Apendicite aguda complicada na criança: antibioticoterapia em doses múltiplas versus dose única diária.

Trabalho de Conclusão de Curso - Universidade Federal de Santa Catarina. Curso de Medicina. Departamento de Pediatria

Artrite de Poncet: relato de caso Poncet's arthritis: case report

A doença de Poncet é uma condição clínica rara, caracterizada por um acometimento poliarticular em um paciente com diagnóstico de tuberculose, sem evidência de invasão direta do bacilo nas articulações, configurando uma artrite reativa. Documentamos um caso em Porto Alegre: um homem de 56 anos, com evidência de poliartrite aditiva de grandes articulações, investigada há 5 anos, sem diagnóstico definido. Ele havia sido submetido a uma nefrectomia unilateral há 5 anos, e o exame anatomopatológico do órgão revelou tuberculose renal. O teste tuberculínico atual revelou um forte reator (PPD = 20 mm). Análise do líquido sinovial não demonstrou invasão direta do bacilo. Foi instituído tratamento empírico com tuberculostáticos com remissão clínica após 2 meses. Embasados nesses dados, foi feito diagnóstico de doença de Poncet.<br>Poncet's disease is a rare clinical condition, characterized by polyarticular impairment in a patient diagnosed with tuberculosis, with no evidence of direct bacillary invasion of the joints, constituting reactive arthritis. We report a case of a 56-year old, white male from the city of Porto Alegre, with evidence of additive polyarthritis of the large joints, investigated for five years, and with no defined diagnosis. The patient had undergone unilateral nephrectomy five years before, and the anatomicopathological exam of the specimen revealed renal tuberculosis. The current tuberculin test was strongly reactive (PPD = 20 mm). Analysis of the synovial fluid showed no direct bacillary invasion. Tuberculostatic treatment was initiated and clinical remission occurred after two months. The diagnosis of Poncet's arthritis was established

Avaliação do perfil epidemiológico e da mortalidade dos pacientes com diagnóstico de melanoma cutâneo primário no município de Florianópolis - SC, Brasil

FUNDAMENTOS: O melanoma é o câncer cutâneo com maior letalidade. Santa Catarina é o estado brasileiro com maior número de casos desse tumor. OBJETIVOS: Estimar a taxa de mortalidade por melanoma no quinto ano de doença. MÉTODOS: A amostra compreendeu 81 laudos de melanoma primário cutâneo, em 75 pacientes, emitidos em Florianópolis - SC em 2002 e 2003. O protocolo de pesquisa incluiu idade, sexo, cor do paciente e localização anatômica, tipo histológico, grau de invasão, índice de Breslow, infiltrado inflamatório, ulceração, regressão, invasão angiolinfática e estadiamento do tumor. Foi feito contato telefônico com os pacientes para verificar seu status (vivo, morto por melanoma ou morto por outra causa). Para análise estatística, utilizou-se o teste exato de Fisher e a curva de sobrevida de Kaplan-Meier. RESULTADOS: O perfil dos pacientes foi: feminino, branco, 51,3 anos, melanoma invasivo em tronco ou membros, tipo extensivo superficial, Breslow 2,63 mm. A taxa de mortalidade por melanoma cutâneo foi de 7,0%, maior entre homens (11,1%), com Breslow superior a 4,0 mm (66,0%), com ulceração (33,3%) e em estádio IV (80,0%). A sobrevida média foi de 56,7 meses. Conclusões: A taxa de mortalidade por melanoma primário cutâneo foi de 7,0%, e a ulceração e o estadiamento final foram os fatores com significância estatística sobre o resultado

Cardiac dysfunction and ferritin as early markers of severity in pediatric sepsis

