[The use of sublingual nifedipine in pediatric hypertensive patients at the Hospital de la Capital]. / El uso de nifedipina sublingual en pacientes pediátricos hipertensos del Hospital de la Capital.

The response to sublingual nifedipina was observed in 7 pediatric patients with renal disease and acute severe hypertension. Average dose used was 0.21 mg/kg, and an initial rapid response was evidenced as early as 3 minutes post administration. The greatest hypotensive effect was seen during the first 30 minutes, but continued its effect up to 60-120 minutes. The drug was well tolerated, of rapid action and results suggests it is efficient in the management of children and adolescents with acute secondary hypertension. No mayor adverse effects were encountered.

[Experience with the use of immune intravenous immunoglobulin in symptomatic children with human immunodeficiency virus infection]. / Experiencia con el uso de la gammaglobulina inmune intravenosa en niños sintomáticos con infección del virus de la inmunodeficiencia humana.

The Department of Pediatrics of the San Juan City Hospital participated in a collaborative clinical trial, placebo controlled, designed by NICHD with the purpose of determining if the use of gamma immunoglobulin is effective in preventing serious infections in symptomatic children infected with HIV. Of the 372 children randomized, 33 were from San Juan City Hospital. Of the 16 children on placebo, 9 (56%) developed 23 episodes of serious infections and 4 of 15 children on IVIG developed 5 episodes. A total of 24 hospitalizations occurred in the placebo group and six in the IVIG group. The mortality in our center was 12% (4/31). No adverse reactions were registered from the infusions in our center. Intravenous gamma immunoglobulin demonstrated to be effective in preventing bacterial infections and decreasing the number of hospitalizations in a subgroup of children infected with HIV.

Alpha-chain disease without qualitative serum IgA abnormality. Report of two cases, including a "nonsecretory" form.

Two cases of alpha-chain disease (alpha-CD) without detectable amounts of alpha-CD protein in serum are reported. Both patients presented with the usual epidemiologic, clinical and pathologic features of alpha-CD, including a predominantly plasmacytic infiltration of the whole small intestine, alpha-CD Protein was found in the jejunal fluid in one case but not in the other, the latter presenting as a "nonsecretory" form of alpha-CD. In both cases, immunofluorescence study of the small bowel mucosa showed that most of the infiltrating cells were positive for alpha chains and negative for other isotypes, and kappa and lambda light chains. These findings warrant a reevaluation of the prevalence of alpha-CD protein synthesis in immunoproliferative small intestinal disease (IPSID) (including lymphomas previously described as Mediterranean lymphoma) by performing an adequate search for alpha-CD protein in the jejunal juice, and at the cellular level in patients without detectable amounts of this protein in serum.

The microbial etiologies of diarrhea in hospitalized patients from the Puerto Rico Medical Center Hospitals

The development of diarrhea in hospitalized patients is a frequently encountered clinical problem, which may be due to infectious or non-infectious causes. The purpose of this study was to identify which common community enteric pathogens, if any, are responsible for diarrheal episodes in hospitalized patients. Stool samples from 76 consecutive, hospitalized patients were analyzed utilizing routine bacterial cultures, smears for identification of ova and parasites and Enzyme-Link Immunoadsorbent Assay (ELISA) for enteric bacteria, parasites and viruses. The results obtained demonstrated that the usual community enteric pathogens were not identified as a major cause of nosocomial diarrhea. In hospital-acquired diarrhea, Clostridium difficile toxins assay was the only clinically significant test in the evaluation of these patients. As a result of this study a guideline for the management of this condition in hospitalized patients is presented.

Experiencia con el uso de la gammaglobulin inmune intravenosa en niños sintomáticos con infección del virus de la inmunodeficiencia humana / Experience with the use of immune intravenous immunoglobulin in symptomatic children with human immunodeficiency virus infection

El Departamento de Pediatría del Hospital Municipal de san Juan participó en un estudio clínico colaborativo, placebo controlado, diseñado por NICHD con el propósito de determinar si el uso de la GIIV es efectiva en prevenir infecciones serias en niños sintomáticos con infección por VIH. De los 372 niños randomizados, 33% fueron del Hospital Municipal de san Juan. De los 16 niños en placebo, 9 (56%) desarrollaron 23 episodios de infecciones severas y 4 de 15 niños en GIIV desarrollaron cinco episodios (33%). Hubo hospitalizaciones en el grupo placebo y 6 en el grupo GIIV. La mortalidad en nuestro centro fue de 12%. En el Hospital Municipal de San Juan no se registraron reacciones adversas a las infusiones. La GIIV demostró ser efectiva en prevenir infecciones bacterianas y disminuir el número de hospitalizaciones en un subgrupo de niños infectados con el VIH