Eosinofilia inducida por Olanzapina: A propósito de un caso / Olanzapine-induced eosinophilia: A case report

Resumen Se han descrito una serie de reacciones adversas asociadas a antipsicóticos, entre las que destacan las reacciones adversas hematológicas propias de algunos antipsicóticos atípicos. Las más renombradas han sido clásicamente las discrasias sanguíneas asociadas al uso de olanzapina. En este trabajo nos enfocamos en una reacción adversa poco común: eosinofilia en un paciente esquizofrénico paranoide usuario de olanzapina, situación documentada en contadas publicaciones a lo largo de la historia de uso de este medicamento. Se trata de una reacción adversa infrecuente, y por lo mismo poco conocida y estudiada.

Many adverse effects of antipsychotic drugs have been described, among which hematologic adverse effects stand out. Classically, blood discrasias have been associated to the use of olanzapine. On this paper we will focus on an uncommon adverse reaction: eosinophilia in a patient diagnosed with a paranoid schitzophrenia, who had been using olanzapine. There have been just a few reported cases of eosinophilia secondary to the use of olanzapine, which makes this an infrequent, rarely known and even less studied adverse reaction.

Salmonelosis neonatal: reporte de un caso y revisión de la literatura / Neonatal Salmonella infections: a case report and literature review

En Chile aún existe la salmonelosis como causal de enfermedad entérica, prevaleciendo el serotipo Enteritidis. En sepsis neonatal el germen más frecuente es Streptococcus grupo B (SGB); los bacilos Gram negativos entéricos ocupan el segundo lugar. La Salmonella spp. es infrecuente. Las vías de transmisión pueden ser hematógena, canal del parto, ascendente u horizontal. CASO CLÍNICO: Mujer sana, 31 años, embarazo de 39 semanas. Cultivo de SGB negativo. Presenta cuadro diarreico el día previo al parto, el cual fue vaginal, dilatación de cuatro horas, expulsivo de 15 minutos, líquido amniótico claro, destaca temperatura (T°) intraparto de 38,3°C. Recién nacido (RN)sexo masculino, adecuado para la edad gestacional, Apgar 9/9,con T° rectal 38,1°C al nacer. Al segundo día de vida presenta deposiciones líquidas verdosas con estrías de sangre, descenso de peso de 10,6 por ciento (367,82 gr) y T° rectal 37,7°C. Ingresa a neonatología, destacando Proteína C Reactiva elevada de 2,7 mg/dL. Por persistir cuadro se solicitan cultivos previo a antibioterapia con Ampicilina y Gentamicina. Test APT-Downey positivo, cultivo orina y líquido cerebroespinal negativos, hemocultivo y coprocultivo positivo a Salmonella tipo D subtipo Panamá. Evoluciona favorablemente, es dado de alta al noveno día con diagnóstico de sepsis por Salmonella tipo D connatal. Coprocultivo de madre positivo para Salmonella. DISCUSIÓN: La prevalencia de infecciones por Salmonella se ha incrementado en neonatos. Es importante realizar prevención durante el embarazo además de un diagnóstico y tratamiento precoz. Se debe considerar este agente según factores de riesgo y como diagnóstico diferencial de hemorragia digestiva baja en el RN...

Salmonella infections are still a cause of entericdisease in Chile, with a predominance of the Enteritidis serotype. In neonatal sepsis the most frequent etiology is Group B Streptococcal (GBS) infection; enteric Gram-negative bacilli occupy second place. Salmonella spp. is infrequent. The transmission routes can be hematogenous, by birth canal, vertical, or horizontal. CASE REPORT: Healthy 31 year old female, 39 week pregnancy. Negative GBS culture. Presents with diarrhea the day before labor, with vaginal delivery, four hour dilation period,15 minute expulsion period, clear amniotic fluid, intra delivery temperature (T°) of 38.3°C. Male, adequate for gestational age newborn, Apgar 9/9, with rectal T° of 38.1°C at birth. During second day of life, presents green liquid stools with blood streaks, weight loss of 10.6 percent (367.82 gr), and rectal T° of 37.7°C. Patient is admitted to neonatology service, where he presents elevated C-Reactive Protein of 2.7 mg/dL. Cultures were taken due to persistent findings, before antibiotic therapy with Ampicillinand Gentamicin. Positive APT-Downey test, negative urine and cerebrospinal fluid cultures, positive blood and stool cultures for type D, subtype Panama Salmonella. Favorable evolution, discharged on day nine with diagnosis of sepsis due to connatal type D Salmonella. Mother’s stool culture is positive for same bacteria. DISCUSSION: The prevalence of Salmonella infections has increased in neonates. Prevention during pregnancy, along with early diagnosis and treatment, are important. This agent should be considered according to risk factors, and as a differential diagnosis of lower gastrointestinal bleeding in newborns...

