Corpo estranho esofágico. Sobre um caso

Introduction: the esophageal foreign body is the most frequent emergency in children. Retropharyngeal abscess and mediastinitis are some of its main complications, reflecting the importance of an early diagnosis. Neck radiography is the radiological study performed in children with a suspected pharyngeal or esophageal lesion.Case presentation: the case of a 2-year-old girl from a rural area is presented, who was referred from the Serekunda Hospital for presenting a persistent dry cough and difficulty swallowing the solid, of three months of evolution. Diagnosed as an upper respiratory tract infection with several antibiotic treatments without clinical improvement. A week before remission, the girl began with difficulty swallowing fluids and a high fever.Discussion: the physical examination found severe signs of inflammation in the posterior wall of the pharynx. Cervical esophagus X-ray with lateral view reports a metallic foreign body and inflammation of the posterior wall of the esophagus. The retropharyngeal abscess is confirmed by rigid esophagoscopy, incision and drainage were performed. He was admitted with antibiotics and steroids for 5 days.Conclusions: by means of rigid esophagoscopy, the foreign body is extracted. Respiratory symptoms are more common than gastrointestinal symptoms in pediatric patients with a chronic esophageal foreign body, an early and accurate diagnosis is imperative, because the complications are serious and can compromise the life of the patient.Introducción: el cuerpo extraño esofágico es la emergencia más frecuente en niños. El absceso retrofaringeo y la mediastinitis son unas de sus principales complicaciones, lo que refleja la importancia de un diagnóstico temprano. La radiografía de cuello (Rx de esófago cervical simple) es el estudio radiológico realizado a niños con sospecha de una lesión faríngea o esofágica.Presentación de caso: se presenta el caso de una niña de 2 años de edad de área rural, quien fue remitida del Hospital de Serekunda por presentar tos persistente seca y dificultad para tragar lo sólido, de tres meses de evolución. Diagnosticada como una infección del tracto respiratorio alto con varios tratamientos con antibiótico sin mejoría clínica. Una semana antes de la remisión, la niña comenzó con dificultad para tragar los líquidos y fiebre alta. Discusión: al examen físico se encontró signos severos de inflamación en la pared posterior de la faringe. El Rx de esófago cervical con vista lateral informa un cuerpo extraño metálico e inflamación de la pared posterior del esófago. El absceso retro faríngeose confirma por esofagoscopia rígida, se le realizó incisión y drenaje. Se ingresa con antibiótico y esteroides por 5 días.Conclusiones: mediante esofagoscopia rígida se extrae el cuerpo extraño. Los síntomas respiratorios son más comunes que los síntomas gastrointestinales en pacientes pediátricos con un cuerpo extraño esofágicocrónico, un diagnóstico temprano y certero es imperativo, porque las complicaciones son serias y pueden comprometer la vida del paciente. Introdução: o corpo estranho de esôfago é a emergência mais frequente em crianças. Abscesso retrofaríngeo e mediastinite são algumas de suas principais complicações, refletindo a importância do diagnóstico precoce. A radiografia de pescoço é o estudo radiológico realizado em crianças com suspeita de lesão faríngea ou esofágica.Apresentação do caso: é apresentado o caso de uma menina de 2 anos de idade, procedente de zona rural, encaminhada do Hospital Serekunda por apresentar tosse seca persistente e dificuldade de engolir o sólido, de três meses de evolução. Diagnosticada como uma infecção do trato respiratório superior com vários tratamentos antibióticos sem melhora clínica. Uma semana antes da remissão, a menina começou a ter dificuldade para engolir líquidos e febre alta.Discussão: o exame físico encontrou sinais graves de inflamação na parede posterior da faringe. A radiografia do esôfago cervical com visão lateral mostra um corpo estranho metálico e inflamação da parede posterior do esôfago. O abscesso retrofaríngeo é confirmado por esofagoscopia rígida, sendo realizada incisão e drenagem. Ele foi internado com antibióticos e esteróides por 5 dias.Conclusões: por meio de esofagoscopia rígida, o corpo estranho é extraído. Os sintomas respiratórios são mais comuns que os sintomas gastrointestinais em pacientes pediátricos com corpo estranho esofágico crônico, um diagnóstico precoce e preciso é imprescindível, pois as complicações são graves e podem comprometer a vida do paciente

