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BACKGROUND: Guillain-Barré syndrome is the most common cause of flaccid paralysis, with multiple known clinical variants. Autonomic dysfunction, although frequently reported in the clinical course, is often overlooked in the pediatric population and is usually not the initial presenting symptom in this age group CASE PRESENTATION: We present the case of a previously healthy 17-year-old who arrived at the Emergency Department complaining of gastrointestinal symptoms associated with lipothymia. An initial electrocardiogram (ECG) showed sustained sinus bradycardia subsequently associated with arterial hypertension. Structural and inflammatory cardiac pathology were ruled out, as well as auriculoventricular conduction block and posterior reversible encephalopathy syndrome. On the ninth day after initial symptoms, the patient presented sensory and motor nerve disturbances with the cerebrospinal fluid analysis showing a clear albumin-cytologic dissociation, consistent with an atypical presentation of GBS with autonomic dysfunction. Immunoglobulin therapy was administered, developing subsequent aseptic meningitis, that required discontinuation of previous therapy and treatment with plasmapheresis. Clinical improvement was achieved with full motor function recovery. CONCLUSION: This case illustrates a Guillain-Barré syndrome variant in which autonomic dysfunction preceded neurologic deficit, a finding uncommon in children, emphasizing this as an important differential diagnosis for severe bradycardia in pediatric patients.
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Síndrome de Guillain-Barré , Hipertensão , Síndrome da Leucoencefalopatia Posterior , Adolescente , Bradicardia/complicações , Bradicardia/etiologia , Criança , Diagnóstico Diferencial , Síndrome de Guillain-Barré/complicações , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/terapia , Humanos , Hipertensão/diagnóstico , Síndrome da Leucoencefalopatia Posterior/complicações , Síndrome da Leucoencefalopatia Posterior/diagnósticoRESUMO
RESUMEN Objetivo. Utilizar los sistemas de información geográfica (SIG) como herramienta complementaria para caracterizar la ganadería bovina realizada en la región de la Orinoquia. Materiales y métodos. A través del uso de tecnologías espaciales se recopiló la información concerniente a la orientación ganadera, fisiografía, cobertura vegetal y catastro de la zona de estudio para su posterior análisis a través del software ACCESS de Microsoft. Resultados. En un alto porcentaje de los predios ganaderos ubicados en los cuatro departamentos de la Orinoquía (Casanare:72.7%, Meta:49.5%, Arauca:42% y Vichada:32%) predominan las coberturas de pastos, herbazales y vegetación secundaria, confirmando la expansión en la frontera agropecuaria que es promovida por la actividad ganadera en el país. Conclusiones. El uso de los SIG, permite realizar una mejor planificación y distribución eficiente de los recursos destinados a mejorar el funcionamiento de los sistemas de producción. Por ejemplo, en zonas donde la matriz de coberturas predominante son los pastizales y herbazales, las estrategias en pro de la sostenibilidad pueden enfocarse en la implementación de sistemas silvopastoriles, contrario a lo que pasaría en zonas donde la matriz de coberturas tenga un alto porcentaje de bosques naturales.
ABSTRACT Objective. Use Geographic Information Systems (GIS) as a complementary tool to characterize cattle farming in the Orinoquia region. Materials and methods. Through the use of space technologys, information concerning the livestock orientation, physiography, vegetation cover and land registry of the study zone was collected for further analysis over Microsoft ACCESS software. Results. In a high percentage of the cattle ranches located in the four departments (Casanare: 72.7%, Meta: 49.5%, Arauca: 42% and Vichada: 32%) the cover of pastures, grasslands and secondary vegetation predominates, confirming the expansion in the agricultural border that has had the cattle activity in the country. Conclusions. The use of complementary tools such as GIS allows for better planning and efficient distribution of resources to improve the functioning of production systems, for example, in zones where the predominant coverage matrix is grasslands, strategies in pro of sustainability can focus on the implementation of silvopastoral systems, contrary to what would happen in areas where the matrix has a high percentage of natural forests.
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Animais , Bovinos , Sistemas de Informação Geográfica , Análise de Dados , Criação de Animais DomésticosRESUMO
The two co-authors of the mentioned above article were incorrect. The correct are authors should have been "P. A. Beltrán" instead of "P. A. B. Roa" and "J. F. Diaz-Coto" instead of "L. Diaz Soto".