Dimensión vertical en edentados: relación con síntomas referidos / Vertical dimension on edentulous patient: relationship with symptoms reported

La dimensión vertical es una medida aproximada de las relaciones fisiológicas intermaxilares. Su obtención es un proceso sensible y metódico que produce efectos craneofaciales colaterales cuando es erróneamente lograda. Los conceptos individualistas de su obtención deben ser cambiados e interiorizados de una manera colectiva debido a la complejidad de la dinámica masticatoria que exige una perspectiva más amplia de esta noción. La correspondencia entre la dimensión vertical y lo funcional-disfuncional cráneo-cervical es innegable y va mas allá de una relación exclusivamente dental. Esta revisión busca situar al lector en una realidad estomatognática y no solo odontológica, que exige mayores esfuerzos y un cambio de perspectiva en la conceptualización de la importancia de la dimensión vertical en el normal funcionamiento del sistema estomatognático y de estructuras vecinas en el paciente edentado.

Vertical dimension is an approximate measure of the physiological inter-maxillary relations. Its register is a sensitive and methodical process with craniofacial side effects when wrongly achieved. Single concepts for vertical dimension register should be changed and understood in a collective manner. The complexity of the masticatory dynamics requires a broader view of this notion. The correspondence between the vertical dimension and the functional-dysfunctional cranio-cervical relations is undeniable and goes beyond an exclusively dental relation. This review seeks to place the reader in a stomatognathic functional perspective, which requires greater efforts of the prosthodontics operator. Normal functioning of the stomatognathic system and surrounding structures in the edentulous patient depends on the conceptualization about the importance of vertical inter-maxillary relations.

¿Debemos seguir haciendo salpingoooforectomía como profilaxis de cáncer de ovario? / Should we continue prophylactic salpingo-oophorectomy for ovarian cancer?

Hasta hace algunos años en las mujeres sometidas a histerectomía por patología benigna, que tuvieran 45 o más años, se efectuaba de regla una salpingoooforectomía (SOB) bilateral, como prevención de cáncer de ovario. Esto está actualmente en discusión. Hay dos grandes estudios de cohortes poblacionales y un estudio prospectivo observacional que analizan los efectos adversos cardiovasculares y el cáncer de ovario en mujeres sometidas a SOB. Basados en estos análisis y otros datos de la literatura, se pueden plantear algunas conclusiones. En mujeres premenopáusicas y hasta los 50 años la conducta óptima es preservar los ovarios, entre 51 y 65 años no está claro que lo mejor sea extirparlos y en mayores de 65 aún no se ha probado efectos deletéreos a raíz de la intervención.

The age to perform prophylactic oophorectomy at the time of hysterectomy for benign conditions is being actually discussed. Two population based cohorts studies and one prospective observational study evaluate cardiovascular disease and ovarian cancer with a history of oophorectomy. Some conclusions can be drawn. Until 50 years or premenopausal women, ovarian conservation should be the norm, between 51 and 65 there are no clear indications for removal and in older than 65 no negative effects have been described.

Revisión de los conocimientos actuales sobre alopecia areata / Review of updated knowledge about alopecia areata

La alopecia areata (AA) es una enfermedad frecuente que provoca serios trastornos estéticos y psicológicos a los individuos afectados. Aunque su etiología no ha sido bien aclarada, las últimas investigaciones apuntan hacia una causa autoinmune. Los tratamientos disponibles hasta la fecha son sólo paliativos y no cambian el curso de la enfermedad. La presente revisión tiene como objetivo dar a conocer los conceptos actuales sobre aspectos epidemiológicos fisiopatológicos y clínicos de la AA. Se revisan los medicamentos más utilizados en su tratamiento y esquemas terapéuticos propuestos

Bacterial contamination of bottle milk in infants under 6 months in Children's Hospital, Bangkok, Thailand.

The bacterial contamination of bottle milk samples obtained randomly from 500 infants under 6 months of age who came to the Out-patient Department of Children's Hospital Bangkok was determined by collecting bottle milk samples prepared at home following interview of their caretakers after obtaining their consent. Bacterial contamination was found in 91.8% (459/500) of bottle milk samples. Among the positive samples, 82.8% (380/459) contained enteric bacteria, another 17.2% were unidentified bacteria. The dominant enteric bacteria isolated from bottle milk were Klebsiella spp (56.6%), Enterobacter spp (41.3%), Aeromonas spp (14.4%), E. coli (13.4 %) and Vibrio cholerae non 0-1 (1.8%). Isolated E. coli were further identified as enteropathogenic E. coli (7.8%, 4/51) and enterotoxigenic E. coli (3.9%, 2/51). About 74% of the contaminated bottle milk contained one type of bacteria, 23.7% had two types and 2.3 % had 3 or more types of bacteria. A level of bacterial contamination greater than the US government limited number (USGLN 2x10(4) CFU/ml) was found in 86.4% of total examined samples (432/500) [geometric mean (GM) of 2.9 x 10(6) CFU/ml]. About 66% (333/500) of bottle milk samples had coliforms greater than the USGLN (1 x l0(2) CFU/ml) with GM of 1.3 x 10(4) CFU/ml. Therefore, in the preparation of bottle milk, feeding practice should be emphasized in every setting of maternal-child health care and promotion of breast-feeding should be encouraged by the health personnel.

