RESUMO
Takotsubo cardiomyopathy (MTT) is an acute ventricular dysfunction and reversible in absence of coronary disease. It is a rare presentation of pheochromocytoma and paraganglioma (FPGL). It was described for the first time in 1990 by Sato et al, the physiopathology is not clear yet. It is associated with high levels of catecholamines, vasospasm in the micro vascularization, rupture of atheromatous plaque and myiocarditis. The clinical presentation is similar to an acute myocardial infarction because of that the FPGL must be considered in patients without obstructive coronary lesions. We present a case of a 50 years old women with history of Arterial Hypertension, active smoking and Neurofibromatosis, who is admitted to emergency room with an acute myocardial pain.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Cardiomiopatia de Takotsubo/etiologia , Feocromocitoma/complicações , Feocromocitoma/diagnóstico , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico , Cardiomiopatia de Takotsubo/diagnóstico , Catecolaminas/análise , Feocromocitoma/cirurgia , Neoplasias das Glândulas Suprarrenais/cirurgiaRESUMO
BACKGROUND: Among the preventive strategies for lowering the incidence of upper respiratory tract infections (URTI) and acute diarrhoea episodes, two of the most common diseases in children, zinc supplementation has received special interest. However, there is a need for additional studies that determine the preventive effects of different doses of zinc on URTI and diarrhoeal disease episodes in children. METHODS: In a randomised, triple-blind clinical trial, we evaluated the efficacy of 12 months of daily zinc supplementation in the incidence of URTI and acute diarrhoea in a population of healthy children aged between 6 and 12 months living in Bogota, Colombia. The outcomes analysed were incidence of URTI, acute diarrhoeal disease episodes, and side effects of the interventions. RESULTS: Between 2010 and 2013, a total of 355 children underwent randomisation, with 174 assigned to the zinc supplementation group and 181 to the control group. In the multivariate analyses, having been randomised to the non-supplemented control group (IRR 1.73, 95% CI 1.52-1.97, p<0.001), and nursery attendance (IRR 1.41, 95% CI 1.07-1.87, p=0.016) were independently linked to the number of URTI. Likewise, having been randomised to the non-supplemented group (IRR 1.43, 95% CI 1.20-1.71, p<0.001), and lower socioeconomic status (IRR 1.86, 95% CI 1.11-3.13, p=0.018) were independently associated to the number of diarrhoeal disease episodes. CONCLUSIONS: Daily supplementation of 5mg of zinc during 12 months significantly decreased the incidence of URTI and diarrhoeal disease episodes in a healthy population of children aged between 6 and 12 months.
Assuntos
Diarreia Infantil/prevenção & controle , Suplementos Nutricionais , Infecções Respiratórias/prevenção & controle , Oligoelementos/uso terapêutico , Zinco/uso terapêutico , Colômbia/epidemiologia , Diarreia Infantil/epidemiologia , Feminino , Humanos , Incidência , Lactente , Masculino , Testes de Função Respiratória , Infecções Respiratórias/epidemiologia , Oligoelementos/administração & dosagem , Resultado do Tratamento , Zinco/administração & dosagemRESUMO
The impact of an endurance race on pulmonary pro-oxidative formation and lipoperoxidation was evaluated using exhaled breath condensate (EBC). 3 groups of 12, 12 and 17 healthy recreational runners of both sexes ran 10, 21.1 and 42.2 km, respectively. EBC samples were obtained before the run and at 20 and 80 min post run. Concentrations of H2O2, NO2 - , malondialdehyde and pH were determined. The 10 km group showed no post-run variations for H2O2 and NO2 - concentrations. The 21.1 km group showed significant increments for NO2 - , and H2O2 concentrations in 20 min and 80 min samples. The 42.2 km group, showed increased NO2 - concentration in 20 min and 80 min samples, while H2O2 concentration increased only in the 20 min sample. In the 10 and 42.2 km groups neither malondialdehyde concentration nor pH showed differences. The 42.2 km group exhibited ΔH2O2 and ΔNO2 - medians higher than the 10 km group. ΔpH median decreased in 21.1 and 42.2 km groups, exhibiting values significantly lower than the 10 km group. ΔH2O2 y ΔNO2 - correlated directly with race time, while ΔpH, correlated inversely. In conclusion, intense prolonged exercise favors the increase in pulmonary pro-oxidative levels, with no modifications on lipoperoxidation. Running time relates to the magnitude of acute post exercise pro-oxidative formation.
