RESUMO
Infant formulas (IF) can contain harmful chemical substances, such as pesticides and mycotoxins, resulting from the contamination of raw materials and inputs used in the production chain, which can cause adverse effects to infants. Therefore, the quick, easy, cheap, effective, rugged, and safe (QuEChERS) methodology prior ultra-high performance liquid chromatography coupled to triple quadrupole mass spectrometry (UHPL-QqQ-MS/MS) analysis was applied for the determination of 23 contaminants, in 30 samples of Brazilian IF. The method was validated in terms of limit of detection (0.2 to 0.4 µg/kg), limits of quantification (1 and 10 µg/kg), and recovery (64 % to 122 %); precision values, in terms of relative standard deviation (RSD), were ≤ 20 %. Fenitrothion, chlorpyrifos, and bifenthrin were the pesticides detected in the samples, but the values did not exceed the limit set by the European Union (EU), and ANVISA, and they were detected under their limits of quantification. Additionally, suspect screening and unknown analysis were conducted to tentatively identify 32 substances, including some compounds not covered in this study, such as pesticides, hormones, and veterinary drugs. Carbofuran was identified, confirmed and quantified in 10 % of the samples.
Assuntos
Contaminação de Alimentos , Fórmulas Infantis , Limite de Detecção , Espectrometria de Massas em Tandem , Espectrometria de Massas em Tandem/métodos , Cromatografia Líquida de Alta Pressão/métodos , Brasil , Fórmulas Infantis/química , Contaminação de Alimentos/análise , Praguicidas/análise , Humanos , Resíduos de Praguicidas/análise , Reprodutibilidade dos Testes , Micotoxinas/análise , Lactente , Piretrinas/análiseRESUMO
BACKGROUND: Microscale environmental features are usually evaluated using direct on-street observations. This study assessed inter-rater reliability of the Microscale Audit of Pedestrian Streetscapes, Global version (MAPS-Global), in an international context, comparing on-street with more efficient online observation methods in five countries with varying levels of walkability. METHODS: Data were collected along likely walking routes of study participants, from residential starting points toward commercial clusters in Melbourne (Australia), Ghent (Belgium), Curitiba (Brazil), Hong Kong (China), and Valencia (Spain). In-person on the street and online using Google Street View audits were carried out by two independent trained raters in each city. The final sample included 349 routes, 1228 street segments, 799 crossings, and 16 cul-de-sacs. Inter-rater reliability analyses were performed using Kappa statistics or Intraclass Correlation Coefficients (ICC). RESULTS: Overall mean assessment times were the same for on-street and online evaluations (22 ± 12 min). Only a few subscales had Kappa or ICC values < 0.70, with aesthetic and social environment variables having the lowest overall reliability values, though still in the "good to excellent" category. Overall scores for each section (route, segment, crossing) showed good to excellent reliability (ICCs: 0.813, 0.929 and 0.885, respectively), and the MAPS-Global grand score had excellent reliability (ICC: 0.861) between the two methods. CONCLUSIONS: MAPS-Global is a feasible and reliable instrument that can be used both on-street and online to analyze microscale environmental characteristics in diverse international urban settings.
Assuntos
Pedestres , Austrália , Bélgica , Brasil , China , Cidades , Planejamento Ambiental , Hong Kong , Humanos , Reprodutibilidade dos Testes , Características de Residência , Espanha , CaminhadaRESUMO
Introducción El objetivo del estudio es pormenorizar los factores asociados a fracturas de cadera, prestando especial atención a las necesidades de transfusión de hemoderivados y sus factores de riesgo, así como su modificación a través del tratamiento preoperatorio mediante la administración de hierro intravenoso. Materiales y métodos Estudio observacional prospectivo de 119 pacientes ingresados por fractura de cadera. Descripción detallada del protocolo para la optimización prequirúgica de estos pacientes. Se recopilaron datos epidemiológicos, valores analíticos, así como datos acerca de la administración de hierro intravenoso y necesidad de transfusión. Resultados El 31,09% de los pacientes se encontraban antiagregados y el 21,85% estaban anticoagulados en el momento de la admisión. La hemoglobina media al ingreso fue de 12,5g/dl. El 43,2% se transfundieron durante la estancia hospitalaria. En el análisis de los factores de riesgo para la transfusión demostramos estadísticamente que tanto la hemoglobina al ingreso (p<0.001), como los diagnósticos previos de anemia crónica, hipertensión arterial e insuficiencia renal, tienen una relación con la necesidad de transfusión intrahospitalaria. Encontramos una relación estadísticamente significativa entre la administración de hierro y la cantidad de concentrados de hematíes trasfundidos (p<0.005). Los requerimientos de transfusión sanguínea fueron mayores en las fracturas extracapsulares que en las intracapsulares (p=0,024). Discusión Los pacientes con fractura de cadera presentan frecuentemente bajos niveles de hemoglobina al ingreso, así como comorbilidades y tratamientos que predisponen al desarrollo de anemia perioperatoria. La optimización preoperatoria de estos pacientes mediante la administración de hierro intravenoso podría reducir las necesidades transfusionales.