Comparación de dos técnicas para la determinación de glicemia por método de cinta reactiva / Comparison of 2 techniques for blood glucose measuring with reagent strips method

Dado el amplio uso de dispositivos de autocontrol para medir glucosa sanguínea con cintas reactivas, se decide comparar los resultados de mediciones de glucosa procesadas con cinta reactiva Glucostix (Bayer Diagnósticos) en un reflectómetro Glucometer GX (Miles, Elkhart, In), a partir de muestras de sangre capilar y venosa para determinar las posibles diferencias de sensibilidad en la técnica de muestreo,utilizando como referencia la glicemia en sangre total y venosa procesada en el laboratorio (Método de glucosa-oxidasa).Con este propósito se tomaron y analizaron muestras de pacientes diabéticos bajo control, 95 de sangre capilar y 11 de sangre venosa, obteniéndose un coeficiente de correlación similar en las dos muestras (0,852 y 0,7981 respectivamente), sin diferencias estadísticamente significativas entre ambos.La curva de regresión lineal demuestra que no se producen sobre o subvaloraciones importantes. El resultado comprueba una buena sensibilidad del instrumento con las muestras de sangre capilar y venosa, sin establecerse diferencias significativas en la obtención de resultados comparativos; sin embargo, el uso de estas técnicas debe realizarse con cautela, considerando las implicancias terapéuticas de sus resultados

Cáncer de la vesícula biliar: estudio de casos y controles / Gallbladder cancer: a case control study

Gallbladder cancer is the principal oncological cause of death in chilean women and cholelithiasis is a well recognized risk factor. Aiming to unravel other risk factors for gallbladder cancer, we compared 50 patients subjected to cholecystectomy in whom a gallbladder cancer was found with 50 age and sex matched operated controls without cancer. Subjects were clinically assessed and interrogated about demographic, obstetrical features and feeding features. Multiples and early pregnacies were factors significantly associated to the development of gallbladder cancer. 20 subjects (44 percent) with cancer knew that they had cholelithiasis and 41 patients in each group were symptomatic. It is concluded that pregnancy may be a risk factor for gallbladder cancer probably due to the lithogenic effect of its hormonal changes. Also, early cholecystectomy in symptomatic individuals may be an effective preventive measure

Aspectos prácticos del test de la absorbancia en líquido amniótico / Practical aspects of the absorbance test in amniotic fluid

El test de la absorbancia de líquido amniótico a 650 nm, ha sido recomendado como un método rápido, simple, objetivo y de bajo costo, que puede reemplazar al test de Clements, como índice de madurez pulmonar fetal, en nuestro medio. El presente trabajo informa sobre aspectos prácticos del test, tales como: a) Estabilidad de la muestra a diferentes temperaturas, b) Efectos del meconio y c) Factibilidad de dilución de la muestra. Los resultados indican que: a) Es posible diluir hasta 4 u 8 veces, dependiendo de la madurez del líquido que se analice, b) La estabilidad de las muestras es mayor en líquidos conservados a temperatura ambiente, siendo importante la alteración que sufre con la refrigeración o el congelamiento y c) El meconio altera la absorbancia en forma impredescible, por lo que su presencia invalidaría el test

Amebiasis at an evacuation site on the Thai-Cambodian border.

Symptomatic intestinal amebiasis was highly endemic among the Cambodians living at Green Hill, an evacuation site on the Thai-Cambodian border between June 1987 through May 1989. Monthly incidence rates of intestinal amebiasis were determined to be inversely proportional to cumulative monthly rainfall. The highest incidence of amebic dysentery was 63/1000 in children 12-23 months old. Behavioral risk factors were investigated by conducting a case-control study. A questionnaire was administered to 73 families, each having at least one member with confirmed intestinal amebiasis within the past 3 months, and to 95 randomly selected control families having no individual with diarrhea for at least 3 months. Individuals from families with greater than 4 members were at higher risk for acquiring intestinal amebiasis. No significant differences in behavioral risk factors were identified between case and control families. Eighty-six percent of 51 water samples drawn from wells where amebiasis patients obtained their drinking water had greater than 10 coliforms/100 ml. The main route of transmission of E. histolytica was not identified, but was most likely via the fecal-oral route.

Behavior of urban based child caretakers in the home treatment of diarrheal diseases.

