Fatal Methanol Ingestion in a Child: Case Report

The records of Forensic Medicine Council of Turkey Bursa Morgue Department reveal the first case of fatal methanol ingestion in a child. Household methanol exposures are mostly due to accidental ingestion of washing fluids. A 4 year-old girl was admitted to the emergency department with her parents with gastrointestinal symptoms; nausea, vomiting and abdominal pain. Toxicological studies revealed 79 mg/dl blood level of methanol. We presented infant autopsy case of methanol toxicity and discussed the case from medicolegal aspect

Dapsone Hypersensitivity Syndrome In An Adolescent During Treatment Of Leprosy

A 12 y old girl was admitted 24 days after start a WHO multidrug therapy scheme for multibacillary leprosy (dapsone, clofazimine and rifampicin) with intense jaundice, generalized lymphadenopathy, hepatoesplenomegaly, oral erosions, conjunctivitis, morbiliform rash and edema of face, ankles and hands. The main laboratory data on admission included: hemoglobin, 8.4 g/dL; WBC, 15,710 cells/mm3; platelet count, 100,000 cells/mm3; INR = 1.49; increased serum levels of aspartate and alanine aminotransferases, gamma-glutamyl transpeptidase, alkaline phosphatase, direct and indirect bilirubin. Following, the clinical conditions had deteriorated, developing exfoliative dermatitis, shock, generalized edema, acute renal and hepatic failure, pancytopenia, intestinal bleeding, pneumonia, urinary tract infection and bacteremia, needing adrenergic drugs, replacement of fluids and blood product components, and antibiotics. Ten days after admission she started to improve, and was discharged to home at day 39th, after start new supervised treatment for leprosy with clofazimine and rifampicin, without adverse effects. This presentation fulfils the criteria for the diagnosis of dapsone hypersensitivity syndrome (fever, generalized lymphadenopathy, exfoliative rash, anemia and liver involvement with mixed hepatocellular and cholestatic features). Physicians, mainly in geographical areas with high prevalence rates of leprosy, should be aware to this severe, and probably not so rare, hypersensitivity reaction to dapsone.466331334Aldday, E.J., Barnes, J., Toxic effects of diaminodiphenylsulphone in leprosy (1951) Lancet, 2, pp. 205-206Andrade, Z.M.V., França, E.R., Teixeira, M.A.G., Santo, I.B., Síndrome sulfônica: Relato de um caso (1999) An. Bras. Derm., 74, pp. 59-61Barbosa, A.M., Martins Jr., E., Fleury, R.N., Opromolla, D.V.A., Mais um caso de síndrome da sulfona (2000) Hansenol. Int., 25, pp. 159-162Bluhm, R.E., Adedoyin, A., Mccarver, D.G., Branch, R.A., Development of dapsone toxicity in patients with inflammatory dermatoses: Activity of acetylation and hydroxylation of dapsone as risk factors (1999) Clin. Pharmacol. Ther., 65, pp. 598-605Bocquet, H., Bourgault-Villada, I., Delfau-Larue, M.H., Syndrome d'hypersensibilité à la dapsone. Clone T circulant transitoire (1995) Ann. Derm. Vénér., 122, pp. 514-516Brasil, M.T.L.R.F., Opromolla, D.V., Marzliak, M.L.C., Nogueira, W., Results of a surveillance system for adverse effects in leprosy's WHO/MDT (1996) Int. J. Leprosy, 64, pp. 