RESUMO
PURPOSE: Thyroid ultrasound is a key tool in the evaluation of the thyroid, but billions of people around the world lack access to ultrasound imaging. In this study, we tested an asynchronous telediagnostic ultrasound system operated by individuals without prior ultrasound training which may be used to effectively evaluate the thyroid and improve access to imaging worldwide. METHODS: The telediagnostic system in this study utilizes volume sweep imaging (VSI), an imaging technique in which the operator scans the target region with simple sweeps of the ultrasound probe based on external body landmarks. Sweeps are recorded and saved as video clips for later interpretation by an expert. Two operators without prior ultrasound experience underwent 8 h of training on the thyroid VSI protocol and the operation of the telemedicine platform. After training, the operators scanned patients at a health center in Lima. Telediagnostic examinations were sent to the United States for remote interpretation. Standard of care thyroid ultrasound was performed by an experienced radiologist at the time of VSI examination to serve as a reference standard. RESULTS: Novice operators scanned 121 subjects with the thyroid VSI protocol. Of these exams, 88% were rated of excellent image quality showing complete or near complete thyroid visualization. There was 98.3% agreement on thyroid nodule presence between VSI teleultrasound and standard of care ultrasound (Cohen's kappa 0.91, P < 0.0001). VSI measured the thyroid size, on average, within 5 mm compared to standard of care. Readers of VSI were also able to effectively characterize thyroid nodules, and there was no significant difference in measurement of thyroid nodule size (P = 0.74) between VSI and standard of care. CONCLUSION: Thyroid VSI telediagnostic ultrasound demonstrated both excellent visualization of the thyroid gland and agreement with standard of care thyroid ultrasound for nodules and thyroid size evaluation. This system could be deployed for evaluation of palpable thyroid abnormalities, nodule follow-up, and epidemiological studies to promote global health and improve the availability of diagnostic imaging in underserved communities.
Assuntos
Acessibilidade aos Serviços de Saúde , Telemedicina , Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide , Ultrassonografia , Adulto , Feminino , Saúde Global/tendências , Acessibilidade aos Serviços de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/normas , Acessibilidade aos Serviços de Saúde/tendências , Humanos , Masculino , Área Carente de Assistência Médica , Peru/epidemiologia , Melhoria de Qualidade , População Rural , Padrão de Cuidado , Telemedicina/métodos , Telemedicina/organização & administração , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/epidemiologia , Ultrassonografia/métodos , Ultrassonografia/normasRESUMO
Resumen En la actualidad existe un gran número de apósitos dada la amplia disponibilidad de biomateriales y principios bioactivos, por lo cual se hace necesario un consenso acerca de la clasificación de estos, para no generar confusiones a la hora de entender su utilidad y su idóneo manejo en el ambiente clínico. Por este motivo, en el presente artículo se hace una revisión bibliográfica utilizando las bases de datos SCOPUS, ScienceDirect y Web of Science, con ecuaciones de búsqueda que incluían las palabras clave de los diferentes tipos de apósitos. Con esta información se encuentra que los apósitos pueden ser clasificados de acuerdo con su complejidad, la naturaleza del material polimérico, su permeabilidad, su interacción biológica con la herida y su acción terapéutica, lográndose tener una definición detallada con todos las características relevantes para hacer una adecuada elección de un apósito. Adicionalmente, se incluye una revisión acerca del proceso de cicatrización y los tipos de heridas, dado que de esto dependen los fines terapéuticos y la selección de un apósito u otro.
Abstract Nowadays, there is wide variety of dressings because availability of biomaterials and bioactive components, thus a consensus is needed on their classification, to avoid in understanding their usefulness and their proper handling in clinical practice. Therefore, in this paper a bibliographic review is made using the SCOPUS, ScienceDirect and Web of science databases, with search equations which include the keywords of different types of wound dressings. With this information, we found that dressings can be classified according to their complexity, the nature of the polymeric material, its permeability, its biological interaction with the wound and its therapeutic action, in order to have a detailed definition with all the relevant characteristics to make a proper choice of a dressing. Additionally, a review about the healing process and the types of wounds is included, since this have an important influence on the therapeutic purposes and the correct selection of dressings.
