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[PMID]:28449906
[Au] Autor:Lancien M; Inocente CO; Dauvilliers Y; Kugener B; Scholz S; Raverot V; Lin JS; Guyon A; Gustin MP; Franco P
[Ad] Endereço:Integrative Physiology of Brain Arousal System, CRNL, INSERM-U1028, CNRS UMR5292, University Lyon 1, Lyon, France.
[Ti] Título:Low cerebrospinal fluid hypocretin levels during sudden infant death syndrome (SIDS) risk period.
[So] Source:Sleep Med;33:57-60, 2017 May.
[Is] ISSN:1878-5506
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: The temporal association between sudden infant death syndrome (SIDS) and sleep suggests that the arousability from sleep provides a protective mechanism for survival. Recently, the hypocretin system, which promotes wakefulness, has been implicated in SIDS, since it has been reported that SIDS victims have fewer hypocretin neurons than infants who have died from other causes. To understand the role of hypocretin in SIDS, it is essential to better understand how this system matures. The present study compared cerebrospinal fluid (CSF) hypocretin in children aged 2-6 months, which is the age of peak incidence for SIDS, to both younger and older children. METHOD: Hypocretin levels were measured in CSF samples from 101 children who underwent a clinically relevant lumbar puncture. Children were separated into five age groups: 0-2 months, 2-6 months, 1-5 years, 5-10 years, and 10-18 years. RESULTS: Hypocretin levels were not significantly different between 1-5 years, 5-10 years, and 10-18 years. Therefore, these three groups were pooled into a single one (1-18 years) for further analysis. Between the 0-2 month, 2-6 month, and 1-18 year groups, a significant difference in CSF hypocretin levels existed (p = 0.001). Simple comparisons showed that CSF hypocretin levels in the 2-6 month age group were significantly lower than hypocretin levels in both the 0-2 month and 1-18 year group (p < 0.001 and p = 0.008, respectively), but not significantly between 0-2 month and 1-18 year children. CONCLUSIONS: The CSF hypocretin levels were lower at the age of peak incidence for SIDS. This could underlie an increased vulnerability to SIDS at this specific age.
[Mh] Termos MeSH primário: Orexinas/análise
Sono/fisiologia
Morte Súbita do Lactente/líquido cefalorraquidiano
Vigília/fisiologia
[Mh] Termos MeSH secundário: Adolescente
Criança
Pré-Escolar
Feminino
Seres Humanos
Incidência
Lactente
Recém-Nascido
Masculino
Punção Espinal/métodos
Morte Súbita do Lactente/epidemiologia
Morte Súbita do Lactente/etiologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (HCRT protein, human); 0 (Orexins)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE


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[PMID]:28452990
[Au] Autor:Pircher A; Montali M; Berberat J; Remonda L; Killer HE
[Ad] Endereço:Department of Ophthalmology, Cantonal Hospital Aarau, Aarau, Switzerland.
[Ti] Título:Relationship between the optic nerve sheath diameter and lumbar cerebrospinal fluid pressure in patients with normal tension glaucoma.
[So] Source:Eye (Lond);31(9):1365-1372, 2017 Sep.
[Is] ISSN:1476-5454
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:PurposeTo investigate on the relationship between the optic nerve sheath diameter (ONSD) and the lumbar cerebrospinal fluid pressure (CSF-p) in Caucasian patients with normal tension glaucoma (NTG).Patients and methodsRetrospective analysis of medical records of patients with open-angle glaucoma in the period from 2005 to 2015 from the Ophthalmology Department, Cantonal Hospital Aarau, Switzerland was performed. A total of 38 patients (mean age 68.6±11.3 years, 21 females and 17 males) fulfilled the diagnostic criteria of NTG and underwent computed tomography (CT) of the orbit and lumbar puncture (LP). In total, 38 age- and gender-matched Caucasian subjects (mean age: 68.9±10.9 years) without known ON diseases served as controls for ONSD measurements. ONSDs were measured at a distance of 3 mm from the posterior globe and lumbar CSF-p was related to the measurements. Statistical analysis was performed by using the independent two-tailed t-test and the non-parametric Spearman's correlation test.ResultsThe mean ONSD in NTGs measured 6.4±0.9 mm and in controls 5.4±0.6 mm. The difference between NTGs and controls showed statistical significance (t-test: P<0.000). The mean CSF-p in NTG was 11.6±3.7 mm Hg. There was no statistical significant correlation between ONSD and CSF-p (Spearman's correlation coefficient ρ=0.06, P=0.72).ConclusionsThis study demonstrates enlarged ONSDs and normal lumbar CSF-p in 38 Caucasian NTG patients. As enlarged ONSDs generally are associated with increased intracranial CSF-p, these results can be explained by a disturbed communication of CSF-p between the intracranial and intraorbital subarachnoid spaces.