Eficacia de un entrenamiento en Funciones Ejecutivas sobre las Habilidades Matemáticas Básicas y la Conciencia Fonológica en niños de Educación Infantil

El objetivo principal del presente estudio fue llevar a cabo un entrenamiento en Funciones Ejecutivas (FE) para comprobar sus efectos sobre las Habilidades Matemáticas Básicas (HMB) y la Conciencia Fonológica (CF) en niños de Educación Infantil (EI). La investigación se realizó a lo largo de tres fases: una de evaluación previa a la intervención, una segunda fase en la que implementó un entrenamiento en FE, y finalmente una fase de evaluación al finalizar el entrenamiento. Este entrenamiento se aplicó por separado a dos grupos de 6 niños de 6º curso de EI (un grupo TIC y un grupo en lápiz y papel) que recibieron igual tratamiento. Los resultados mostraron mejoras tanto en HMB como en CF en ambos grupos

Epidemiología y pronóstico de los pacientes con VIH ingresados en la UCI en la era de tratamiento antirretroviral de gran actividad actual

Observational study[Abstract] Purpose: To describe the epidemiology of critical disease in HIV-infected patients during the current highly active antiretroviral therapy (HAART) era and to identify hospital mortality predictors. Methods: A longitudinal, retrospective observational study was made of HIV-infected adults admitted to the ICU in two Spanish hospitals between 1 January 2000 and 31 December 2014. Demographic and HIV-related variables were analyzed, together with comorbidities, severity scores, reasons for admission and need for organ support. The chi-squared test was used to compare categorical variables, while continuous variables were contrasted with the Student's t-test, Mann-Whitney U-test or Kruskal-Wallis test, assuming an alpha level=0.05. Multivariate logistic regression analysis was used to calculate odds ratios for assessing correlations to mortality during hospital stay. Joinpoint regression analysis was used to study mortality trends over time. Results: A total of 283 episodes were included for analyses. Hospital mortality was 32.9% (95%CI: 21.2-38.5). Only admission from a site other than the Emergency Care Department (OR 3.64, 95%CI: 1.30-10.20; p=0.01), moderate-severe liver disease (OR 5.65, 95%CI: 1.11-28.87; p=0.04) and the APACHE II score (OR 1.14, 95%CI: 1.04-1.26; p<0.01) and SOFA score at 72h (OR 1.19, 95%CI: 1.02-1.40; p=0.03) maintained a statistically significant relationship with hospital mortality. Conclusions: Delayed ICU admission, comorbidities and the severity of critical illness determine the prognosis of HIV-infected patients admitted to the ICU. Based on these data, HIV-infected patients should receive the same level of care as non-HIV-infected patients, regardless of their immunological or nutritional condition.[Resumen] Objetivos. Describir la epidemiología de la patología crítica en el paciente infectado por VIH durante la era de tratamiento antirretroviral de gran actividad actual y encontrar predictores de mortalidad hospitalaria. Métodos. Estudio observacional, retrospectivo y longitudinal que incluye pacientes infectados por VIH adultos ingresados en las UCI de hospitales de Galicia, entre el 1 de enero de 2000 y el 31 de diciembre de 2014. Analizamos variables demográficas y relacionadas con la infección por el VIH, comorbilidades, puntuaciones de gravedad, motivo de ingreso y necesidad de soporte de órganos. Empleamos la prueba de la Chi-cuadrado para comparar las variables categóricas y las pruebas de la T-Student, U de Mann-Whitney o H de Kruskal-Wallis para las variables continuas, asumiendo un error α = 0,05. Utilizamos la regresión logística multivariante para calcular la OR de la asociación con la mortalidad hospitalaria. Aplicamos análisis de regresión de joinpoint para estudiar la tendencia temporal de mortalidad. Resultados. Incluimos 283 episodios. La mortalidad hospitalaria fue del 32,9% (IC 95% = 21,2-38,5%). El ingreso no procedente de Urgencias (OR 3,64; IC 95% = 1,30-10,20; p = 0,01), la enfermedad hepática moderada-grave (OR 5,65; IC 95% = 1,11-28,87; p = 0,04), el APACHE II (OR 1,14; IC 95% = 1,04-1,26; p < 0,01) y el SOFA a las 72 h (OR 1,19; IC 95% = 1,02-1,40; p = 0,03) se relacionan con la mortalidad hospitalaria en el análisis multivariante. Conclusiones. El retraso en el ingreso en UCI, las comorbilidades y la gravedad del episodio determinan el pronóstico del paciente infectado por VIH ingresado en UCI. Los pacientes con VIH deberían recibir el mismo nivel de cuidados que los pacientes no infectados por VIH, independientemente de su estado inmunológico o nutricional