RESUMO
Surfaces were prepared with polyelectrolyte derivatives of poly(styrene- alt-maleic anhydride) (PSMA) functionalized with amino acids of different hydropathy indices, with the aim of evaluating the effect of the chemical functionality of polyelectrolytes on SH-SY5Y neuroblastoma cell adhesion. Functionalizing PSMA derivatives with l-glutamine, l-methionine, and l-tyrosine yielded PSMA-Gln, PSMA-Met, and PSMA-Tyr polyelectrolytes, respectively. We first studied the adsorption behavior of PSMA functionalized with amino acids on silicon wafer surfaces modified with 3-aminopropyltriethoxysilane at pH 4.0 and 7.0 and at low and high ionic strengths. The highest rate of polyelectrolyte adsorption was at pH 4.0 and high ionic strength and was higher with the glutamine and tyrosine films. The advance contact angles (θA) of the polyelectrolyte surfaces showed a moderate effect of ionic strength and pH on polyelectrolyte film wettability, with PSMA-Tyr being slightly more hydrophobic. Atomic force microscopy images of the polyelectrolyte surfaces showed two types of morphology: the well-defined globular nanostructure of PSMA-Met and PSMA-Tyr and densely packed nanofibrous-like structure of PSMA-Gln. The highest level of ionic strength caused a slight decrease in the size of the nanostructure that formed the surface domains, which was reflected in the degree of surface roughness. Cell adhesion assays with the polyelectrolyte film showed that SH-SY5Y neuroblastoma cells cultured on PSMA-Met present a well-extended morphology characterized by a stellate shape, with five or more actin-rich thin processes, whereas SH-SY5Y cells that were seeded on PSMA-Gln and PSMA-Tyr have a round morphology, with fewer and shorter processes. These results indicate that it is possible to modulate the surface characteristics of polyelectrolyte films based on their chemical functionality and environmental parameters such as pH and ionic strength in order to evaluate their effect on cell adhesion. Thus, surfaces prepared from polyelectrolytes functionalized with amino acids are an attractive and simple platform for cell adhesion, which can be used in developing biomaterials with modulated surface properties.
Assuntos
Aminoácidos/química , Nanoestruturas/química , Polieletrólitos/química , Polímeros/química , Adesão Celular/efeitos dos fármacos , Linhagem Celular Tumoral , Humanos , Concentração de Íons de Hidrogênio , Maleatos/química , Microscopia Eletrônica de Varredura , Nanoestruturas/ultraestrutura , Polímeros/farmacologia , Poliestirenos/química , Espectroscopia de Infravermelho com Transformada de Fourier , Propriedades de Superfície , MolhabilidadeAssuntos
Enterite/diagnóstico , Eosinofilia/diagnóstico , Gastrite/diagnóstico , Gastroenterite/diagnóstico , Adulto , Enterite/dietoterapia , Enterite/tratamento farmacológico , Eosinofilia/dietoterapia , Eosinofilia/tratamento farmacológico , Feminino , Gastrite/dietoterapia , Gastrite/tratamento farmacológico , Gastroenterite/dietoterapia , Gastroenterite/tratamento farmacológico , Humanos , Prednisolona/uso terapêutico , Doenças RarasRESUMO
The use of implants carries on a series of problems, among them infections, poor biocompatibility, high levels of cytotoxicity, and significant mechanical differences between implants and host organs that promote stress shielding effects. These problems indicate that the materials used to make implants must meet essential requirements and high standards for implantations to be successful. In this work, we present the synthesis, characterization and evaluation of the antibiofilm, mechanical, and thermal properties, and cytotoxic effect of a nanocomposite-based scaffold on polyurethane (PU) and gold nanoparticles (AuNPs) for soft tissue applications. The effect of the quantity of AuNPs on the antibacterial activity of nanocomposite scaffolds was evaluated against Staphylococcus epidermidis and Klebsiella spp., with a resulting 99.99% inhibition of both bacteria using a small quantity of nanoparticles. Cytotoxicity was evaluated with the T10 1/2 test against fibroblast cells. The results demonstrated that porous nanogold/PU scaffolds have no toxic effects on fibroblast cells to the 5 day exposition. With respect to mechanical properties, stress-strain curves showed that the compressive modulus and yield strength of PU scaffolds were significantly enhanced by AuNPs (by at least 10 times). This is due to changes in the arrangement of hard segments of PU, which increase the stiffness of the polymer. Thermogravimetric analysis showed that the degradation onset temperature rises with an increase in the quantity of AuNPs. These properties and characteristics demonstrate that porous nanogold/PU scaffolds are suitable material for use in soft tissue implants.