[Mh] Termos MeSH primário: Pressão do Líquido Cefalorraquidiano/fisiologia
Glaucoma de Baixa Tensão/fisiopatologia
Bainha de Mielina/patologia
Nervo Óptico/patologia
[Mh] Termos MeSH secundário: Idoso
Grupo com Ancestrais do Continente Europeu
Feminino
Seres Humanos
Pressão Intraocular/fisiologia
Masculino
Nervo Óptico/diagnóstico por imagem
Estudos Retrospectivos
Punção Espinal
Espaço Subaracnóideo
Tomografia Computadorizada por Raios X
Tonometria Ocular
Testes de Campo Visual
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180109
[Lr] Data última revisão:
180109
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1038/eye.2017.70


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[PMID]:28991127
[Au] Autor:Estepp JH; Smeltzer MP; Kang G; Howard SC; Reiss UM
[Ad] Endereço:*Department of Hematology †Department of Pathology §Department of Biostatistics, St. Jude Children's Research Hospital ‡Division of Epidemiology, Biostatistics, and Environmental Health, The University of Memphis School of Public Health ¶University of Tennessee Health Science Center, Memphis, Memphis, TN.
[Ti] Título:Safe Use of Low-Molecular-weight Heparin in Pediatric Acute Lymphoblastic Leukemia and Lymphoma Around Lumbar Punctures.
[So] Source:J Pediatr Hematol Oncol;39(8):596-601, 2017 Nov.
[Is] ISSN:1536-3678
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Children with acute lymphoblastic leukemia or lymphoma (ALL) undergo multiple lumbar punctures (LPs) and frequently require low-molecular-weight heparin (LMWH) for thromboembolic complications. We evaluated if withholding LMWH 24 hours before and after LPs prevented bleeding complications. Children (n=133) with ALL from who were: (1) treated at St. Jude Children's Research Hospital, (2) received LMWH (2×/day of ~1 mg/kg) between January 2004 until December 2012, and (3) underwent a LP were analyzed. Spinal hematoma was defined as a clinical suspicion leading to diagnostic imaging. Traumatic LP was defined as ≥10 red blood cells per microliter of cerebrospinal fluid. In 1708 LPs, no hematomas occurred. For each child treated with LMWH, the probability of experiencing a spinal hematoma during the entire ALL treatment course was 0% (95% confidence interval [CI], 0.0%-2.7%), and in each LP, assuming no intrapatient correlation, the probability of spinal hematoma was 0% (95% CI, 0.0%-0.2%). Traumatic LPs were more common when performed when children were not receiving LMWH therapy (odds ratio [OR], 1.5; 95% CI, 1.1-2.2) which may be explained by clinician optimization of known risk factors for traumatic cerebrospinal fluid before the procedures. Withholding LMWH for 24 hours before and after LPs in children being treated for ALL is safe.
