Nystatin antifungal micellar systems on endotracheal tubes: development, characterization and in vitro evaluation.

Decontamination of patients' clinical devices in intensive care units is generally performed with an antifungal suspension. Nystatin is a widely-used high spectrum antifungal due to its low systemic absorption. However, nystatin has high hydrophobicity which hinders the contact with the internal lumen of the devices. In this work, hydrophilic micellar systems of nystatin were developed with sodium deoxycholate on silicone endotracheal tubes. The physical characteristics of the micellar system at different nystatin:deoxycholate ratios were studied using scanning electron microscopy, X-ray powder diffraction and differential scanning calorimetry. The electron microscopy results reveal that the deoxycholate micellar system altered the surface morphology, and the size of the aggregates was observed to be smaller. The hydrophilic structures of deoxycholate produce systems with a high surface area containing nystatin molecules on their interior. The X-ray and differential scanning calorimetry assays revealed a typical change in the crystallinity of micellar systems when the deoxycholate proportion increases. The endothermic peak of nystatin was not observed in the micellar systems as a consequence of the reduced crystallinity. Nystatin was homogenously dispersed in the surfactant matrix. Micellar systems with 1:0.8 nystatin:deoxycholate ratio (MS-N:DC [1:0.8]) showed increased antifungal activity compared to nystatin raw material. Micellar systems also achieved an over 40% inhibition of Candida albicans biofilm formation. The results obtained in this study conclude that the higher hydrophilic characteristic of the surfactant deoxycholate enhances nystatin penetration into the surface of the endotracheal tubes.

Renal failure associated with intestinal transplantation: our experience in Spain.

BACKGROUND: Renal failure (RF) is a frequent complication in non-renal solid organ transplants. In the present study, we analyze our experience with intestinal transplants (ITx). METHODS: Between 2004 and 2012, we performed 21 ITx in 19 adult patients. Alemtuzumab was used as an induction agent followed by tacrolimus. Renal function was assessed before ITx and during the perioperative period. RESULTS: The main cause for transplants was non-resectable desmoids tumors (33.3%), followed by vascular thrombosis (19%) and others. Medical complications were frequent, especially infectious diseases, which were the most common (51%). Surgical complications were also frequent, but most of them (>50%) were mild but leading to a great number of re-operations and prolonged stays in hospital. Acute rejection is very frequent (66.6%) but mild in more than 70% of the cases. Finally, RF was very frequent (68.4%; 13/19 patients) and accounted for 15.6% of all medical complications. Causes were multiple. One patient is awaiting a kidney transplant, but no other patients need renal replacement therapy at the moment. Ileostomy closure was performed in 5 of 12 patients alive, showing improved renal function in 3 of them. CONCLUSIONS: RF is a problem in ITx and is always multifactorial. Increases in hospital stay, higher morbidity and is a cause for hospital readmission. Almost all patients had an impaired renal function when discharged. Immunosuppressants and ileostomy closure as soon as possible might prevent RF.

[Pharmacological pseudo-Fuchs]. / Pseudo-Fuchs farmacológico.

CASE REPORT: A case of unilateral iridis hyperpigmentation and uveitis due to travoprost is presented. DISCUSSION: Anterior uveitis is a rare side-effect of travoprost. In this case, heterochromic iris was also presented, which led us to the wrong diagnosis of a Fuchs heterochromic iridocyclitis. The differencial diagnosis along with the associated literature is discussed.

Vínculos entre las creencias y prácticas de los cuidadores de una población vulnerable, con la malnutrición y las alteraciones del neurodesarrollo en la infancia temprana / Links between beliefs and practices of caregivers in a vulnerable population, with malnutrition and neurodevelopment disorders in early childhood

