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Search Results: 1 - 10 of 10509 matches for " Marcus Jones "
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Seqüelas respiratórias de doen?as virais: do diagnóstico ao tratamento
Teper, Alejandro;Fischer, Gilberto Bueno;Jones, Marcus Herbert;
Jornal de Pediatria , 2002, DOI: 10.1590/S0021-75572002000800009
Abstract: objective: the objective of the present article is to present a review of the main clinical issues faced by pediatricians while defining the diagnosis, management and prognosis of postinfectious bronchiolitis obliterans. sources: data from national and international scientific journals selected from the lilacs and medline databases. summary of the findings: with the purpose of establishing the diagnosis, a radiological investigation shows high levels of pulmonary insufflation, thickened bronchovascular bundles and, less often, bronchiectasis, atelectasis and pulmonary hyperlucency. the ct exam allows the visualization of structural and functional findings, such as air trapping, bronchiectasis and mosaic pattern. lung function tests in children and infants always reveal significant reduction of expiratory flows. pulmonary biopsy is not mandatory in order to confirm bronchiolitis obliterans. diagnosis can be established through the combination of history of bronchiolitis, chronic obstructive pulmonary disease and typical tomographic findings. the treatment used by most services includes oral and inhaled corticosteroids and bronchodilators for long periods. the management of exacerbated conditions often requires antibiotics and physical therapy. conclusions: most patients present a favorable outcome with slow improvement of the pulmonary function and reduced necessity for supplementary oxygen. some patients present progressive worsening of hypoxemia and co2 retention, which leads to pulmonary hypertension and cor pulmonale. postinfectious bronchiolitis obliterans is mild and moderate in most patients, with consequent good prognosis and low mortality.
Prognóstico pulmonar em prematuros
Friedrich, Luciana;Corso, Andréa L.;Jones, Marcus H.;
Jornal de Pediatria , 2005, DOI: 10.1590/S0021-75572005000200010
Abstract: objective: the increased survival of preterm infants poses the challenge of dealing with a wide range of chronic pulmonary diseases, including bronchopulmonary dysplasia, wilson-mikity syndrome and recurrent wheezing. this article reviews the pulmonary clinical and functional prognosis of preterm newborns in infancy and adolescence. source of data: medline search for articles published between 1970 and 2004 that focused on lung growth and function of preterm infants, besides a clinical follow-up of this group. summary of the findings: prenatal and postnatal events, such as placental insufficiency, tobacco exposure, infections, oxygen and mechanical ventilation, have an important effect on lung development and can lead to chronic lung diseases, of which bronchopulmonary dysplasia is the most severe complication. however, significant loss of lung function occurs in preterm infants who do not fulfill the criteria for bronchopulmonary dysplasia, and even in those who did not have significant respiratory disease during the neonatal period. the impact of prematurity on the respiratory system of these patients is usually underestimated. clinically, preterm infants have an increased incidence of pneumonia and bronchiolitis, hospital readmissions due to respiratory diseases, chronic cough and wheezing and bronchial hyperresponsiveness. in adolescence, there is a tendency for normalization of the lung function, but they persist with reduced flows, lower exercise tolerance and bronchial hyperresponsiveness. conclusion: prematurity, the events that cause it and the interventions that follow it permanently change the development of the respiratory system. studies are necessary to clarify the effect of each of these perinatal insults on the development of the respiratory system.
Seqüelas respiratórias de doen as virais: do diagnóstico ao tratamento
Teper Alejandro,Fischer Gilberto Bueno,Jones Marcus Herbert
Jornal de Pediatria , 2002,
Abstract: Objetivos: o objetivo do presente texto é apresentar uma revis o acerca das principais quest es clínicas que envolvem o pediatra frente ao diagnóstico, manejo e prognóstico da situa o. Fontes de dados: foram utilizadas informa es de artigos publicados em revistas científicas nacionais e internacionais, selecionadas das bases de dados Lilacs e Medline. Síntese dos dados: para fins diagnósticos, a investiga o radiológica evidencia hiperinsufla o pulmonar, espessamento dos feixes broncovasculares e, menos freqüentemente, bronquiectasias, atelectasias e hiperlucência pulmonar. A tomografia computadorizada permite visualizar altera es estruturais e funcionais, como aprisionamento de ar, bronquiectasias e padr o mosaico. Estudos funcionais pulmonares, em crian as e lactentes, revelam invariavelmente redu o acentuada dos fluxos expiratórios. Biópsia pulmonar n o é obrigatória para confirma o de bronquiolite obliterante (BO). O diagnóstico pode ser feito pela combina o de história de bronquiolite, doen a pulmonar obstrutiva cr nica e altera es tomográficas características. O tratamento feito pela maioria dos centros inclui corticóides orais e inalatórios e broncodilatadores por períodos prolongados, e o manejo das exacerba es freqüentemente requer antibióticos e fisioterapia. Conclus es: a maioria dos pacientes tem uma evolu o favorável, com lenta melhora da fun o pulmonar e da necessidade de oxigênio suplementar. Alguns pacientes evoluem com piora progressiva da hipoxemia e reten o de CO2, levando à hipertens o pulmonar e cor pulmonale. A maioria dos pacientes portadores de BO pós-infecciosa apresenta quadros leves e moderados, fazendo com que o prognóstico, em geral, seja bom, com baixa mortalidade.