Assuntos
Testes Respiratórios/métodos , Estresse Oxidativo/fisiologia , Esforço Físico/fisiologia , Corrida/fisiologia , Adulto , Feminino , Humanos , Peróxido de Hidrogênio/análise , Concentração de Íons de Hidrogênio , Masculino , Malondialdeído/análise , Nitritos/análise , Adulto JovemRESUMO
El síndrome de respuesta inflamatoria sistémica es una complicación frecuente en el período posoperatorio cardiovascular. Su gravedad es variable y múltiples factores generan una disfunción endotelial que se expresa de diferentes formas en la hemodinamia del paciente, ya sea con cuadros clínicos similares al shock frío o al shock caliente, según el mecanismo fisiológico predominante. Utilizamos un método de monitoreo mínimamente invasivo, configurando perfiles hemodinámicos basales e inducidos por fármacos, de tal modo de realizar un manejo racional de agentes vasoactivos. El propósito de este trabajo es mostrar la aplicación del monitoreo hemodinámico funcional, graficar la variabilidad de la hemodinamia en el período posquirúrgico y evidenciar la respuesta clínica al azul de metileno. Para tal fin, se presenta a modo de ejemplo un paciente con shock vasopléjico.(AU)
Cardiac surgery with cardiopulmonary bypass in children is associated with a systemic inflammatory response syndrome of different degree. The endothelial dysfunction may be followed by acute circulatory dysfunction that results in different hemodynamic profiles like cold or warm shock. Hemodynamic variables were measured with a minimal invasive method of hemodynamic monitoring and they were grouped in order to define profiles and evaluate the response to therapy. The goal of this work is to describe the functional hemodynamic monitoring in the care of pediatric cardiac surgery patients through the presentation of a child with vasodilatory shock and his response to the administration of methylene blue.(AU)
Assuntos
Humanos , Cirurgia Torácica , Período Pós-OperatórioRESUMO
In control programs for vectorial transmission of Chagas' disease, conventional microscopic procedures are generally performed to determine baseline levels of infectivity of vectors. Reported here are data using Polymerase Chain Reaction in the detection of Trypanosoma cruzi in Triatoma dimidiata, one of the principal vectors of Chagas' disease in Ecuador. The microscopy and PCR techniques showed a high percentage of vector infection in Pedro Carbo, province of Guayas (Ecuador), with 44.16% and 46.13% positive insects, respectively. This contrasted with the very low Chagas seropositivity recorded (0.5%). Since T. dimidiata was the only vector of the Chagas' disease found in Pedro Carbo and looking at the vector behavior, our data suggest that despite the high T. dimidiata infection, the low Chagas seropositivity detected is closely associated with the epidemiological and ecological context of T. dimidiata in Pedro Carbo.
Assuntos
Doença de Chagas/transmissão , Insetos Vetores/parasitologia , Triatoma/parasitologia , Trypanosoma cruzi/isolamento & purificação , Animais , Anticorpos Antiprotozoários/sangue , Doença de Chagas/epidemiologia , DNA de Protozoário/análise , Vetores de Doenças , Equador/epidemiologia , Fezes/parasitologia , Humanos , Reação em Cadeia da Polimerase/métodos , Sensibilidade e Especificidade , Estudos Soroepidemiológicos , Trypanosoma cruzi/genética , Trypanosoma cruzi/imunologiaRESUMO
With the objective of monitoring the distribution of HIV-1 subtypes and circulating recombinant forms (CRFs)in South America, population-based surveillance studies were performed in seven countries. Peripheral blood mononuclear cell, filter paper, fresh blood, and cocultivation samples were collected from HIV-positive patients from Colombia, Ecuador, Peru, Bolivia, Chile, Argentina, and Uruguay, during a 7-year period(1995-2001). DNA was prepared and HIV envelope subtypes were determined by heteroduplex mobility as-say and DNA sequencing from 1289 HIV-positive samples. While subtypes B and F were the most commonly observed subtypes, two CRF02_AG strains were detected, in Ecuador. This is the first report of the existence of this CRF in South America.