[Mh] Termos MeSH primário: Anticoagulantes/uso terapêutico
Hematoma/etiologia
Hematoma/prevenção & controle
Heparina de Baixo Peso Molecular/uso terapêutico
Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações
Punção Espinal/efeitos adversos
[Mh] Termos MeSH secundário: Adolescente
Anticoagulantes/administração & dosagem
Anticoagulantes/efeitos adversos
Criança
Pré-Escolar
Feminino
Hematoma/epidemiologia
Hematoma/terapia
Heparina de Baixo Peso Molecular/administração & dosagem
Heparina de Baixo Peso Molecular/efeitos adversos
Seres Humanos
Incidência
Lactente
Recém-Nascido
Masculino
Razão de Chances
Contagem de Plaquetas
Transfusão de Plaquetas
Leucemia-Linfoma Linfoblástico de Células Precursoras/sangue
Fatores de Risco
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Heparin, Low-Molecular-Weight)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171103
[Lr] Data última revisão:
171103
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171010
[St] Status:MEDLINE
[do] DOI:10.1097/MPH.0000000000000988


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[PMID]:28987430
[Au] Autor:Long B; Koyfman A; Runyon MS
[Ad] Endereço:Department of Emergency Medicine, San Antonio Military Medical Center, 3841 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA. Electronic address: Brit.long@yahoo.com.
[Ti] Título:Subarachnoid Hemorrhage: Updates in Diagnosis and Management.
[So] Source:Emerg Med Clin North Am;35(4):803-824, 2017 Nov.
[Is] ISSN:1558-0539
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Subarachnoid hemorrhage (SAH) is a neurologic emergency due to bleeding into the subarachnoid space. Mortality can reach 50%. The clinical presentation is most often in the form of headache, classically defined as maximal at onset and worst of life. The most common cause is traumatic; approximately 80% of nontraumatic SAH are due to aneurysmal rupture, with the remainder from idiopathic peri-mesencephalic hemorrhage or other less common causes. Noncontrast brain computed tomography (CT) performed within 6 hours of symptom onset has sensitivity approaching 100%. Lumbar puncture may be considered after this period for definitive diagnosis if initial CT is normal.
[Mh] Termos MeSH primário: Neuroimagem/métodos
Punção Espinal/métodos
Hemorragia Subaracnóidea
[Mh] Termos MeSH secundário: Angiografia por Tomografia Computadorizada
Saúde Global
Seres Humanos
Incidência
Hemorragia Subaracnóidea/diagnóstico
Hemorragia Subaracnóidea/epidemiologia
Hemorragia Subaracnóidea/terapia
Taxa de Sobrevida/tendências
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171009
[St] Status:MEDLINE


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[PMID]:28984753
[Au] Autor:Zhang JH; Wang ZL; Wan L
[Ad] Endereço:a903 Hospital, Jiangyou City, Sichuan Province bThe Second Affiliated Hospital, State Key Clinical Specialty in Pain Medicine, Guangzhou Medical University, Guangzhou, Guangdong, P.R. China.
[Ti] Título:Cervical epidural analgesia complicated by epidural abscess: A case report and literature review.
[So] Source:Medicine (Baltimore);96(40):e7789, 2017 Oct.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Spinal epidural abscess is an uncommon complication in clinical practice. If the abscess is large enough, the patient will rapidly develop neurologic signs of spinal injury, and urgent neurosurgical intervention may be required. PATIENT CONCERNS: Rapid and correct diagnosis and treatment is important for spinal epidural abscess complication. DIAGNOSES: This report describes a cervical epidural abscess (CEA) caused by epidural analgesia, wherein the patient was punctured twice. A CEA was suspected based on the patient's significant neck pain and elevated white blood cell and neutrophil counts. A CEA from C6 to T8 was confirmed by magnetic resonance imaging scan. INTERVENTIONS: The patient was treated with a combination of intravenous vancomycin and imipenem/cilastatin for more than 4 weeks. OUTCOMES: After more than 2 weeks of intensive antibiotic treatment, the epidural abscess gradually diminished in size, the white blood cell count, neutrophil count, hyperallergic C-reactive protein (CRP), and general CRP decreased, and the patient's neck and back pain resolved. After more than 4 weeks of anti-inflammation therapy, the epidural abscess was completely absorbed, and there was no relapse during the 3-month follow-up period. LESSONS: Although an effective combination of intravenous antibiotics can cure an epidural abscess, caution is warranted when performing epidural steroid injections in immunocompromised patients.
