RESUMO
AIM: Cherubism is an uncommon hereditary disease that leads to the development of giant cell lesions in the jaws, alterations in the dentition, and malocclusion. The biological behavior of bones to orthodontic forces in these patients is not described in the literature, leading dentists to avoid this management. The aim of this article was to describe a case report of management with orthodontics. We present details regarding clinicoradiographic features, diagnosis, treatment, and follow-up. CASE REPORT: A 12-year-old male patient diagnosed with cherubism presented to our service with complaints about his esthetic facial and dental appearance. Management was interdisciplinary, including careful and controlled orthodontic treatment. The results were satisfactory; alignment, dental leveling, and correction of the malocclusion were achieved. CONCLUSION: Patients with cherubism may benefit from orthodontics, improving oral function, and esthetic and psychosocial well-being. The orthodontic treatment might be performed according to the severity of clinical manifestation, expectations of the patients, and limitations of each case.
Assuntos
Querubismo , Má Oclusão , Dente , Criança , Estética Dentária , Humanos , Masculino , Ortodontia CorretivaRESUMO
ABSTRACT Herein we report a fatal case of donor-derived transmission of XDR-resistant carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) in cardiac transplantation. A 59-year-old male patient with non-obstructive hypertrophic cardiomyopathy underwent heart transplantation. On day 5 post-operation, blood cultures from the donor were positive for colistin-resistant carbapenemase-producing K. pneumoniae (ColR KPC-Kp) susceptible only to amikacin. Recipient blood cultures were also positive for ColR KPC-Kp with the same sensitivity profile as the donor isolate with an identical PFGE pattern. The patient was treated with double-carbapenems and amikacin. The patient evolved to pericarditis, osteomyelitis, and pulmonary necrosis, all fragment cultures positive for the same agent. The patient developed septic shock, multiple organ failure and died on day 50 post-transplantation. Based on current microbiological scenario worldwide the possibility of transmitting multidrug resistant (MDR) organisms should be considered.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Doadores de Tecidos , Infecções por Klebsiella/transmissão , Transplante de Coração/efeitos adversos , Transplantados , Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Klebsiella pneumoniae/isolamento & purificação , Infecções por Klebsiella/tratamento farmacológico , Fatores de Risco , Colistina/farmacologia , Evolução Fatal , Farmacorresistência Bacteriana Múltipla , Antibacterianos/farmacologiaRESUMO
Herein we report a fatal case of donor-derived transmission of XDR-resistant carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) in cardiac transplantation. A 59-year-old male patient with non-obstructive hypertrophic cardiomyopathy underwent heart transplantation. On day 5 post-operation, blood cultures from the donor were positive for colistin-resistant carbapenemase-producing K. pneumoniae (ColR KPC-Kp) susceptible only to amikacin. Recipient blood cultures were also positive for ColR KPC-Kp with the same sensitivity profile as the donor isolate with an identical PFGE pattern. The patient was treated with double-carbapenems and amikacin. The patient evolved to pericarditis, osteomyelitis, and pulmonary necrosis, all fragment cultures positive for the same agent. The patient developed septic shock, multiple organ failure and died on day 50 post-transplantation. Based on current microbiological scenario worldwide the possibility of transmitting multidrug resistant (MDR) organisms should be considered.
Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Transplante de Coração/efeitos adversos , Infecções por Klebsiella/transmissão , Klebsiella pneumoniae/isolamento & purificação , Doadores de Tecidos , Transplantados , Antibacterianos/farmacologia , Colistina/farmacologia , Farmacorresistência Bacteriana Múltipla , Evolução Fatal , Humanos , Infecções por Klebsiella/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
Para muchos, la sociedad puede entenderse como un organismo, cuyos fenómenos y acontecimientos pueden abordarse de la misma manera que un médico examina y estudia un cuerpo. La lógica del organismo establece que una sociedad está formada por un conjunto de unidades individuales dotadas de vida propia. La sociedad, tal como sucede con todo organismo vivo, puede enfermar o verse seriamente amenazado por elementos nocivos que pueden afectarlo estructural y funcionalmente, poner en riesgos u integridad o incluso su vida. Aunque no todas las sociedades son iguales, ni todos sus componentes comparten las mismas características, existen elementos que afectan a todas sus capas, aunque sus efectos son más evidentes en unas comunidades que en otras
Assuntos
Pobreza , Resíduos , Comportamento Aditivo , Transtornos Relacionados ao Uso de Substâncias , Meio Ambiente , Poluição AmbientalRESUMO
La masacre en el local gay de Orlando dejó como saldo 50 muertos y 53 heridos y abre nuevamente el debate sobre varios temas polémicos en la sociedad. La homofobia, la intolerancia, el extremismo religioso,la violencia y un sin fin de otras cuestiones no menos preocupantes.
Assuntos
Problemas Sociais , Violência , Homofobia , Discriminação SocialRESUMO
Two patients with mild cognitive impairment underwent C-PiB and F-FDG brain PET. Both patients had previously gone through a contrast-enhanced MRI scan that revealed extra-axial tumors next to the sphenoid wing, suggestive of meningiomas. C-PiB PET images showed a highly increased uptake by the extra-axial masses. These 2 cases represent 1.2% of our C-PiB population (n = 163). No meningioma was found with negative C-PiB uptake. The F-FDG concentration was not increased within the lesions. C-PiB could be used as a meningioma marker.
