Transmisión del plasmodium falciparum en un transplante renal: Diagnóstico incidental por biopsia con aguja fina (Reporte de un caso) / Transmission of Plasmodium Falciparum in a renal transplant: incidental finding in a fine needle aspiration biopsy

La transmisión de malaria por órganos transplantados, constituye una fuente rara pero real de infección y el diagnóstico generalmente no es sospechado. Presentamos el caso de un transplante renal obtenido en una área endémica de paludismo, que consultó por fiebre y artralgias a nuestro Centro para su seguimiento. Una biopsia por aspiración con aguja fina del órgano transplantado reveló como hallazgo incidental la presencia de P. falciparum. Un alto grado de sospecha y el diagnóstico temprano, especialmente en áreas no endémicas, son indispensbles para evitar complicaciones serias como la pérdida del injerto o incluso mortalidad en el paciente inmunosuprimido

Growth and development in preterm infants receiving fluoroquinolones.

Growth and development were followed in 7 preterm newborn infants who received fluoroquinolones in the neonatal period. Quinolones were used as a "life saving" therapy in cases of sepsis caused by bacterial agents sensitive only to these drugs. Two other groups of neonates matched for gender, birth weight and gestational age served as controls. Although the quinolone group had more severe illness, no statistically significant differences were observed in growth and development between the groups. No osteoarticular problems or joint deformities were observed in the quinolone group. Therefore, quinolones could be a therapeutic option for newborns with sepsis caused by multiply resistant organisms.

[Changes in the contraceptive method mix during fertility decline: Latin America and the Caribbean]. / Cambios en la combinacion de metodos anticonceptivos durante la transicion de la fecundidad: America Latina y el Caribe.

"This paper reviews survey-based data regarding contraceptive prevalence and methods employed in Latin America and the Caribbean, with an emphasis on changes in the mix of methods over time. The most striking recent trend is the rise in use of female sterilization.... By contrast, use of male sterilization remains negligible in most countries. The oral contraceptive pill is by far the most popular of the temporary methods, though its prevalence has more often declined than increased in recent years. Together female sterilization and the pill make up around [two-thirds] of contraceptive practice in Latin America and the Caribbean." (SUMMARY IN ENG)

Intubating conditions after pipecuronium bromide: the influence of dose and time.

STUDY OBJECTIVE: To determine the intubating conditions following the administration of pipecuronium bromide in doses of two (0.07 mg/kg) or three (0.1 mg/kg) times ED95 (average dose that gives 95% block of the first twitch). DESIGN: To compare intubating conditions at 11/2 and 21/2 minutes in 41 patients receiving balanced anesthesia. SETTING: Surgical patients at Thomas Jefferson University Hospital. PATIENTS: Forty-one patients undergoing surgical procedure who received general anesthesia. INTERVENTIONS: After obtaining a stable baseline of train-of-four (TOF), 41 patients randomly received either 0.07 mg/kg or 0.1 mg/kg of pipecuronium as a single intravenous (IV) bolus dose, and the trachea was intubated either at 11/2 or 21/2 minutes. MEASUREMENTS AND MAIN RESULTS: Intubating conditions at 21/2 minutes appeared significantly better than those at 11/2 minutes, regardless of the pipecuronium dose. The mean time for T1 (first twitch of TOF) to reach 50% and 90% suppression was 1.36 +/- 0.51 minutes and 2.29 +/- 0.8 minutes, respectively, for the 0.07 mg/kg dose and 1.07 +/- 0.27 minutes and 1.72 +/- 0.45 minutes, respectively, for the 0.1 mg/kg dose. This did not make a significant difference in intubating conditions at either time. The time to 25% recovery of T1 was 68.2 +/- 22 minutes for the 0.07 mg/kg dose and 121.5 +/- 49 minutes for the 0.1 mg/kg dose. In patients who had spontaneous recovery of T1 to between 10% and 25% of control, administration of neostigmine or edrophonium resulted in identical recovery in 10 minutes. However, in patients with less than 10% spontaneous recovery of T1, neostigmine appeared to be superior to edrophonium. CONCLUSION: Pipecuronium has a relatively rapid onset. The trachea could be intubated successfully in 11/2 minutes with a dose of either 0.07 mg/kg or 0.1 mg/kg. If the clinical situation requires perfect relaxation with no movement or bucking, we recommend waiting at least 21/2 minutes.

