RESUMO
El ectima gangrenoso es un trastorno infeccioso infrecuente clásicamente relacionado a bacteriemia, descrito principalmente en poblaciones inmunodeprimidas. El agente más comúnmente relacionado es Pseudomonas aeruginosa, sin embargo, se han descrito otras etiologías bacterianas, hongos filamentosos y levaduras. Su patogénesis está dada por la invasión de la pared de los vasos sanguíneos, causando trombosis arterial y venosa, desencadenando necrosis de epidermis y tejidos subdérmicos. Clínicamente, se manifiesta como máculas, vesículas o pústulas hemorrágicas que evolucionan a úlceras de superficie necrótica rodeadas por un halo eritematoso característico, habitualmente en un contexto clínico de sepsis. El diagnóstico de este cuadro es clínico, sin embargo, el estudio microbiológico es clave en la identificación del agente etiológico y un posterior tratamiento dirigido. En su manejo es esencial una alta sospecha clínica y el inicio de tratamiento antibiótico en forma precoz. La duración del tratamiento es variable y en algunos casos debe asociarse a debridación quirúrgica. El pronóstico es variable dependiendo de múltiples factores: estado inmunológico, agente etiológico, presencia de sepsis y el tiempo de inicio de tratamiento.(AU)
Ecthyma gangrenosum is an infrequent infectious disorder classically related to bacteremia, described mainly in immunosuppressed populations. The most related agent is Pseudomonas aeruginosa, however other bacterial etiologies, filamentous fungi and yeasts have been described. Its pathogenesis is given by the invasion of the blood vessel wall, causing arterial and venous thrombosis, triggering necrosis of epidermis and subdermal tissues. Clinically, it manifests as hemorrhagic macules, vesicles or pustules that evolve into ulcers with a necrotic surface surrounded by a characteristic erythematous halo, usually in a clinical setting of sepsis. The diagnosis of this condition is clinical, however the microbiological study is key in the identification of the etiological agent and a subsequent directed treatment. In its management, a high clinical suspicion and an early start of antibiotic treatment are essential. The duration of treatment is variable and in some cases it must be associated with surgical debridement. The prognosis is variable depending on multiple factors: immunological status, etiological agent, presence of sepsis and time of initiation of treatment.(AU)
Assuntos
Humanos , Infecções por Pseudomonas/microbiologia , Sepse , Ectima/diagnóstico , Prognóstico , Ectima/etiologia , Ectima/tratamento farmacológicoRESUMO
There are four different conceptual approaches to assess the factors that explain, condition and determine the use of health services. This article discusses the epidemiological, psychosocial, sociological and economical models. The stages and determinants of the health service use process are described and a cross study is made with each of the four models, using a contingency matrix. A holistic analysis is proposed, as a starting point, for the search of a model that will allow the identification of factors that determine the use of health services. This analysis should be used as a conceptual framework for future work on health services utilization
Assuntos
Humanos , Necessidades e Demandas de Serviços de Saúde , Financiamento da Assistência à Saúde , Honduras , Qualidade da Assistência à SaúdeRESUMO
OBJECTIVE: To describe ten years of experience with congenital mitral stenosis. METHOD: All cases with congenital mitral stenosis from January 1991 to 2001 were analized. RESULTS: 16 patients with congenital mitral stenosis were found, mean age 3 +/- 3.08 years. TYPES OF OBSTRUCTIONS: Mitral commisures combined with tendinous cords fusion (45%), parachute mitral valve 37%, supravalvar mitral ring in one, fusion between papillary muscle and leaflets in one, and double mitral orifice in one. Hemodynamic (in mmHg) findings: wedge pressure 18.4 +/- 4, pulmonary artery systolic 61 +/- 21, diastolic 34 +/- 15, mean 47 +/- 18 mmHg, mean transvalvar gradient (MTG) 12.9 +/- 7.3, PRU 5.5 +/- 3.8. Four patients received medical treatment. Surgical results: Six patients underwent mitral repair, and four were subjected to mitral valve replacement (two with previous mitral repair). Global mortality was 2 (12.5%). Follow-up was 3.5 +/- 3 years. There was a significant difference when the initial MTG 22.6 +/- 11.5 mmHg before surgical repair was compared with the final MTG 4.75 +/- 1.5 (P < 0.05), also when initial MTG 12 +/- 2.3 before mitral valve replacement was compared with the final MTG 6 +/- 1.15 mmHg (P < 0.05). CONCLUSION: Most patients are candidates for mitral surgical repair, however at mid term one third will require mitral valve replacement.