Long-Term Follow-Up of Children Treated With Peginterferon and Ribavirin for Hepatitis C Virus Infection

Objectives: The aim of the study was to describe the 5-year follow-up of children who received peginterferon and ribavirin in a global, open-label study. Methods: A 5-year follow-up study of 107 children and adolescents ages 3 to 17 years with chronic hepatitis C virus infection who received peginterferon and ribavirin for 24 or 48 weeks. No drugs were administered during follow-up. Results: Ninety-four patients were enrolled in the long-term follow-up portion of the study;the median duration of follow-up was 287 weeks (range, 73-339). Of 63 patients with sustained virologic response who were enrolled, 54 completed 5 years of follow-up;none had relapse in the 5-year follow-up period. Significant decreases in height z scores were observed during treatment. The effect of treatment on height z score was larger in patients treated for 48 weeks compared with those treated for 24 weeks (mean change from baseline to the end of treatment was -0.13 [P < 0.001] and -0.44 [P < 0.001] in the 247 and 48-week treatment groups, respectively). Among patients treated for 24 weeks, full recovery of height z scores to baseline was observed by 1 year of follow-up, whereas only partial recovery was observed during 5 years of follow-up in patients treated for 48 weeks (mean change from baseline to the final follow-up visit was -0.16 (P=NS) and 0.32 (P < 0.05) in the 24- and 48-week treatment groups, respectively). Similar patterns were observed for weight and body mass index z scores. Conclusions: Impairment of growth should be considered when assessing the risk-benefit profile of peginterferon/ribavirin therapy in children with hepatitis C virus infection. In deciding to treat children with chronic hepatitis C virus, considerations should include both deferring treatment in patients during optimal growth periods, and the possibility that interferon free regimens may be available to children in the next 5 to 10 years

Azathioprine in refractory sprue: results from a prospective, open-label study

OBJECTIVE: Refractory sprue is a rare and severe malabsorptive disorder that mimics celiac disease but is refractory to a gluten-free diet and is without initial evidence of overt lymphoma. Treatment is largely empiric and often ineffective, with steroids and immunosuppression being the mainstream therapeutic options. The aim of this study was to evaluate prospectively the effect of azathioprine on a group of patients diagnosed with refractory sprue. METHODS: We studied seven consecutive patients (five women and two men) with a well-defined diagnosis of refractory sprue and a lack of response to oral or parenteral steroids. At diagnosis, five patients had endoscopic evidence of ulcerative jejunitis, and five underwent exploratory laparotomy for exclusion of malignancies. The characteristic monoclonal TCR gene rearrangement was shown in five of six patients studied. Patients were treated for a mean of 11 months (range 8–12 months), and clinical, biochemical, molecular, and histological parameters were reassessed at the end of the trial. The study was a prospective, open-label, non–placebo-controlled study using azathioprine (2 mg/kg/ day) plus oral prednisone (1 mg/kg/day). A gluten-free diet (n 7) as well as enteral (n 6) and parenteral nutrition (n 5) were administered during the trial. RESULTS: After treatment, five patients had a complete clinical remission, and biochemical and nutritional parameters were significantly improved. Steroids were tapered after the onset of azathioprine, and no patient was on steroids at the end of the trial. Intestinal histology improved significantly in all cases (normal histology in three cases and minor infiltration in the lamina propria in two). Two patients did not respond to treatment at any time and died in months 10 and 9, of an irreversible ventricular fibrillation and sepsis, respectively. No overt lymphoma was demonstrated during the follow-up. CONCLUSIONS: The present study confirms earlier anecdotal reports on the efficacy of azathioprine in refractory sprue, with clear clinical and histological improvement shown in most patients. However, monoclonality persisted after treatment. We consider that a larger number of patients should be evaluated before a definitive recommendation is adopted for use of this drug in refractory sprue.Fil: Maurino, Eduardo. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; Argentina. Universidad del Salvador; ArgentinaFil: Niveloni, Sonia Isabel. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Cherñavsky, Alejandra Claudia. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín. Laboratorio de Inmunogenética; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Inmunología, Genética y Metabolismo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Inmunología, Genética y Metabolismo; ArgentinaFil: Pedreira, Silvia. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Mazure, Roberto. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Vazquez, Daniel Horacio. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Reyes, Hugo. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Fiorini, Alcira. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Smecuol, Edgardo. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Cabanne, Ana. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Capucchio, Monica. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín. Laboratorio de Inmunogenética; ArgentinaFil: Kogan, Zulema. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Bai, Julio C.. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; Argentina. Universidad del Salvador; Argentin

