RESUMO
PURPOSE: To evaluate the prevalence of sleep disorders in Brazilian preschool children and its associations with parental report of dental pain and discomfort. METHODS: This cross-sectional study involved 604 Brazilian preschoolers (4-5 years old). Sleep disorders (SD) and the parental report of dental pain and discomfort (DPD) were evaluated using the Brazilian versions of the Sleep Disturbance Scale for Children (SDSC) and the Dental Discomfort Questionnaire (DDQ-B), respectively. Bivariate and multivariate Poisson regression analyses with robust variance were performed to analyze the association between SDSC and DP. RESULTS: Prevalence of SD ranged from 7 to 21%. 7.9% of the children had DPD indicating the need for more invasive dental procedures (DDQ-B ≥ 5). Significant associations were found between DPD and the following SDSC domains: sleep hyperhidrosis (p = 0.024; PRa = 1.38; 95% CI: 1.04-1.83), disorders of initiating and maintaining sleep (p < 0.001; PRa = 1.41; 95% CI: 1.15-1.73), parasomnias (p < 0.001; PRa = 1.82; 95% CI: 1.39-2.37), and sleep-wake transition disorders (p = 0.018; PRa = 1.28; 95% CI: 1.04-1.58). Children with higher prevalence of DPD presented 20% higher prevalence of SD than children lower prevalence of DPD (p = 0.039; PRa = 1.20; 95% CI: 1.01-1.44). CONCLUSION: Preschool children with higher prevalence of DPD are more likely to have SD, such as hyperhidrosis, disorders of initiating and maintaining sleep, parasomnias, and sleep-wake transition.
Assuntos
Hiperidrose , Parassonias , Distúrbios do Início e da Manutenção do Sono , Transtornos do Sono-Vigília , Pré-Escolar , Humanos , Brasil/epidemiologia , Estudos Transversais , Hiperidrose/complicações , Dor/complicações , Parassonias/complicações , Pais , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/complicações , Inquéritos e Questionários , OdontopediatriaRESUMO
Hyperhidrosis is characterized by excessive sweating beyond thermoregulatory needs that affects patients' quality of life. It results from an excessive stimulation of eccrine sweat glands in the skin by the sympathetic nervous system. Hyperhidrosis may be primary or secondary to an underlying cause. Nocturnal hyperhidrosis is associated with different sleep disorders, such as obstructive sleep apnea, insomnia, restless legs syndrome/periodic limb movement during sleep and narcolepsy. The major cause of the hyperhidrosis is sympathetic overactivity and, in the case of narcolepsy type 1, orexin deficiency may also contribute. In this narrative review, we will provide an outline of the possible mechanisms underlying sudomotor dysfunction and the resulting nocturnal hyperhidrosis in these different sleep disorders and explore its clinical relevance.
Assuntos
Hiperidrose , Narcolepsia , Síndrome das Pernas Inquietas , Transtornos do Sono-Vigília , Humanos , Qualidade de Vida , Relevância Clínica , Hiperidrose/complicações , Narcolepsia/complicações , Transtornos do Sono-Vigília/complicações , Síndrome das Pernas Inquietas/etiologiaRESUMO
Background This study aimed to investigate the presence of sleep disturbances in children with Prader-Willi syndrome (PWS) using the Sleep Disturbance Scale for Children (SDSC). Methods The SDSC, which was designed to identify the presence and severity of different sleep disorders, was applied to 50 patients with PWS and 112 controls. Results Patients with PWS achieved worse scores in the sleep-disordered breathing and disorders in initiating and maintaining sleep in the SDSC questionnaire as compared with controls. We also observed that patients with PWS were more prone to having hyperhidrosis. We did not observe significant differences in the presence of other types of sleep disorders (such as hypersomnolence) between the PWS and control groups. Conclusions The results obtained with the SDSC questionnaire showed that children with PWS have more sleep breathing disorders and disorders in initiating and maintaining sleep as compared to controls. Additionally, we demonstrated that patients with PWS associates significantly with the presence of hyperhidrosis during sleep. However, SDSC was not reliable to identify the excessive daytime somnolence in patients with PWS, as previously reported in the literature.