97-104Chalasani, P., Baffoe-Bonnie, H., Jurado, R.I., Dapsone therapy causing sulfone syndrome and lethal hepatic failure in an HIV-infected patient (1994) Sth. Med. J., 87, pp. 1145-1146Frey, H.M., Gershon, A.A., Borkowsky, W., Bullock, W.E., Fatal reaction to dapsone during treatment of leprosy (1981) Ann. Intern. Med., 94, pp. 777-779Gallo, M.E.N., Nery, J.A.C., Garcia, C.G., Interconências pelas drogas utilizadas nos esquemas poliquimioterápicos em hanseníase (1995) Hansenol. Int., 20, pp. 46-50Johnson, D.A., Cattau Jr., E.L., Kurltsky, J.N., Zimmerman, H.J., Liver involvement in the sulfone syndrome (1986) Arch. Intern. Med., 146, pp. 875-877Kaluarachchi, S.I., Fernandopulle, B.M., Gunawardane, B.P., Hepatic and haematological adverse reactions associated with the use of multidrug therapy in leprosy: A five year retrospective study (2001) Indian J. Leprosy, 73, pp. 121-129Kumar, R.H., Kumar, M.V., Thappa, D.M., Dapsone syndrome: A five year retrospective analysis (1998) Indian J. Leprosy, 70, pp. 271-276Lastória, J.C., De Mello, M.S., Putinatti, A., Souza, V., Síndrome de hipersensibilidade à dapsona (2004) Diagn. Tratam., 9, pp. 19-21Leta, G.C., Simas, M.E.P.A.S., Oliveira, M.L.W., Gomes, M.K., Síndrome de hipersensibilidade à dapsona: Revisão sistemática dos critérios diagnósticos (2003) Hansenol. Int., 28, pp. 79-84Lowe, J., Treatment of leprosy with diamino diphenylsulphone by mouth (1950) Lancet, 1, pp. 145-150Mandell, G.L., Petri Jr., W.A., Drugs used in the chemotherapy of tuberculosis, Mycobacterium avlum complex disease and leprosy (1996) Goodman & Gilman's Pharmacological Basis of Therapeutics. 9. International Ed., pp. 1155-1174. , Hardman, J.G.Limbird, L.E.Molinoff, P.B.Ruddon, R.W. & Gilman, A.G., ed. New York, McGraw HillOpromolla, D.V.A., Fleury, R.N., Sindrome da sulfona e reação reversa (1994) Hansenol. Int., 19, pp. 70-76Prussik, R., Shear, N.H., Dapsone hypersensitivity syndrome (1996) J. Amer. Acad. Derm., 35, pp. 346-349Rao, P.N., Lakshmi, T.S., Increase in the incidence of dapsone hypersensitivity syndrome: An appraisal (2001) Leprosy Rev., 72, pp. 57-62Reeve, P.A., Ala, J.L., Hall, J.J., Dapsone syndrome in Vanuatu: A high incidence during multidrug treatment (MDT) of leprosy (1992) J. Trop. Med. Hyg., 95, pp. 266-270Risse, L., Bernard, P., Brosset, A., Syndrome d'hypersensibilitȩ a la disulone® (1994) Ann. Derm. Vȩnȩr., 121, pp. 242-244Saito, S., Ikezawa, Z., Miyamoto, H., Kim, S., A case of dapsone syndrome (1994) Clin. Exp. Derm., 19, pp. 152-156Santos, M.E., Leta, G.C., Oliveira, M.L.W., Dapsone hypersensitivity syndrome (DHS): Not so rare to be minimized in endemic countries (2002) International Leprosy Congress, 16 (PART 16). , Salvador, Brazil. Book of abstractsThong, B.Y., Leong, K.P., Chng, H.H., Hypersensitivity syndrome associated with dapsone/pyrimethamine (Maloprim) antimalaria chemoprophylaxis (2002) Ann. Allergy Asthma Immunol., 88, pp. 527-529Tomecki, K.J., Catalano, C.J., Dapsone hypersensitivity. The sulfone syndrome revisited (1981) Arch. Derm., 117, pp. 38-39(2004) Leprosy Elimination Project. Status Report, 2003, , http://www.who.int/lep/Reports/s20042.pdf, WHO, Genev