Assuntos
Poliuretanos/química , Materiais Biocompatíveis , Sobrevivência Celular , Ouro , Nanopartículas Metálicas , Porosidade , Engenharia Tecidual , Alicerces TeciduaisRESUMO
The house mouse (Mus musculus) and the black rat (Rattus rattus) are reservoir hosts for zoonotic pathogens, several of which cause neglected tropical diseases (NTDs). Studies of the prevalence of these NTD-causing zoonotic pathogens, in house mice and black rats from tropical residential areas are scarce. Three hundred and two house mice and 161 black rats were trapped in 2013 from two urban neighbourhoods and a rural village in Yucatan, Mexico, and subsequently tested for Trypanosoma cruzi, Hymenolepis diminuta and Leptospira interrogans. Using the polymerase chain reaction we detected T. cruzi DNA in the hearts of 4·9% (8/165) and 6·2% (7/113) of house mice and black rats, respectively. We applied the sedimentation technique to detect eggs of H. diminuta in 0·5% (1/182) and 14·2% (15/106) of house mice and black rats, respectively. Through the immunofluorescent imprint method, L. interrogans was identified in 0·9% (1/106) of rat kidney impressions. Our results suggest that the black rat could be an important reservoir for T. cruzi and H. diminuta in the studied sites. Further studies examining seasonal and geographical patterns could increase our knowledge on the epidemiology of these pathogens in Mexico and the risk to public health posed by rodents.
Assuntos
Doença de Chagas/veterinária , Himenolepíase/veterinária , Leptospirose/veterinária , Camundongos , Ratos , Doenças dos Roedores/epidemiologia , Animais , Doença de Chagas/epidemiologia , Doença de Chagas/parasitologia , Reservatórios de Doenças/microbiologia , Reservatórios de Doenças/parasitologia , Meio Ambiente , Himenolepíase/epidemiologia , Himenolepíase/parasitologia , Hymenolepis diminuta/isolamento & purificação , Leptospira interrogans/isolamento & purificação , Leptospirose/epidemiologia , Leptospirose/microbiologia , México/epidemiologia , Prevalência , Doenças dos Roedores/microbiologia , Doenças dos Roedores/parasitologia , Roedores , Trypanosoma cruzi/isolamento & purificação , Zoonoses/epidemiologia , Zoonoses/microbiologia , Zoonoses/parasitologiaRESUMO
Este artículo presenta la experiencia de aplicación de una prueba tamiz para la identificación precoz de la patología bucal. Se expone el concepto, los componentes, las características, las ventajas y desventajas del método y se analizan los resultados de su aplicación en la práctica. Los índices precisos de caries en las colectividades no se conocen por la dificultad de realizar estudios masivos y periódicos, pero se infiere que su incidencia va en aumento porque los escolares no están acudiendo a los centros de atención, según informes recientes de instituciones odontológicas comprometidas con la salud pública en Antioquia. El tamizaje es una estrategia que permite la detección de factores de riesgo y el diagnóstico precoz de enfermedades desde la fase asintomática. Con el tamizaje bucal se induce la demanda a los centros de atención, detectando tempranamente muchas patologías orales en grandes poblaciones de niños y adolescentes. También se puede lograr un diagnóstico presuntivo del estado de salud bucal que provea información para establecer la magnitud de los problemas y un programa de tratamiento preventivo. En el municipio de Envigado, Antioquia, se tamizaron 10.489 niños de las escuelas públicas con el mínimo de costos, complejidad y demora y con buena aceptación de la comunidad. Se orientaron los niños afectados a sus respectivos servicios de salud por medio de remisiones a padres de familia y maestros. El tamizaje bucal debe efectuarse periódicamente con el fin de hacer vigilancia epidemiológica a problemas tan frecuentes como la caries dental.