Background Aim of the study is to describe the elements associated with hip fractures about needs for transfusion of blood products and their risk factors, as well as their modification through preoperative treatment through the administration of intravenous iron. Material and methods A Cohort study of 119 patients admitted for hip fracture was conducted. Detailed description of the protocol for the pre-surgical optimization of these patients, epidemiological data, analytical values, as well as data on intravenous iron administration and need for transfusion were collected. Results 31.09% of the patients were using platelet aggregation inhibitors and 21.85% were were using anticoagulants at the time of admission. The mean hemoglobin on admission was 12.5g / dl. 43.2% were transfused during the hospital stay. In the analysis of risk factors for transfusion, we statistically demonstrated that both hemoglobin on admission (p <0.001), as well as previous diagnoses of chronic anemia, arterial hypertension, and renal failure, are related to the need for intra-hospital transfusion. We found a statistically significant relationship between iron administration and the amount of packed red blood cells transfused (p <0.005). Blood transfusion requirements were higher in extra-capsular than in intra-capsular fractures (p=0.024). Discussion Patients with hip fracture frequently present low hemoglobin levels upon admission, as well as comorbidities and treatments that predispose to the development of perioperative anemia. Preoperative optimization of these patients by administering intravenous iron could reduce transfusion requirements.
Assuntos
Humanos , Fraturas do Quadril , Transfusão de Sangue , Hemoglobinas , Ferro , AnticoagulantesRESUMO
BACKGROUND: Treating wide-necked aneurysms is challenging for the interventional neuroradiologist. Recently, numerous devices dedicated to the treatment of these aneurysms have become available. We report our early experience using the pCONus2 device and present the technical success rate, clinical outcomes, and immediate angiographic occlusion rates. METHODS: We performed a retrospective review of prospectively collected data to identify patients treated with the pCONus2 device between February 2015 and February 2017. RESULTS: We identified 12 patients (10 females) treated with the pCONus2 device. The average patient age was 56.6 ± 15.8 years (range, 13-71 years). The average aneurysm dome width was 8.83 ± 5.3 mm (range, 3.8-20 mm), the average dome height was 7.23 ± 4.06 mm (range, 3.36-15 mm), and the average neck width was 5.88 ± 2.92 mm (range, 2.77-11 mm). The angulation of the aneurysm to the parent vessel varied between 0 and 78° (mean, 32.2°). Ten aneurysms were located in the anterior circulation, and 2 were in the posterior circulation. Immediate posttreatment angiography showed 11 aneurysms with modified Raymond-Roy classification (mRRC) grade I occlusion and 1 aneurysm with mRRC grade II occlusion. There were no deaths or hemorrhagic complications. Three patients developed small thrombi during treatment, all of whom were successfully treated with glycoprotein IIb/IIIa antagonists. Early angiographic follow-up data for 6 patients showed adequate aneurysm occlusion in 5 patients and aneurysm recanalization in 1 patient. CONCLUSIONS: The early results on the use of the pCONus2 device suggest that it can be useful for treating wide-necked aneurysms; however, larger studies with longer-term follow-up data are needed.
Assuntos
Angiografia Cerebral , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Stents , Adolescente , Adulto , Idoso , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: The use of surgical drains in abdominal surgery is still today controversial. While accepting their role in certain circumstances, their systematic use advocated by other schools, is not fully accepted. We present a case of secondary blind drilling drainage tube perineum following an abdominoperineal amputation of the rectum that forced a surgical repair in a neoplastic patient CLINICAL CASE: This is a patient who underwent abdomino perineal resection for rectal neoplasia. It was decided to leave a silicone-type drain tube for perineum and in late postoperative he presented cecum perforation due to traumatic introduction thereof into the cecal light, which forced his reoperation and surgical repair. DISCUSSION: There is a tendency to use less and less drains in abdominal surgery, although there are certain occasions when it becomes inevitable. On the other hand it entails morbidity associated with its use that significantly complicates and delays the recovery of the patient. It is accepted that is not useful to prevent the occurrence of fistulas, although it contributes to its early detection. CONCLUSIONS: The cecal perforation due to drain is a rare complication which must always be taken into account, and that perhaps could be avoided by using soft and less rigid drains.