Assuntos
Síndrome de Prader-Willi/complicações , Transtornos do Sono-Vigília/etiologia , Inquéritos e Questionários , Adolescente , Criança , Pré-Escolar , Distúrbios do Sono por Sonolência Excessiva/complicações , Feminino , Humanos , Hiperidrose/complicações , Masculino , Síndromes da Apneia do Sono/etiologia , Distúrbios do Início e da Manutenção do Sono/etiologiaRESUMO
OBJECTIVE:: to compare the intensity of reflex sweating with the degree of anxiety and its interference in the quality of life of patients undergoing Thoracoscopic (VATS) sympathectomy in the pre- and postoperative period. METHODS:: we evaluated 54 patients with a mean age of 26 years (16-49 years) undergoing sympathectomy in the R3-R4 level. We applied two questionnaires at three different times: "Quality of life in patients with primary hyperhidrosis" and "Scale for anxiety and depression". RESULTS:: of the patients studied, 93% showed significant improvement in quality of life 30 days after surgery, the effects remaining after six months. There were no postoperative complications. The patient's level of anxiety is highly correlated with the intensity of reflex sweating after 30 and 180 days. CONCLUSION:: Thoracoscopic sympathectomy improves quality of life of patients with primary hyperhidrosis, even with the emergence of reflex sweating. Anxiety directly relates to the intensity of reflex sweating, without compromising the degree of patient satisfaction. OBJETIVO:: avaliar a intensidade de sudorese reflexa com o grau de ansiedade e sua interferência na qualidade de vida de indivíduos submetidos à simpatectomia por videotoracoscopia nos períodos pré e pós-operatório. MÉTODOS:: foram avaliados 54 pacientes com média de idade de 26 anos (16 a 49 anos), submetidos à simpatectomia em nível R3-R4. Dois questionários foram aplicados em três momentos diferentes: "Qualidade de vida em pacientes com hiperidrose primária e "Escala para ansiedade e depressão". RESULTADOS:: dos pacientes estudados, 93% mostrou melhora significativa na qualidade de vida após 30 dias da cirurgia, com os efeitos remanescentes após seis meses. Não houve complicações pós-operatórias. A análise mostrou que o nível de ansiedade do paciente é altamente correlacionado com a intensidade da sudorese reflexa após 30 e 180 dias. CONCLUSÃO:: a simpatectomia torácica por videotoracoscopia melhora a qualidade de vida de pacientes com hiperidrose primária, mesmo com o surgimento de sudorese reflexa. A ansiedade está diretamente relacionada com a intensidade da sudorese reflexa, sem comprometer o grau de satisfação do paciente.
Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Hiperidrose/cirurgia , Qualidade de Vida , Reflexo , Sudorese , Simpatectomia/métodos , Toracoscopia , Adolescente , Adulto , Ansiedade/complicações , Depressão/complicações , Feminino , Humanos , Hiperidrose/complicações , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Adulto JovemRESUMO
ABSTRACT Objective: to compare the intensity of reflex sweating with the degree of anxiety and its interference in the quality of life of patients undergoing Thoracoscopic (VATS) sympathectomy in the pre- and postoperative period. Methods: we evaluated 54 patients with a mean age of 26 years (16-49 years) undergoing sympathectomy in the R3-R4 level. We applied two questionnaires at three different times: "Quality of life in patients with primary hyperhidrosis" and "Scale for anxiety and depression". Results: of the patients studied, 93% showed significant improvement in quality of life 30 days after surgery, the effects remaining after six months. There were no postoperative complications. The patient's level of anxiety is highly correlated with the intensity of reflex sweating after 30 and 180 days. Conclusion: Thoracoscopic sympathectomy improves quality of life of patients with primary hyperhidrosis, even with the emergence of reflex sweating. Anxiety directly relates to the intensity of reflex sweating, without compromising the degree of patient satisfaction.
RESUMO Objetivo: avaliar a intensidade de sudorese reflexa com o grau de ansiedade e sua interferência na qualidade de vida de indivíduos submetidos à simpatectomia por videotoracoscopia nos períodos pré e pós-operatório. Métodos: foram avaliados 54 pacientes com média de idade de 26 anos (16 a 49 anos), submetidos à simpatectomia em nível R3-R4. Dois questionários foram aplicados em três momentos diferentes: "Qualidade de vida em pacientes com hiperidrose primária e "Escala para ansiedade e depressão". Resultados: dos pacientes estudados, 93% mostrou melhora significativa na qualidade de vida após 30 dias da cirurgia, com os efeitos remanescentes após seis meses. Não houve complicações pós-operatórias. A análise mostrou que o nível de ansiedade do paciente é altamente correlacionado com a intensidade da sudorese reflexa após 30 e 180 dias. Conclusão: a simpatectomia torácica por videotoracoscopia melhora a qualidade de vida de pacientes com hiperidrose primária, mesmo com o surgimento de sudorese reflexa. A ansiedade está diretamente relacionada com a intensidade da sudorese reflexa, sem comprometer o grau de satisfação do paciente.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Ansiedade/epidemiologia , Qualidade de Vida , Reflexo , Sudorese , Simpatectomia/métodos , Toracoscopia , Depressão/epidemiologia , Hiperidrose/cirurgia , Ansiedade/complicações , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Depressão/complicações , Hiperidrose/complicações , Pessoa de Meia-IdadeRESUMO
We present a clinical case that we did not find described in literature and yet is quite common in primary care. The patient described is female with a diagnosis of diabetes mellitus treated with insulin and poor clinical response according to glycated haemoglobin measurements. In addition to the main diagnosis, she also shows excessive sweating in palms and feet, which explains why her blood sugar levels were wrong. This also led to treatment adjustments that were carried out with disregard to her true plasma glucose concentration. To conclude, this case report highlights the importance of treating subjects in lieu of separate conditions, as well as the need of a team approach to patients in care.