Thoracic actinomycosis simulating neoplastic disease in Pediatrics

OBJECTIVE: To describe a pulmonary actinomycosis case in a pediatric patient. CASE DESCRIPTION: A ten-year-old healthy girl was admitted with a history of chest pain for the past three months. During the last two months, she evolved with bulging of the left anterior chest wall. Physical examination showed a mass with 8.0cm diameter in the left inframamilar region, without signs of inflammation. Chest tomography showed an expansion process in the left anterior chest wall. Biopsy and culture of the material identified Actinomyces israelli. She was treated with crystalline penicillin and amoxicillin, leading to the disappearance of the thoracic mass. COMMENTS: Actinomycosis is a rare, indolent and invasive bacterial infection, and is often not considered in children as a cause of chest masses. Early diagnosis is uncommon.OBJETIVO: Descrever um caso de actinomicose pulmonar em paciente pediátrico. DESCRIÇÃO DO CASO: Menina de dez anos, saudável, com história de dor torácica há três meses, evoluindo há dois meses com abaulamento em parede torácica anterior esquerda. Ao exame físico, apresentava massa de 8,0cm de diâmetro em região inframamilar esquerda, sem sinais flogísticos. A tomografia do tórax mostrou processo expansivo em parede torácica anterior esquerda. Realizou-se biópsia e a cultura do material identificou Actinomyces israelli. Foi tratada com penicilina cristalina e amoxicilina, com desaparecimento da massa torácica. COMENTÁRIOS: A actinomicose é uma doença bacteriana rara, indolente, invasiva e, frequentemente, não considerada em crianças como causa provável de massas torácicas, sendo incomum o diagnóstico precoce.OBJETIVO: Describir un caso de actinomicosis pulmonar en paciente pediátrico. DESCRIPCIÓN DEL CASO: Muchacha de diez años, saludable, con historia de dolor torácico hace tres meses, evolucionando, hace dos meses, con abombamiento en pared torácica anterior izquierda. Al examen físico, presentaba masa de 8,0 cm de diámetro en región inframamilar izquierda, sin señales flogísticas. La tomografía del tórax mostró proceso expansivo en pared torácica anterior izquierda. Se realizó biopsia y la cultura del material identificó Actinomyces israelli. Se trató con penicilina cristalina y amoxicilina, con desaparición de la masa torácica. COMENTARIOS: La actinomicosis es una enfermedad bacteriana rara, indolente, invasiva y, frecuentemente, no considerada en niños como causa probable de masas torácicas, siendo poco común el diagnóstico temprano.45045

O Ouvido Atento - Escuta e comunicação no estúdio de gravação

Este Cd contém 2 anexos que só podem ser consultados na Biblioteca Mário Sottomayor CardiaEste trabalho tem como ponto de partida um estágio para estudar a importância que a comunicação desempenha num contexto de gravação, de produção musical e de áudio em estúdio. Por razões práticas, aqui é considerada como produção musical os processos de discussões e escolhas que permeiam as sessões de gravação propriamente ditas, não a préprodução que precede as mesmas. Partindo de situações práticas, são abordadas a importância do conhecimento técnico do som (durante os processos de gravação e manipulação do som) e a relevância da comunicação entre o(s) performer(s) e responsáveis pela produção (e ou gravação) do conteúdo. Este trabalho visa refletir sobre esta questão e oferecer pistas no que diz respeito ao diálogo entre produtor e performer, propondo abordagens que facilitam a alternância entre as diferentes funções que são realizadas neste ambiente de trabalho. Finalmente, sugerimos possibilidades que auxiliam na criação de um ambiente técnico e psicológico adequado ao registo da performance com a melhor qualidade possível, ao mesmo tempo que esclarecemos alguns pontos que pretendem auxiliar aqueles interessados a se iniciarem na área.This work has as a starting point an internship in a recording studio to study the importance that communication plays in the context of recording a music production or audio. For practical reasons, here is considered as musical production the discussions and choices that permeate the recording sessions themselves, rather than the pre-production that precedes them. Based on practical situations, we will discuss the importance of the technical aspects of sound (regarding its recording and its manipulation) and the relevance of the communication between the performer(s) and those responsible for the production (and/or recording) of a content. This work explores the dialogue between producer and performer, and indicates approaches that facilitate the alternation between the different tasks that are performed in this work environment. Finally, we suggest possibilities that help create a technical and psychological environment suitable for the recording of the best performance possible, while at the same time, we clarify some points that may help those interested in starting in these area

Self-medication In Children And Adolescents.