Assuntos
Ceco/lesões , Drenagem/efeitos adversos , Perfuração Intestinal/etiologia , Amputação Cirúrgica , Fístula Anastomótica/etiologia , Carcinoma/cirurgia , Carcinoma/terapia , Ceco/cirurgia , Quimiorradioterapia , Terapia Combinada , Drenagem/instrumentação , Emergências , Hepatectomia/métodos , Humanos , Perfuração Intestinal/cirurgia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Períneo/cirurgia , Pneumonectomia/métodos , Neoplasias Retais/cirurgia , Neoplasias Retais/terapia , Reto/cirurgiaRESUMO
The influence of different factors on shoot proliferation and the occurrence of hyperhydricity in teak (Tectona grandis L.) have been studied. Four concentrations of BA (2.22, 4.44, 6.66 and 8.88 µM) and a control treatment with 0 BA were examined. Aiming at reducing the costs during commercial propagation by using gelrite in stead of agar, the use of both gelling agent in the proliferation and hyperhydricity was tested. In order to evaluate if hyperhydricity can be reduced by increasing the gelrite concentration in the culture medium, three concentrations (2.0, 2.5 and 3.0 g L-1) were tested in combination with 4.44 µM BA. The proliferation and occurrence of hyperhydricity during 21 successive subcultures were evaluated. The highest proliferation was achieved in the treatments with 6.66 or 8.88 µM BA. They yielded 5.22 and 5.56 shoots/explant, respectively. But also, the highest percent of hyperhydric shoots was achieved in this treatment. Gelrite resulted in a higher proliferation, but also an almost two times higher hyperhydricity as compared to agar-solidified media. Satisfactory reduction in hyperhydricity (18%) was achieved with 3.0 g L-1 gelrite. However, the successive subcultures onto proliferation in this treatment favored hyperhydricity compromising shoot quality and it´s competence to proliferate. in vitro teak plants were ex vitro rooted and then transferred to greenhouse conditions for acclimatization; ten weeks after transfer they were ready for field plantation.
Se estudió la influencia de diferentes factores en la proliferación y la ocurrencia de la hiperhidricidad in teca (Tectona grandis L.). Se probaron cuatro concentraciones de BA (2,22; 4,44; 6,66 and 8,88 µM) y un control sin BA. Con el objetivo de reducir los costos durante la propagación comercial se experimentó sustituir el agar por el gelrite, para lo cual se estudió en efecto de ambos gelificantes en la proliferación y la hiperhidricidad de los brotes. Se estudiaron, tres concentraciones de gelrite (2,0; 2,5 and 3,0 g L-1) combinadas con 4,44 µM BA, con el objetivo de evaluar si la hiperhidricidad podía ser reducida incrementando la concentración de gelrite. Se evaluó la proliferación de brotes y la ocurrencia de la hiperhidricidad durante 21 subcultivos. Se logró una alta proliferación de brotes en los tratamientos con 6,66 y 8,88 µM BA (5,22 y 5,56 brotes), pero el porcentaje de brotes hiperhídricos también se incrementó. El gelrite resultó en una alta proliferación de brotes, pero con mayor incidencia de la hiperhidricidad que el medio gelificado con agar. Se obtuvo una reducción satisfactoria de la hiperhidricidad (18%), cuando la concentración de gelrite se incrementó hasta 3,0 g L-1. No obstante, la multiplicación de los brotes en este tratamiento más allá del 11no subcultivo favoreció la hiperhidricidad, lo que afectó la calidad de los brotes y su competencia para la proliferación. Las plantas fueron enraizadas ex vitro, transferidas a condiciones de invernadero para su aclimatización y diez semanas después de la transferencia estaban listas para la plantación en campo.