Se da cuenta de un caso clínico que puede presentarse con frecuencia en atención primaria, aunque no se registran casos similares en la literatura. Se trata de una mujer con diagnóstico de diabetes mellitus en tratamiento con insulina y con mala evolución según las hemoglobinas glicosiladas. Además del diagnóstico principal, también presenta hiperhidrosis palmo-plantar, lo que conducía a error en los controles glucémicos. Ello es de gran importancia, dado que se ajustaba tratamiento sin considerar que el control no se realizaba de forma adecuada. De este reporte se concluye la relevancia de tratar al paciente como tal y no como patologías individuales, así como la importancia del trabajo en equipo.
Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hiperidrose/complicações , Adulto , Automonitorização da Glicemia/métodos , Diabetes Mellitus Tipo 2/sangue , Feminino , Hemoglobinas Glicadas/análise , Mãos , Humanos , Hipoglicemiantes/uso terapêuticoRESUMO
Spontaneous periodic episodes of hypothermia still defy medical knowledge. In 1969, Shapiro et al. described the first two cases of spontaneous periodic hypothermia associated with agenesis of the corpus callosum. Recently, Dundar et al. reported a case of spontaneous periodic hypothermia and hyperhidrosis without corpus callosum agenesis, suggesting that the periodic episodes of hypothermia might be of epileptiform origin. Here we describe two paediatric patients with spontaneous periodic hypothermia without corpus callosum agenesis and demonstrate, to our knowledge for the first time, altered levels of neurotransmitter metabolites within the cerebrospinal fluid.
Assuntos
Córtex Cerebral , Hiperidrose/complicações , Hipotermia/complicações , Neurotransmissores/metabolismo , Periodicidade , Córtex Cerebral/metabolismo , Córtex Cerebral/patologia , Córtex Cerebral/fisiopatologia , Pré-Escolar , Feminino , Humanos , LactenteAssuntos
Agenesia do Corpo Caloso , Hiperidrose/complicações , Doenças Hipotalâmicas/complicações , Hipotermia/complicações , Hipotireoidismo/complicações , Criança , Ciproeptadina/uso terapêutico , Humanos , Hiperidrose/tratamento farmacológico , Doenças Hipotalâmicas/tratamento farmacológico , Hipotermia/tratamento farmacológico , Hipotireoidismo/tratamento farmacológico , Imageamento por Ressonância Magnética , Masculino , Antagonistas da Serotonina/uso terapêutico , Síndrome , Tireotropina/deficiência , Hormônio Liberador de Tireotropina/deficiência , Tiroxina/uso terapêuticoRESUMO
Abnormal sensory processing seems to be involved in hyperhidrosis. To test this hypothesis, we investigated tactile acuity and cortical plastic changes in patients with primary hyperhidrosis (PH) and their asymptomatic relatives. We studied thirteen subjects belonging to two families with PH and thirteen age-matched healthy controls using Johnson-Van Boven-Phillips domes before and after 45min of transient visual deafferentation. Spatial discrimination thresholds (SDTs) were lower in controls than in the familial group (1.08+/-0.25 vs 1.59+/-0.71; p=0.0032). After 45min of light deprivation and blindfolding, SDTs decreased significantly in controls (0.83+/-0.3; p=0.003), but not in patients (1.4+/-0.62; p=0.108). Interestingly, two subjects without clinical complaints of hyperhidrosis had abnormal SDTs behavior after short term visual deprivation. This study demonstrates that sensory processing is abnormal in PH, with a lack of plastic cortical somatosensory changes regardless of clinical condition. These modulatory abnormalities would affect gating processes in the somatosensory cortex which may play a role in maintaining hyperhidrosis.