To determine the prevalence of self-medication in children and adolescents in the municipalities of Limeira and Piracicaba, state of São Paulo, and to correlate results with sociodemographic indicators and with the use of health care services (public or private). Descriptive population-based study of a simple random sample from the two municipalities, comprised of 772 inhabitants from 85 urban census sectors selected through cluster sampling. age < or = 18 years; interview with one parent/tutor; consumption of at least one drug in the previous 15 days. Subjects were divided into two study groups according to their pattern of drug use: self-medication (lay advice) and medical prescription. Linear association tests, descriptive analysis of variables and multiple logistic regression tests were carried out to analyze data. The prevalence of self-medication was 56.6%. Mothers (51%) and drugstore employees (20.1%) were most frequently responsible for self-medication. The main groups of self-prescribed drugs were: analgesic/antipyretic and non-hormonal anti-inflammatory drugs (52.9%); drugs acting on the respiratory tract (15.4%) and gastrointestinal drugs (9.6%); and systemic antibiotics (8.6%). The situation that most commonly motivated self-medication were respiratory diseases (17.2%), fever (15%), and headache (14%). Subjects in the age group of 7-18 years (odds ratio = 2.81) and public health care users (odds ratio = 1.52) showed increased risk for self-medication. The prevalence of self-medication in children and adolescents was high, which reinforces the need for public health interventions aiming at preventing this practice.83453-

Disponibilidade De Antídotos No Município De Campinas, São Paulo

The lack of availability of antidotes in emergency services is a worldwide concern. The aim of the present study was to evaluate the availability of antidotes used for treating poisoning in Campinas (SP). DESIGN AND SETTING: This was a cross-sectional study of emergency services in Campinas, conducted in 2010-2012. METHODS: The availability, amount in stock, place of storage and access time for 26 antidotal treatments was investigated. In the hospitals, the availability of at least one complete treatment for a 70 kg adult over the first 24 hours of admission was evaluated based on stock and access recommendations contained in two international guidelines. RESULTS: 14 out of 17 functioning emergency services participated in the study, comprising pre-hospital services such as the public emergency ambulance service (SAMU; n = 1) and public emergency rooms for admissions lasting ≤ 24 hours (UPAs; n = 3), and 10 hospitals with emergency services. Six antidotes (atropine, sodium bicarbonate, diazepam, phytomenadione, flumazenil and calcium gluconate) were stocked in all the services, followed by 13 units that also stocked activated charcoal, naloxone and diphenhydramine or biperiden. No service stocked all of the recommended antidotes; only the regional Poison Control Center had stocks close to recommended (22/26 antidotal treatments). The 10 hospitals had almost half of the antidotes for starting treatments, but only one quarter of the antidotes was present with stocks sufficient for providing treatment for 24 hours. CONCLUSION: The stock of antidotes for attending poisoning emergencies in the municipality of Campinas is incomplete and needs to be improved. © 2017, Associacao Paulista de Medicina. All rights reserved.13511522FAPEAM, Fundação de Amparo à Pesquisa do Estado do Amazona

