications, diagnostic procedures and final diagnoses. Despite collodion baby is an uncommon entity, we highlight the importance of knowing its treatment and the different processes that may arise from it...
Assuntos
Humanos , Masculino , Lactente , Eritrodermia Ictiosiforme Congênita , Ictiose LamelarRESUMO
OBJECTIVE: The aim of this study was to identify the etiology and the serotypes of S. pneumoniae (Sp) in Mexican children with acute otitis media (AOM). MATERIALS AND METHODS: The study includessamples frompatientsdiagnosed with AOM at the Federico Gomez Children's Hospital of Mexico (2002-2003),with positive culture for Sp bacteriologically confirmed in middle ear fluid obtained by tympanocentesis. All Sp were serotyped. A total of 138 samples from 135 children with AOM were included. RESULTS: Sp was isolated in 72 samples from 70 children. Sixty (85.7%) were previously healthy and 10 (14.3%) were immunocompromised. The most common serotypes were 6B and 19F (16.67%), and 6 A, 14 and 23F (15.27%). CONCLUSION: The distribution of serotypes among the children with AOM in the study is similar to that reported in developing cities, and 63.9% of the isolated serotypes are found to be included in the 7-Valent Pneumococcal Conjugate Vaccine (PCV), 68.1% in the 10-Valent PCV and 83.3% in 13-Valent PCV.
Assuntos
Orelha Média/microbiologia , Otite Média/microbiologia , Infecções Pneumocócicas/microbiologia , Streptococcus pneumoniae/classificação , Doença Aguda , Criança , Pré-Escolar , Estudos Transversais , Países em Desenvolvimento , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Hospedeiro Imunocomprometido , Lactente , México/epidemiologia , Otite Média/epidemiologia , Infecções Pneumocócicas/epidemiologia , Vacinas Pneumocócicas/imunologia , Estudos Retrospectivos , Sorotipagem , Streptococcus pneumoniae/isolamento & purificação , Vacinação/estatística & dados numéricos , Vacinas Conjugadas/imunologia , VirulênciaAssuntos
Seio Etmoidal , Fibromatose Agressiva/cirurgia , Neoplasias dos Seios Paranasais/cirurgia , Pré-Escolar , Fibromatose Agressiva/diagnóstico , Fibromatose Agressiva/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias dos Seios Paranasais/diagnóstico , Neoplasias dos Seios Paranasais/patologiaRESUMO
BACKGROUND: We investigated the effect of oral alendronate (ALN) treatment on radiological and clinical measurements of periodontal disease in postmenopausal women without hormone replacement therapy. METHODS: We evaluated the effect of 6 months of ALN treatment in 40 postmenopausal women, 55 to 65 years old with established periodontal disease, in a controlled, double-masked, prospective study. Volunteers were paired by age and randomized to receive ALN (10 mg/day) or placebo for the study period. Periodontal mechanical treatment was carried out in both groups. At baseline and after treatment, clinical evaluation, hormone blood levels, distance from the crestal alveolar bone (CAB) to the cemento-enamel junction (CEJ), calcaneus bone mineral density (BMD), hormone levels, serum N-telopeptide (NTx), and bone-specific alkaline phosphatase (BSAP) were assessed. RESULTS: Periodontal disease conditions improved in both groups, but greater improvement in probing depth (-0.8 +/- 0.3 mm versus -0.4 +/- 0.4 mm, P = 0.02) and gingival bleeding (-0.3% +/- 0.13% versus -0.2% +/- 0.06%, P = 0.006) was found in the ALN treated group. Calcaneus BMD increased in the ALN treated group (68 +/- 47 mm3 versus -26 +/- 81 mm3, P = 0.0006). CAB-CEJ distance diminished in the ALN group (-0.4 +/- 0.40 mm versus 0.60 +/- 0.53 mm, P = 0.00008). Marginal reduction in both NTx and BSAP levels was found in the ALN group (-9.4 +/- 6.6 nmol versus -4.3 +/- 4.7 nmol bone collagen equivalents, P = 0.08, and -7.7 +/- 8.4 versus -1.5 +/- 5.0 U/l, P = 0.1, respectively). Hormone levels were unchanged after treatment. Similar improvement of calcaneus BMD and CAB-CEJ distance with ALN treatment was found in obese and non-obese women. CONCLUSION: ALN treatment improved periodontal disease and bone turnover in postmenopausal women.