[Mh] Termos MeSH primário: Analgesia Epidural/efeitos adversos
Vértebras Cervicais
Abscesso Epidural/etiologia
Deslocamento do Disco Intervertebral/tratamento farmacológico
Cervicalgia/tratamento farmacológico
Punção Espinal/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Feminino
Seres Humanos
Hipertensão/complicações
Deslocamento do Disco Intervertebral/complicações
Cervicalgia/etiologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171007
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007789


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[PMID]:28925647
[Au] Autor:Mount HR; Boyle SD
[Ad] Endereço:University of Cincinnati College of Medicine, Cincinnati, OH, USA.
[Ti] Título:Aseptic and Bacterial Meningitis: Evaluation, Treatment, and Prevention.
[So] Source:Am Fam Physician;96(5):314-322, 2017 Sep 01.
[Is] ISSN:1532-0650
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The etiologies of meningitis range in severity from benign and self-limited to life-threatening with potentially severe morbidity. Bacterial meningitis is a medical emergency that requires prompt recognition and treatment. Mortality remains high despite the introduction of vaccinations for common pathogens that have reduced the incidence of meningitis worldwide. Aseptic meningitis is the most common form of meningitis with an annual incidence of 7.6 per 100,000 adults. Most cases of aseptic meningitis are viral and require supportive care. Viral meningitis is generally self-limited with a good prognosis. Examination maneuvers such as Kernig sign or Brudzinski sign may not be useful to differentiate bacterial from aseptic meningitis because of variable sensitivity and specificity. Because clinical findings are also unreliable, the diagnosis relies on the examination of cerebrospinal fluid obtained from lumbar puncture. Delayed initiation of antibiotics can worsen mortality. Treatment should be started promptly in cases where transfer, imaging, or lumbar puncture may slow a definitive diagnosis. Empiric antibiotics should be directed toward the most likely pathogens and should be adjusted by patient age and risk factors. Dexamethasone should be administered to children and adults with suspected bacterial meningitis before or at the time of initiation of antibiotics. Vaccination against the most common pathogens that cause bacterial meningitis is recommended. Chemoprophylaxis of close contacts is helpful in preventing additional infections.
[Mh] Termos MeSH primário: Meningite Asséptica/diagnóstico
Meningites Bacterianas/diagnóstico
[Mh] Termos MeSH secundário: Algoritmos
Anti-Infecciosos/uso terapêutico
Vacinas Bacterianas/uso terapêutico
Proteína C-Reativa/análise
Calcitonina/sangue
Líquido Cefalorraquidiano/microbiologia
Líquido Cefalorraquidiano/virologia
Quimioprevenção
Diagnóstico Diferencial
Glucocorticoides/uso terapêutico
Seres Humanos
Ácido Láctico/líquido cefalorraquidiano
Meningite Asséptica/tratamento farmacológico
Meningite Asséptica/microbiologia
Meningite Asséptica/virologia
Meningites Bacterianas/tratamento farmacológico
Meningites Bacterianas/microbiologia
Prognóstico
Punção Espinal/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Infective Agents); 0 (Bacterial Vaccines); 0 (Glucocorticoids); 33X04XA5AT (Lactic Acid); 9007-12-9 (Calcitonin); 9007-41-4 (C-Reactive Protein)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170920
[St] Status:MEDLINE


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[PMID]:28768582
[Au] Autor:Bhandohal JS; Mirza T
[Ad] Endereço:Department of Internal Medicine, New York Medical College at Metropolitan Hospital Center, 1901 First avenue, New York, NY 10029, United States. Electronic address: jpsbhandohal87@gmail.com.
[Ti] Título:BLIND OVERNIGHT: A case of fulminant idiopathic intracranial hypertension.
[So] Source:Am J Emerg Med;35(10):1581.e1-1581.e2, 2017 Oct.
[Is] ISSN:1532-8171
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Idiopathic Intracranial Hypertension (IIH) is a syndrome seen predominantly in obese women of reproductive age group, characterized by signs and symptoms of increased intracranial pressure due to an unknown cause. Some individuals have a more malignant form of disease called fulminant idiopathic intracranial hypertension with rapid worsening of symptoms over days. We report a case of 33year-old obese female (BMI 36.9) who presented with a severe headache and blurred vision for one week, found to have idiopathic intracranial hypertension with rapid worsening of symptoms suggestive of a fulminant course of disease. She was managed with prompt surgical intervention. In patients with fulminant idiopathic intracranial hypertension, surgery such as cerebrospinal fluid shunting or optic nerve sheath fenestration should not be delayed to prevent vision loss.
