Navegando por Palavras-chave "etiology"
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- ItemAcesso aberto (Open Access)Associação entre a evolução da disfunção orgânica e as concentrações de citocinas na fase inicial do choque séptico(Associação de Medicina Intensiva Brasileira - AMIB, 2011-12-01) Machado, Flávia Ribeiro [UNIFESP]; Sanches, Luciana Coelho [UNIFESP]; Azevedo, Luciano Cesar Pontes [UNIFESP]; Brunialti, Milena Karina Coló [UNIFESP]; Lourenco, Dayse Maria [UNIFESP]; Noguti, Maria Aparecida Eiko [UNIFESP]; Salomão, Reinaldo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)OBJECTIVE: To investigate the correlation of organ dysfunction and its progression with inflammatory response during the early phases of septic shock by assessing baseline cytokine concentrations. METHODS: This study included patients over 18 years old with septic shock within the first 48 hours after the onset of organ dysfunction. Interleukin 6 (IL-6), interleukin 8 (IL-8), interleukin 10 (IL-10) and C-reactive protein levels were assessed at inclusion and after 24 hours, and the differences between these values were calculated. The progression of organ dysfunction was assessed using the Sequential Organ Failure Assessment (SOFA) score upon admission and 24 hours later for a delta-SOFA determination and were categorized as either worsened or improved. The results were expressed as means + standard deviation or median (25-75% percentiles). Values with descriptive p values of 0.05 or less were considered significant. RESULTS: Overall, we included 41 patients with median SOFA scores of 8.0 (6.5-10.0) upon admission (T0) and 8.0 (6.0-10.0) 24 hours later (T1). Worsened, improved or unchanged SOFA scores were observed in 11 (Group 1), 17 (Group 2) and 13 (Group 3) patients, respectively. For Group 1, the baseline IL-6, IL-8 and IL-10 values were higher, and a significant increase of IL-8 levels was found after 24 hours. The change in the SOFA score after 24 hours was significantly, although weakly, correlated with baseline IL-6 and IL-8 concentrations. CONCLUSIONS: Higher baseline IL-6, IL-8 and IL-10 levels are associated with unfavorable organ dysfunction outcomes. Increased IL-8 levels within the first 24 hours are correlated with a worsening dysfunction.
- ItemAcesso aberto (Open Access)Conjugal amyotrophic lateral sclerosis in Brazil(Academia Brasileira de Neurologia - ABNEURO, 2009-12-01) Godeiro-Júnior, Clécio de Oliveira [UNIFESP]; Oliveira, Acary Souza Bulle [UNIFESP]; Felício, André Carvalho [UNIFESP]; Chieia, Marco A. [UNIFESP]; Gabbai, Alberto Alain [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Federal University of Rio Grande do Norte Department of NeurologyThe origin of amyotrophic lateral sclerosis (ALS) remains unknown, although it seems to be multifactorial. The role of environmental factors has been frequently investigated and suspicion of its influence can be obtained when clusters of a rare disease are described. OBJECTIVE: To describe conjugal cases of ALS in Brazil. METHOD: We describe 2 couples in which both spouses were affected by ALS. Both couples had lived in southeast Brazil and were married for at least 20 years. RESULTS: There was a great variability in clinical presentation of ALS in our patients. In both couples the interval between disease onsets was short. No precise environmental factors could be identified at the origin of these conjugal cases. CONCLUSION: The occurrence of ALS in couples living in the same area may be epidemiologically important, but we cannot exclude that cases may be due to a chance association.
- ItemAcesso aberto (Open Access)Osteomielite hematogênica aguda em Pediatria: análise de casos atendidos em hospital universitário(Sociedade de Pediatria de São Paulo, 2012-09-01) Puccini, Pedro Fiorini; Ferrarini, Maria Aparecida G.; Iazzetti, Antônio Vladir [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To describe occurrence, evolution, and outcome of acute hematogenous osteomyelitis in children and adolescents. METHODS: A descriptive study of 21 cases with patients aged zero to 14 years-old, diagnosed with acute hematogenous osteomyelitis assisted at the Pediatric Infectious Disease Follow-Up Clinic of Escola Paulista de Medicina, between 2005 and 2009. The medical records were reviewed. Descriptive analysis and Spearman's rank correlation were performed, with a 95% confidence interval. RESULTS: The incidence in males was higher than in females, and children over five years of age were the most affected ones. Fever and pain were the main symptoms, and the long bones were the most often affected. The most commonly recovered pathogen was Staphylococcus aureus. The time interval between the onset of symptoms and the diagnosis was 9.7 days, the length of hospital stay was 24.7 days, and the duration of treatment was 71.7 days. Complete resolution occurred in 71.4% of the cases and complications appeared in 28.6% of them, being chronic osteomyelitis the main one. CONCLUSIONS: Data regarding gender, age, etiology, and evolution were in accordance with literature reports. The duration of the treatment was ten weeks, which is longer than usual reports. There were no significant correlations between duration of symptoms before the diagnosis, duration of hospital stay, and duration of treatment, considering the small sample size.
- ItemAcesso aberto (Open Access)Pneumonia adquirida na comunidade em pacientes tratados ambulatorialmente: aspectos epidemiológicos, clínicos e radiológicos das pneumonias atípicas e não atípicas(Sociedade Brasileira de Pneumologia e Tisiologia, 2000-02-01) Rocha, Rosali Teixeira [UNIFESP]; Vital, Anna Cristina [UNIFESP]; Silva, Clystenes Odyr Soares [UNIFESP]; Pereira, Carlos Alberto de Castro [UNIFESP]; Nakatani, Jorge [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Aim: To evaluated the etiologic percentage of the atypical pneumoniae in outpatients and to identify the epidemiologic, clinical and radiographic features that permit to distinguish between atypical and non-atypical pneumonia. Methods: All patients underwent clinical and radiographic evaluation. Serum and sputum samples were obtained to serological tests including Legionella sp, Chlamydia sp, M. pneumoniae, Influenza A and Influenza B virus, and Gram stain, respectively. These procedures were performed on the first and 21 days after inclusion. Three independent observers reviewed chest X-rays. Results: During 22 months, 129 patients were evaluated. The final population under study comprised 69 patients (46 men ¾ 23 women) with a mean age of 37 years. The etiologic diagnosis was defined in 34 (50%) of the patients. Etiologic agents included Chlamydia sp, 11 (16%) isolated cases; M. pneumoniae 7 (10%) cases. Influenza A was the third more frequent agent in 4 (6%) patients, and Legionella sp in 4 (6%). Mixed infections were observed with association of Chlamydia sp and M. pneumoniae in 5 (7.3%) cases, Chlamydia sp and Influenza B one (1.5%) case, and another of M. pneumoniae and Influenza A. The atypical pneumonia and non-atypical pneumonia groups were compared to respiratory symptoms and signs. There were no differences between them. The three independent observers' radiographic evaluation showed disagreement among them as to the type of pneumonia. Radiographic diagnoses of individual observers were compared to the clinical diagnoses, and no significant association was obtained for any observer. Conclusion: Pneumonia caused by atypical agents occurs in 50% of the outpatients with community acquired pneumonia. It is not possible to distinguish atypical pneumonia from non-atypical pneumonia. The clinical and radiographic presentations are similar in both groups.