In its severe form, kala-azar, a neglected tropical disease, initiates a systemic inflammatory response that leads to DIC and other manifestations. Children may have higher risk of death due to the more intense cytokine release. The data supports the notion that IL-6 is the central cytokine that is associated with lethal disease, but interferon-gamma, IL1beta, IL-8, and TNF-alpha are also involved with disease severity. Inhibition of IL-6 is a potential target of adjuvant therapy for severe or pediatric forms of this disease.
ResumoObjetivo: Investigar a etiologia, as principais manifestações clínicas e as alterações presentes em crianças de 3 a 9 anos, respiradoras orais, residentes na região urbana de Abaeté (MG). Métodos:Estudo com amostra aleatória representativa da população do município de 23.596 habitantes. Clinicamente, foram consideradas respiradoras orais as crianças que roncavam, dormiam com a boca aberta, babavam no travesseiro e apresentavam queixas de obstrução nasal freqüente ou intermitente. As crianças com diagnóstico clínico de respirador oral foram submetidas a endoscopia nasal, teste alérgico cutâneo e raio X do cavum, hemograma, contagem de eosinófilos, dosagem de IgE total e parasitológico de fezes. Os dados foram analisados utilizando o programa SPSS ® versão 10.5. Resultados:As principais causas da respiração oral foram: rinite alérgica (81,4%), hipertrofia de adenóides (79,2%), hipertrofia de amígdalas (12,6%) e desvio obstrutivo do septo nasal (1,0%). As principais manifestações clínicas do respirador oral foram: dormir com a boca aberta (86%), roncar (79%), coçar o nariz (77%), babar no travesseiro (62%), dificuldade respiratória noturna ou sono agitado (62%), obstrução nasal (49%) e irritabilidade durante o dia (43%). Conclusão:Algumas manifestações clínicas são muito freqüentes na criança respiradora oral. Essas manifestações devem ser reconhecidas e consideradas no diagnóstico clínico da respiração oral.J Pediatr (Rio J). 2008;84(6):529-535: Prevalência, respiração oral, rinite alérgica, hipertrofia de adenóides, hipertrofia de amígdalas, desvio do septo nasal. diagnosis of mouth breathing underwent nasal endoscopy, allergy skin tests and X ray of the rhinopharynx, full blood tests, eosinophil counts, total IgE assay and fecal parasitology. Data were analyzed using SPSS ® version 10.5. Results:The main causes of mouth breathing were: allergic rhinitis (81.4%), enlarged adenoids (79.2%), enlarged tonsils (12.6%), and obstructive deviation of the nasal septum (1.0%). The main clinical manifestations of mouth breathers were: sleeping with mouth open (86%), snoring (79%), itchy nose (77%), drooling on the pillow (62%), nocturnal sleep problems or agitated sleep (62%), nasal obstruction (49%), and irritability during the day (43%). Conclusion:Certain clinical manifestations are very common among mouth-breathing children. These manifestations must be recognized and considered in the clinical diagnosis of mouth breathing.J Pediatr (Rio J). 2008;84(6):529-535: Prevalence, mouth breathing, allergic rhinitis, hypertrophic adenoids, hypertrophic tonsils, deviated nasal septum.