[Mh] Termos MeSH primário: Pressão Intracraniana
Pseudotumor Cerebral/complicações
Transtornos da Visão/etiologia
Acuidade Visual
[Mh] Termos MeSH secundário: Doença Aguda
Adulto
Feminino
Seguimentos
Seres Humanos
Pseudotumor Cerebral/diagnóstico
Pseudotumor Cerebral/cirurgia
Punção Espinal
Derivação Ventriculoperitoneal/métodos
Transtornos da Visão/diagnóstico
Transtornos da Visão/fisiopatologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170804
[St] Status:MEDLINE


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[PMID]:28727859
[Au] Autor:Lee AG; Mader TH; Gibson CR; Tarver W
[Ad] Endereço:Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas.
[Ti] Título:Space Flight-Associated Neuro-ocular Syndrome.
[So] Source:JAMA Ophthalmol;135(9):992-994, 2017 Sep 01.
[Is] ISSN:2168-6173
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:New and unique physiologic and pathologic systemic and neuro-ocular responses have been documented in astronauts during and after long-duration space flight. Although the precise cause remains unknown, space flight-associated neuro-ocular syndrome (SANS) has been adopted as an appropriate descriptive term. The Space Medicine Operations Division of the US National Aeronautics and Space Administration (NASA) has documented the variable occurrence of SANS in astronauts returning from long-duration space flight on the International Space Station. These clinical findings have included unilateral and bilateral optic disc edema, globe flattening, choroidal and retinal folds, hyperopic refractive error shifts, and nerve fiber layer infarcts. The clinical findings of SANS have been correlated with structural changes on intraorbital and intracranial magnetic resonance imaging and in-flight and terrestrial ultrasonographic studies and ocular optical coherence tomography. Further study of SANS is ongoing for consideration of future manned missions to space, including a return trip to the moon or Mars.
[Mh] Termos MeSH primário: Doenças da Coroide/etiologia
Hiperopia/etiologia
Doenças do Nervo Óptico/etiologia
Papiledema/etiologia
Voo Espacial
Transtornos da Visão/etiologia
Ausência de Peso/efeitos adversos
[Mh] Termos MeSH secundário: Astronautas
Doenças da Coroide/diagnóstico
Seres Humanos
Hiperopia/diagnóstico
Pressão Intracraniana
Pressão Intraocular
Imagem por Ressonância Magnética
Fibras Nervosas/patologia
Doenças do Nervo Óptico/diagnóstico
Papiledema/diagnóstico
Células Ganglionares da Retina/patologia
Punção Espinal
Tomografia de Coerência Óptica
Transtornos da Visão/diagnóstico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170922
[Lr] Data última revisão:
170922
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170721
[St] Status:MEDLINE
[do] DOI:10.1001/jamaophthalmol.2017.2396


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[PMID]:28661942
[Au] Autor:Ling L; Guo L; Wang J; Zhang L; Zhu J; Huang Z
[Ad] Endereço:Ling Ling, RN BSN, is Nurse Practitioner, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China. Lu Guo, MD, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China. Jingjuan Wang, RN BSN, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China. Lili Zhang, PhD, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China. Jie Zhu, PhD, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China.
[Ti] Título:Nursing Management of Lumbar Drainage in Cryptococcal Meningitis: A Case Report.
[So] Source:J Neurosci Nurs;49(4):198-202, 2017 Aug.
[Is] ISSN:1945-2810
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Raised intracranial pressure is a hallmark of cryptococcal meningitis and is associated with increased mortality. Continuous drainage of lumbar cerebrospinal fluid is suggested to control intracranial pressure. The complications induced by this treatment have been described. However, nursing care associated with identification and management of complications is less well known. We encountered a patient with human immunodeficiency virus-negative cryptococcal meningitis who developed increasing cerebrospinal fluid pressure, hearing impairment, and limb weakness. The patient's symptoms improved significantly by antifungal therapy and continuous lumbar drainage. Nurses play a vital role in monitoring patients with lumbar drainage for complications and to maintain integrity of the system. The nursing role in this approach is discussed with particular emphasis on recognition of complications and responses toward immediate emergent intervention.
