RESUMO
Abstract Primary cardiac tumors are rare, especially in the pediatric age. Most of them are benign in the sense they are not invasive. However, benign tumors maintain the potential for serious illness related to significant hemodynamic compromise or life-threatening dysrhythmias. We present the case of an infant with an initial diagnosis of cardiac rhabdomyoma who suffered ventricular arrhythmia and cardiac arrest. He suffered irreversible severe neurologic sequelae, due to his prolonged cardiopulmonary arrest and was finally diagnosed of cardiac fibroma. Good arrhythmia control was obtained after an extensive partial surgical resection of the tumor. This case highlights the importance of arrhythmia burden in this condition. A correct diagnosis based essentially in different imaging modalities and closer clinical and rhythm follow up could have avoided this ominous event.
Resumen Los tumores cardíacos primarios son raros, especialmente en la edad pediátrica. La mayoría de ellos son benignos, en el sentido de que no son invasivos. Sin embargo, los tumores benignos tienen el potencial para producir enfermedades graves que pueden causar compromiso hemodinámico significativo o arritmias potencialmente letales. Se presenta el caso de un niño con un diagnóstico inicial de rabdomioma cardíaco, quien sufrió una arritmia ventricular y una parada cardíaca. Tuvo secuelas neurológicas severas irreversibles debido al tiempo prolongado en parada cardiorrespiratoria y se le diagnosticó finalmente fibroma cardíaco. Se obtuvo un buen control de las arritmias después de una extensa resección parcial del tumor. Este caso pretende subrayar la importancia del riesgo de aparición de arritmias en esta situación. El diagnóstico correcto basado fundamentalmente en el uso de distintas modalidades de imagen y el seguimiento clínico y arritmológico, podrían haber evitado este desenlace fatal.
Assuntos
Humanos , Pré-Escolar , Pediatria , Criança , Parada Cardíaca , Rabdomioma , Radiografia Torácica , NeoplasiasRESUMO
Catheter-based ablation of isthmus-dependent common atrial flutter results in very high success rates and almost no complications. However, bidirectional conduction block through the isthmus may be challenging in a small percentage of patients regarding the use of high power and high temperature settings during radiofrequency delivery. Anatomical and physiological circumstances may be the reason for such difficulties to achieve bidirectional block at the cavo-tricuspid isthmus. However, in the present case we show edema formation after multiple shots of radiofrequency delivery at the cavo-tricuspid isthmus, which complicates the achievement of bidirectional conduction block.
Assuntos
Flutter Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Edema Cardíaco/etiologia , Átrios do Coração/lesões , HumanosRESUMO
Catheter-based ablation of isthmus-dependent common atrial flutter results in very high success rates and almost no complications. However, bidirectional conduction block through the isthmus may be challenging in a small percentage of patients regarding the use of high power and high temperature settings during radiofrequency delivery. Anatomical and physiological circumstances may be the reason for such difficulties to achieve bidirectional block at the cavo-tricuspid isthmus. However, in the present case we show edema formation after multiple shots of radiofrequency delivery at the cavo-tricuspid isthmus, which complicates the achievement of bidirectional conduction block.
La ablación con catéter del flutter de tipo común dependiente del istmo es un procedimiento con elevada tasa de éxito y rara vez complicaciones. Sin embargo, en un pequeño porcentaje de casos puede resultar complicado conseguir el objetivo de bloquear bidireccionalmente el istmo durante el procedimiento de ablación a pesar de incrementar la potencia y temperatura del catéter de radiofrecuencia. Las características anatómicas y fisiológicas del istmo cavo-tricuspídeo pueden ocasionar dificultades en la consecución del bloqueo bidireccional. Sin embargo, en el presente caso mostramos cómo la propia aplicación de radiofrecuencia puede ocasionar edema importante tras múltiples aplicaciones con las consiguientes dificultades para conseguir el bloqueo bidireccional del istmo.
Assuntos
Humanos , Flutter Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Edema Cardíaco/etiologia , Átrios do Coração/lesõesRESUMO
INTRODUCCIÓN Actualmente, en el campo de las Ciencias Sociales hay pocos trabajos investigativos sobre la temática de la sexualidad y todo lo concerniente a ella. OBJETIVOS Indagar acerca de las representaciones sociales de las mujeres sobre la sexualidad, y su influencia en las decisiones respecto a la planificación familiar. MÉTODOS La investigación se encuadró dentro del paradigma interpretativo. Respondió a un diseño prospectivo cualitativo, que permitió comprender por qué ocurren las cosas, interpretando la subjetividad de las mujeres y su relación con el entorno. Se trabajó con personas incluidas en el Programa de Salud Sexual y Reproductiva (Plan Mujer) del Centro de Adiestramiento René Favaloro de la provincia de San Juan. Para la recolección de datos se realizaron entrevistas semiestructuradas. El muestreo fue no probabilístico, y se utilizó el procedimiento de saturación de datos. RESULTADOS Las 37 entrevistas realizadas revelaron que, en salud sexual, las concepciones de las mujeres quedan ligadas a la esfera meramente biológica, al sistema reproductor, sus funciones y procesos; la sexualidad la vinculan al ámbito físico, a través de cuestiones relacionadas con enfermedades de transmisión sexual y embarazos no deseados. Las entrevistadas manifestaron que recibían información de familiares mujeres, mayormente sus madres. El método más elegido resultó ser la píldora, seguida de inyectables, preservativos, ligadura tubaria, dispositivo intrauterino (todos utilizados en pocos casos). DISCUSIÓN El proceso de objetivación de las representaciones sociales sobre sexualidad no está culminado. Las prácticas sexuales están ligadas a la procreación. Las mujeres presentan contradicciones en sus enunciados y prácticas, y orientan sus acciones y decisiones a situaciones de riesgo, que van en detrimento de la propia salud.