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INTRODUCTION: Biologics have improved the treatment of rheumatic diseases, resulting in better outcomes. However, their high cost limits access for many patients in both North America and Latin America. Following patent expiration for biologicals, the availability of biosimilars, which typically are less expensive due to lower development costs, provides additional treatment options for patients with rheumatic diseases. The availability of biosimilars in North American and Latin American countries is evolving, with differing regulations and clinical indications. OBJECTIVE: The objective of the study was to present the consensus statement on biosimilars in rheumatology developed by Pan American League of Associations for Rheumatology (PANLAR). METHODS: Using a modified Delphi process approach, the following topics were addressed: regulation, efficacy and safety, extrapolation of indications, interchangeability, automatic substitution, pharmacovigilance, risk management, naming, traceability, registries, economic aspects, and biomimics. Consensus was achieved when there was agreement among 80% or more of the panel members. Three Delphi rounds were conducted to reach consensus. Questionnaires were sent electronically to panel members and comments about each question were solicited. RESULTS: Eight recommendations were formulated regarding regulation, pharmacovigilance, risk management, naming, traceability, registries, economic aspects, and biomimics. CONCLUSION: The recommendations highlighted that, after receiving regulatory approval, pharmacovigilance is a fundamental strategy to ensure safety of all medications. Registries should be employed to monitor use of biosimilars and to identify potential adverse effects. The price of biosimilars should be significantly lower than that of reference products to enhance patient access. Biomimics are not biosimilars and, if they are to be marketed, they must first be evaluated and approved according to established regulatory pathways for novel biopharmaceuticals. KEY POINTS: ⢠Biologics have improved the treatment of rheumatic diseases. ⢠Their high cost limits access for many patients in both North America and Latin America. ⢠Biosimilars typically are less expensive, providing additional treatment options for patients with rheumatic diseases. ⢠PANLAR presents its consensus on biosimilars in rheumatology.
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Medicamentos Biossimilares/uso terapêutico , Doenças Reumáticas/tratamento farmacológico , Medicamentos Biossimilares/efeitos adversos , Consenso , Medicina Baseada em Evidências , Humanos , América Latina/epidemiologia , América do Norte , Guias de Prática Clínica como Assunto , Reumatologia , Sociedades MédicasRESUMO
PURPOSE: To compare the effectiveness of abdominal wall closure using the vacuum-assisted closure (NPC) as described by Barker et al. with an institutional protocol using a double polyvinyl bag in the first surgery, which is changed in subsequent surgeries to a polyvinyl bag placed over the bowel loops and a prolene mesh attached to the abdominal fascia (MMFC). METHODS: Randomized controlled trial. Patients with open abdomen (OA) due to a traumatic or a medical cause were included in the study. Variables studied included demographics, indication for surgery, number of interventions, hospital length of stay (HLOS), ICU length of stay, abdominal wound care costs, complication rates, and method and time to definitive fascial closure. RESULTS: From June 2011 to April 2013, 75 patients were enrolled in the study. Patients who died within 48 h were excluded; therefore, 53 patients in total were assessed. NPC achieved fascial closure in 75% of patients, and MMFC achieved closure in 71.9% of patients. The closure rates in patients with OA secondary to medical causes (80% by NPC vs. 71.4% by MMFC) or traumatic causes (70% by NPC vs. 73.7% by MMFC) were similar in both treatment groups. There were no differences between the groups with respect to cause of OA, complications, length of hospital stay, or the length of stay in the intensive care unit. CONCLUSION: MMFC is a method comparable to NPC for the temporary management of OA that results in similar closure and complication rates.