Objetivo: establecer vínculos entre prácticas y creencias de cuidadores, con el fenómeno de nutrición y alteraciones del neurodesarrollo en una población vulnerable de menores de 5 años que asisten a un Programa de Recuperación Nutricional.\r\nMetodología: entre 2007 y 2008 se realizó en una fundación para la recuperación nutricional infantil, en Bogotá, Colombia, una investigación mixta descriptiva y fenomenológica a 56 niños, clasificándolos nutricionalmente con los referentes de crecimiento de la Organización Mundial de la Salud (OMS), valoración de neurodesarrollo con la Escala de Nelson Ortiz, y a sus cuidadores, una encuesta validada por la Organización Panamericana de la Salud (OPS) de las 16 prácticas saludables acerca de nutrición; además se realizaron grupos focales sobre conocimientos, prácticas y actitudes de la nutrición y neurodesarrollo. El análisis cuantitativo se hizo con el programa SPSS y cualitativo a través de una codificación abierta manual por medio de categorización de la información; posteriormente se desarrolló una triangulación de toda la información para establecer los vínculos.\r\nResultados: la población participante se encontró bajo condiciones de vulnerabilidad: 5.8% con desnutrición aguda, 21% con desnutrición global, 40% con desnutrición crónica y 18% presentó alteraciones en el neurodesarrollo global. Existe desconocimiento y malas prácticas alimentarias como patrón cultural, generalmente transmitido por tradición oral y desconocimiento de las madres sobre el neurodesarrollo de sus hijos.\r\nprácConclusiones:\r\nes fundamental evaluar el contexto biopsicosocial de los niños que presentan el fenómeno de la malnutrición para realizar intervenciones que generen impacto. Se requiere de la intervención multisectorial bidireccional que incluya la comunidad como formadora de su propia estrategia de transformación para lograr un cambio en la perspectiva del aprendizaje de prácticas que mejoren el estado nutricional infantil en un contexto integral que involucre el neurodesarrollo

Objective: to establish links between practices and beliefs of caregivers with the phenomena of nutrition and neurodevelopmental disorders in a vulnerable population of children under 5 years who attend a nutrition recovery program.\r\nMethods: data was collected between 2007 and 2008 at a foundation for nutritional recovery of children in Bogota, Colombia. A descriptive and phenomenological mixed study was performed on fifty-six (56) children, classifying them nutritionally according to Growth Standards of the World Health Organization (WHO), performing an evaluation of neurodevelopment with Nelson Ortiz Scale, and applying a validated survey of the sixteen (16) healthy practices on nutrition of the Pan American Health Organization (PAHO) to their caregiver. Focus groups on knowledge, beliefs, and practices of nutrition and neurodevelopment were also performed. The quantitative analysis was done using SPSS and qualitative analysis with an open coding manual through categorization of the information. Later, a triangulation was performed on all the information to establish the links.\r\nResult: the studied population was found to be in a vulnerable condition: 5.8% with acute malnutrition, 21% global malnutrition, 40% with chronic malnutrition, and 18% showed neurodevelopment global disorders. There exists ignorance and poor feeding practices as a result of cultural patterns usually being transmitted by oral tradition as well as ignorance on the part of the mothers about their children's neurodevelopment.\r\nConclusions: it is essential to evaluate the biopsychosocial context of children with malnutrition in order to create strategy that will generate impact. This requires a two-way multi-sectorial intervention that involves the community as trainers of their own transformation strategy for change in the perspective of learning practices that improve the nutritional status of children in a comprehensive context involving neurodevelopment.

Interculturalidad en pediatría: creencias tradicionales en la salud infantil en un área rural / Interculturality in pediatrics: traditional beliefs in the child health in a rural area

Esta investigación tuvo como propósito establecer el sentido de las creencias tradicionales en madres jóvenes y cuidadores y su relación con la salud infantil en un área rural de la Sabana de Bogotá, Colombia. Metodología: estudio cualitativo de caso. Se utilizó la técnica de grupos focales, con una entrevista semiestructurada previo consentimiento informado. Se realizaron siete grupos focales en la consulta externa de pediatría de los municipios de Guasca y Guatavita. Para la selección de participantes se usó un muestreo no probabilístico, intencional por conveniencia, de casos homogéneos. Para el análisis de la información se realizó un análisis cualitativo manual con una codificación abierta. Resultados: se encontró que la creencia tradicional más significativa para la población participante es la de “mal de ojo”, una entidad que produce síntomas físicos en los niños; sin embargo, tiene un origen místico, una prevención y tratamiento en el ámbito de lo religioso, energético y espiritual. Con respecto a este, existe poco conocimiento y confianza por parte del personal de salud. Conclusiones: las creencias son fenómenos dentro de una población que generan actitudes y acciones a gran escala, son base de vital importancia para la crianza de sus hijos y son una tradición. El personal de salud no percibe este fenómeno como algo real, por lo que ignora las creencias y cultura de la población, lo que se convierte en una barrera que afecta la comunicación. Lo anterior demuestra la importancia de la generación de un puente que permita la unión de las creencias y la ciencia.