Assuntos
Diagnóstico Bucal , Técnicas e Procedimentos Diagnósticos , Diagnóstico Precoce , Odontologia Preventiva , Prevenção Primária , Peneiramento de LíquidosRESUMO
The purpose of this investigation was to explore the frequency and nature of ungual alterations in patients of a pediatric dermatology department at a third-level pediatric hospital. The first 20 patients with nail alterations seen each year during a 5-year period from 1992 through 1996 were included, totaling 100 patients. The rate of nail alterations was 11% (1/9) in pediatric dermatology patients. There were 5 infants, 19 preschoolers (2- to 5-year-olds), 38 school children (6- to 11-year-olds), and 38 adolescents (12- to 17-year-olds). The most frequent diagnoses were onychomycosis (23), nail alterations in a genodermatosis (23), nail alterations associated with dermatoses (16), onychocryptosis (11), and paronychia (10). Toenails were involved in 54 patients, fingernails in 25, and both in 21 patients. Twenty nails were involved in 21 patients. A high prevalence of nail alterations was found in pediatric dermatology patients, some of which were nonspecific, while others provided important diagnostic clues.
Assuntos
Doenças da Unha/patologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , México/epidemiologia , Doenças da Unha/complicações , Doenças da Unha/epidemiologia , Prevalência , Estudos Retrospectivos , Dermatopatias/complicaçõesRESUMO
Three cutaneous manifestations are characteristic of Bart syndrome: congenital localized absence of skin (CLAS), mucocutaneous blistering, and nail abnormalities. Six cases of Bart syndrome are herein reported. Localized absence of skin is present at birth, particularly on the anterior aspects of the lower extremities and dorsa of the feet. Physical trauma in utero has been proposed as a mechanism to explain the denuded areas on the limbs. The recurrent, highly similar pattern of the congenital defect in regard to location and clinical appearance in our patients and in most of the reported cases strongly suggests that trauma is too simplistic an explanation. Because of the observed bilateral and symmetric distribution of denuded areas in an S-shaped broad band, their sharply demarcated borders, the involvement of the toe webs, and the frequent similar involvement of the soles, we suggest that congenital localized absence of skin in Bart syndrome may follow the lines of Blaschko.