Assuntos
Anticoncepção , Sexualidade , Direitos Sexuais e Reprodutivos , Saúde Reprodutiva , Instituições de Assistência AmbulatorialRESUMO
Background: The metabolic syndrome (MS) is associated to a significant increase in the risk of diabetes, coronary heart disease and stroke, resulting in a 5-fold increase of the cardiovascular death rate. Aim: To determine the relationship between gestational diabetes (GD) and the development of MS at the end of puerperal period. Patients and Methods: We conducted a case-control study in the Curanilahue Hospital, in southern Chile, including 58 women with GD during their pregnancy, studied in day 42 of their puerperal period (study group) and 58 puerperal women from the same hospital, who had a physiological pregnancy (control group). Triglycerides, HDL cholesterol, fasting and post prandial blood glucose levels, blood pressure, waist circumference, weight and height were measured. MS was diagnosed using the National Cholesterol Education Program (NCEP - ATP III) criteria. Results: Mean weight, body mass index, waist circumference, blood glucose and triglycerides were significantly higher in the study group and HDL cholesterol was significantly lower in the control group. Conclusions: These results suggest a significant relationship between GD and the ocurrence of MS.
Assuntos
Feminino , Humanos , Recém-Nascido , Gravidez , Diabetes Gestacional/sangue , Lipídeos/sangue , Síndrome Metabólica/etiologia , Período Pós-Parto , Biomarcadores/sangue , Glicemia , Pressão Sanguínea , Índice de Massa Corporal , Estudos de Casos e Controles , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Diabetes Mellitus/genética , Diabetes Gestacional/diagnóstico , Síndrome Metabólica/sangue , Síndrome Metabólica/diagnóstico , Fatores de Risco , Triglicerídeos/sangue , Relação Cintura-QuadrilRESUMO
BACKGROUND: The metabolic syndrome (MS) is associated to a significant increase in the risk of diabetes, coronary heart disease and stroke, resulting in a 5-fold increase of the cardiovascular death rate. AIM: To determine the relationship between gestational diabetes (GD) and the development of MS at the end of puerperal period. PATIENTS AND METHODS: We conducted a case-control study in the Curanilahue Hospital, in southern Chile, including 58 women with GD during their pregnancy, studied in day 42 of their puerperal period (study group) and 58 puerperal women from the same hospital, who had a physiological pregnancy (control group). Triglycerides, HDL cholesterol, fasting and post prandial blood glucose levels, blood pressure, waist circumference, weight and height were measured. MS was diagnosed using the National Cholesterol Education Program (NCEP - ATP III) criteria. RESULTS: Mean weight, body mass index, waist circumference, blood glucose and triglycerides were significantly higher in the study group and HDL cholesterol was significantly lower in the control group. CONCLUSIONS: These results suggest a significant relationship between GD and the occurrence of MS.
Assuntos
Diabetes Gestacional/sangue , Lipídeos/sangue , Síndrome Metabólica/etiologia , Período Pós-Parto , Biomarcadores/sangue , Glicemia , Pressão Sanguínea , Índice de Massa Corporal , Estudos de Casos e Controles , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Diabetes Mellitus/genética , Diabetes Gestacional/diagnóstico , Feminino , Humanos , Recém-Nascido , Síndrome Metabólica/sangue , Síndrome Metabólica/diagnóstico , Gravidez , Fatores de Risco , Triglicerídeos/sangue , Relação Cintura-QuadrilRESUMO
There is limited data on immunity against varicella-zoster virus (VZV) in adults in different parts of Argentina, and it is not known which VZV strains are circulating in Argentina. The objectives of this study were as follows: (i) to evaluate seroprevalence of varicella among adults, assessing the accuracy of clinical history and determining the sociodemographic factors associated with seropositivity; and (ii) to determine the VZV strains circulating in Argentina. A cross-sectional serological survey enrolling 2,807 women aged 15 to 49 years attending public health-care settings in four cities in Argentina (i.e., Buenos Aires, Salta, Mendoza, and Rosario) and one rural area was conducted from August to November 2002. Specimens for identification of VZV strains were obtained from vesicular lesions from 13 pediatric patients with varicella from different areas of the country. PCR amplification was used for genotyping. The overall seroprevalence of varicella antibodies was 98.5% (95% confidence interval, 98.0 to 98.9), ranging from 97.2% in central Buenos Aires to 99.3% in southern Buenos Aires and Salta. Varicella seroprevalence increased with age. Crowding and length of residence in the same place were associated with seropositivity. The positive predictive value of varicella history for immunity to varicella was 99.4%; however, the negative predictive value was 2.5%. The European genotype was identified in all viral specimens. In Argentina, seroprevalence in women more than 15 years old was high regardless of the area of residence. Negative or uncertain varicella history was not a good predictor of immunity. VZV genotype was stable in all areas of the country.