Assuntos
Alendronato/administração & dosagem , Densidade Óssea/efeitos dos fármacos , Doenças Periodontais/tratamento farmacológico , Pós-Menopausa/efeitos dos fármacos , Administração Oral , Idoso , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/prevenção & controle , Método Duplo-Cego , Feminino , Retração Gengival/prevenção & controle , Humanos , Pessoa de Meia-Idade , Obesidade/fisiopatologia , Índice Periodontal , Estudos Prospectivos , Radiografia , Mobilidade Dentária/prevenção & controleRESUMO
Objetivos: investigar la frecuencia y el impacto económico del uso de remedios no convencionales (RNC) en una población de enfermos reumáticos. Pacientes y métodos: Se encuestaron 275 pacientes con diferentes enfermedades reumáticas, que incluyeron variables de uso, características, costos y satisfacción de los RNC, apego al tratamiento formal, educación, estado laboral y estado funcional. Se excluyeron 4 por falta de consistencia en las respuestas. Resultados principales: Los pacientes encuestados provinieron de 8 consultorios de Reumatología de 2 hospitales de alta referencia, 2 hospitales de segundo nivel de atención y de 2 consultas privadas. El 84 por ciento fueron mujeres, la edad promedio fue de 40.7 años (ñ 14.1 DS) y la escolaridad fue de 8.4 años (ñ 4.7 DS). El 85.6 por ciento de los encuestados admitió haber utilizado RNC; el promedio fue de 3.4 RNC por paciente (rango 0-15). El 40 por ciento de los pacientes suspendió por lo menos una vez el tratamiento formal mientras que utilizaban RNC. El 31 por ciento de los RNC utilizados fueron percibidos por el paciente como de mucha utilidad. Sólo el 36.2 por ciento (n=98) de los encuestados refirió el costo de los RNC usados, siendo un total de N$70,137.62, o el equivalente a 48 días de salario mínimo en el área, por paciente. Conclusiones: El uso de RNC es frecuente en nuestra población de enfermos reumáticos y el impacto económico es importante. Desafortunadamente, la frecuencia de suspensión del tratamiento formal al utilizar RNC es elevada. Aunque es obvio el daño, queda por determinar el papel de los RNC en la morbimortalidad de los pacientes con enfermedades reumáticas
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Artrite Reumatoide/terapia , Terapias Complementares/tendências , Condutas Terapêuticas Homeopáticas/economia , Condutas Terapêuticas Homeopáticas/tendências , Doença Crônica/economia , Doença Crônica/terapia , Doenças Reumáticas/terapiaRESUMO
Se administró a 15 pacientes con artritis reumatoide resistente tratamiento convencional, un gramo de metilprednisolona por vía intravenosa, cada mes, durante seis meses. Once de ellos tuvieron respuesta favorable en el índice articular, rigidez matinal, fuerza de prensión y tiempo de marcha, así como mejoría en la calase funcional. Dos tuvieron respuesta regular y en los dos restantes la respuesta fue nula y tuvieron que abandonar el estudio. La sedimentación globular y proteína C reactiva disminuyeron en siete pacientes. Los efectos indeseables se presentaron en forma transitoria en 10 pacientes, sólo en cuatro obligaron a suspender el medicamento. La respuesta global fue poco significativa después del tercer pulso y los efectos indeseables fueron más comunes. Se concluye que el tratamiento con pulsos de metilprednisolona es de tres meses, en pacientes con artritis reumatoide activa y resistente