Intravenous ketoprofen in thyroid and parathyroid surgery.

UNLABELLED: We compared the ketoprofen-propacetamol combination relative to propacetamol alone in thyroid and parathyroid surgery in terms of postoperative analgesic efficacy, bleeding, and incidence of nausea and vomiting to determine whether ketoprofen results in any benefit in this type of surgery. Patients were distributed in two parallel groups to be managed by anesthesiologists habitually prescribing (Ketoprofen group) or not prescribing (Control group) ketoprofen in this situation. The same anesthetic technique was used for all patients. Postoperative analgesia consisted of 2 g of propacetamol every 6 h and morphine boluses if the pain score measured by the numerical rating scale pain exceeded 40 (3 mg IV every 10 min in the recovery room, then 5 mg SC every 4 h in the ward). The Ketoprofen group received 100 mg of ketoprofen IV during surgery (starting on resection of specimen) and 8 h later. In the recovery room, patients received oxygen if the SpO(2) while they were breathing room air was < 95% on admission and at 1 and 2 h. Pain scores, opioid consumption, the volume of the cervical draining fluid, and the concentration and mass of hemoglobin in this fluid collected over 24 h were recorded. The 214 patients were distributed into two groups (n = 107 in each group) that were comparable in terms of age, weight, sex, duration of surgery, type of endocrinopathy, surgeon involvement, and the intraoperative dose of sufentanil (P > 0.2). The Ketoprofen group had lower numerical rating scale (P < 0.05), received less morphine during the first 24 h after surgery (7.4 +/- 5 vs 11.7 +/- 6 mg, P < 0.05), had fewer nausea and vomiting episodes (21 vs 38, P < 0.05), and were less likely to require oxygen breathing after 1 h in the recovery room (33 vs 59 patients, P < 0.05). The two groups had the same 24-h volume of cervical draining fluid (72.5 +/- 43 vs 70 +/- 42 mL, P > 0.2) and the same concentration (5.9 +/- 3.4 vs 6.4 +/- 2.8 g per 100 mL, P > 0.1) and mass of hemoglobin (3.9 +/- 2.8 vs 4.2 +/- 2.5 g, P > 0.2) in this collected fluid. Two cervical hematomas necessitating reintervention occurred in the Control group, compared with none in the Ketoprofen group. Ketoprofen reduces the pain score after thyroid and parathyroid surgery, as well as morphine requirements and related adverse effects, without increasing the risk of cervical bleeding. IMPLICATIONS: In a prospective open study, ketoprofen reduced the pain score after thyroid and parathyroid surgery, as well as morphine requirements and related adverse effects, without increasing the risk of cervical bleeding.

Pidotimod en el tratamiento de la infección respiratoria recurrente / Treatment of recurrent respiratory tract infection with pidotimod

Se evaluó la eficacia y seguridad de pidotimod* 400 mg solución, dos veces al día, en una población pediátrica de entre tres y 10 años de edad, con infecciones respiratorias recurrentes con anamnesis positiva. Para el estudio, se seleccionaron 80 pacientes de tres unidades médicas de Ciudad Nezahualcóyotl, que ingresaron a un protocolo doble ciego contra placebo. La duración del tratamiento fue de 10 días con un seguimiento de 60 días. Se evidenció una importante reducción de los episodios respiratorios, correlacionándola con la sintomatología en el grupo tratado con pidotimod*; asimismo, se observó disminución del número de días de inasistencia a la escuela y de la necesidad de utilizar antibióticos y terapéutica sintomática. Por la seguridad y eficacia clínica demostrada, se concluye que pidotimod* provee un tratamiento óptimo para la reducción de los cuadros de infecciones respiratorias recurrentes en pediatría

[Child abuse: a world problem]. / El maltrato infantil: un problema mundial.

Several problems are encountered in the study of child abuse: ignorance of its real proportions, deep cultural and historical roots, diversity of opinion as to its definition and classification and, finally, very diverse considerations on its repercussions and therapeutic management. The present study approaches child abuse from its historical precedents, its classifications, definitions and epidemiology. In addition, repercussions are reviewed, and treatment alternatives considered which are held as fundamental to confront this alarmingly increasing phenomenon. It is important to unify criteria as to the definition and classification of scientific information surrounding demographic data which, in the end, will situate the problem, the progress related to its causes, diagnosis, preventive measures and treatment. It is extremely important to prevent child abuse by all possible means, since this harm is reflected in the adult life of the child. Various classifications are considered, as well as characteristics of the abuser and of the abused.

[Prevalence of Haemophilus influenzae carrier state in children in Ciudad Nezahualcóyotl, State of Mexico, Mexico]. / Prevalencia de estado de portador de Haemophilus influenzae en niños de Ciudad Nezahualcóyotl, estado de México, México.

OBJECTIVE: To determine the prevalence of H. influenzae (Hi) carrier state among children, in Ciudad Nezahualcóyotl, State of Mexico. MATERIAL AND METHODS: A cross-sectional comparative random study was designed. Study subjects were 639 children under 15 years of age, stratified by age and sex. Nasopharyngeal cultures were used to identify Hi and to typify encapsulated strains. Sample size was computed with the software package Epi-Info, using a p value of 0.5%, 95% confidence intervals and a 5% error; statistical analysis was performed using frequencies, means and proportions. Differences were tested by comparison of two proportions from independent populations. RESULTS: Hi was isolated from 136 of 639 pharyngeal cultures (21%). Hi types found were Hi b (n = 6, 4%), Hi a, c, and f (n = 5, 4%), and non-typifiable (NT) Hi (n = 125, 92%). CONCLUSIONS: The prevalence of pharyngeal colonization by Hi found among children under 15 years of age, in Ciudad Nezahualcóyotl, is similar to that reported in the literature. The inverse relation of pharyngeal carriers with age can be accounted for by the progressive development of specific and non-specific immunity against encapsulated and non-encapsulated strains.

First reported outbreak of classical dengue fever at 1,700 meters above sea level in Guerrero State, Mexico, June 1988.

An outbreak of classical dengue fever occurred from March to August 1988 in the city of Taxco, Guerrero State, Mexico. Taxco is at an elevation of 1,700 meters above sea level, and this study represents the highest altitude at which an outbreak of dengue has been documented. An investigation was conducted to obtain serologic confirmation of dengue infection, determine the extent of the outbreak, and identify risk factors for dengue illness. Toxorhynchites cell lines were used for viral isolation, and hemagglutination inhibition was used to measure anti-dengue antibody titers. The case definition used in the investigation was any person with fever, headache, myalgias, and arthralgias, or rash or retroocular pain. Dengue virus type 1 was isolated from five acute cases. Of 1,686 persons living in the affected area, 42% (715) met the case definition. Large (200-liter) water containers were significantly associated with infection (relative risk = 1.7, 95% confidence interval 1.5-1.9). The effect of altitude on epidemic transmission is most likely modulated by seasonal temperatures. The epidemiologic and serologic confirmation of a dengue outbreak at 1,700 meters above sea level represents the capability of Aedes aegypti to adapt to new environments, and the potential for epidemic spread in cities at comparable altitudes or higher.