Assuntos
Estenose da Valva Mitral/congênito , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/cirurgia , Estudos Retrospectivos , UltrassonografiaRESUMO
The mitotic index (MI) is an important measure in cell proliferation studies. Determination of the MI is usually made by light-microscope analysis of slide preparations. The analyst identifies and counts thousands of cells and reports the percentage of mitotic shapes found among the interphase nuclei. Full automation of this process is an ambitious task, because there can exist very few mitotic shapes among hundreds of nuclei and thousands of artifacts, resulting in a high probability of false positives, i.e. objects erroneously identified as mitosis or nuclei. A semi-automated approach for MI calculation is reported, based on the development of a neural network (NN) for automatic identification of metaphase spreads and stimulated nuclei in digital images of microscope preparations at 10X magnification. After segmentation of the objects on each image, ten different morphometrical, photometrical and textural features are measured on each segmented object. An NN is used to classify the feature vectors into three classes: metaphases, nuclei and artifacts. The system has been able to classify correctly approximately 91% of the objects in each class, in a test set of 191 mitosis, 331 nuclei and 387 artifacts, obtained from 30 different microscope slides. Manual editing of false positives from the metaphase classification results allows the calculation of the MI with an error of 6.5%.
Assuntos
Processamento de Imagem Assistida por Computador/métodos , Metáfase , Redes Neurais de Computação , Humanos , Índice MitóticoRESUMO
Se presenta un caso de meningioma que destruyo la totalidad del piso de la fosa craneal media derecha, localizándose en la fosa pterigomaxilar y con extension a la region parotidea, tratado en el Hospital Universitario de Barranquilla. Se evaluo a una mujer campesina de 40 años, a quien se le encontro al inicio un tumor en la region parotidea derecha con extension de la masa de consistencia quistica a la rinofaringe. Se le realizaron estudios radiográficos para establecer la extension del tumor y posteriormente fue tratada mediante cirugia como unico metodo terapeutico. En la actualidad, al completar dos años y medio de evolución, se encuentra asintomática y sin recidiva tumoral
Assuntos
MeningiomaRESUMO
Se estudian las características demográficas y los antecentes psiquiátricos de las víctimas de suicidios por precipitación de altura acaecidos entre 1983 y 1985 (Instituto Médico Legal de Santiago). En el período señalado hubo 26 suicidios por precipitación de altura, correspondientes a 13 hombres y a 13 mujeres. En los hombres el suicidio se dio con una frecuencia similar en los distintos grupos etarios. En las mujeres, el 69,2% de las suicidas eran mayores de 50 años. En el 86,3% de los casos había antecedentes de trastornos psicológicos o conductuales y en un 54,5% había un diagnóstico psiquiátrico formal, siendo la Esquizofrenia el más frecuentemente formulado. El 59% de los suicidas había tenido ideación o conductas autodestructivas previas. Los presuntos motivos desendenantes predominantes fueron las dificultades económicas en los hombres (85,7%) y el aislamiento social en las mujeres (66,6%)
Assuntos
Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Suicídio/psicologia , Suicídio/epidemiologia , DemografiaRESUMO
Levamisol (fenilimidotiazol), considerado um potente imunoestimulante, quando administrado a camundongos suíços näo causou aumento significante nos pesos do timo, figado, ou baço, apesar de a droga ter sido usada em diferentes tempos antes da remoçäo desses órgäos. Doses elevadas da droga usadas no esquema profilático de 4 dias näo tiveram efeito antimalárico. Entretanto quando dada a camundongos com malária, 24 horas antes, ao mesmo tempo ou 24 horas após inoculaçäo de uma cepa de Plasmodium berghei cloroquina-sensível ou uma cepa cloroquina resistente o levamisol reduziu, ainda que discretamente, a parasitemia nos graus tratados, sendo a dose de 1 mg/kg o melhor esquema. Foi observado também atraso na mortalidade por malária nos grupos tratados com o levamisol. No entanto, todos os animais morreram. Os dados sugerem que o levamisol tem efeito imunoestimulante, ainda que discreto, na resposta imune de animais, deprimida pela malária