ABSTRACT
BACKGROUND: The prevention of rabies in Mexico continues to be an important goal for the health sector. Although the prevalence of this disease continues to fall, between 1990 and 1995 a total of 238 cases were registered (an average of 40 cases annually), with a mean annual incidence of 0.04 cases per 100,000 inhabitants and a mortality of almost 100%, so that it is important to rely on highly effective vaccines with few side effects. The objective of this work was to evaluate seroconversion and tolerance to the human diploid cell antirabies vaccine administered to individuals with a history of exposure to rabies, to compare these results with those reported in the literature for the Fuenzalida vaccine, a rabies vaccine produced in the brain tissue of suckling mice, and to find the role antirabies hyperimmune gamma globulin plays in the concentration of post-vaccination antibody concentrations. METHODS: An analytical transverse study was carried out in 40 children and adults with a history of rabies exposure who were given a complete, five-dose intramuscular schedule of the human diploid cell rabies vaccine. Subjects were followed daily, and local and systemic signs and symptoms were recorded. Two blood samples (at baseline and at the end of the vaccination schedule) were taken and antibody titers against rabies glycoprotein, using the ELISA technique, were measured. RESULTS: Adverse side effects produced by the human diploid cell antirabies vaccine, such as frequency of pain, erythema, itching, and regional adenopathy were fewer than those reported in the literature for the Fuenzalida vaccine (p < 0.05), and of induration and local pain (p < 0.05) in relation to the latter vaccine. All patients seroconverted, producing geometric mean antibody titers of 6.22 IU/mL, an arithmetic mean titer of 9.66 IU/mL with a SD of 9.1 IU/mL. The level of tolerance to the diploid cell vaccine was good and its adverse effects were minimal and fewer than those reported for the Fuenzalida rabies vaccine. Patients receiving the diploid cell vaccine plus antirabies hyperimmune gamma globulin developed higher antibody titers (measured by ELISA test) at the end of the vaccination schedule than those only receiving the vaccine. CONCLUSIONS: These results are important in order to achieve an adequate and opportune level of protection provided by prophylactic vaccines to patients with exposure to rabies.
Subject(s)
Antibodies, Viral/immunology , Immunoglobulins/immunology , Rabies Vaccines/immunology , Rabies/prevention & control , Adolescent , Adult , Child , Humans , Immunization, Passive/methods , Mexico/epidemiology , Rabies/epidemiologyABSTRACT
OBJECTIVE: To alert about an unusual and poorly informed entity, with high mortality. That should be considered in critically ill neonates with central venous catheter and parenteral nutrition, in order to establish early diagnosis and treatment. CASE REPORT: Two neonates, one born at term and the other premature, with central venous catheter and parenteral nutrition. They had sudden unexplained hypotension and signs of decompensation and death secondary to cardiac tamponade. DISCUSSION: Cardiac tamponade secondary to central venous catheter is an unusual entity seldom discussed in the literature. The estimated incidence is 0.3 to 2% with a 74 to 100% mortality. It must be suspected and diagnosed early in order to decrease the mortality.
Subject(s)
Cardiac Tamponade/etiology , Catheterization, Central Venous/adverse effects , Infant, Premature, Diseases/etiology , Parenteral Nutrition , Cardiac Tamponade/diagnostic imaging , Female , Humans , Infant, Newborn , Infant, Premature, Diseases/diagnostic imaging , Male , Radiography, ThoracicABSTRACT
Primary cardiac tumors are very infrequent at all ages; the most frequent in the pediatric age is rhabdomyoma. This tumor is associated with tuberous sclerosis in 37 to 80%, with a frequency of 1 for each 40,000 live newborns. This case is about a newborn, who in the immediate postnatal period presented pansystolic murmur, grade IV cardiomegaly, electrocardiographic changes of biventricular hypertrophy and heart failure. Echocardiogram and magnetic resonance images showed several tumors in the septum and in ventricular walls; histopathology study of the heart, confirmed the diagnosis. The diagnosis of tuberous sclerosis was made clinically (seizures, hypomelanotic macules) and with the image of parenchymal hypodense areas. In our country there is little information about both diseases, that's why we made a review of the incidence, diagnosis, prognosis and treatment.