Assuntos
Agricultura Florestal , Células TecaisRESUMO
The imperforate hymen is a congenital anomaly of the female genital development. This is a rare pathology with an estimated incidence of 0.1% in female newborns. In many cases, the diagnosis goes unnoticed until puberty, debuting with cyclical abdominal pain in adolescents who have not submitted menarche. Diagnosis is based on history and physical examination, although additional tests, especially the ultrasound that allows to confirm clinical diagnosis and to exclude other genital malformations. We report a case of a 13-year-old that was diagnosed after consulting several times for recurrent abdominal pain.
Assuntos
Dor Abdominal/etiologia , Hematocolpia/complicações , Hímen/anormalidades , Distúrbios Menstruais/complicações , Adolescente , Anormalidades Congênitas , Feminino , HumanosRESUMO
El himen imperforado es una anomalía congénita del desarrollo genital femenino. Es una patología poco frecuente, con una incidencia estimada del 0,1% de los recién nacidos del sexo femenino. En muchas ocasiones, el diagnóstico pasa inadvertido hasta la pubertad y debuta con dolor abdominal cíclico en adolescentes que no han presentado la menarquia. El diagnóstico se basa en la anamnesis y la exploración física, aunque las pruebas complementarias, en especial la ecografía, permiten la comprobación del diagnóstico clínico y la exclusión de otras malformaciones genitales. Se presenta el caso clínico de una paciente de 13 años que fue diagnosticada tras consultar en varias ocasiones por dolor abdominal recurrente.(AU)
The imperforate hymen is a congenital anomaly of the female genital development. This is a rare pathology with an estimated incidence of 0.1% in female newborns. In many cases, the diagnosis goes unnoticed until puberty, debuting with cyclical abdominal pain in adolescents who have not submitted menarche. Diagnosis is based on history and physical examination, although additional tests, especially the ultrasound that allows to confrm clinical diagnosis and to exclude other genital malformations. We report a case of a 13-year-old that was diagnosed after consulting several times for recurrent abdominal pain.(AU)
RESUMO
El himen imperforado es una anomalía congénita del desarrollo genital femenino. Es una patología poco frecuente, con una incidencia estimada del 0,1% de los recién nacidos del sexo femenino. En muchas ocasiones, el diagnóstico pasa inadvertido hasta la pubertad y debuta con dolor abdominal cíclico en adolescentes que no han presentado la menarquia. El diagnóstico se basa en la anamnesis y la exploración física, aunque las pruebas complementarias, en especial la ecografía, permiten la comprobación del diagnóstico clínico y la exclusión de otras malformaciones genitales. Se presenta el caso clínico de una paciente de 13 años que fue diagnosticada tras consultar en varias ocasiones por dolor abdominal recurrente.
The imperforate hymen is a congenital anomaly of the female genital development. This is a rare pathology with an estimated incidence of 0.1% in female newborns. In many cases, the diagnosis goes unnoticed until puberty, debuting with cyclical abdominal pain in adolescents who have not submitted menarche. Diagnosis is based on history and physical examination, although additional tests, especially the ultrasound that allows to confrm clinical diagnosis and to exclude other genital malformations. We report a case of a 13-year-old that was diagnosed after consulting several times for recurrent abdominal pain.
Assuntos
Adolescente , Feminino , Humanos , Dor Abdominal/etiologia , Hematocolpia/complicações , Hímen/anormalidades , Distúrbios Menstruais/complicaçõesRESUMO
The imperforate hymen is a congenital anomaly of the female genital development. This is a rare pathology with an estimated incidence of 0.1
in female newborns. In many cases, the diagnosis goes unnoticed until puberty, debuting with cyclical abdominal pain in adolescents who have not submitted menarche. Diagnosis is based on history and physical examination, although additional tests, especially the ultrasound that allows to confirm clinical diagnosis and to exclude other genital malformations. We report a case of a 13-year-old that was diagnosed after consulting several times for recurrent abdominal pain.
RESUMO
In order to determine the impact of the application of the American Thyrold Associations (ATA) criteria for the diagnosis of hypothyroidism in pregnant women in the health district of Vigo, Spain, concentrations of serum thyrotropin (TSH), free thyroxine (T4L) and anti-thyroid antibodies were analyzed, comparing the frequency of pregnant women diagnosed with hypothyroidism and applying the criteria used in the hormone laboratory at Xeral Hospital and referential criteria established by ATA. The application of ATA referential criteria increased by 29.6% the number of female patients diagnosed with hypothyroidism. The application of ATA guidelines had an impact on the measurement of TSH concentrations in pregnant women, which calls for an evaluation of referential values of TSH based on the population and the local diagnostic methods.