RESUMO Objetivo: Caracterizar o grau de acometimento neurológico, estabelecendo uma correlação entre o nível funcional da lesão e a aquisição da marcha, além de identificar os fatores que interferem nessa capacidade. Método: Foram avaliadas prospectivamente vinte e oito crianças portadoras de mielomeningocele operadas com idade igual ou superior a três anos. Foram determinados o nível funcional da lesão, a aquisição ou não da marcha e os fatores associados por meio das medidas do grau de força muscular nos membros inferiores, presença de deformidades articulares, ocorrência de contratura da musculatura flexora e trato iliotibial, eficácia da reação de equilíbrio e presença de hidrocefalia tratada. Resultados: Todos os fatores avaliados, exceto a hidrocefalia, foram relacionados de forma significativa à aquisição da marcha. Conclusão: A aquisição da marcha em crianças portadoras de mielomeningocele sofre influência de vários fatores, além do nível de acometimento neurológico, o que deve ser considerado no prognóstico e na programação terapêutica. PALAVRAS-CHAVE Mielomeningocele. Distúrbios neurológicos da marcha. ABSTRACT Prognostic factors influencing ambulation in children with myelomeningocele Objective: To characterize the degree of neurological deficit, establishing a correlation between functional level of the lesion and the gait acquisition and also to identify other factors that interfere with this capacity. Method: Twenty-eight children were evaluated prospectively. The functional level of the lesion was identified and correlated with gait acquisition as well as others associates factors like degree of muscular force, presence of joint deformities, occurrence of contractures, effectiveness of the balance reaction and presence of hydrocephalus. Results: All the evaluated factors, except hydrocephalus, were related with the ability to walk. Conclusion: Several factors, was related to the gait acquisition in children with myelomeningocele, what should be considered in the prognosis and in the therapeutic programming. KEY WORDS Meningomyelocele. Gait disorders, neurologic.
Objective: To investigate the etiology, main clinical manifestations and other concurrent findings in mouth-breathing children aged 3 to 9 years and resident in the urban area of Abaeté (MG), Brazil. Methods:This study was based on a representative random sample of the town population, of 23,596 inhabitants.Clinical diagnosis of mouth-breathing was defined as a combination of snoring, sleeping with mouth open, drooling on the pillow and frequent or intermittent nasal obstruction. Children with a clinical diagnosis of mouth-breathing underwent nasal endoscopy, allergy skin tests and X ray of the rhinopharynx, full blood tests, eosinophil counts, total IgE assay and fecal parasitology. Data were analyzed using SPSS ® version 10.5. Results:The main causes of mouth-breathing were: allergic rhinitis (81.4%), enlarged adenoids (79.2%), enlarged tonsils (12.6%), and obstructive deviation of the nasal septum (1.0%). The main clinical manifestations of mouth breathers were: sleeping with mouth open (86%), snoring (79%), itchy nose (77%), drooling on the pillow (62%), nocturnal sleep problems or agitated sleep (62%), nasal obstruction (49%), and irritability during the day (43%). Conclusion:Certain clinical manifestations are very common among mouth-breathing children. These manifestations must be recognized and considered in the clinical diagnosis of mouth-breathing.J Pediatr (Rio J). 2008;84(6):529-535: Prevalence, mouth-breathing, allergic rhinitis, hypertrophic adenoids, hypertrophic tonsils, deviated nasal septum.
Objetivo: Determinar a prevalência de crianças respiradoras orais com idade entre 3 a 9 anos residentes na região urbana de Abaeté (MG). Métodos: Estudo com amostra aleatória representativa da população do município, que é de 23.596 habitantes. Foram realizados sorteios através de tabela de números aleatórios até completar 370 crianças, número determinado por cálculo estatístico. Elaborou-se roteiro para anamnese e avaliação clínica dos pacientes, especificamente para esta pesquisa, pois não foi encontrado na literatura instrumento adequado e validado para esta finalidade. Os dados foram analisados utilizando o programa SPSS versão 10.5. Resultados: A prevalência da respiração oral foi determinada em 204 crianças (55%). Conclusão: São necessários estudos adicionais para validar questionário para o diagnóstico clínico de respiradores orais no nível primário de atendimento médico.