Assuntos
Infecções por HIV/epidemiologia , HIV-1/classificação , Recombinação Genética , Adulto , DNA Viral/sangue , Equador/epidemiologia , Feminino , Infecções por HIV/virologia , HIV-1/genética , Análise Heteroduplex , Humanos , Masculino , Dados de Sequência Molecular , Vigilância da População , Análise de Sequência de DNA , América do Sul/epidemiologiaRESUMO
A molecular phylogeographic study of Paragonimus mexicanus collected from Guatemala and Ecuador was performed. Genomic DNA was extracted from individual metacercariae, and two gene regions (partial mitochondrial cytochrome c oxidase subunit 1 (CO1) and the second internal transcribed spacer of the nuclear ribosomal gene repeat (ITS2)) were amplified by the polymerase chain reaction (PCR). Sequences segregated in a phylogenetic tree according to their geographic origins. ITS2 sequences from Ecuador and Guatemala differed at only one site. Pairwise distances among CO1 sequences within a country were always lower than between countries. Nevertheless, genetic distances between countries were less than between geographical forms of P. westermani that have been suggested to be distinct species. This result suggests that populations from Guatemala and Ecuador are genetically differentiated perhaps at the level of subspecies.
Assuntos
DNA de Helmintos/análise , Paragonimus/genética , Animais , Sequência de Bases , Equador , Guatemala , Haplótipos , Larva , Dados de Sequência Molecular , Filogenia , Alinhamento de Sequência , Análise de Sequência de DNAAssuntos
Anti-Infecciosos/farmacologia , Farmacorresistência Bacteriana/fisiologia , Gonorreia/microbiologia , Neisseria gonorrhoeae/efeitos dos fármacos , Cuba/epidemiologia , Feminino , Fluoroquinolonas , Gonorreia/tratamento farmacológico , Gonorreia/epidemiologia , Humanos , Masculino , Testes de Sensibilidade Microbiana/estatística & dados numéricos , Testes de Sensibilidade Microbiana/tendências , Neisseria gonorrhoeae/isolamento & purificaçãoRESUMO
We have analysed by multilocus enzyme electrophoresis (MLEE) at 21 genetic loci 10 Trypanosoma cruzi stocks isolated from chronic chagasic patients and 3 stocks isolated from Triatoma dimidiata collected in human habitats from the coastal part of Ecuador (all stocks isolated in August-December 1998). Isoenzyme profiles were compared to those of 4 laboratory-cloned stocks representing the major phylogenetic subdivisions of T. cruzi. This parasite's genetic variability in Ecuador proved to be considerable, even in this limited sample, since all main isoenzyme genotypes were recorded. Four stocks from patients were identical at all loci to the reference stock MNcl2 ('major clonet #39'; T. cruzi II) isolated in Chile. The 3 stocks isolated from T. dimidiata were closely related to the formerly described zymodeme I (T. cruzi I). Finally, 3 stocks from chronic chagasic patients (one with an asymptomatic form, 2 with a cardiac-digestive form) were closely related to the formerly described zymodeme III (presently not classified in either T. cruzi I or T. cruzi II). This is the first observation of this category of T. cruzi genotypes in chronic chagasic patients. In the past it was recorded only in acute patients, wild mammals and wild triatomine bugs. The epidemiological implications of these results are discussed.
