Comparative study of perceived invalidating environment and stress coping strategies between patients with drug resistant epilepsy and functional dissociative seizures.

BACKGROUND AND OBJECTIVES: We investigated perceived invalidating environment during childhood and stress-coping strategies in patients with; functional dissociative seizures (FDS, n=26), drug-resistant epilepsy patients with no psychiatric comorbidity (DREnc, n=23), and drug-resistant epilepsy patients with psychiatric comorbidity (DREpc, n=34). DESIGN/METHODS: We performed a cross-sectional study. Patients underwent Video Electroencephalography to confirm the diagnosis and completed a psychiatric assessment supported by clinical instruments. Invalidating environment and stress coping were studied through the ICES and CAE questionaries, respectively. A series of multinomial logistic regression analyses were performed with the explored variables. RESULTS: The maternal negative response model predicted a higher probability of FDS condition. A chaotic family type increased the likelihood of DREpc instead of FDS. DREpc and FDS patients displayed many different behaviors to cope with stress other than trying to solve the problem, the most used strategy in the DREnc group. Parental invalidation was higher in DREpc than in FDS. CONCLUSIONS: Our results deepen the data provided by previous studies indicating that multiple variables of biosocial origin have significant effects on these groups of patients. The presence of an invalidating environment may predict FDS but also the presence of psychiatric disorders among DRE. Psychotherapeutic strategies to enhance these variables might be necessary for this population.

Leflunomide use in a cytomegalovirus infection of a patient with dermatomyositis.

Human cytomegalovirus (CMV) is responsible for significant morbidity and mortality in immunocompromised populations, such as those suffering from dermatomyositis (DM). We present here a case study of a DM patient undergoing methotrexate treatment who presents with weakness, myalgia, elevated levels of hepatic transaminases and serological markers of CMV primo-infection. The antiviral activity of leflunomide against CMV was described recently. The use of leflunomide as an immunomodulator may have contributed to the satisfactory evolution of the treatment for a symptomatic CMV infection in an immunocompromised patient, since the typical treatment outcome is more prolonged and with additional complications.

Cat scratch disease during etanercept therapy in a rheumatoid arthritis patient. / Enfermedad por arañazo de gato en paciente con artritis reumatoidea tratado con etanercept.

Cat scratch disease (CSD) is an infectious disorder caused by Bartonella henselae and characterized by fever and granulomatous lymphadenopathy. Immunosuppression is a risk factor for the development of atypical forms of the disease. We report the case of a 52-year-old woman who presented with fever and bilateral inguinal lymph node enlargement. She did not have apparent contact with animals. The patient was receiving etanercept therapy for rheumatoid arthritis. Lymph node biopsy demonstrated granulomatous lymphadenitis. She was successfully managed by discontinuing etanercept and by treatment with minocycline. She developed clinical remission and typical seroconversion. Infection with Bartonella should be considered in the differential diagnosis in rheumatoid arthritis patients with lymphadenopathy of unknown origin.

Indications of a new antibiotic in clinical practice: results of the tigecycline initial use registry

Tigecycline is the first of a new class of antibiotics named glycylcyclines and it was approved for the treatment of complicated intra-abdominal infections and complicated skin and skin structure infections. Notwithstanding this, tigecycline's pharmacological and microbiological profile which includes multidrug-resistant pathogens encourages physicians' use of the drug in other infections. We analyzed, during the first months after its launch, the tigecycline prescriptions for 113 patients in 12 institutions. Twenty-five patients (22 percent) received tigecycline for approved indications, and 88 (78 percent) for "off label" indications (56 percent with scientific support and 22 percent with limited or without any scientific support). The most frequent "off label" use was ventilator associated pneumonia (VAP) (63 patients). The etiology of infections was established in 105 patients (93 percent). MDR-Acinetobacter spp. was the microorganism most frequently isolated (50 percent of the cases). Overall, attending physicians reported clinical success in 86 of the 113 patients (76 percent). Our study shows that the "off label" use of tigecycline is frequent, especially in VAP. due to MDR-Acinetobacter spp., where the therapeutic options are limited (eg: colistin). Physicians must evaluate the benefits/risks of using this antibiotic for indications that lack rigorous scientific support.

Colonización e infección en pacientes leucémicos: análisis de 195 cultivos de vigilancia / Colonization and infection in leukemic patients: analysis of 195 surveillance cultures

Nuestro objetivo en este trabajo fue determinar el rol de la vigilancia microbiológica y la evaluación clínica en el manejo de pacientes leucémicos con fiebre y granulocitopenia. Fueron analizados 42 casos de leucemia aguda y 57 episodios de fiebre en pacientes hospitalizados en el período comprendido entre el 1§ de enero y el 31 de diciembre del año 1982. Hubo 195 cultivos de vigilancia. Observamos 14 a 20% de colonización orofaríngea con flora potencialmente invasiva desde la primera semana de internación, sin cambios significativos en su composición ni en la velocidad de adquisición. La colonización por Candida se incrementó en la segunda y tercera semanas, y fue un hallazgo constante en los pacientes fallecidos con micosis diseminadas. No pudimos correlacionar colonización bacteriana con infección, quizá debido al escaso aislamiento de patógenos invasivos potenciales: Klebsiella. Pseudomonas (6 y 3%, respectivamente). Staphylococcus aureus fue el principal agente etiológico de las infecciones microbiológicamente documentadas (42%); no realizamos cultivos nasales de vigilancia como para establecer una correlación entre infecciones estafilocócicas y condición de portador nasal del mismo gérmen