Superior Mesenteric Vein Occlusion Causing Severe Gastrointestinal Haemorrhage in Two Paediatric Cases
Anna L. Fox,Matthew Jones,Andrew Healey,Marcus K. H. Auth
Case Reports in Pediatrics , 2012, DOI: 10.1155/2012/964845
Abstract: Reports about superior mesenteric vein thrombosis in childhood are very rare and have not been associated with gastrointestinal bleeding. We describe two cases of severe bleeding from the upper and lower gastrointestinal tract in children who had undergone complex abdominal surgery at considerable time before. The first child had a tracheoesophageal fistula, corrected by division, gastrostomy insertion, and repair of duodenal rupture. The child presented with severe bleeding from the gastrostomy site and was diagnosed with a thrombosis of the proximal superior mesenteric vein. The second child had a gastroschisis and duodenal atresia, and required duodenoplasty, gastrostomy insertion, hemicolectomy, and adhesiolysis. The child presented with intermittent severe lower gastrointestinal bleeding, resulting from collateral vessels at location of the surgical connections. He was diagnosed with a thrombosis of the superior mesenteric vein. In both children, the extensive previous surgery and anastomosis were considered the cause of the mesenteric thrombosis. CT angiography confirmed the diagnosis in both cases, in addition to characteristic findings on endoscopy. Paediatricians should suspect this condition in children with severe gastrointestinal bleeding, particularly in children with previous, complex abdominal surgery.
Severe Gastrooesophageal Reflux Disease Associated with Foetal Alcohol Syndrome
N. K. Sujay,Matthew Jones,Emma Whittle,Helen Murphy,Marcus K. H. Auth
Case Reports in Pediatrics , 2012, DOI: 10.1155/2012/509253
Abstract: Prenatal alcohol exposure may have adverse effects on the developing foetus resulting in significant growth restriction, characteristic craniofacial features, and central nervous system dysfunction. The toxic effects of alcohol on the developing brain are well recognised. However, little is known about the effects of alcohol on the developing gastrointestinal tract or their mechanism. There are few case reports showing an association between foetal alcohol syndrome and gastrointestinal neuropathy. We report a rare association between foetal alcohol syndrome and severe gastrooesophageal reflux disease in an infant who ultimately required fundoplication to optimise her growth and nutrition. The child had failed to respond to maximal medical treatment (domperidone and omeprazole), high calorie feeds, PEG feeding, or total parenteral nutrition. The effect of alcohol on the developing foetus is not limited to the central nervous system but also can have varied and devastating effects on the gastrointestinal tract.
Exogenous Interferon-α and Interferon-γ Increase Lethality of Murine Inhalational Anthrax
Jeffrey A. Gold, Yoshihiko Hoshino, Marcus B. Jones, Satomi Hoshino, Anna Nolan, Michael D. Weiden
PLOS ONE , 2007, DOI: 10.1371/journal.pone.0000736
Abstract: Background Bacillus anthracis, the etiologic agent of inhalational anthrax, is a facultative intracellular pathogen. Despite appropriate antimicrobial therapy, the mortality from inhalational anthrax approaches 45%, underscoring the need for better adjuvant therapies. The variable latency between exposure and development of disease suggests an important role for the host's innate immune response. Type I and Type II Interferons (IFN) are prominent members of the host innate immune response and are required for control of intracellular pathogens. We have previously described a protective role for exogenous Type I and Type II IFNs in attenuating intracellular B.anthracis germination and macrophage cell death in vitro. Methodology and Principal Findings We sought to extend these findings in an in vivo model of inhalational anthrax, utilizing the Sterne strain (34F2) of B.anthracis. Mice devoid of STAT1, a component of IFN-α and IFN-γ signaling, had a trend towards increased mortality, bacterial germination and extrapulmonary spread of B.anthracis at 24 hrs. This was associated with impaired IL-6, IL-10 and IL-12 production. However, administration of exogenous IFN-γ, and to a lesser extent IFN-α, at the time of infection, markedly increased lethality. While IFNs were able to reduce the fraction of germinated spores within the lung, they increased both the local and systemic inflammatory response manifest by increases in IL-12 and reductions in IL-10. This was associated with an increase in extrapulmonary dissemination. The mechanism of IFN mediated inflammation appears to be in part due to STAT1 independent signaling. Conclusions In conclusion, while endogenous IFNs are essential for control of B.anthracis germination and lethality, administration of exogenous IFNs appear to increase the local inflammatory response, thereby increasing mortality.