Características clínicas y evolución a largo plazo de una serie de pacientes con sprue refractario diagnosticados en una sola institución

Background: Refractory sprue (RS) is a rare and severe celiac-like enteropathy not responding to a strict gluten-free diet. Although prognosis is generally poor, little is known about the long-term outcome of patients. Aim: to report baseline characteristics and long-term outcome of a series of patients diagnosed and treated in a single institution. Materials: We report a retrospective cohort of 25 consecutive patients (15 females; mean age 46 yr; range 28-71) diagnosed with RS based on the presence of a non-responsive celiac-like enteropathy. All patients were intensively treated with a gluten-free diet, steroids, nutritional support and immunosupression. Results: Clinical and biological characteristics of patients suggest that, at least, 24 patients had clear evidences of celiac disease. HLA DQ2/DQ8 genes were present in all the 24 patients typed and autoimmune enteropathy was excluded in all. According to the genotyping, 12 patients had a polyclonal lymphocyte population (RS type I) and 13 exhibited monoclonal TCR-γ gene rearrangements (RS type II). Sixteen patients had evidence of ulcerative jejunitis (UJ) (7 in RS type I and 9 in type II). Overall median follow-up time after diagnosis of RS was 29 mo/patient (range 7 to 204) (45 mo for type I and 24 mo for type II). Overall mortality was 48% (12 patients), 6 in each type. Eight patients with UJ (50%), 3 with lymphoma (two T-cell and one B-cell type) and 4 (44%) without ulcers died during follow-up. The causes of death were sepsis in the context of a progressive deterioration but without overt malignancies (n=5), vascular causes (n=3) and severe malnutrition (n=1). Three- and 5-yr survival rate after diagnosis of RS for the overall population was 60% and 56%. There was no differences between type I (67%, 58%) and type II RS patients (54% for both periods). Patients with UJ had lower but non-significant 3- and 5-yr survival rates (56% and 50%, respectively) compared with patients without ulcers (78% and 66%). Survivors had a favorable outcome. While 11 patients persists asymptomatic, two other cases still have mild diarrhea and one low body weight. Conclusions: We confirm that RS is a severe celiac disease-related disorder with very high mortality. Diagnosis of overt lymphoma (12%) in our long-term follow-up was not as frequent as was reported by other groups. A proportion of patients persist in good health for a long time irrespective of the nature of the IEL infiltration or the presence of UJ.Fil: Mauriño, Eduardo. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Niveloni, Sonia Isabel. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Cherñavsky, Alejandra Claudia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Inmunología, Genética y Metabolismo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Inmunología, Genética y Metabolismo; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín. Laboratorio de Inmunogenética; ArgentinaFil: Sugai, Emilia. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Vázquez, Horacio. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Pedreira, Silvia. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Periolo, Natalia. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín. Laboratorio de Inmunogenética; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Mazure, Roberto. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Smecuol, Edgardo. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Moreno, Maria L.. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Litwin, Néstor. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Nachman, Fabio. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Kogan, Zulema. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; ArgentinaFil: Bai, Julio C.. Gobierno de la Ciudad de Buenos Aires. Hospital de Gastroenterología "Dr. Carlos B. Udaondo"; Argentin