Hypothalamic versus pituitary dysfunction in Down's syndrome as cause of growth retardation.

We have found that some children with Down's syndrome (DS) have growth retardation secondary to growth hormone (GH) deficiency. To test the hypothesis that hypothalamic dysfunction is the primary cause for GH deficiency and growth retardation, hypothalamic-pituitary responses of serum GH concentrations to levodopa and clonidine as well as pituitary responses in serum GH concentrations to growth-hormone-releasing hormone (GHRH) were analysed in 14 prepubertal children with DS. Levodopa and clonidine were given, and blood was drawn for determining serum GH levels. Seven prepubertal control children had both levodopa and clonidine tests done. The delta serum GH during levodopa was 5.7 +/- 6.3 ng ml-1 in DS and 13.1 +/- 9.8 ng ml-1 in controls. The delta serum GH during clonidine administration was 3.0 +/- 3.2 ng ml-1 in DS and 17.3 +/- 5.6 ng ml-1 in controls. Children with DS had a significantly lower response to levodopa and clonidine, compared with controls by the Mann-Whitney U-test (P < 0.03 and P < 0.009, respectively). Growth-hormone-releasing hormone was given at 1 microgram kg-1 i.v. bolus and bloods for GH were drawn at-15, 0, 15, 30, 60, 90 and 120 min in 14 subjects with DS and 24 normal controls, both groups prepubertal. The mean delta serum GH concentration in DS was 53.6 +/- 38.3 ng ml-1, and it was 35.6 +/- 25.1 ng ml-1 in controls with P < 0.23 non-significant by the Mann-Whitney U-test. These results indicate that levodopa and clonidine (drugs stimulating hypothalamic GHRH release and secondary pituitary GH release in normal individuals) do not stimulate GH release in DS. Furthermore, normal GH response to GHRH in DS indicates normal pituitary function (normal somatotroph response to GHRH) and supports hypothalamic dysfunction in DS.

Time course of hemostatic abnormalities in sepsis and its relation to outcome.

OBJECTIVES: To investigate the time course and the relation to prognosis of coagulation and fibrinolytic abnormalities in patients with septic shock. PATIENTS AND METHODS: Forty-eight consecutive patients admitted to the medical ICU with the diagnosis of septic shock (diagnosed by defined criteria) were studied. Mortality was 25 of 48. Mean age was 57 +/- 7.3 years. Blood samples were obtained on days 1, 4, and 7 after hospital admission to measure tissue-type plasminogen activator antigen (t-PA), urokinase-type plasminogen activator (u-PA), plasminogen activator inhibitor antigen (PAI-1), plasminogen, alpha 2-antiplasmin, fibrinogen, antithrombin III, protein C, protein S, thrombin-antithrombin complexes (TAT), D-dimer, and von Willebrand factor-related antigen (vWF:Ag). RESULTS: All patients showed marked abnormalities in both the coagulation and fibrinolytic systems. There were signs of coagulation activation and elevation of both activators and inhibitors of fibrinolysis. Nonsurvivors showed lower levels of protein C and antithrombin III and higher concentration of TAT than survivors. While both t-PA and PAI-1 concentrations were high in survivors and nonsurvivors, only survivors showed a progressive normalization of both parameters during the study period. Low plasminogen levels and plasminogen/alpha 2-antiplasmin ratio were found in both groups, presenting a trend toward normalization only in survivors. The differences reported were not apparent at the time of hospital admission. CONCLUSIONS: Septic shock is characterized by coagulation activation and fibrinolysis activation and inhibition. Nonsurvivors present a particular hemostatic profile characterized by a more marked activation of coagulation and a more intense inhibition of fibrinolysis. None of the abnormalities studied was significantly different between survivors and nonsurvivors at the time of hospital admission. In the presence of fibrin formation, nonsurvivors present a maintained imbalance in the fibrinolytic response determined by higher PAI-1 plasma concentration, probably contributing to their poor outcome.