Assuntos
Hipotireoidismo/diagnóstico , Complicações na Gravidez/diagnóstico , Adulto , Feminino , Humanos , Gravidez , Sociedades Médicas , Espanha , Estados UnidosRESUMO
OBJECTIVE: To evaluate novel eligibility criteria and outreach methods to identify and recruit women at high risk of HIV-1 infection in the Caribbean. METHODS: A prospective cohort study was conducted in 2009-2012 among 799 female commercial sex workers in the Dominican Republic, Haiti, and Puerto Rico. Minimum eligibility criteria included exchange of sex for goods, services, or money in the previous 6 months and unprotected vaginal or anal sex with a man during the same period. Sites used local epidemiology to develop more stringent eligibility criteria and recruitment strategies. Participants were asked questions about HIV/AIDS and their level of concern about participating in an HIV vaccine trial. Logistic regression modeling was used to assess predictors of prevalent HIV infection and willingness to participate in a future HIV vaccine study. RESULTS: HIV prevalence at screening was 4.6%. Crack cocaine use [odds ratio (OR) = 4.2, 95% confidence interval (CI) (1.8-9.0)] was associated with and having sex with clients in a hotel or motel [OR = 0.5, CI (0.3-1.0)] was inversely associated with HIV infection. A total of 88.9% of enrolled women were definitely or probably willing to participate in a future HIV vaccine trial. CONCLUSIONS: This study indicated that local eligibility criteria and recruitment methods can be developed to identify and recruit commercial sex workers with higher HIV prevalence than the general population who express willingness to join an HIV vaccine trial.
Assuntos
Ensaios Clínicos como Assunto/métodos , Infecções por HIV/epidemiologia , Doenças Profissionais/epidemiologia , Seleção de Pacientes , Profissionais do Sexo , Vacinas contra a AIDS , Adolescente , Adulto , Atitude Frente a Saúde , Cultura , República Dominicana/epidemiologia , Feminino , Soroprevalência de HIV , Haiti/epidemiologia , Humanos , Consentimento Livre e Esclarecido , Pessoa de Meia-Idade , Estudos Prospectivos , Porto Rico/epidemiologia , Risco , Assunção de Riscos , Profissionais do Sexo/psicologia , Comportamento Sexual , Parceiros Sexuais , Fatores Socioeconômicos , Adulto JovemRESUMO
Con el objetivo de determinar el impacto de la aplicación de los criterios de la Asociación Americana de Tiroides (ATA) en el diagnóstico de hipotiroidismo en gestantes del área sanitaria de Vigo en España, se analizó la concentración sérica de tirotropina (TSH), tiroxina libre (T4L) y anticuerpos antitiroideos, comparando la frecuencia de gestantes diagnosticadas de hipotiroidismo aplicando los criterios utilizados en el laboratorio de hormonas del Hospital Xeral y los criterios de referencia propuestos por la ATA. La asunción de dichos criterios implicaría un aumento de un 29,6% de pacientes diagnosticadas de hipotiroidismo. La aplicación de los criterios ATA tuvo una repercusión en la medición de la concentración de TSH en gestantes lo que sugiere una evaluación de los valores de referencia de TSH en función de la población y los métodos de diagnóstico locales.
In order to determine the impact of the application of the American Thyrold Associations (ATA) criteria for the diagnosis of hypothyroidism in pregnant women in the health district of Vigo, Spain, concentrations of serum thyrotropin (TSH), free thyroxine (T4L) and anti-thyroid antibodies were analyzed, comparing the frequency of pregnant women diagnosed with hypothyroidism and applying the criteria used in the hormone laboratory at Xeral Hospital and referential criteria established by ATA. The application of ATA referential criteria increased by 29.6% the number of female patients diagnosed with hypothyroidism. The application of ATA guidelines had an impact on the measurement of TSH concentrations in pregnant women, which calls for an evaluation of referential values of TSH based on the population and the local diagnostic methods.