Assuntos
Hiperidrose/complicações , Hiperidrose/genética , Plasticidade Neuronal/genética , Transtornos da Percepção/genética , Transtornos da Percepção/fisiopatologia , Tato/genética , Adolescente , Adulto , Sinais (Psicologia) , Análise Mutacional de DNA , Retroalimentação/fisiologia , Feminino , Testes Genéticos , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Inibição Neural/genética , Exame Neurológico , Testes Neuropsicológicos , Linhagem , Transtornos da Percepção/diagnóstico , Estimulação Física , Privação Sensorial/fisiologia , Limiar Sensorial/fisiologia , Córtex Somatossensorial/fisiopatologia , Percepção Espacial/fisiologia , Percepção Visual/fisiologiaAssuntos
Criança , Humanos , Masculino , Corpo Caloso/anormalidades , Hiperidrose/complicações , Doenças Hipotalâmicas/complicações , Hipotermia/complicações , Hipotireoidismo/complicações , Ciproeptadina/uso terapêutico , Hiperidrose/tratamento farmacológico , Doenças Hipotalâmicas/tratamento farmacológico , Hipotermia/tratamento farmacológico , Hipotireoidismo/tratamento farmacológico , Imageamento por Ressonância Magnética , Síndrome , Antagonistas da Serotonina/uso terapêutico , Hormônio Liberador de Tireotropina/deficiência , Tireotropina/deficiência , Tiroxina/uso terapêuticoRESUMO
La hiperhidrosis es una condición idiopática con una sudoración excesiva, en condiciones fisiológicas normales, generalmente localizada en manos, axilas, cara y pies. Esta condición puede afectar social, psíquica y profesionalmente a los pacientes más comprometidos. El tratamiento médico ha sido poco efectivo y a menudo lleva a los pacientes a usar múltiples terapias con una mejoría escasa y muchas veces transitoria. Una posibilidad de tratamiento definitivo, en los casos más severos, es la videocirugía, utilizando micro instrumentos, con resección de la cadena simpática, en T2 a T4, con una morbilidad mínima y con resultados a largo plazo muy satisfactorios. Este trabajo explica las indicaciones quirúrgicas, los detalles técnicos y los resultados obtenidos.
Assuntos
Humanos , Hiperidrose/cirurgia , Hiperidrose/complicações , Hiperidrose/diagnóstico , Simpatectomia/métodos , Sistema Nervoso Autônomo/anatomia & histologia , Sistema Nervoso Autônomo/cirurgia , Resultado do TratamentoRESUMO
Between 1990 and 2000, The Medical Mycology Laboratory at University of Antioquia (Medellín, Colombia), attended 4621 patients, with nail dystrophies. We used the direct test and culture of nail samples for diagnostic purposes. This report includes 310 patients, 7% (310/4621), with positive cultures for the same non-dermathophyte fungi, in five or more places of inoculation. From the 310 positive cultures, 284 (92%) were positive in direct test. No characteristic morphology for any of the genera could be detected. Until 1989 we had an average of 9 cases per year and between 1990 and 2000 we found 28 cases per year (an increase of 211%). The implicated genera were: Fusarium 50%, Nattrassia 31%, Aspergillus and Dendrophoma 7% each, Penicillium and Scopulariopsis contributed with 2% each, and Acremonium was found in less of 1% of cases. The general prevalence of onychomycosis due to non-dermatophytic fungi was about 12,4% between 1990-2000. This report describes the main epidemiological characteristics found, comparing them with results from other authors, and defines the basic profile of affected patients: adults (31-40 years old) who use occlusive shoes (trainers) and practice sport, which predispose to hyperhydrosis and consequently to onychomycosis. The course of the disease takes in average 30 months in both sexes. The percentage of onychomycosis found was 62% for women and 38% for men.
Assuntos
Fungos/isolamento & purificação , Onicomicose/microbiologia , Adulto , Ascomicetos/isolamento & purificação , Colômbia/epidemiologia , Feminino , Fusarium/isolamento & purificação , Humanos , Hiperidrose/complicações , Hospedeiro Imunocomprometido , Incidência , Masculino , Fungos Mitospóricos/isolamento & purificação , Unhas/lesões , Unhas/microbiologia , Onicomicose/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Sapatos , EsportesRESUMO
The purpose of this investigation was to find out how often pathogenic dermatophytes are found in apparently normal versus scaly feet of children. In this prospective protocol, we studied 100 patients, 2 to 12 years of age, consulting for plantar and/or interdigital scaling with or without erythema, maceration, and pruritus, and 100 controls with apparently healthy feet. Direct microscopic examination (KOH) and mycologic culture (Mycosel) of skin scrapings were performed from the lesions of patients and from the soles and interdigital folds of controls. Mean age of patients and controls was 7 years 7 months (SD = 3 years 2 months). Scaling was present in 100% of patients with a mean time of evolution of 8.9 months (SD = 16.3 months). Shoes fashioned from man-made material were significantly more frequently used by patients than by controls (chi 2(df = 1) = 9.4; p = 0.002). Pathogenic dermatophytes were present in the soles and/or interdigital webs of 21 patients and 7 controls. Not all foot scaling in children, pruritic or not, is associated with dermatophytes. Dermatophytes may be present on the apparently healthy feet of children.