Growth hormone deficiency in Down's syndrome children.

Down's syndrome (DS) children have been reported to have severe postnatal growth arrest and microcephaly. To determine if growth hormone (GH) deficiency plays a role in growth retardation in DS, 20 children were studied. The subjects (13 boys, 7 girls) were aged between 15 months and 13.9 years, had a height SDS ranging from -1.19 to -5.48, weight SDS ranging from -0.21 to -4.58, head circumference SDS ranging from -0.40 to -6.6, and a skeletal age ranging from 0.9 to 4.6 SD below the mean for normal children of same age and sex. GH was evaluated by levodopa (125 mg up to 15 kg, and 250 mg between 15-30 kg), clonidine (0.15 mg m-2) stimulation tests and hGH secretory patterns by the integrated 24 h. GH concentration (IC-GH) using a constant withdrawal pump with continuous blood collection every 30 min. The serum concentrations were: TSH, 0.7-8.0 mIU ml-1 (0.2-5.5); T4, 6.6-14.3 micrograms dl-1 (5-12); T3, 95-254 ng dl-1 (85-185); LH, less than 2.0-8.3 mIU ml-1 (less than 3); FSH, less than 1.3-7.2 mIU ml-1 (less than 3); testosterone, less than 30 ng dl-1 (5-35); estradiol, less than 5 ng dl-1 (less than 5-25); prolactin, 35.7-2.9 (F: 5-25; m 5-15); and somatomedin-C (Sm-C), 0.14-1.98 U ml-1 (0.08-5.90) (normal values in brackets). Peak serum GH after levodopa and clonidine was found to be below 10 ng ml-1 for both stimulatory tests in seven out of the 20 children studied. Twelve children showed a disparity between levodopa and clonidine testing. Of the 12 children, peak serum GH after levodopa was found to be below 10 ng ml-1 in five children; and peak serum GH after clonidine was found to be below 10 ng ml-1 in six. One child had a clonidine peak increase in serum GH concentration exactly 10 ng ml-1, but had a 12 h IC-GH of 1.5 ng ml-1 (N greater than 3.2). Two children with peak GH after clonidine above 10 ng ml-1 had a 24 h IC-GH of 0.7 and 1.3 ng ml-1. A fourth child who had peak GH concentrations above 10 ng ml-1 with levodopa and clonidine had a 12 h IC-GH of 0.5 ng ml-1.(ABSTRACT TRUNCATED AT 400 WORDS)

Treatment of children with Down syndrome and growth retardation with recombinant human growth hormone.

The effect of recombinant human growth hormone on children with Down syndrome who had growth retardation and microcephaly was examined. Thirteen children with trisomy 21 without congenital heart disease who were short for age (-1.19 to -3.5 standard deviation score) and microcephalic (-1.58 to -6.60 standard deviation score) were given recombinant human growth hormone, 0.1 mg/kg subcutaneously, 3 days a week for 1 year. Before treatment, peak serum growth hormone concentrations were less than 10 micrograms/L after levodopa and clonidine stimulation tests in five patients, after clonidine in three patients, and after levodopa in three patients. Three patients had nocturnal integrated growth hormone concentrations of 0.5, 1.5 and 0.65 micrograms/L, respectively. The mean growth rate before treatment was 5.4 +/- 1.6 cm/yr and increased to 12.2 +/- 3.2 cm/yr (p less than 0.001) after 12 months of recombinant human growth hormone treatment. The mean head circumference standard deviation score before treatment was -3.1 +/- 1.3 and increased to -2.3 +/- 1.2 (p less than 0.001) at 12 months. Bone age before and 1 year after treatment increased in correspondence with chronologic age. Plasma hemoglobin A1c concentration was normal during treatment with recombinant human growth hormone. The mean plasma concentrations of insulin-like growth factor I at baseline and at 12 months were 0.54 +/- 0.19 U/ml and 1.25 +/- 0.97 U/ml, respectively (p less than 0.02). We conclude that recombinant human growth hormone therapy can result in a significant increase in annual growth rate and head circumference in children with Down syndrome, without significant side effects.