Assuntos
Adulto , Doenças da Glândula Tireoide , Gravidez , Hipotireoidismo , EspanhaRESUMO
OBJECTIVE: To evaluate novel eligibility criteria and outreach methods to identify and recruit women at high risk of HIV-1 infection in the Caribbean. METHODS: A prospective cohort study was conducted in 2009-2012 among 799 female commercial sex workers in the Dominican Republic, Haiti, and Puerto Rico. Minimum eligibility criteria included exchange of sex for goods, services, or money in the previous 6 months and unprotected vaginal or anal sex with a man during the same period. Sites used local epidemiology to develop more stringent eligibility criteria and recruitment strategies. Participants were asked questions about HIV/AIDS and their level of concern about participating in an HIV vaccine trial. Logistic regression modeling was used to assess predictors of prevalent HIV infection and willingness to participate in a future HIV vaccine study. RESULTS: HIV prevalence at screening was 4.6%. Crack cocaine use [odds ratio (OR) = 4.2, 95% confidence interval (CI) (1.8-9.0)] was associated with and having sex with clients in a hotel or motel [OR = 0.5, CI (0.3-1.0)] was inversely associated with HIV infection. A total of 88.9% of enrolled women were definitely or probably willing to participate in a future HIV vaccine trial. CONCLUSIONS: This study indicated that local eligibility criteria and recruitment methods can be developed to identify and recruit commercial sex workers with higher HIV prevalence than the general population who express willingness to join an HIV vaccine trial.
OBJETIVO: Evaluar nuevos criterios de selección y métodos extrainstitucionales encaminados a detectar y captar a las mujeres con alto riesgo de contraer la infección por virus de la inmunodeficiencia humana (VIH) en el Caribe. MÉTODOS: Del 2009 al 2012, se llevó a cabo un estudio prospectivo de cohortes de 799 mujeres profesionales del sexo en la República Dominicana, Haití y Puerto Rico. Los requisitos mínimos de selección fueron el intercambio de relaciones sexuales por bienes, servicios o dinero en los últimos 6 meses y las relaciones sexuales vaginales o anales sin protección con un hombre durante el mismo período. En cada centro se aplicaron criterios de selección y estrategias de captación más restrictivos, en función de las características epidemiológicas locales. Se formularon a las participantes preguntas acerca de la infección por el VIH/sida y su motivación para participar en un estudio clínico sobre la vacuna contra el VIH. Se usó un modelo de regresión logística con el fin de analizar los factores pronósticos de prevalencia de infección por el VIH y la voluntad de participar en un estudio futuro sobre la vacuna contra el virus. RESULTADOS: La prevalencia de infección por el VIH en el momento del tamizaje fue 4,6%. El consumo de crack se asoció con la infección por el VIH (razón de posibilidades [OR]: 4,2; intervalo de confianza [IC] de 95%: 1,8-9,0) y la práctica de relaciones sexuales con clientes en un hotel o un motel se asoció inversamente con esta infección (OR: 0,5; IC 95%: 0,3-1,0). El 88,9% de las mujeres inscritas manifestó una disposición decidida o probable de participar en un estudio futuro sobre la vacuna contra el VIH. CONCLUSIONES: Los resultados del estudio indican que es posible formular criterios de selección e introducir métodos de captación locales con el propósito de detectar y captar a las mujeres profesionales del sexo, que presentan una prevalencia de infección por el VIH mayor que la población general y manifiestan una buena disposición de participar en un ensayo clínico sobre la vacuna contra el VIH.
Assuntos
Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Ensaios Clínicos como Assunto/métodos , Infecções por HIV/epidemiologia , Doenças Profissionais/epidemiologia , Seleção de Pacientes , Profissionais do Sexo , Vacinas contra a AIDS , Atitude Frente a Saúde , Cultura , República Dominicana/epidemiologia , Soroprevalência de HIV , Haiti/epidemiologia , Consentimento Livre e Esclarecido , Estudos Prospectivos , Porto Rico/epidemiologia , Risco , Assunção de Riscos , Profissionais do Sexo/psicologia , Comportamento Sexual , Parceiros Sexuais , Fatores SocioeconômicosRESUMO
Clostridium difficile is the most common cause of infectious diarrhea in adults healthcare institutions. Recent studies have shown an increase in the incidence, severity and recurrence of C. difficile infection (CDI). Factors associated with the patient and medical care provided contribute to establishing colonization and, in some cases, subsequent progression to symptomatic disease. The availability of new microbiological techniques has contributed greatly to improving care for these patients. A diagnostic algorithm is provided for cases in which CDI is suspected based on current evidence regarding the effectiveness of microbiological and radiological methods. In cases in which CDI is confirmed, the first and most effective measure is the withdrawal of any antibiotic treatment the patient is receiving, if possible. The antimicrobial treatment of CDI is based on three classic agents: metronidazole, vancomycin and teicoplanin, along with the recent addition of fidaxomicin. Patients presenting serious symptoms, in addition to appropriate support and monitoring measures, may require surgical treatment. Infection prevention and control strategies can interrupt the transmission mechanism. This manuscript reviews current evidence on the approach of this entity from a multidisciplinary point of view.