Assuntos
Benzotiazóis , Fluordesoxiglucose F18 , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Idoso , Compostos de Anilina , Feminino , Humanos , Imagem Multimodal , Tiazóis , Tomografia Computadorizada por Raios XRESUMO
Hablar de justicia y equidad exige más que un análisis semántico. Se trata de problemas reales y complejos, enraizados en el seno mismo de la sociedad y donde actúan como causas y consecuencias un sinfín de situaciones que ponen a prueba las bases jurídicas, morales y humanas del mundo y del tiempo en el que vivimos.La justicia, conmutativa cuando trata de igualdad y distributiva cuando asigna proporciones, está supeditada a quienes se encargan de administrarla, de ejercerla o de otorgarla. Por tanto, la justicia no es una virtud ni es un atributo infalible, sino una cuestión humana, por tanto falible, imperfecta y con frecuencia injusta y desigual. Justicia y equidad son cuestiones de carácter humano cuya mejoría debe apoyar en mayor conciencia social, más empatía, más bondad, y más amor. Necesitamos más corazón y más humanidad, con ello, la justicia y la equidad vendrán solas
Assuntos
Saúde Pública , Equidade/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde , Direitos Humanos , Direito SanitárioRESUMO
El avance de las sociedades postula desafíos y problemas que complejizan la vida comunitaria. Los cambios son vertiginosos. A veces, las acciones avanzan más rápido que las ideas o las propuestas destinadas a resolver los problemas que suscitan. El aborto ocupa un lugar destacado dentro del debate público. Implica aspectos fundamentales entre los que se cuentan: la vida, la muerte, la salud, la religión, la ética, la moral y sus límites, la capacidad de decidir por uno mismo y la potestad para decidir por alguien más. El aborto es una problemática socio-sanitaria que trasciende a sí misma y nos arrolla con su complejidad.
Assuntos
Humanos , Feminino , Gravidez , Gravidez não Desejada , Religião , Educação Sexual , Aspirantes a Aborto , Aborto Legal , Aborto Legal/educação , Aborto Legal/legislação & jurisprudência , Aborto Legal/éticaAssuntos
Dor Abdominal/etiologia , Linfoma Difuso de Grandes Células B/diagnóstico , Mesentério , Neoplasias Peritoneais/diagnóstico , Idoso , Biópsia , Humanos , Laparoscopia , Linfoma Difuso de Grandes Células B/complicações , Masculino , Mesentério/patologia , Neoplasias Peritoneais/complicações , Tomografia Computadorizada por Raios XRESUMO
Pulmonary infiltrates remain as a diagnostic and therapeutic challenge in cancer patients. In order to evaluate the etiology, diagnostic methods used, Intensive Care Unit admission and in-hospital mortality, we conducted an observational, prospective study which included all patients with cancer and recent pulmonary infiltrates admitted to the Instituto Alexander Fleming between August 2003 and March 2006. Diagnostic methods were categorized in sequential steps of complexity: 1st step: radiological pattern of the pulmonary infiltrates, blood and sputum cultures, serological tests and empirical treatment response; 2nd step: bronchoalveolar lavage (BAL), non bronchoscopic tracheal aspirate and mini-BAL; 3rd step: pulmonary or extrapulmonary biopsies. Pulmonary infiltrate etiology was classified as: infection, treatment complication, disease progression, cardiovascular or mixed. Diagnosis was classified as proved or probable. A total of 106 samples from 103 patients were included. The etiologies were infection in 61 cases, disease progression in 4, treatment complication in 6, cardiovascular in 6 and mixed in 7. Proved diagnosis was obtained in 33 cases and probable diagnosis in 51 while 22 cases could not be diagnosed. Nine of the 10 diagnoses of mycoses were in oncohematologic cases. Seventy cases did not go further than procedures included in the 1st step. Thirty two cases stopped after diagnostic procedures of the 2nd step and 4 required biopsies. Forty four cases required Intensive Care Unit admission. In-hospital mortality was 30.2%. In our study, infection was the most frequent etiology. Mycoses were more frequent in oncohematologic cases. A proved or probable diagnosis was obtained in 84 (79.2%) cases. In 53.7% of the cases only non-invasive diagnostic methods were required.