[Mh] Termos MeSH primário: Drenagem/métodos
Meningite Criptocócica/complicações
Papel do Profissional de Enfermagem
Punção Espinal/métodos
[Mh] Termos MeSH secundário: Anfotericina B/administração & dosagem
Anfotericina B/uso terapêutico
Antifúngicos/administração & dosagem
Pressão do Líquido Cefalorraquidiano
Drenagem/instrumentação
Feminino
Flucitosina/administração & dosagem
Flucitosina/uso terapêutico
Perda Auditiva/etiologia
Seres Humanos
Pressão Intracraniana
Meningite Criptocócica/mortalidade
Meningite Criptocócica/enfermagem
Meningite Criptocócica/terapia
Meia-Idade
Enfermagem em Neurociência/métodos
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antifungal Agents); 7XU7A7DROE (Amphotericin B); D83282DT06 (Flucytosine)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170717
[Lr] Data última revisão:
170717
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:170630
[St] Status:MEDLINE
[do] DOI:10.1097/JNN.0000000000000293


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[PMID]:28627004
[Au] Autor:Bortcosh W; Siedner M; Carroll RW
[Ad] Endereço:Massachusetts General Hospital, Boston, MA, USA.
[Ti] Título:Utility of the urine reagent strip leucocyte esterase assay for the diagnosis of meningitis in resource-limited settings: meta-analysis.
[So] Source:Trop Med Int Health;22(9):1072-1080, 2017 Sep.
[Is] ISSN:1365-3156
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Diagnosis of bacterial meningitis often requires cytometry, chemistry and/or microbiologic culture capabilities. Unfortunately, laboratory resources in low-resource settings (LRS) often lack the capacity to perform these studies. We sought to determine whether the presence of white blood cells in CSF detected by commercially available urine reagent strips could aid in the diagnosis of bacterial meningitis. METHODS: We searched PubMed for studies published between 1980 and 2016 that investigated the use of urine reagent strips to identify cerebrospinal fluid (CSF) pleocytosis. We assessed studies in any language that enrolled subjects who underwent lumbar puncture and had cerebrospinal fluid testing by both standard laboratory assays and urine reagent strips. We abstracted true-positive, false-negative, false-positive and true-negative counts for each study using a diagnostic threshold of ≥10 white blood cells per microlitre for suspected bacterial meningitis and performed mixed regression modelling with random effects to estimate pooled diagnostic accuracy across studies. RESULTS: Our search returned 13 studies including 2235 participants. Urine reagent strips detected CSF pleocytosis with a pooled sensitivity of 92% (95% CI: 84-96), a pooled specificity of 98% (95% CI: 94-99) and a negative predictive value of 99% when the bacterial meningitis prevalence is 10%. CONCLUSIONS: Urine reagent strips could provide a rapid and accurate tool to detect CSF pleocytosis, which, if negative, can be used to exclude diagnosis of bacterial meningitis in settings without laboratory infrastructure. Further investigation of the diagnostic value of using protein, glucose and bacteria components of these strips is warranted.
[Mh] Termos MeSH primário: Contagem de Leucócitos/métodos
Leucócitos
Meningites Bacterianas/diagnóstico
Fitas Reagentes
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Bactérias
Hidrolases de Éster Carboxílico/metabolismo
Criança
Pré-Escolar
Recursos em Saúde
Seres Humanos
Lactente
Recém-Nascido
Leucocitose/líquido cefalorraquidiano
Meningites Bacterianas/líquido cefalorraquidiano
Meningites Bacterianas/imunologia
Meia-Idade
Sensibilidade e Especificidade
Punção Espinal
Adulto Jovem
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Reagent Strips); EC 3.1.- (leukocyte esterase); EC 3.1.1.- (Carboxylic Ester Hydrolases)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170620
[St] Status:MEDLINE
[do] DOI:10.1111/tmi.12913



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