Assuntos
Clostridioides difficile , Infecções por Clostridium , Algoritmos , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/etiologia , Infecções por Clostridium/terapia , Humanos , Técnicas Microbiológicas/métodos , Equipe de Assistência ao Paciente , Recidiva , Fatores de Risco , Índice de Gravidade de DoençaAssuntos
Infecções por HIV , Síndrome da Imunodeficiência Adquirida , Vacinas contra a AIDS , Profissionais do Sexo , Região do Caribe , República Dominicana , Haiti , Porto Rico , Infecções por HIV , Síndrome da Imunodeficiência Adquirida , Vacinas contra a AIDS , Profissionais do Sexo , Região do Caribe , República Dominicana , Ensaios Clínicos como Assunto , Cultura , Consentimento Livre e Esclarecido , Porto Rico , Risco , Comportamento Sexual , Parceiros Sexuais , Infecções por HIV , Doenças Profissionais , Seleção de Pacientes , Profissionais do Sexo , Vacinas contra a AIDS , Atitude Frente a Saúde , Soroprevalência de HIV , Estudos Prospectivos , Assunção de Riscos , Fatores SocioeconômicosRESUMO
La estomatitis aftosa recurrente es una forma de ulceración que afecta la mucosa bucal, de presentación frecuente, que se caracteriza por la aparición de una o varias úlceras dolorosas, variable en forma, tamaño y número; las lesiones se repiten periódicamente. Cura en pocos días, semanas o meses, en dependencia de los factores de riesgo que la desencadenaron; para su tratamiento se han ensayado una gran cantidad de terapias, pero sin resolver el problema subyacente. Con el objetivo de evaluar el comportamiento epidemiológico de la estomatitis aftosa recurrente en pacientes atendidos en el Instituto Superior de Medicina Militar Dr Luis Díaz Soto en el período de junio de 2006 hasta febrero de 2007, se realizó un estudio descriptivo de corte transversal a 97 pacientes, de uno y otro sexo con diagnóstico de estomatitis aftosa recurrente. Se tuvieron en cuenta los grupos de edades a partir de 15 hasta 60 años y más. Se evaluaron las variables: sexo, edad, forma clínica de la lesión, posibles factores de riesgo y tratamiento indicado. Se confeccionó una base de datos informatizado; para comprobar la relación entre las variables se utilizó la prueba chi cuadrado y se aplicó el valor porcentual. Desde el inicio del estudio se tuvieron en cuenta las consideraciones éticas que deben regir toda investigación. La mayoría de los individuos encuestados presentaron la forma menor de la enfermedad; solo el 6,2 y el 4,2 por ciento padecieron la forma mayor y herpetiforme, respectivamente; la mayor afectación ocurrió en los individuos más jóvenes y en el sexo femenino; la terapia combinada fue la que más se aplicó en los pacientes, seguida de las diferentes técnicas de tratamientos alternativos; se usó únicamente el tratamiento convencional en muy pocos casos.
Recurrent aphthous stomatitis is a way of ulceration affecting buccal mucosa, has a frequent presentation characterizing appearance of one or some painful ulcers, with a variable size, number and way, lesions are periodically repeated. It is recovery in days, weeks or months, depending of risk factors triggering it. For treatment of this condition we assayed many therapies but without solution of underlying problem. The aim of present paper is to assess the epidemiologic behavior of recurrent stomatitis in patients seen in Dr. Luís Díaz Soto Higher Institute of Military Medicine from June 2006 to February 2007. We made a cross-sectional and descriptive study in 97 patients of both sexes diagnosed with this condition. We took into account age groups aged from 15 up to 60 or more. We assessed the following variables: sex, age, clinical presentation of lesion, possible risk factors and treatment prescribed. An information database was created; to verify relation among variables we used Chi2 test and percentage value was applied. From the beginning of study we took into account the ethical considerations that must to determine a research. Most of surveyed individuals had the lower way of disease, only the 6,2 and the 4,2 percent suffered from the great way and the herpertiform type, respectively; the greatest affection was present in younger individuals and in female sex; combined therapy was the more used in patients, followed by different techniques of alternative treatments; we used only the conventional treatment in very few cases.