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Abstract Introduction Epistaxis is a common presentation among children. Objective To investigate the suitability of a simple tool of assessment for patients with epistaxis that could guide in subgrouping those with possible bleeding tendencies who may need further assessment. Methods Children who presented to a tertiary outpatient clinic with epistaxis of an unknown cause were recruited. They underwent thorough clinical assessment and answered the pediatric bleeding questionnaire and the epistaxis severity score. All patients underwent complete blood count as well as coagulation profile, and confirmatory diagnostic tests were performed as needed. Results Among the 30,043 patients who presented to the outpatient clinic over a year, 100 children had epistaxis, with an estimated annual frequency of 1 in 300. A total of 84% of the patients were younger than 12, and nearly half of these were younger than 6 years. Seventy-six patients had recurrent epistaxis, and 12 had systemic comorbidities. A significant higher percentage of patients presented with epistaxis in the hot months of the year. A total of 90% of the patients presented anterior bleeding, and the majority were treated with nasal compression only. Forty-three patients presented with epistaxis only; 37 of them were diagnosed as idiopathic epistaxis, and 6 had local causes. Fifty-seven patients presented with other bleeding manifestations, 47 of whom had a definite bleeding disorder and the other 10 had undiagnosed bleeding tendency. Those with other bleeding manifestations showed a higher frequency of positive family history of epistaxis; of being referred from a primary care physician; of having alarming low platelet count, and of presenting less seasonal variability. A bleeding score ≥ 2 showed significant value in suspecting an underlying systemic pathology as a cause of epistaxis. Conclusion The pediatric bleeding questionnaire is a useful and simple tool in the identification of pediatric patients who need further diagnostic testing to detect any underlying bleeding tendency.

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Introduction Epistaxis is a common presentation among children. Objective To investigate the suitability of a simple tool of assessment for patients with epistaxis that could guide in subgrouping those with possible bleeding tendencies who may need further assessment. Methods Children who presented to a tertiary outpatient clinic with epistaxis of an unknown cause were recruited. They underwent thorough clinical assessment and answered the pediatric bleeding questionnaire and the epistaxis severity score. All patients underwent complete blood count as well as coagulation profile, and confirmatory diagnostic tests were performed as needed. Results Among the 30,043 patients who presented to the outpatient clinic over a year, 100 children had epistaxis, with an estimated annual frequency of 1 in 300. A total of 84% of the patients were younger than 12, and nearly half of these were younger than 6 years. Seventy-six patients had recurrent epistaxis, and 12 had systemic comorbidities. A significant higher percentage of patients presented with epistaxis in the hot months of the year. A total of 90% of the patients presented anterior bleeding, and the majority were treated with nasal compression only. Forty-three patients presented with epistaxis only; 37 of them were diagnosed as idiopathic epistaxis, and 6 had local causes. Fifty-seven patients presented with other bleeding manifestations, 47 of whom had a definite bleeding disorder and the other 10 had undiagnosed bleeding tendency. Those with other bleeding manifestations showed a higher frequency of positive family history of epistaxis; of being referred from a primary care physician; of having alarming low platelet count, and of presenting less seasonal variability. A bleeding score ≥ 2 showed significant value in suspecting an underlying systemic pathology as a cause of epistaxis. Conclusion The pediatric bleeding questionnaire is a useful and simple tool in the identification of pediatric patients who need further diagnostic testing to detect any underlying bleeding tendency.

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AIM: Bernard-Soulier syndrome (BSS) is an inherited bleeding disorder characterized by macroplatelets and thrombocytopenia, prolonged bleeding time, and a prevalence of less than 1 in 1,000,000. In view of the recognition of the risk of bleeding and the management of daily surgical practice in these patients, adequate strategies are necessary to provide the safest care. This article aims to perform an integrative review of the literature on the management of invasive procedures in the oral cavity of individuals with BSS. METHOD: The PubMed/Medline and LILACS databases were searched using Boolean operators related to BSS, bleeding disorders, and oral care. RESULTS: As a result, only five articles with the main theme were included: one letter to the editor and four case reports, described chronologically as to date of publication, classification of the article, and medical/odontological measures taken. CONCLUSION: We conclude with this review the need for adequate knowledge of surgeons regarding coagulation disorders and the need to discuss and plan procedures with the hematology team, as well as the importance of the notion of management of possible complications resulting from invasive treatments in the oral cavity of patients with BSS.

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Dental treatments in hemophilic patients are challenging, and the absence of adequate preparation for the procedures can be life-threatening. This letter describes a delayed postoperative bleeding after multiple dental implants with sinus floor elevation in a patient with mild hemophilia A.

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Resumen: Los virus son agentes infecciosos, causantes de diversas enfermedades en los seres humanos, comportamiento demostrado, por ejemplo, con el brote de viruela en los nativos americanos que causó la muerte de miles de ellos en la época de la Conquista. En los últimos años, se ha reportado la reaparición de algunos padecimientos causados por virus en países tropicales, que amenazan con convertirse en pandemias. Padecimientos como las fiebres del Zika y el chikunguña han afectado a varios países de América del Sur, principalmente, Brasil, Perú y Colombia, donde se reportaron miles de contagios y algunos casos de desenlace fatal. Debido a la importancia del tema, se realizó una revisión crítica para evidenciar las características de los virus, las manifestaciones clínicas del contagio, estadísticas de los afectados y los tratamientos disponibles. Asimismo, se analizaron las acciones preventivas propuestas por la OMS y el Instituto Nacional de Salud (INH). Finalmente, se consultaron algunas propuestas en el desarrollo de vacunas, de donde se concluye que, a pesar de los significativos avances y cuantiosas posibilidades en fases clínicas, aún no hay ningún producto comercial para ninguno de los dos virus analizados, pero se proyecta tenerlos después de 2020.

Abstract: Viruses are infectious agents causing various diseases in humans; this behavior is demonstrated by, for example, the outbreak of smallpox in Native Americans that resulted in the death of thousands at the time of the Conquest. In recent years, the reappearance of some diseases caused by viruses has been reported in tropical countries, which threaten to become pandemics. Conditions such as Zika and chikungunya fevers have affected several countries in South America, mainly Brazil, Peru, and Colombia, where thousands of infections and some fatal outcomes were reported. Due to the importance of the matter, the characteristics of the viruses, clinical manifestations of the infection, statistics on those affected, and treatments available are critically reviewed. Likewise, the preventive actions proposed by the WHO and the National Institute of Health (NIH) are discussed. Finally, some proposals in the development of vaccines are checked to conclude that, despite the significant advances and considerable possibilities in clinical phases, there is still no commercial products for either of the two viruses analyzed, but they are planned for after 2020.

Resumo: Os vírus são agentes infecciosos que causam várias doenças nos seres humanos, esse comportamento pode ser demonstrado, por exemplo, com o surto de varíola que causou a morte de milhares de nativos americanos na época da conquista. Nos últimos anos, o reaparecimento de algumas doenças causadas por vírus tem sido relatado em países tropicais, emergindo a ameaça delas se tornarem pandemias. Doenças como a febre zika e a febre Chikungunya afetaram vários países da América do Sul, principalmente o Brasil, o Peru e a Colômbia, onde milhares de infecções e alguns casos de resultados fatais foram relatados. Devido à importância desse tema, realizamos uma revisão crítica para mostrar as características dos vírus, as manifestações clínicas da infecção, as estatísticas sobre os afetados e os tratamentos disponíveis. Além disso, as ações preventivas propostas pela Organização Mundial da Saúde (OMS) e pelo Instituto Nacional de Saúde (INH) também foram analisadas. Finalmente, a partir da consulta de algumas propostas no desenvolvimento de vacinas, concluímos que, apesar dos avanços significativos e das possibilidades consideráveis nas fases clínicas, ainda não existe nenhum produto comercial para enfrentar os vírus analisados neste estudo. Porém, depois de 2020, é provável que algum produto seja disponibilizado no mercado.

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La deficiencia de factor XIII de la coagulación es un trastorno raro de la coagulación, entre los que están la afibrinogenemis y los de factor II, V, V+VIII, VII, X y XI. Estos son son anormalidades de la hemostasia con herencia autosómica recesiva; su prevalencia es de 1 en 500,000 a 2 millones de personas. Por su rareza, tipo y severidad de las hemorragias y lo poco claro que es el defecto molecular y su manejo son un reto diagnóstico y terapéutico. Para algunas de estas deficiencias no existen concentrados del factor de coagulación implicado disponibles, por lo que es necesario utilizar derivados sanguíneos o medicamentos hemostáticos alternativos, lo que puede generar complicaciones, en ocasiones fatales; estas complicaciones pueden ser minimizadas evaluando en cada caso el riesgo de sangrado o de trombosis seleccionando como tratamiento alternativas diferentes a los derivados de la sangre, o incluso no administrando tratamiento en los episodios hemorrágicos leves. En este artículo se describe el caso de una paciente con diagnóstico de déficit de factor XIII que debutó con hematuria y complicaciones ginecoobstétricas; hay historia familiar de consanguinidad y de déficit de factor XIII; recibió manejo con crioprecipitados y antifibrinolíticos y profilaxis con crioprecipitados durante el transcurso de su segundo embarazo, lográndose un producto a término con un parto por cesárea sin complicaciones hemorrágicas o trombóticas.

The factor XIII deficiency is a rare clotting disorder, among which are afibrinogenemia and factor II, V, V+VIII, VII, X and XI ones. These are hemostasis anomalies with autosomal recessive herency; its prevalence is 1 in 500,000 to 2 million people. For its rarity, type and bleeding severity, and its unclear molecular defect, this is a challenge diagnostic and therapeutic effort. The are not clotting factor concentrates available, reason what it is necessary to use blood derivatives or alternative hemostatic agents, which can generate complications, sometimes fatal; these complications can be minimized assessing in each case its bleeding or thrombosis riks to select alternatives to blood or not to do treatment in mild bleeding episodes. This paper describes a case of a women diagnosed with XIII deficiency that began with hematuria and gynocobstetric complications; she received plasma concentrates and antifibrinolytic agents, plus prophylaxis with these products in her second pregnancy, achieving a at term product by caesarean section without any complications.

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