Assuntos
Doença de Chagas/enzimologia , Isoenzimas/genética , Proteínas de Protozoários/genética , Trypanosoma cruzi/enzimologia , Adulto , Idoso , Animais , Doença de Chagas/genética , Equador , Ensaio de Imunoadsorção Enzimática , Genótipo , Humanos , Pessoa de Meia-Idade , Trypanosoma cruzi/genéticaRESUMO
Because concurrent infections with geohelminth parasites might impair the immune response to oral vaccines, we studied the vibriocidal antibody response to the oral cholera vaccine CVD 103-HgR in children infected with Ascaris lumbricoides and investigated the effect of albendazole pretreatment on the postvaccination response. Children with ascariasis were randomized to receive either 2 sequential doses of 400 mg of albendazole or placebo. After the second dose, CVD 103-HgR was given, and serum vibriocidal antibody levels were measured before and 10 days after vaccination. Postvaccination rates of seroconversion were greater in the treatment group that received albendazole (P=.06). Significantly greater rates of seroconversion and geometric mean titer were observed in the albendazole group in subjects with non-O ABO blood groups. A significant association was observed between vibriocidal seroconversion rates and treatment group, suggesting that A. lumbricoides infections impair the immune response to oral cholera vaccine, particularly in subjects of non-O blood groups.
Assuntos
Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Anticorpos Antibacterianos/sangue , Ascaríase/tratamento farmacológico , Ascaríase/imunologia , Ascaris lumbricoides , Vacinas Bacterianas/imunologia , Vacinas contra Cólera/imunologia , Vacinas Atenuadas/imunologia , Adolescente , Animais , Formação de Anticorpos , Ascaris lumbricoides/efeitos dos fármacos , Antígenos de Grupos Sanguíneos/imunologia , Criança , Interações Medicamentosas , Equador , Feminino , Humanos , Masculino , Trichuris/efeitos dos fármacosAssuntos
Acetilcisteína/farmacologia , Doença de Chagas/tratamento farmacológico , Doença de Chagas/imunologia , Glutationa/farmacologia , Animais , Doença de Chagas/sangue , Glutationa/análogos & derivados , Glutationa/sangue , Tolerância Imunológica/efeitos dos fármacos , Ativação Linfocitária/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos BALB C , Baço/imunologia , Subpopulações de Linfócitos T/efeitos dos fármacos , Subpopulações de Linfócitos T/imunologiaRESUMO
OBJECTIVE: To study the results of surgical treatment of pulmonary metastases in our department. PATIENTS AND METHODS: We retrospectively studied 44 patients undergoing surgery between 1986 and 1999 for complete resection of pulmonary metastases. Primary tumors had been eradicated, no metastasis to other organs was evident, and functional respiratory capacity was adequate. The patients were assigned to different prognostic groups based on the criteria of the International Registry of Lung Metastases. RESULTS: Forty-eight operations were performed on the 44 patients (21 men and 23 women) whose mean age was 58 years (31-74 years). The most frequent type of primary tumor was epithelial (82%); other types in order of frequency were sarcoma (9%), thyroid gland (4.4%), germ cell (2.2%) and melanoma (2.2%). The mean disease-free interval was 37.7 months (0.168) and the median was 30 months. A single site of metastasis was seen in 66.7% of the cases whereas 33.3% had multiple metastases (17.9% of them bilateral). Posterolateral thoracotomy was the surgical approach in over half the cases (66.7%). We performed wedge resections in 86.6% and lobectomies in 11.1%. Perioperative mortality was 4.4%. Mean survival was 70 months, with 87% alive at one year and 29% at 10 years. For group I (resectable, no risk factors; n = 13) survival was 100% at one year and 75% at 10 years. For group II (resectable, one risk factor; n = 16) the actuarial survival was 78% at one year and 12% at 10 years. For group III (resectable, two risk factors; n = 8), survival was 87% at one year, 62% at three years, 15% at four years and 0% at five years (Log-rank chi 2 9.8 [df = 2)], p = 0.0097). CONCLUSIONS: Surgical resection of pulmonary metastasis is a treatment and diagnostic procedure associated with low mortality and good survival. Prognostic grouping that takes into account number of metastases, disease-free interval and resectability correlates significantly with expected survival regardless of histological typing of the primary tumor.
