Population pharmacokinetics of valproate in Mexican children with epilepsy.

BACKGROUND: The aim of this study was to determine the factors that influence valproate clearance (CL) in Mexican epileptic pediatric patients using a mixed-effect model and sparse data of serum concentrations of valproic acid (VPA) collected during routine clinical care of patients. METHODS: The number of patients included in the study was 110. The population CL was calculated by using the NONMEM program. The following covariates were tested by their influence on CL: total body weight (TBW), height, age, body surface area, daily dose (DD), sex of the patient and comedication with phenobarbital (PB) or carbamazepine. RESULTS: The final regression model for valproic CL found best to describe the data was: CL/F=(0.0466+0.00363 TBW+0.000282 DD)*(1+0.236 PB). This model allows a reduction of 50% of the interindividual variability and of 31% of the residual variability described by the basic model that does not include covariables. CONCLUSIONS: Total body weight, daily dose of valproate and concomitant therapy with PB are factors that significantly influence VPA kinetic disposition and they should be considered in programming dosage regimens for this antiepileptic drug in the pediatric population. The validation of the model supports its acceptability for clinical purposes.

Clinical utility of polymerase chain reaction-based detection of Leishmania in the diagnosis of American cutaneous leishmaniasis.

We evaluated the use of polymerase chain reaction (PCR) for diagnosis of American cutaneous leishmaniasis (ACL) in an area in Bahia, Brazil, where Leishmania braziliensis is endemic. Leishmania DNA was detected in 50 cases, yielding a positivity rate of 100%, which was higher than the rates for all of the other diagnostic methods studied--namely, the Montenegro skin test, anti-Leishmania serological testing, and microscopic examination of lesion biopsy specimens. These findings have led us to propose guidelines for the diagnosis of ACL that use PCR as the principal means of parasitological confirmation of cases.

Dengue y factores teratogénicos. Reporte de un paciente / Dengue and Teratogenic Factors. Report of a Patient

Se reportó un caso de aborto espontáneo producido entre la décima y oncena semanas de gestación en una gestante durante la epidemia de dengue que afectó la ciudad de Holguín, en el año 2015. El objetivo fue realizar el análisis de los factores teratogénicos que incidieron en el fracaso gestacional. La transmisión transplacentaria de la infección por el virus dengue al embriofeto, que provocó alteraciones en el proceso metabólico del desarrollo embriofetal fue el factor teratogénico primario, potencializados en forma sinérgica por la prolongada exposición febril que afectó la gestante, con la formación de un hematoma retroplacentario y la producción secundaria de un grado variable de insuficiencia placentaria, que ulteriormente condujo al desprendimiento placentario abortivo. La terapéutica farmacológica empleada (dipirona, gravinol, omeprazol, difenhidramina y benadrilina) por la insuficiente actividad enzimática microsómica y citosólica, característica en este estadio del desarrollo de la concepción, suele haber interrumpido o dificultado la actividad farmacocinética embriofetal, que actuó en calidad de coteratógeno en este estadio del desarrollo e incidió en el desarrollo de la concepción para producir el aborto espontáneo.

A case of spontaneous abortion occurred between the tenth and eleventh weeks of gestation in a pregnant woman during the dengue epidemic that affected the city of Holguín in 2015. The objective of this was to analyze of the teratogenic factors that affected the gestational failure. The transplacental transmission of dengue virus infection to embryofeto, which caused alterations in the metabolic process of the embryofoetal development, was the primary teratogenic factor, together with the prolonged febrile exposure that affected the pregnant woman, with the formation of a retroplacental hematoma, and secondary variable degree of placental insufficiency, causing the abortion. Dipyrone, gravinol, omeprazole, diphenhydramine and benadryline were the pharmacological therapy used, due to the insufficient microsomal and cytosolic enzymatic activity, characteristic at this stage of conception development, has usually interrupted or hindered the embryofoetal pharmacokinetic activity, acting as coteratogen, influenced in the development of conception to produce embryolethal effects, producing the spontaneous abortion.

Parálisis facial, cofosis, vértigo. Carcinomatosis meníngea / Facial paralysis, cophosis, vertigo. Meningeal carcinomatosis

En este trabajo abordamos la historia clínica de un paciente de 68 años que se presenta con sintomatología otorrinolaringológica (ORL); presentando paresia facial, hipoacusia y "vértigos" rápidamente progresiva hacia la parálisis y cofosis. En la evolución agrega compromiso bilateral así como de otros pares craneanos. El compromiso rápido y progresivo de varios pares craneanos homo y contralaterales nos lleva a la sospecha clínica de una carcinomatosis meníngea, patología poco frecuente que se confirma con citología licuoral positiva para células tumorales. (AU)##