Trombólisis con rt-PA en ECV isquémica en el HNGAI / Thrombolysis with rt-PA in ischemic stroke in HNGAI

La enfermedad cerebral vascular (ECV), representa la primera causa de discapacidad permanente y la tercera en mortalidad. Su tratamiento incluye el control de funciones vitales, prevención de complicaciones, rehabilitación precoz y Activador de Plasminógeno tisular (rt-PA) para trombolisis en ECV isquémica en pacientes rigurosamente seleccionados, de manera preferente en Unidades de Ictus (UI), no existiendo actualmente ninguna en nuestro país. Presentamos un paciente varón de 83 años de edad, hipertenso con Rankin 1 que presentó súbitamente disartria y hemiparesia izquierda, evaluado en emergencia del >Hospital Nacional Guillermo Almenara Irigoyen (HNGAI), se le realizaron exámenes de laboratorio, TAC cerebral, consentimiento informado y se le administró rt-PA Ev dentro del período de ventana terapéutica, con respuesta clínica favorable inicial y posterior empeoramiento de los síntomas deficitarios, se realizó valoración permanente hasta su alta y seguimiento por consultorio externo. Revisamos los factores asociados y le hacemos sugerencias para implementar UI y generalizar el empleo de rt-PA en nuestro medio.

The effects of zidovudine in the subset of infants infected with human immunodeficiency virus type-1 (Pediatric AIDS Clinical Trials Group Protocol 076).

OBJECTIVE: To describe the effect of zidovudine on human immunodeficiency virus type 1 (HIV-1) and on the course of disease in infants who became infected while they and their mothers received zidovudine preventive therapy or placebo in Pediatric AIDS Clinical Trials Group Protocol 076. STUDY DESIGN: Observational substudy of a multicenter, randomized, double-blind, placebo-controlled trial. METHODS: We compared the progression of disease, timing of HIV-1 transmission, and the plasma HIV-1 RNA level in infected infants of mother-infant pairs who were randomly assigned to receive zidovudine (n = 14) or placebo (n = 43). The development of genotypic zidovudine resistance was assessed among infected infants in the zidovudine treatment group. RESULTS: In this limited study, zidovudine therapy during pregnancy and labor and in the neonatal period for 6 weeks failed to have a major effect on rapid progression of disease, timing of transmission, and viral replication in HIV-infected infants. When the zidovudine treatment regimen failed to prevent maternal-infant transmission of HIV-1, resistance to zidovudine did not develop during study treatment. CONCLUSIONS: Our study supports the safety of zidovudine use in pregnancy and in the newborn period but demonstrates the continued need for more potent antiretroviral treatment of the infected infant.