Assuntos
Neoplasias Pulmonares/cirurgia , Adulto , Idoso , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/cirurgia , Intervalo Livre de Doença , Feminino , Germinoma/mortalidade , Germinoma/secundário , Germinoma/cirurgia , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/secundário , Masculino , Melanoma/mortalidade , Melanoma/secundário , Melanoma/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Sarcoma/mortalidade , Sarcoma/secundário , Sarcoma/cirurgia , Análise de SobrevidaRESUMO
An outbreak of delta hepatitis occurred during 1998 among the Waorani of the Amazon basin of Ecuador. Among 58 people identified with jaundice, 79% lived in four of 22 Waorani communities. Serum hepatitis B surface antigen (HBsAg) was found in the sera of 54% of the jaundiced persons, and 14% of asymptomatic persons. Ninety-five percent of 105 asymptomatic Waorani had hepatitis B core (HBc) IgG antibody, versus 98% of 51 with jaundice. These data confirm that hepatitis B virus (HBV) infection is highly endemic among the Waorani. Sixteen of 23 (70%) HBsAg carriers identified at the onset of the epidemic had serologic markers for hepatitis D virus (HDV) infection. All 16 were jaundiced, where as only two of seven (29%) with negative HDV serology were jaundiced (P = .0006). The delta cases clustered in families, 69% were children and most involved superinfection of people chronically infected with HBV. The data suggest that HDV spread rapidly by a horizontal mode of transmission other than by the sexual route.
Assuntos
Surtos de Doenças , Hepatite D/epidemiologia , Vírus Delta da Hepatite/imunologia , Falência Hepática/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Equador/epidemiologia , Etnicidade/estatística & dados numéricos , Feminino , Anticorpos Anti-Hepatite/sangue , Antígenos de Superfície da Hepatite B/sangue , Hepatite D/complicações , Vírus Delta da Hepatite/genética , Humanos , Lactente , Falência Hepática/etiologia , Masculino , Pessoa de Meia-Idade , RNA Viral/sangueRESUMO
We report the distribution of the APOB signal peptide polymorphism in 5 native populations of South America: 2 samples of Mataco and 1 sample each of Pilagá and Toba from the Argentinian Chaco and 1 sample of Ache from the Paraguay forest. A randomly selected subsample of a previously studied sample from the Cayapa of Ecuador (Scacchi et al. 1997) was reanalyzed to investigate probable differences attributable to sampling, laboratory techniques, or interobserver error. The polymorphism observed in the signal peptide region of the APOB gene among native populations of South America exhibits the same range of variation found among geographic continental populations, confirming the high genetic heterogeneity of South Amerindians. Extremes in the allele prevalences were found among the Mataco and Ache, populations not far apart geographically. The small differences in genotype and allele frequencies between the subsample of the Cayapa analyzed here and the original Cayapa sample and between the 2 Mataco samples were not statistically significant and most likely were due to sampling error.
Assuntos
Apolipoproteínas B/genética , Variação Genética/genética , Indígenas Sul-Americanos/genética , Polimorfismo Genético/genética , Sinais Direcionadores de Proteínas/genética , Alelos , Argentina , Viés , Frequência do Gene/genética , Heterogeneidade Genética , Genótipo , Humanos , ParaguaiRESUMO
La parálisis periódica tirotóxica es una rara complicación del hipertiroidismo, excepcional en el mundo occidental, que se incluye dentro del grupo de las parálisis periódicas hipopotasémicas. Su incidencia aproximada entre hipertiroideos orientales es del 2 por ciento y alcanza tan solo del 0.1 por ciento al 0.2 por ciento en la raza blanca. el 90 por ciento de los más de 500 casos publicados son originarios del Japón. Por su extraordinaria rareza en nuestro medio creemos interesante comunicar un caso que hemos tenido ocasión de observar. En este reporte, se describe un paciente de 30 años con tirotoxicosis y crisis de parálisis hipokalémica de un año de evolución. Fue posible presenciar una crisis de parálisis flácida, con niveles séricos de potasio de 1.7 mEq/L.