Chronic cough in childhood: approach to diagnosis and treatment.

Chronic cough in childhood has many possible causes. The two most common are asthma and viral upper respiratory infection. Although usually associated with wheezing, dyspnea, or both, cough may be the sole manifestation of asthma ("cough-variant asthma"). Most important to initial evaluation are physical examination, patient history, and chest radiograph. Bronchial provocation testing may also prove helpful but is usually unnecessary. A trial of antiasthma therapy is appropriate when the pattern of symptoms is typical of asthma (excepting the lack of wheezing) and when nothing incompatible with asthma is present in the clinical picture. Drug therapy for cough-variant asthma is the same as that for more typical asthma. A vigorous trial of antiasthma therapy should not be considered complete unless a short course of high oral doses of corticosteroids has been included. The presence of clinical signs or symptoms atypical or incompatible with asthma and the failure of symptoms to respond to aggressive antiasthma therapy both warrant a more aggressive and complete diagnostic study.

Salt intake and blood pressure in humans.

Abundant evidence exists to link the dietary intake of sodium to the development of high blood pressure and the potential occurrence of cardiovascular consequences including stroke, congestive heart failure and other forms of cardiovascular disease as well as renal failure. Not all individuals are sensitive to the blood pressure-raising effects of sodium. Genetic or acquired factors may determine an individual's ability to handle the sodium load. In sodium-sensitive hypertensives, modest dietary sodium restriction is beneficial in both reducing blood pressure and in controlling the elevated pressure with medication. A role for potassium and/or calcium with respect to the effects of sodium is an intriguing area of current inquiry.

Early intervention with short courses of prednisone to prevent progression of asthma in ambulatory patients incompletely responsive to bronchodilators.

The effect of high orally administered doses of prednisone for 1 week early in the course of an acute exacerbation of asthma incompletely responsive to bronchodilators was examined in 41 patients randomly assigned to receive either prednisone or an identical appearing placebo. All 22 of the patients who received prednisone improved during the week of treatment, although one had a subsequent exacerbation 5 days after discontinuing the study medication. Of the 19 who received placebo, eight required rescue intervention (P = less than 0.004) in association with continued symptoms, increased frequency of metered-dose inhaler use, and decreased pulmonary function; the other 11 improved at about the same rate as those who received prednisone. Although the mean initial FEV1 was suggestively lower among those who did not improve and required intervention, there was considerable overlap with those who improved spontaneously, and no reliable distinguishing characteristics were found at entry into the study that could serve as predictors of those who would or would not improve spontaneously. There were no clinically important adverse effects from the prednisone. Because continued symptoms of asthma often result in emergency care or hospitalization, these data support early intervention with orally administered prednisone for acute exacerbations that do not respond fully to bronchodilators, at least in those patients with a prior history of a protracted course or emergency care.

Evaluation of a scheme for establishing and maintaining dosage of theophylline in ambulatory patients with chronic asthma.

To assess the utility of a dose-titration scheme for determining maintenance theophylline requirements, dose requirements and stability of serum concentrations were examined using 3537 serum determinations from 1073 patients with chronic asthma during a 5-year period. When the dosing scheme was followed, 78% of initial serum concentrations were within the target range of 10 to 20 micrograms/ml; the mean number of measurements to attain this range was 1.3. Among 404 of these patients prospectively questioned, adverse effects were not present in all 41 whose initial serum concentration was less than 10 micrograms/ml, occurred in eight of 296 patients when serum concentrations were between 10 and 20 micrograms/ml, and were present in 21 of 67 when concentrations were greater than 20 micrograms/ml. After final dose adjustment, mean dose requirements among those who attained serum concentrations of 10 to 20 micrograms/ml averaged 22 mg/kg/day in 1- to 9-year-old children, 20 mg/kg/day in 9- to 12-year-old children, 18 mg/kg/day in 12- to 16 year-old children, and 13 mg/kg/day in the 94 patients older than 16 years of age. Repeat serum concentrations after 3 months to 2 years showed 66% remaining within the 10 to 20 micrograms/ml range and another 15% between 7.5 and 10 micrograms/ml; 9% were greater than 20 micrograms/ml, and none greater than 30 micrograms/ml. Thus the dosing scheme produces serum concentrations in the usual therapeutic range with a minimum of samples and few side effects; most patients maintained acceptably stable blood levels.