Behaviors of low income urban mothers and child caretakers in the treatment of childhood less than 5 year diarrhea were analysed from a surveillance study conducted between August 1988 and July 1989. Help seeking behaviors of mothers and caretakers for 412 episodes of child diarrhea were as follows: investigators 37.1%, drug stores 18.2%, wait and see or self treatment 17.0%, private clinics 12.6%, near by hospital 10.2%, and local health center 4.9%. Major treatment practices included ORT alone (54%) and ORT plus antibiotics and/or antidiarrheal drug (22%). Overall ORT usage was 76%. Twelve percent of diarrheal episodes no treatment was given to the children. Antimicrobials were believed to be essential in addition to ORT especially when diarrhea was associated with fever, vomiting and bloody stools. Thirty-six percent of invasive diarrhea cases (Shigella, Salmonella, Campylobacter) were treated with antibiotics. Only 18.2% of noninvasive diarrhea received antibiotics, most of this antibiotic use being in rotavirus diarrhea where vomiting and some fever are prominent. Availability of oral rehydration salts (ORS) and good experience with ORT were the key to the extensive use or ORT in this study. A surprisingly small number of mothers and child caretakers (4.9%) sought help from the local health center when their children had diarrhea.

Symptoms associated with diarrhoeal illness at San Lazaro Hospital, Manila in 1983 and 1984.

The clinical features associated with various agents of diarrhoeal disease were studied using 2,836 patients admitted to San Lazaro Hospital, Manila. Three general patient groups were considered including single pathogen isolations, "multiple pathogen" isolations, and "no pathogen" isolations. In general, symptoms of diarrhoeal illness were found to be non-specific. However, Shigella flexneri. Vibrio parahemolyticus, and rotavirus were significantly associated with a number of prominent symptoms and could sometimes be predictably diagnosed on clinical grounds, especially when age of the patient was considered. Clinical diagnosis cannot be considered an adequate substitute for laboratory methods; other enteric pathogens can sometimes present with the same symptoms. When appropriate laboratory testing is unavailable, as is often the case in developing countries, symptomatologic diagnosis may be of limited value for the organisms mentioned.

A comparison of methods for the isolation of Campylobacter species from stool specimens.

Eight methods used for isolation of Campylobacter species were compared. Using a combination of methods Campylobacter species were isolated from 30 (11%) of 270 children with diarrhea seen at Bamrasnaradura Infectious Disease Hospital, Nonthaburi, Thailand. The membrane filter method using a gas generating envelope at 37 degrees C identified 73% of the total positive specimens and was found to be the best isolation method for Campylobacter species from stool specimens. This method identified two strains that failed to grow on antibiotic containing media, and also gave a higher isolation rate of C. jejuni than could be isolated with conventional methods. The combination of the membrane filter method and a selective antibiotic method identified 90% of all isolates. At present the cost of the membrane filter method is higher than other methods. Therefore, the selective antibiotic method (Campy-BAP) with sheep blood under gas mixture at 42 degrees C is recommended for laboratories with limited supplies. Diagnosis by direct smear with 1% basic fuchsin revealed high degree of sensitivity and specificity. This rapid, inexpensive, and simple method could be used to make a presumptive diagnosis of Campylobacter enteritis when isolation methods are unavailable.

Simple serological tests for detecting classical heat labile enterotoxin (LT-I) of Escherichia coli.

Diarrhoea caused by enterotoxigenic Escherichia coli (ETEC) remains a problem in Southeast Asia. At present, no routine laboratories as yet are available for ETEC detection. In this study, attempts were made to produce reagents for use in simple serological tests for detecting LT. The serological methods were the Biken, the staphylococcal coagglutination and the reverse passive hemagglutination tests. For the Biken test, medium was prepared locally by mixing constituents as described previously by Honda et al., (1981). Anti-CT-B subunit was prepared by immunizing a rabbit with commercial CT-B subunits (Sigma). Other chemical reagents e.g. colistin, lincomycin etc. were obtained from the local supplies. Using the locally made reagents to detect LT from 100 WHO reference strains of E. coli by the Biken test, it was found that the test had 100%, 92%, 96%, 100% and 92.5% of specificity, sensitivity, accuracy, positive predictive value and negative predictive value, respectively. Protein A rich Staphylococcus aureus from the stock culture of the Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University were grown in suitable medium i.e. blood agar containing lincomycin (BA-Lin). Suitable amount of the rabbit anti CT-B subunit (0.1 ml) was used to sensitize each ml of the formalinized, heat-fixed bacteria. The sensitized bacteria were used for detecting LT in the lysates of the 100 E. coli reference strains. The lysates were prepared by growing the E. coli strains on BA-Lin medium for 8 hours, then a loopful of each strain was inoculated into colistin solution (20,000 unit/ml).(ABSTRACT TRUNCATED AT 250 WORDS)