Assuntos
Anormalidades da Pele/patologia , Vesícula/patologia , Feminino , Humanos , Recém-Nascido , Perna (Membro)/embriologia , Masculino , Unhas Malformadas/patologia , Anormalidades da Pele/embriologia , SíndromeAssuntos
Artrite Psoriásica/diagnóstico , Dermatoses do Pé/diagnóstico , Dermatoses da Mão/diagnóstico , Doenças da Unha/diagnóstico , Pré-Escolar , Diagnóstico Diferencial , Dermatoses do Pé/patologia , Dermatoses da Mão/patologia , Humanos , Masculino , Doenças da Unha/patologia , Psoríase/diagnóstico , Psoríase/patologiaRESUMO
BACKGROUND: Silvery hair and severe dysfunction of the central nervous system (neuroectodermal melanolysosomal disease or Elejalde syndrome) characterize this rare autosomal recessive disease. Main clinical features include silver-leaden hair, bronze skin after sun exposure, and neurologic involvement (seizures, severe hypotonia, and mental retardation). Large granules of melanin unevenly distributed in the hair shaft are observed. Abnormal melanocytes and melanosomes and abnormal inclusion bodies in fibroblasts may be present. Differential diagnosis with Chédiak-Higashi syndrome and Griscelli syndrome must be done. OBSERVATIONS: We studied pediatric patients with silvery hair and profound neurologic dysfunction. Immune impairment was absent. Age of onset of neurologic signs ranged from 1 month to 11 years; the signs included severe muscular hypotonia, ocular alterations, and seizures. Mental retardation since the first months of life was noted in 4 cases. Psychomotor development was normal in 3 cases, but suddenly the patients presented with a regressive neurologic process. Four patients died between 6 months and 3 years after the onset of neurologic dysfunction. One patient showed characteristic ultrastructural findings of Elejalde syndrome. CONCLUSIONS: Elejalde syndrome is different from Chédiak-Higashi and Griscelli syndrome and is characterized by silvery hair and frequent occurrence of fatal neurologic alterations. Psychomotor impairment may have 2 forms of presentation: congenital or infantile. Although Elejalde syndrome and Griscelli syndrome are similar, the possibility that they are 2 different diseases, although probably allelic related, is suggested.
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Doenças do Sistema Nervoso Central , Fibroblastos/patologia , Cor de Cabelo , Cabelo/anormalidades , Melanócitos/patologia , Transtornos da Pigmentação , Doenças do Sistema Nervoso Central/diagnóstico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Transtornos da Pigmentação/diagnóstico , SíndromeRESUMO
Dried blood specimens spotted on filter paper were evaluated by the HIV-1 DAVIH Dot system from DAVIH Laboratories (Havana, Cuba). The samples used, 103 positive and 105 negative, were previously confirmed by DAVIH Blot from DAVIH Laboratories. In order to use the dried blood on filter paper some modifications were made to the original procedure regarding the times of incubation of the samples and conjugate, and the agitation in both stages. Relative sensitivity and specificity of 100 and 99.05%, respectively, were attained.
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Sorodiagnóstico da AIDS/métodos , Western Blotting/métodos , Anticorpos Anti-HIV/sangue , Filtração/instrumentação , Humanos , Papel , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Because of their size and the possibility of complications, giant hemangiomas represent a therapeutic challenge. Various forms of treatment have been used, with variable results, including surgery, embolization, lasers, pentoxifylline, and corticosteroids. Interferon alfa has been used successfully to treat life-threatening hemangiomas, possibly by means of its antiangiogenic activity. OBSERVATIONS: We treated 7 infants with organ-interfering and/or life-threatening giant hemangiomas with subcutaneous injections of 3 million U/m2 per day of interferon alfa-2b during the first month and subsequently every 48 to 72 hours, depending on the evolution in each case. The treatment lasted from 3 to 12 months. In 2 patients, interferon alfa-2b was administered while prednisone therapy was being tapered. In all 7 patients, there was considerable reduction of the volume of the hemangiomas and remission of their complications. All patients presented with fever, neutropenia, and an increase in serum aminotransferase levels. The patients who received interferon alfa-2b and prednisone seemed to improve at a faster rate. CONCLUSIONS: Interferon alfa-2b is a good option for the treatment of patients with steroid-resistant, organ-interfering and/or life-threatening giant hemangiomas. In our experience, the adverse effects were transient and minor and did not require the interruption of the treatment.