Assuntos
Anticorpos Antivirais/sangue , Varicela/epidemiologia , Herpes Zoster/epidemiologia , Herpesvirus Humano 3/genética , Epidemiologia Molecular , Adolescente , Adulto , Argentina/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Herpes Zoster/virologia , Herpesvirus Humano 3/imunologia , Humanos , Pessoa de Meia-IdadeRESUMO
BACKGROUND: In Chile, the prevalence of teenage pregnancy is 17%. AIM: To assess relationship between adolescent pregnancy and school desertion. PATIENTS AND METHODS: At the Hospital Guillermo Grant Benavente's Departament of Obstetrics and Gynecology, in Concepción, Chile, 2001 a comparative, cross sectional and correlational study was conducted. The study group were pregnant adolescents who deserted from school system, divided in two subgroups: 86 adolescents who deserted before pregnancy and 130 who deserted during pregnancy. RESULTS: Twenty percent of teenagers that deserted from school before pregnancy belonged to a sublevel of poverty, compared with 5% of those who deserted during pregnancy. Flunk was frequent in both but higher in girls that deserted before pregnancy (46.5 and 36.9% respectively, (p<0.001)). Economic problems were the main cause of desertion before pregnancy (27.6%). Shame (41.6%) and obstetric complications (31.7%) were the main reasons for deserting during pregnancy. Seventy percent of adolescents who deserted before pregnancy had no educational, working or recreational activities. The parental educational level of both groups was low. CONCLUSIONS: There is a relationship between teenage pregnancy and school desertion. Adolescents who deserted from school before pregnancy are more vulnerable.
Assuntos
Gravidez na Adolescência/estatística & dados numéricos , Evasão Escolar/estatística & dados numéricos , Adolescente , Chile/epidemiologia , Estudos Transversais , Escolaridade , Feminino , Humanos , Gravidez , Pais Solteiros/estatística & dados numéricos , Fatores Socioeconômicos , Estatísticas não ParamétricasRESUMO
Es muy frecuente en Costa Rica utilizar intervalos de referencia reportados en la literatura para pruebas químicas de laboratório. Debido a que los valores de gases sanguíneos varían considerablemente con la edad y presión barométrica, es muy importante conocer los valores de referencia locales en la población de niños y de adultos. Se analizó un total de 200 niños y 100 adultos sin enfermedades aparentes, utilizando sangre arterial obtenida y mantenida en anaerobiosis a 4§C por no más de dos horas. Los valores promedio obtenidos en la determinación de pH, pCO2, HCO3, PO2 fueron los soguientes: Niños de 2 a 5 años: pH 7.425, pCO2 29.4 mmHg, HCO3 18.9 mmHg, PO2 74.2 mmHg. Adultos de 18 a 50 años: pH 7.416, pCO2 35.2 mmHg, HCO3 22.5 mmHg PO2 83.1 mmHg. Estos datos muestran una diferencia significativa entre ambas poblaciones, datos semejantes a los reportados en la literatura. También se confirmó que la altitud de 1200 metros, con una presión barométrica de 667 mmHg, tiene intervalos de referencia diferentes a aquellos obtenidos al nivel del mar, como ha sido demostrado en otros trabajos
Assuntos
Pré-Escolar , Adolescente , Adulto , Pessoa de Meia-Idade , Gasometria , Concentração de Íons de Hidrogênio , Valores de ReferênciaRESUMO
Se determinó el intervalo de referencia para plomo sanguíneo (PbS) por el método de absorción atómica, en 180 personas (100 hombres y 80 mujeres), adultos, caucásicos, no expuestos a contaminación laboral, escogidos al azar entre donadores de sangre, personal médico y estudiantes universitarios del Hospital San Juan de Dios. El valor promedio (X) para el PbS fue de 17,08 ug/dl para población masculina y de 12,9 ug/dl para población femenina, con una diferencia estadísticamente significativa (P<0.001). Estos datos coinciden con los valores de referencia reportados en la literatura. El mismo estudio se practicó en 174 trabajadores (159 hombres y 15 mujeres) expuestos a contaminación por plomo en distintos ambientais laborales, trabajadores de fábricas de baterías, resinas, joyerías, empalmadores, pintores y linotipistas. El grupo de más alta contaminación fue el de la fábrica de baterías, con un promedio (X) de 66,0 ug/dl. Los promedios de los cuatro grupos restantes difieren significativamente del grupo control (P<0.001)