Paracoccidioidomicose disseminada fatal em criança de dois anos

A two year-old female child was admitted at the Pediatric Intensive Care Unit in a septic shock associated with a lymphoproliferative syndrome, with history of fever, adynamia and weight loss during the last two months. On admission, the main clinical and laboratory manifestations were: pallor, jaundice, disseminated enlarged lymph nodes, hepatosplenomegaly, crusted warts on face, anemia, eosinophilia, thrombocytopenia, increased direct and indirect bilirubin, alkaline phosphatase, and gammaglutamyl transpeptidase. A parenteral administration of fluids, dobutamine and mechanical ventilation was started, without improvement of the clinical conditions. A direct examination of exsudate collected from cervical lymph node revealed numerous oval-to-around cells with multiple budding, like a "pilot wheel" cell, suggesting Paracoccidioides brasiliensis. Even though treatment with intravenous sulfamethoxazole-trimethoprine was soon started, the child died 36 hours after hospital admission. Disseminated paracoccidioidomycosis was confirmed in the autopsy. This is the youngest case of paracoccidioidomycosis in children reported in the literature.Uma menina de dois anos foi internada em Unidade de Terapia Intensiva com o diagnóstico de choque séptico associado a sindrome linfoproliferativa febril, adinamia e perda de peso nos últimos dois meses. Na admissão, as principais manifestações clínicas e laboratoriais eram: palidez, icterícia, aumento ganglionar em todas as cadeias superficiais, hepatoesplenomegalia, lesões crostosas em face, anemia, eosinofilia, plaquetopenia, elevação de bilirrubina indireta e direta, de fosfatase alcalina e de gama glutamil transferase. A terapêutica instituída foi infusão de fluidos, dobutamina e ventilação mecânica, sem melhora das condições clínicas, seguido da introdução de sulfametoxazol-trimetoprina. O exame direto do linfonodo revelou numerosas estruturas ovaladas, com múltiplos brotamentos, como "roda de leme" sugerindo Paracoccidioides brasiliensis. A paciente evoluiu para o óbito 36 horas após a internação. Paracoccidioidomicose disseminada foi confirmada na necropsia. Trata-se do caso mais jovem de paracoccidioidomicose reportado na literatura consultada

Fatal Disseminated Paracoccidioidomycosis In A Two-year-old Child.

A two year-old female child was admitted at the Pediatric Intensive Care Unit in a septic shock associated with a lymphoproliferative syndrome, with history of fever, adynamia and weight loss during the last two months. On admission, the main clinical and laboratory manifestations were: pallor, jaundice, disseminated enlarged lymph nodes, hepatosplenomegaly, crusted warts on face, anemia, eosinophilia, thrombocytopenia, increased direct and indirect bilirubin, alkaline phosphatase, and gammaglutamyl transpeptidase. A parenteral administration of fluids, dobutamine and mechanical ventilation was started, without improvement of the clinical conditions. A direct examination of exsudate collected from cervical lymph node revealed numerous oval-to-around cells with multiple budding, like a pilot wheel cell, suggesting Paracoccidioides brasiliensis. Even though treatment with intravenous sulfamethoxazole-trimethoprine was soon started, the child died 36 hours after hospital admission. Disseminated paracoccidioidomycosis was confirmed in the autopsy. This is the youngest case of paracoccidioidomycosis in children reported in the literature.4637-

Snakebites By Bothrops Spp In Children In Campinas, São Paulo, Brazil.

From January, 1984 to March, 1999, 73 children under 15 y old (ages 1-14 y, median 9 y) were admitted after being bitten by snakes of the genus Bothrops. Twenty-six percent of the children were classified as mild envenoming, 50.7% as moderate envenoming and 20.6% as severe envenoming. Two patients (2.7%) showed no signs of envenoming. Most of the patients presented local manifestations, mainly edema (94.5%), pain (94.5%) ecchymosis (73.9%) and blisters (11%). Local and/or systemic bleeding was observed in 28.8% of the patients. Before antivenom (AV) administration, blood coagulation disorders were observed in 60.7% (incoagulable blood in 39.3%) of the 56 children that received AV only in our hospital. AV early reactions, most of which were considered mild, were observed in 44.6% of these cases (in 15/30 patients not pretreated and in 10/26 patients pretreated with hydrocortisone and histamine H1 and H2 antagonists). The main clinical complications observed were local infection (15.1%), compartment syndrome (4.1%), gangrene (1.4%) and acute renal failure (1.4%). No deaths were recorded. There were no significant differences with regard to severity of envenoming versus the frequency of blood coagulation disorders among the three categories of envenoming (p = 0.75) or in the frequency of patients with AV early reactions between the groups that were and were not pretreated (p = 0.55). The frequency of local infection was significantly greater in severe cases (p < 0.001). Patients admitted more than 6 h after the bite had a higher risk of developing severe envenoming (p = 0.04).43329-3