Objective: The aim of this study was to verify the association of echocardiogram, ferritin, C-reactive protein, and leukocyte count with unfavorable outcomes in pediatric sepsis. Methods: A prospective cohort study was carried out from March to December 2014, with pediatric critical care patients aged between 28 days and 18 years. Inclusion criteria were diagnosis of sepsis, need for mechanical ventilation for more than 48 h, and vasoactive drugs. Serum levels of C-reactive protein, ferritin, and leukocyte count were collected on the first day (D0), 24 h (D1), and 72 h (D3) after recruitment. Patients underwent transthoracic echocardiography to determine the ejection fraction of the left ventricle on D1 and D3. The outcomes measured were length of hospital stay and in the pediatric intensive care unit, mechanical ventilation duration, free hours of VM, duration of use of inotropic agents, maximum inotropic score, and mortality. Results: Twenty patients completed the study. Patients with elevated ferritin levels on D0 had also fewer ventilator-free hours (p = 0.046) and higher maximum inotropic score (p = 0.009). Patients with cardiac dysfunction by echocardiogram on D1 had longer hospital stay (p = 0.047), pediatric intensive care unit stay (p = 0.020), duration of mechanical ventilation (p = 0.011), maximum inotropic score (p = 0.001), and fewer ventilator-free hours (p = 0.020). Conclusion: Cardiac dysfunction by echocardiography and serum ferritin value was significantly associated with unfavorable outcomes in pediatric patients with sepsis. Resumo: Objetivo: Verificar a associação do ecocardiograma, da ferritina, da Proteína C Reativa (PCR) e da contagem de leucócitos com desfechos desfavoráveis na sepse pediátrica. Métodos: Estudo de coorte prospectivo, no período de março a dezembro de 2014, com pacientes críticos pediátricos de idade entre 28 dias e 18 anos. Critérios de inclusão foram diagnóstico de sepse, necessidade de ventilação mecânica (VM) por mais de 48 horas e uso de drogas vasoativas. Avaliaram-se os níveis séricos PCR, ferritina, contagem de leucócitos, no recrutamento (D0), 24 horas (D1) e 72 horas (D3) após o recrutamento. No D1 e no D3 todos pacientes foram submetidos a ecocardiograma transtorácico para determinação da Fração de Ejeção (FE) do ventrículo esquerdo. Os desfechos avaliados foram tempo de internação hospitalar e na Unidade de Terapia Intensiva pediátrica (UTIP); duração da VM; horas livres de VM; duração do uso de inotrópicos; escore de inotrópicos máximo e mortalidade. Resultados: Vinte pacientes completaram o estudo. Ferritina elevada no D0 associou-se com menor tempo livre de ventilação (p = 0,046) e maior escore de inotrópicos máximo (p = 0,009). A disfunção cardíaca pelo ecocardiograma no D1 relacionou-se com maior tempo de internação hospitalar (p = 0,047), de UTIP (p = 0,020), VM total (p = 0,011), escore de inotrópicos máximo (p = 0,001) e menor tempo livre de VM (p = 0,020). Conclusão: A disfunção cardíaca pelo ecocardiograma e o valor de ferritina sérica associaram-se significativamente com desfechos desfavoráveis nos pacientes pediátricos com sepse. Keywords: Sepsis, Septic shock, Echocardiogram, Outcome, Pediatric intensive care unit, Palavras-chave: Sepse, Choque séptico, Ecocardiograma, Desfecho, Unidade de Terapia Intensiva Pediátric

Cardiac dysfunction and ferritin as early markers of severity in pediatric sepsis

Objective: The aim of this study was to verify the association of echocardiogram, ferritin, C‐reactive protein, and leukocyte count with unfavorable outcomes in pediatric sepsis. Methods: A prospective cohort study was carried out from March to December 2014, with pediatric critical care patients aged between 28 days and 18 years. Inclusion criteria were diagnosis of sepsis, need for mechanical ventilation for more than 48 h, and vasoactive drugs. Serum levels of C‐reactive protein, ferritin, and leukocyte count were collected on the first day (D0), 24 h (D1), and 72 h (D3) after recruitment. Patients underwent transthoracic echocardiography to determine the ejection fraction of the left ventricle on D1 and D3. The outcomes measured were length of hospital stay and in the pediatric intensive care unit, mechanical ventilation duration, free hours of VM, duration of use of inotropic agents, maximum inotropic score, and mortality. Results: Twenty patients completed the study. Patients with elevated ferritin levels on D0 had also fewer ventilator‐free hours (p = 0.046) and higher maximum inotropic score (p = 0.009). Patients with cardiac dysfunction by echocardiogram on D1 had longer hospital stay (p = 0.047), pediatric intensive care unit stay (p = 0.020), duration of mechanical ventilation (p = 0.011), maximum inotropic score (p = 0.001), and fewer ventilator‐free hours (p = 0.020). Conclusion: Cardiac dysfunction by echocardiography and serum ferritin value was significantly associated with unfavorable outcomes in pediatric patients with sepsis

Cardiac dysfunction and ferritin as early markers of severity in pediatric sepsis,

Abstract Objective: The aim of this study was to verify the association of echocardiogram, ferritin, C-reactive protein, and leukocyte count with unfavorable outcomes in pediatric sepsis. Methods: A prospective cohort study was carried out from March to December 2014, with pediatric critical care patients aged between 28 days and 18 years. Inclusion criteria were diagnosis of sepsis, need for mechanical ventilation for more than 48 h, and vasoactive drugs. Serum levels of C-reactive protein, ferritin, and leukocyte count were collected on the first day (D0), 24 h (D1), and 72 h (D3) after recruitment. Patients underwent transthoracic echocardiography to determine the ejection fraction of the left ventricle on D1 and D3. The outcomes measured were length of hospital stay and in the pediatric intensive care unit, mechanical ventilation duration, free hours of VM, duration of use of inotropic agents, maximum inotropic score, and mortality. Results: Twenty patients completed the study. Patients with elevated ferritin levels on D0 had also fewer ventilator-free hours (p = 0.046) and higher maximum inotropic score (p = 0.009). Patients with cardiac dysfunction by echocardiogram on D1 had longer hospital stay (p = 0.047), pediatric intensive care unit stay (p = 0.020), duration of mechanical ventilation (p = 0.011), maximum inotropic score (p = 0.001), and fewer ventilator-free hours (p = 0.020). Conclusion: Cardiac dysfunction by echocardiography and serum ferritin value was significantly associated with unfavorable outcomes in pediatric patients with sepsis