Objectives: To present a detailed investigation of risk factors, symptoms, and laboratory and imaging tests that may be useful to establish the clinical laboratory diagnosis of visceral larva migrans (VLM) in children, demonstrating the importance of diagnosis and treatment to prevent complications in the eyes, liver, and other organs.Sources: Literature review using the MEDLINE and LILACS (1952-2009) databases, selecting the most recent and representative articles on the topic. Summary of the findings:VLM is an infectious disease with non-specific clinical presentation, whose transmission is related to contact with dogs, especially puppies, and which may progress to late systemic complications in vital organs such as the eyes and the central nervous system. IgG (ELISA) anti-T. canis can be used to establish the laboratory diagnosis. Higher cutoff points suggest recent illness and lower cutoff points demonstrate mild infection or infection in remission. Therapeutic response may be assessed by means of eosinophil blood cell count. The present article provides the pediatrician with updated information regarding VLM, a disease of high prevalence worldwide and in Brazil. Conclusions:The diagnosis of VLM depends mainly on the presence of dogs in the child's household, associated with ELISA (IgG anti-T. canis), using excretory-secretory antigens of Toxocara canis. Prospective studies are warranted to assess the best drug therapy. Prevention is the most important strategy because of the high prevalence of T. canis in urban areas. Adult worms live on average 4 months and, after about 6 months, almost all are spontaneously eliminated by the host. 4
Objectives: To present a detailed investigation of risk factors, symptoms, and laboratory and imaging tests that may be useful to establish the clinical laboratory diagnosis of visceral larva migrans (VLM) in children, demonstrating the importance of diagnosis and treatment to prevent complications in the eyes, liver, and other organs. Sources:Literature review using the MEDLINE and LILACS (1952-2009) databases, selecting the most recent and representative articles on the topic. Summary of the findings:VLM is an infectious disease with nonspecific clinical presentation, whose transmission is related to contact with dogs, especially puppies, and which may progress to late systemic complications in vital organs such as the eyes and the central nervous system. IgG (ELISA) anti-T. canis can be used to establish the laboratory diagnosis. Higher cutoff points suggest recent illness and lower cutoff points demonstrate mild infection or infection in remission. Therapeutic response may be assessed by means of eosinophil blood cell count. The present article provides the pediatrician with updated information regarding VLM, a disease of high prevalence worldwide and in Brazil. Conclusions:The diagnosis of VLM depends mainly on the presence of dogs in the child's household, associated with ELISA (IgG anti-T. canis), using excretory-secretory antigens of Toxocara canis. Prospective studies are warranted to assess the best drug therapy. Prevention is the most important strategy because of the high prevalence of T. canis in urban areas.J Pediatr (Rio J). 2011;87(2):100-110: Toxocara canis, dogs, infection, epidemiology, ELISA, prevalence. ResumoObjetivos: Apresentar investigação detalhada de fatores de risco, sintomatologia, exames laboratoriais e de imagem que possam contribuir para o diagnóstico clínico-laboratorial da larva migrans visceral (LMV) em crianças e mostrar a importância do diagnóstico e do tratamento para evitar complicações oculares, hepáticas e em outros órgãos. Fontes dos dados:Revisão de literatura utilizando os bancos de dados MEDLINE e LILACS , selecionando os artigos mais atuais e representativos do tema. Síntese dos dados:LMV é uma doença infecciosa de apresentação clínica inespecífica cuja transmissão está relacionada ao contato com cães, principalmente filhotes, podendo evoluir com complicações sistêmicas tardias em órgãos vitais como o olho e sistema nervoso central. Para diagnóstico laboratorial, pode ser utilizado IgG (ELISA) anti-Toxocara canis, cujos pontos de corte mais elevados sugerem doença recente e, os mais baixos, infecção leve ou em resolução. A resposta terapêutica pode ser avaliada por meio da contagem de eosinófilos no sangue. Esse artigo atualiza o pediatra em relação à LMV, doença de alta prevalência no mundo e no Brasil.Conclusões: O diagnóstico de LMV depende principalmente da epidemiologia da presença de cães no domicílio da criança, associada ao ELISA (IgG para T. canis), utilizando antígenos Toxocara de excreção e secreção. São necessários estudos prospectivos para avali...
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