Differential Gene Expression to Investigate the Effects of Low-level Electrochemical Currents on Bacillus subtilis
Robert Szkotak, Tagbo H R Niepa, Nikhil Jawrani, Jeremy L Gilbert, Marcus B Jones, Dacheng Ren
AMB Express , 2011, DOI: 10.1186/2191-0855-1-39
Abstract: The rapid development and spread of multidrug resistant infections present an increasing challenge to public health and disease therapy (Alekshun and Levy 2003). As an intrinsic mechanism of drug resistance, biofilm formation renders bacteria up to 1000 times less susceptible to antibiotics than their planktonic (free-swimming) counterparts of the same genotype (Costerton et al. 1994). Such intrinsic mechanisms also facilitate the development of resistance through acquired mechanisms that are based on genetic mutations or drug resistance genes. Consistently, excessive antibiotic treatment of biofilm infections at sublethal concentrations has been shown to generate antibiotic-tolerant strains (Narisawa et al. 2008). Biofilms are responsible for at least 65% of human bacterial infections (Costerton et al. 2003). For example, it is estimated that in the United States 25% of urinary catheters become infected with a biofilm within one week of a hospital stay, with a cumulative 5% chance each subsequent day (Maki and Tambyah 2001). Biofilms are also detected on implanted devices and are a major cause of implant surgical removal (Hetrick and Schoenfisch 2006; Norowski and Bumgardner 2009). Orthopedic implants showed a 4.3% infection rate, or approximately 112,000 infections per year in the U.S. (Hetrick and Schoenfisch 2006). This rate increases to 7.4% for cardiovascular implants (Hetrick and Schoenfisch 2006), and anywhere from 5%-11% for dental implants (Norowski and Bumgardner 2009).In the biofilm state, bacteria undergo significant changes in gene expression leading to phenotypic changes that serve to enhance their ability to survive in challenging environments. Although not completely understood, the tolerance to antibiotic treatments is thought to arise from a combination of limited antibiotic diffusion through the extracellular polymeric substances (EPS), decreased growth rate of biofilm cells, and increased expression of antibiotic tolerance genes in biofilm cells
Prevalência de sintomas de distúrbios respiratórios do sono em escolares brasileiros
Petry, Carine;Pereira, Marilyn U.;Pitrez, Paulo M. C.;Jones, Marcus H.;Stein, Renato T.;
Jornal de Pediatria , 2008, DOI: 10.1590/S0021-75572008000200006
Abstract: objective: to identify the prevalence of symptoms of sleep-disordered breathing among children of low socioeconomic status in the south of brazil. methods: this was a cross-sectional study, carried out in the city of uruguaiana, rs, in which specific questionnaire about the symptoms of sleep-disordered breathing was completed by the parents of a sample of schoolchildren aged 9 to 14 years, enrolled on the international study of asthma and allergies in childhood (isaac). results: from the total of 1,011 eligible schoolchildren, 998 questionnaires were completed. the parents of 27.6% of the children reported habitual snoring, while 0.8% reported apnea, 15.5% described daytime mouth breathing and 7.8% complained of excessive daytime sleepiness. children with excessive daytime sleepiness were at greater risk of habitual snoring (or = 2.7; 95%ci 1.4-5.4), apnea (or = 9.9; 95%ci 1.2-51), mouth breathing (or = 13.1; 95%ci 6.2-27.4) and learning difficulties (or = 9.9; 95%ci 1.9-51.0). rhinitis, maternal smoking and positive allergy skin test results were significantly associated with habitual snoring and daytime mouth breathing. conclusions: there is an elevated prevalence of symptoms of sleep-disordered breathing among children from 9 to 14 in the city of uruguaiana. the prevalence of habitual snoring was almost twice that described in this age group in other populations. children with excessive daytime sleepiness appear to have almost 10 times the risk of learning difficulties.