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Parede Abdominal/cirurgia , Técnicas de Fechamento de Ferimentos Abdominais , Fasciotomia , Tratamento de Ferimentos com Pressão Negativa , Telas Cirúrgicas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Materiais Biocompatíveis , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polipropilenos , Implantação de Prótese , Tração , Adulto JovemRESUMO
INTRODUCTION: Guillain-Barré syndrome, an acute polyradiculoneuropathy that presents with weakness and areflexia, is the most common cause of acute flaccid paralysis. In certain patients, respiratory failure is secondary to this disorder, eventually causing patients to require mechanical ventilation and experience additional complications due to diminished respiratory support and related mobility limitations. Prognoses for most of these cases are positive; treatment consists of basic support combined with plasmapheresis or administration of immunoglobulins. OBJECTIVE: This study sought to describe the socio-demographic, clinical, laboratory and neurophysiological characteristics of patients with Guillain-Barré syndrome who were hospitalised in the Intensive Care Unit of the Neurological Institute of Colombia between 2006 and 2012. METHODOLOGY: This study presents a case series. RESULTS: We surveyed 25 patients (32% female and 68% male) with Guillain-Barré syndrome and an average age of 54 years. Sixty per cent of these patients were admitted between days 3 and 7 after symptom onset; 64% had a history of respiratory infection and 20% had a history of intestinal infection. In addition, 84% of the patients presented with albuminocytological dissociation. We observed the following clinical subtypes of Guillain-Barré syndrome: inflammatory demyelinating polyneuropathy in 32%, acute motor-sensory axonal neuropathy in 28%, acute motor axonal neuropathy in 28%, and Miller Fisher syndrome in 12%. CONCLUSIONS: In this descriptive study of a group of critical care patients with GBS, results depended on patients' clinical severity at time of admission. Our findings are similar to results published in the international literature.
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Cuidados Críticos/métodos , Síndrome de Guillain-Barré/terapia , Neurologia , Adulto , Idoso , Colômbia/epidemiologia , Feminino , Síndrome de Guillain-Barré/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Plasmaferese , Estudos Retrospectivos , Fatores SocioeconômicosRESUMO
OBJECTIVE: To describe the experience with upper gastrointestinal bleeding in two major Latin American hospitals; presenting its main causes, treatment, and prognosis, while exploring some risk factors associated with death. DESIGN: Prospective cohort study. PATIENTS AND METHODS: Four hundred and sixty four patients were admitted into any of the 2 hospitals and were at least 15 years of age. Some variables demographics, clinics and treatment were studied. The association between those variables and the death were explored. RESULTS: Mean age was 57.9 years; the men:women ratio was 1.4:1. Three hundred and fifty nine patients (77.3%) presented as outpatients and 105 patients (22.6%) were inpatients presenting with UGIB. 71.6% of patients had an upper GI endoscopy within 24 hours. The main causes of bleeding were peptic ulcer (190 patients, 41%), erosive disease (162 patients, 34.9%) and variceal bleeding (47 patients, 10.1%). Forty four patients died (9.5%). Bleeding as an inpatient has a higher mortality risk than does bleeding as an outpatient (RR 2.4 IC 95% 1.2-4.6). An increasing number of comorbidities such as those described in the Rockall Score are also associated with a higher risk of dying (RR 2.5 IC 95% 1.1-5.4). CONCLUSION: UGIB as an inpatient and the presence of comorbidities should alert the clinician in identifying patients at higher risk of a fatal outcome, these patients should have a more aggressive management and be entitled to an early intervention.
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Varizes Esofágicas e Gástricas/mortalidade , Hemorragia Gastrointestinal/mortalidade , Adulto , Idoso , Anticoagulantes/efeitos adversos , Colômbia/epidemiologia , Comorbidade , Úlcera Duodenal/mortalidade , Embolização Terapêutica , Endoscopia do Sistema Digestório , Esofagite/complicações , Esofagite/mortalidade , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Hospitais Gerais/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos , Úlcera Péptica Hemorrágica/mortalidade , Estudos Prospectivos , Fatores de Risco , Neoplasias Gástricas/complicações , Neoplasias Gástricas/mortalidade , Úlcera Gástrica/mortalidadeRESUMO
Rhabdomyomatous mesenchymal hamartoma is an extremely rare congenital lesion, and very few cases have been reported even though its macroscopic and microscopic features make diagnosis easy. An 18-year-old woman consulted with a pedunculated mass in the medial region of her neck. The mass was surgically removed, and rhabdomyomatous mesenchymal hamartoma was diagnosed. The clinical, macroscopic, histologic, and immunochemical characteristics that allow diagnosis of this entity are discussed. Although association with congenital abnormalities is uncommon, this possibility should be assessed by the clinician.