Characterization of individuals at high risk of developing melanoma in Latin America: bases for genetic counseling in melanoma

PURPOSE: CDKN2A is the main high-risk melanoma-susceptibility gene, but it has been poorly assessed in Latin America. We sought to analyze CDKN2A and MC1R in patients from Latin America with familial and sporadic multiple primary melanoma (SMP) and compare the data with those for patients from Spain to establish bases for melanoma genetic counseling in Latin America. METHODS: CDKN2A and MC1R were sequenced in 186 Latin American patients from Argentina, Brazil, Chile, Mexico, and Uruguay, and in 904 Spanish patients. Clinical and phenotypic data were obtained. RESULTS: Overall, 24 and 14% of melanoma-prone families in Latin America and Spain, respectively, had mutations in CDKN2A. Latin American families had CDKN2A mutations more frequently (P = 0.014) than Spanish ones. Of patients with SMP, 10% of those from Latin America and 8.5% of those from Spain had mutations in CDKN2A (P = 0.623). The most recurrent CDKN2A mutations were c.-34G>T and p.G101W. Latin American patients had fairer hair (P = 0.016) and skin (P < 0.001) and a higher prevalence of MC1R variants (P = 0.003) compared with Spanish patients. CONCLUSION: The inclusion criteria for genetic counseling of melanoma in Latin America may be the same criteria used in Spain, as suggested in areas with low to medium incidence, SMP with at least two melanomas, or families with at least two cases among first- or second-degree relatives.Genet Med 18 7, 727-736

Guía de Incorporación de Cartas Temáticas Pre-existentes de la Dirección de Geología Ambiental y Aplicada de la República de Argentina a Escala 1:250.000

Fil: Pedreira Junco, José Ángel. SADIM: Sociedad Asturiana de Diversificación Minera; España. .Fil: Avanzas, Rubén. SADIM: Sociedad Asturiana de Diversificación Minera; España.Fil: López Rivas, J. SADIM: Sociedad Asturiana de Diversificación Minera; España.Fil: Tobio, María Inés. SEGEMAR: Servicio Geológico Minero Argentino; Argentina.Fil: Chavez, Roxana. SEGEMAR: Servicio Geológico Minero Argentino; Argentina.Fil: González, María Alejandra. SEGEMAR: Servicio Geológico Minero Argentino; Argentina.Fil: Elisondo, Manuela. SEGEMAR: Servicio Geológico Minero Argentino; Argentina.Fil: Villegas, Daniela. SEGEMAR: Servicio Geológico Minero Argentino; Argentina.Fil: Caballaro, Sandra. SEGEMAR: Servicio Geológico Minero Argentino; Argentina.Fil: Nicosia Burgos, Federico R. SEGEMAR: Servicio Geológico Minero Argentino; Argentina.Fil: Rivas, Irma S. SEGEMAR: Servicio Geológico Minero Argentino; Argentina.Fil: Fratalochi, Catalina. SEGEMAR: Servicio Geológico Minero Argentino; Argentina.Fil: Tello, Norma Elisa. SEGEMAR: Servicio Geológico Minero Argentino; Argentina.Fil: Ferpozzi, Federico Javier. SEGEMAR: Servicio Geológico Minero Argentino; Argentina.Fil: Candaosa, Norberto Gabriel. SEGEMAR: Servicio Geológico Minero Argentino; Argentina.Fil: Chavez, Silvia Beatríz. SEGEMAR: Servicio Geológico Minero Argentino; Argentina.Fil: Álvarez Fernández, Saúl. SADIM: Sociedad Asturiana de Diversificación Minera; España