Assuntos
Antineoplásicos/administração & dosagem , Neoplasias Palpebrais/terapia , Neoplasias Faciais/terapia , Neoplasias de Cabeça e Pescoço/terapia , Hemangioma/terapia , Interferon-alfa/administração & dosagem , Neoplasias Cutâneas/terapia , Antineoplásicos/efeitos adversos , Avaliação de Medicamentos , Neoplasias Palpebrais/diagnóstico , Neoplasias Faciais/diagnóstico , Feminino , Neoplasias de Cabeça e Pescoço/diagnóstico , Hemangioma/diagnóstico , Humanos , Lactente , Injeções Subcutâneas , Interferon alfa-2 , Interferon-alfa/efeitos adversos , Masculino , Estudos Prospectivos , Proteínas Recombinantes , Neoplasias Cutâneas/diagnóstico , Fatores de TempoRESUMO
Two children with acute lymphoblastic leukemia undergoing chemotherapy had a special form of scabies characterized by fine scaling of the scalp simulating seborrheic dermatitis. Pruritus was mild or absent. Immunocompromised children and adults should receive whole-body and scalp antiscabietic treatment.
Assuntos
Dermatite Seborreica/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Escabiose/diagnóstico , Dermatoses do Couro Cabeludo/diagnóstico , Criança , Pré-Escolar , Dermatite Seborreica/imunologia , Diagnóstico Diferencial , Humanos , Hospedeiro Imunocomprometido , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Escabiose/imunologia , Dermatoses do Couro Cabeludo/imunologiaRESUMO
Eighty pediatric patients with giant pigmented nevi more than 20 cm in their greatest diameter are reported. The incidence was 1 in 4150 general pediatric outpatients. The mode of inheritance of giant pigmented nevi is probably multifactorial; four second-degree relatives of our patients also had large nevi, and there was a 2:1 female predominance. Satellite nevi were present in 74% and nevi in mucous membranes in 31% of the patients. Eighty-six percent of nevi were pigmented and hairy. Benign nodules were observed in 19% of the patients and plexiform overgrowths in 6%. Nevi extensively involving the extremities resulted in reduced growth of the affected limb. Electroencephalograms showed abnormalities in 20% of the patients with giant pigmented nevi involving the head and upper portion of the trunk. Malignant transformation appeared in four patients and was fatal in three of them. Management consisted of observation only in 49%, surgery in 27.5%, chemical peel in 21%, and dermabrasion in 2.5% of the patients. The mean follow-up was 4.7 years.
Assuntos
Nevo Pigmentado , Neoplasias Cutâneas , Seguimentos , Humanos , Incidência , Lactente , México/epidemiologia , Nevo Pigmentado/epidemiologia , Nevo Pigmentado/genética , Nevo Pigmentado/terapia , Estudos Prospectivos , Pele/patologia , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/terapia , Fatores de TempoRESUMO
We conducted a 20-year prospective review of 41 pediatric patients with a diagnosis of hypomelanosis of Ito. No evidence pointed to hereditary transmission of the disease. Associated extracutaneous pathology was mainly of the nervous and musculoskeletal systems. Three of 19 patients had chromosomal anomalies. Hypomelanosis of Ito is a clinically well-characterized syndrome in which chromosomal instability may be a component. Criteria for its presumptive and definitive diagnosis are proposed.
Assuntos
Anormalidades Múltiplas , Transtornos da Pigmentação/diagnóstico , Adolescente , Criança , Pré-Escolar , Aberrações Cromossômicas , Transtornos Cromossômicos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Anormalidades Musculoesqueléticas , Doenças do Sistema Nervoso/complicações , Transtornos da Pigmentação/complicações , Transtornos da Pigmentação/genética , Estudos ProspectivosRESUMO
The incidence of primary and metastatic cutaneous malignant solid tumors was investigated in a pediatric dermatology department. Among 25,000 first time patients seen between 1971 and 1985, 19 had cutaneous malignant solid tumors with an annual incidence of 0.7 for every 1,000 pediatric dermatology patients. Nine cases had primary cutaneous tumors and 10 cases metastatic tumors. The majority of patients were infants (zero to two years). The tumors found were rhabdomyosarcoma, six cases; basal-cell carcinoma, four cases; neuroblastoma, three cases; malignant melanoma, two cases, squamous-cell carcinoma, dermatofibrosarcoma, atypical fibroxanthoma and myxopapillary ependymoma, one case of each. Predisposing factors for the developing of malignancy were present in 42% of patients.