Superior Mesenteric Vein Occlusion Causing Severe Gastrointestinal Haemorrhage in Two Paediatric Cases
Anna L. Fox,Matthew Jones,Andrew Healey,Marcus K. H. Auth
Case Reports in Pediatrics , 2012, DOI: 10.1155/2012/964845
Abstract: Reports about superior mesenteric vein thrombosis in childhood are very rare and have not been associated with gastrointestinal bleeding. We describe two cases of severe bleeding from the upper and lower gastrointestinal tract in children who had undergone complex abdominal surgery at considerable time before. The first child had a tracheoesophageal fistula, corrected by division, gastrostomy insertion, and repair of duodenal rupture. The child presented with severe bleeding from the gastrostomy site and was diagnosed with a thrombosis of the proximal superior mesenteric vein. The second child had a gastroschisis and duodenal atresia, and required duodenoplasty, gastrostomy insertion, hemicolectomy, and adhesiolysis. The child presented with intermittent severe lower gastrointestinal bleeding, resulting from collateral vessels at location of the surgical connections. He was diagnosed with a thrombosis of the superior mesenteric vein. In both children, the extensive previous surgery and anastomosis were considered the cause of the mesenteric thrombosis. CT angiography confirmed the diagnosis in both cases, in addition to characteristic findings on endoscopy. Paediatricians should suspect this condition in children with severe gastrointestinal bleeding, particularly in children with previous, complex abdominal surgery. 1. Introduction Superior mesenteric vein (SMV) thrombosis is an uncommon venous thromboembolic event. It first appears in the medical literature at the end of the 19th Century, identified as a cause of intestinal gangrene by Elliot, who described his surgical experiences in cases of mesenteric venous and arterial occlusion [1]. SMV thrombosis has been described in numerous hypercoagulable states, including pregnancy and oral contraceptive pill use, nephrotic syndrome, and hereditary thrombophilias, malignancy, and in the postoperative period. Infective causes, particularly intra-abdominal sepsis, have also been identified as a cause for mesenteric venous thrombosis. Idiopathic, or primary, SMV thrombosis is less common but is described in a small number of case reports [2]. Abdominal pain, vomiting, diarrhea, and intestinal bleeding are the common presenting features in these cases [3]. Raised mesenteric venous pressure proximal to the thrombotic occlusion gives rise to varices and intestinal oedema. At its most severe, mesenteric vein thrombosis can cause acute intestinal ischaemia and necrosis requiring extensive bowel resection and is a surgical emergency. Mortality for such procedures is high and the resulting morbidity from short bowel
Severe Gastrooesophageal Reflux Disease Associated with Foetal Alcohol Syndrome
N. K. Sujay,Matthew Jones,Emma Whittle,Helen Murphy,Marcus K. H. Auth
Case Reports in Pediatrics , 2012, DOI: 10.1155/2012/509253
Abstract: Prenatal alcohol exposure may have adverse effects on the developing foetus resulting in significant growth restriction, characteristic craniofacial features, and central nervous system dysfunction. The toxic effects of alcohol on the developing brain are well recognised. However, little is known about the effects of alcohol on the developing gastrointestinal tract or their mechanism. There are few case reports showing an association between foetal alcohol syndrome and gastrointestinal neuropathy. We report a rare association between foetal alcohol syndrome and severe gastrooesophageal reflux disease in an infant who ultimately required fundoplication to optimise her growth and nutrition. The child had failed to respond to maximal medical treatment (domperidone and omeprazole), high calorie feeds, PEG feeding, or total parenteral nutrition. The effect of alcohol on the developing foetus is not limited to the central nervous system but also can have varied and devastating effects on the gastrointestinal tract. 1. Case Report A 3-month-old girl was admitted to hospital for assessment and management of faltering growth. The child was born at 39 weeks’ gestation by emergency caesarean section due to foetal distress following induction of labour for intrauterine growth restriction. There were no problems in the immediate postnatal period, and she did not need admission to special care. Birth weight was 2.4?kg (0.4th–2nd centile), and head circumference was 33?cm (9th centile). She was bottle fed, consuming around 4 to 5?oz., 3 to 4 hourly with 4 or 5 bowel movements per day. She showed poor weight gain. Her mother’s previous two pregnancies had also resulted in small for gestational age babies (1.4?kg at 34 weeks and 2.3?kg at 41 weeks’ gestation). Both family and social history were fully explored during the admission. There was a history of significant alcohol consumption in the mother for which she had undergone a detoxification course during pregnancy. On admission the child weighed 3.4?kg with a length of 52.4?cm (both below 0.4th centile). She had microcephaly with a head circumference of 35?cm (less than 0.4th centile). On examination she had several distinctive features with a wide anterior fontanelle, large mouth and tongue, short anteverted nose, flat nasal bridge, long smooth philtrum, thin tented upper lip (Figure 1(a)), short neck, widely spaced nipples, mild camptodactyly of the left fifth finger and deep palmar crease on the right hand (Figure 2(a)), wide sandal gap on both feet (Figure 2(b)), and deep sacral crease. She also had a heart
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