Assuntos
Masculino , Adulto , Hipertireoidismo , TireotoxicoseRESUMO
BACKGROUND: The association between bronchial asthma and gastroesofageal reflux provokes in the patient a reserved prognostic which if not diagnosed and treat correctly, if interferes of significative in the life quality. MATERIAL AND METHOD: With the purpose of establishing a relation between the allergic bronchial asthma of the adult, patient with digestive symptoms and healthy volunteer, is carried out a study in 162 subject with these characteristics to whom an barium esophagography was done looking for gastroesofageal reflux. RESULTS: The reflux presence in the asthmatics are of 87.23% and in the patient with digestive upsets, 39.53%, ratio odds (OR), 10-43, confidence interval (IC) of 95%, 3.38-33.83. With relation to the healthy volunteers the OR is in 11.48, IC of 95% 3.93-35.22. Among the patients with digestive upsets and the healthy volunteers the OR is of 1.10, IC of 95%, 0.68-1.64. CONCLUSIONS: The gastroesofageal reflux in the patient with bronchial asthma allergic associated to digestive sintomatology prevails more than in patient with digestive symptoms similar the asthmatics, but without bronchial asthma and also more than in the healthy volunteers.
Assuntos
Asma/complicações , Refluxo Gastroesofágico/complicações , Adolescente , Adulto , Feminino , Humanos , Masculino , PrognósticoRESUMO
The genetic structure of two African-Ecuadorian communities, Rio Cayapas and Viche (Esmeraldas province, northwest Ecuador), was studied on the basis of ACP1, ADA, AK1, CA2, ESD, GLO1, G6PD, PGD, and PGM1 subtypes and thermostability, PGM2, HBbeta, F13A, F13B, ORM1, AHSG, C6, C7, and APOC2 gene frequency, and migration data on 255 individuals. The fixation index of Wright (F(ST)), correspondence, and genetic distance analysis were applied to compare the genetic relationships between these communities and other American populations of African ancestry. F(ST) values from the migration data and surname origins suggest that Rio Cayapas is genetically more isolated and shows less mobility and admixture than does Viche. The genetic admixture estimates indicate a large contribution of African genes to the gene pool of both communities (74.3% to 58.4%), whereas the proportion of the Amerindian component differs significantly (14.5% in Rio Cayapas to 27.6% in Viche).
Assuntos
População Negra/genética , Frequência do Gene , Pool Gênico , África/etnologia , Demografia , Equador , Emigração e Imigração , Enzimas/genética , Etnicidade/genética , Feminino , Humanos , Masculino , Fenótipo , Filogenia , Proteínas/genéticaRESUMO
Our aim in reviewing all cases of chest wounds (CW) treated in our unit to analyze their causes, clinical characteristics and treatment. We performed a retrospective study of all CW patients admitted and/or treated by us between January 1986 and August 1997, studying causes, history, number and type of wounds, location, the association of chest and non-chest lesions, treatment, complications and length of hospital stay. The 90 CW patients treated in our unit accounted for 10.6% of all CW patients admitted during the study period. Eighty-five (94.4%) were men and five were women (5.6%) and mean age was 33.87 years. Physical attack was the most common cause of CW, accounting for 74 cases (82.2%) and stab wounds (77 cases, 85.6%) were more common than gunshot wounds (13 cases, 14.4%). Sixty-one (67.%) were deep and most were to the left hemithorax (46 cases, 51.1%). Besides damage to skin and soft tissues of the chest wall, lesions most often affected the pleura (59 cases, 65.5%) and parenchyma (27 cases, 30%). Local treatment of the wound was sufficient for 31 patients (34.4%) but 29 (32.3%) also required drainage and 30 (33.3%) required surgery. Complications developed in 8 cases (8.9%) and one patient died while in surgery. Mean duration of hospital stay was 8.64 days. CW in our practice is seen most commonly in young men and is caused by physical aggression, usually involving knives. Most wounds are stabs, usually to the left hemithorax. The prognosis for firearm wounds is poorer. One third of patients require thoracic drains and another third require chest surgery in addition to local treatment of CW and other wounds. The patient's hemodynamic status was the parameter that indicated need for surgical treatment.