La acarbosa: coadyuvante en el tratamiento de la diabetes mellitus. / Acarbose: coadjuvant in the treatment of diabetes mellitus

Recientemente se descubrio la acardosa, seudotetrasacarido producido por cultivo de Actynomices. Es un inhibidor competitico de las glucosidohidrolasas intestinales enzimas claves para la digestion de carbohidratos. Estudios clinicos con arcabosa en la diabetes tipo I y II demuestran una disminucion significativa de la glicemia post prandial. Ademas en diabetes tipo I se ha observado un menor requerimiento diario de insulina, asi como tambien un efectivo control de la hipoglicemia nocturna

Comparison of orally administered metaproterenol and theophylline in the control of chronic asthma.

The efficacy of metaproterenol (orciprenaline) and theophylline given orally at currently recommended doses was examined in 34 children with chronic asthma using a randomized double-blind cross-over evaluation of four weeks' duration for each active regimen. No serious adverse effects were seen with either medication, but tremor occurred more frequently with metaproterenol (P less than 0.01). No significant differences were observed in the frequency of nausea, vomiting, headache, or insomnia (P greater than 0.05). Symptoms of wheezing, coughing, exercise intolerance, and interference with sleep were more frequently associated with the oral metaproterenol regimen; completely asymptomatic days occurred 50% more frequently in association with theophylline therapy (P less than 0.01). Mean peak flows, performed twice daily during each of the four-week study periods, were 86 and 92% of predicted for metaproterenol and theophylline, respectively (P less than 0.05). Pulmonary function decreased significantly less with theophylline than with metaproterenol among those who completed six minutes of treadmill exercise during both regimens (P less than 0.05). Corticosteroids, used for acute symptoms that failed to respond to the addition of inhaled metaproterenol, were required in four patients during both regimens, in ten patients only during the metaproterenol regimen, and in one patient only during the theophylline regimen (P less than 0.02). Thus, theophylline therapy was associated with fewer adverse effects, fewer symptoms of asthma, better pulmonary function, better exercise tolerance, and less requirements for corticosteroids than was treatment with metaproterenol.

Hypokalemia, normal blood pressure, and hyperreninemia with hypoaldosteronism.

The etiology of persistent hypokalemia and renal potassium loss was investigated in three children. Each had normal blood pressure but low plasma aldosterone values in relation to elevated plasma renin activity. None had a history of licorice abuse, laxative or diuretic use, persistent vomiting or diarrhea, pyelonephritis, or diabetes insipidus. Additional studies in one patient showed low prostaglandin E excretion and a normal platelet aggregation response to epinephrine and ADP. Although certain aspects of this condition resemble Bartter syndrome, the low concentrations of aldosterone and the absence of evidence for mineralocorticoid excess suggest a previously undescribed syndrome.

Relationship of formulation and dosing interval to fluctuation of serum theophylline concentration in children with chronic asthma.

Completeness of absorption and fluctuations in serum, theophylline concentration were examined in 14 children, 8 to 17 years of age (mean 12.4), with chronic asthma treated in variable sequence with a slow-release formulation at eight- and 12-hour intervals, and plain tablets every six hours. The total fraction absorbed for the slow-release formulation was 0.98 +/- 0.07 (mean +/- SEM) during the eight-hour and 0.99 +/- 0.04 during the 12-hour regimens. Observed fluctuations in serum concentration were closely approximated by predictions determined from absorption of single doses in adult volunteers. Available single-dose absorption data then were used to compare predicted fluctuations in serum concentration among nine formulations (18 brand names) for eight- and 12-hour dosing in an average child and adult (elimination half-lives of 3.7 and 8.2 hours, respectively). Although predicted peak concentrations were less than twice the trough for all products when given at 12-hour intervals to an average nonsmoking adult, only two of the nine formulation (both from the same manufacturer) were likely to maintain predicted fluctuations within the 10 to 20 micrograms/ml therapeutic range during 12-hour dosing intervals in an average child. Most children and those adults with rapid elimination generally will require eight-hour dosing with the other products.