Assuntos
Pneumopatias/etiologia , Neoplasias/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Progressão da Doença , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Pneumopatias/mortalidade , Pneumopatias/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Neoplasias/patologia , Complicações Pós-Operatórias , Estudos Prospectivos , Adulto JovemRESUMO
La aparición de infiltrados pulmonares en los pacientes con cáncer representa un desafío diagnóstico y terapéutico. Con el objeto de evaluar la etiología, utilización de métodos diagnósticos, admisión en Terapia Intensiva (UTI) y letalidad intrahospitalaria de estos pacientes, realizamos un estudio prospectivo observacional donde se incluyeron todos los pacientes con cáncer y nuevos infiltrados pulmonares internados en el Instituto Alexander Fleming entre marzo 2003 y agosto 2006. Los métodos diagnósticos fueron categorizados en 3 etapas (1ª etapa: patrón radiológico de los infiltrados pulmonares, hemocultivos, cultivo de esputo, pruebas serológicas y respuesta al tratamiento empírico inicial; 2ª etapa: lavado broncoalveolar (LBA), aspirado traqueal y mini-LBA; 3ª etapa: biopsias pulmonares o extrapulmonares). La etiología de los infiltrados pulmonares se clasificó como infección, complicación del tratamiento, progresión de enfermedad, cardiovascular o mixta. Los diagnósticos fueron clasificados en diagnóstico de certeza o diagnóstico probable. Se incluyeron 106 casos en 103 pacientes. La etiología fue: infección en 61 casos, progresión de enfermedad en 4, complicación del tratamiento en 6, cardiovascular en 6 y mixta en 7. Se obtuvo diagnóstico de certeza en 33 casos y diagnóstico probable en 51. Se clasificaron como sin diagnóstico 22 casos. Nueve de las 10 micosis diagnosticadas fueron en pacientes oncohematológicos. Setenta casos se detuvieron en la 1ª etapa diagnóstica, 32 en la 2ª etapa y 4 necesitaron biopsias. Requirieron internación en UTI 44 casos. La letalidad intrahospitalaria fue 30.2%. En nuestro estudio, la infección fue la etiología más frecuente y las micosis fueron predominantes en los pacientes oncohematológicos. Se obtuvo diagnóstico de certeza o diagnóstico probable en 84 (79.2%) casos. En 53.7% de los casos no se requirieron métodos diagnósticos invasivos.
Pulmonary infiltrates remain as a diagnostic and therapeutic challenge in cancer patients. In order to evaluate the etiology, diagnostic methods used, Intensive Care Unit admission and in-hospital mortality, we conduced an observational, prospective study which included all patients with cancer and recent pulmonary infiltrates admitted to the Instituto Alexander Fleming between August 2003 and March 2006. Diagnostic methods were categorized in sequential steps of complexity: 1st step: radiological pattern of the pulmonary infiltrates, blood and sputum cultures, serological tests and empirical treatment response; 2nd step: bronchoalveolar lavage (BAL), non bronchoscopic tracheal aspirate and mini-BAL; 3rd step: pulmonary or extrapulmonary biopsies. Pulmonary infiltrate etiology was classified as: infection, treatment complication, disease progression, cardiovascular or mixed. Diagnosis was classified as proved or probable. A total of 106 samples from 103 patients were included. The etiologies were infection in 61 cases, disease progression in 4, treatment complication in 6, cardiovascular in 6 and mixed in 7. Proved diagnosis was obtained in 33 cases and probable diagnosis in 51 while 22 cases could not be diagnosed. Nine of the 10 diagnoses of mycoses were in oncohematologic cases. Seventy cases did not go further than procedures included in the 1st step. Thirty two cases stopped after diagnostic procedures of the 2nd step and 4 required biopsies. Forty four cases required Intensive Care Unit admission. In-hospital mortality was 30.2%. In our study, infection was the most frequent etiology. Mycoses were more frequent in oncohematologic cases. A proved or probable diagnosis was obtained in 84 (79.2%) cases. In 53.7% of the cases only non-invasive diagnostic methods were required.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Pneumopatias/etiologia , Neoplasias/complicações , Argentina/epidemiologia , Progressão da Doença , Mortalidade Hospitalar , Unidades de Terapia Intensiva , Pneumopatias/mortalidade , Pneumopatias/patologia , Neoplasias/mortalidade , Neoplasias/patologia , Complicações Pós-Operatórias , Estudos ProspectivosRESUMO
Objetivo: Evaluar en forma retrospectiva la fiabilidad diagnóstica del sistema de doble lectura en RM craneoespinal a fin de obtener datos que permitan valorar su impacto sobre la calidad del informe final. Material y Métodos: Sobre un total de 13.460 RM craneoespinales realizadas en 2007 se revisaron en forma retrospectiva y aleatoria 450 informes de RM de columna y 900 informes de RM de cráneo. Entre la primera y la segunda lectura se juzgaron unicamente cambios de fondo, es decir aquellos pasibles de modificar la interpretación de las imágenes y consecuentemente, el diagnóstico final. Resultados: Se realizaron modificaciones en 75 informes de columna (17%) y en 115 de cráneo (13%). Conclusión: el sistema de doble lectura modifica de manera significativa la calidad del informe final.
Purpose:The aim of this paper is to evaluate retrospectively the diagnostic reliability of the double reading system in Spinal and Brain MRI. Material and Methods: Along 2007, 13460 Spinal andBrain MRI were performed, we reviewed 450 reports of Spinal MRI and 900 Brain MRI reports.Between the firstand the second report we paid attention only at major modifications that can modify the final diagnosis. Results: We founded major modifications in 75 (17%) of Spinal MRI reports and in 115 (13%) of the MRI brain reports. Conclusion: The double reading system improve significatively the quality of the final report.