Marssoni Deconto Rossoni

Comparação entre as soluções orais de manitol a 10% e bifosfato de sódio no preparo mecânico do cólon

BACKGROUND: To compare the use of sodium biphosphate and 10% mannitol solutions for mechanical bowel preparation in terms of cleansing quality, tolerability, disorder in water and electrolyte balance, and plasma osmolality. METHOD: Sixty patients who had been referred for colonoscopy were analyzed in a randomized, double-blind, prospective study. The quality of bowel cleansing was analyzed by the examiner using Becks classification. Ingestion tolerability was established by investigating taste, whether the patient felt any discomfort or not, the development of adverse effects and the amount of solution ingested. The following measurements were made before and after ingestion of the oral bowel preparation solution: sodium, potassium, calcium, magnesium, phosphorus, urea, creatinine, glucose, hematocrit, hemoglobin and plasma osmolality. RESULTS: Both solutions resulted in bowel preparations that were classified as good or superior in over 80% of the patients. The use of sodium biphosphate resulted in less discomfort and better tolerance, although it was not superior to mannitol in terms of taste or the presence of adverse effects. Sodium biphosphate led to an increase, and mannitol to a decrease, in osmolality, reflecting the changes in plasma sodium in both groups. The former also resulted in a significant measurement change in serum phosphorus, calcium, magnesium and potassium levels, without any clinical repercussions. CONCLUSION: Both types of bowel preparation resulted in adequate cleansing. Sodium biphosphate, although better tolerated, leads to more alterations in water and electrolyte balance.

Esquemas de tratamento da tuberculose na infância e eventos adversos relacionados

The World Health Organization (WHO) recommends an initial treatment regimen for tuberculosis in children that is comparable to that for adults, with directly monitored multiple-drug therapy for 6 months. Early initiation of treatment in younger children is essential due to the possibility of rapid dissemination of the disease, severe sequelae, and death. Children and adolescents usually tolerate antituberculosis drugs very well. This article aims to review the main therapeutic regimens, dosages, and adverse effects associated with first-line drugs used in treatment regimens for tuberculosis in children and to provide some practical recommendations for the follow-up of children and adolescents undergoing treatment. The article reviews current guidelines from the WHO and the Brazilian Ministry of Health as well as currently used therapeutic regimens and their main adverse effects. The reviewed literature states that at recommended doses, antituberculosis drugs are well tolerated by the pediatric population, and severe adverse effects are rare and mostly temporary. The frequency of toxic effects may be related to disease severity. Isoniazid is the most extensively studied drug and the most commonly used in children because it is also used in the treatment of latent tuberculosis. Liver toxicity is the primary described adverse effect. In most cases, when treatment is started adequately on time, it proceeds without severe adverse effects that require the therapy to be suspended. A high degree of suspicion is required to establish the diagnosis and consequently the adequate treatment, aiming for a long-term change in the course of the disease in children. Palavras-chave:1 Physician, Master’s Candidate in the Graduate Program in Child and Adolescent Health of the Sector of Health Sciences of the Federal University of Paraná (UFPR), Curitiba, Brazil. 2 Physician of the Service of Pediatric Infectology of the Clinics Hospital Complex of the Federal University of Paraná (CHC-UFPR), Curitiba, Brazil. 3 Professor of the Department of Medicine State University of Ponta Grossa, Brazil. 4 Professor of Department of Pediatrics of the Federal University of Paraná (UFPR), Curitiba, Brazil. 5 Professor of the Department of Clinical Medicine of the Federal University of Paraná (UFPR), Curitiba, Brazil.

Diagnóstico da tuberculose em crianças: qual o papel do hemograma e das provas de atividades inflamatórias?

It is known that childhood tuberculosis (TB) is a global public health problem, although the diagnosis and treatment of TB are neglected. Few cases are confirmed by laboratory tests because TB is paucibacillary in childhood. Therefore, clinical, epidemiological, radiological, and laboratory criteria are used for diagnostic confirmation. This study reviews the literature to determine the role of hemogram and tests of inflammatory markers in diagnosis. Few studies have addressed this subject and the most common findings in the hemogram are anemia of chronic disease (normochromic and normocytic) with a non-specific leukogram and platelet disorders. The most important factor in the clinical suspicion of TB may be the absence of leukocytosis, which is common in acute febrile respiratory illnesses. The levels of inflammatory markers are usually high, but some studies question the value of ESR for the diagnosis of TB. Future studies will help confirm the usefulness of other laboratory parameters in the screening and diagnosis of TB in children. Palavras-chave: