[Use of a rapid rotavirus test in prescription of antibiotics in acute diarrhea in pediatrics: an observational, randomized, controlled study]. / Uso de una prueba rápida de rotavirus en la prescripción de antibióticos endiarrea aguda pediátrica: un estudio observacional, aleatorizado y controlado.

OBJECTIVE: To determine the impact of a rapid and accurate rotavirus test in the emergency ward on the reduction of antibiotic prescription in children under 5 years old with acute diarrhea at "Arzobispo Loayza National Hospital", Lima, Peru. MATERIAL AND METHODS: We performed an observational prospective randomized controlled study, from July 2008 to January 2009. Stool samples from patients with diarrhea lasting less than 5 days were analyzed. Out of 201 cases, 101 were classified in Group A (with fecal leukocytes test performed) and 100 in Group B (with fecal leukocytes test and rotavirus/adenovirus test performed). We aimed to associate the signs and symptoms with the decision of prescribing antibiotics and with hospitalization risk. RESULTS: Both groups were comparable with regard to age, weight and illness duration. In patients with rotavirus infection, fecal leukocytes were positive in 46.9% of cases. Frequency of antibiotic use was directly associated with the number of fecal leukocytes (P<0.0001). There was a higher risk of admission in the group positive to rotavirus than in the group negative to this agent (21.9% vs. 6.3, P<0.0001). No diarrhea-attributable deaths were reported. CONCLUSION: The use of rotavirus test in the pediatric emergency room decreased antibiotic prescription in children with diarrhea.

Uso de una prueba rápida de rotavirus en la prescripción de antibióticos en diarrea aguda pediátrica: un estudio observacional, aleatorizado y controlado / Use of rotavirus rapid test in the prescription of antibiotics in acute pediatric diarrhea: an observational study, randomized controlled

OBJETIVO: Evaluar el efecto de la disponibilidad de un método diagnóstico rápido y preciso de rotavirus sobre la frecuencia en el uso de antibióticos en niños menores de 5 años con diarrea aguda de menos de 5 días de duración del Hospital Nacional Arzobispo Loayza; Lima, Perú. MATERIALES Y MÉTODOS: se realizó un estudio observacional, prospectivo, aleatorizado, controlado, entre Julio 2008 y Enero 2009. Se asignó aleatoriamente 101 pacientes al Grupo A (con prueba de leucocitos fecales) y 100 al Grupo B (con prueba de leucocitos fecales y prueba rápida de rotavirus/adenovirus). Se evaluó en cada grupo la decisión clínica de administrar o no antibióticos. RESULTADOS: No existieron diferencias significativas en el tiempo de enfermedad, edad ni peso entre ambos grupos. Los casos de rotavirus tuvieron leucocitos fecales positivos en un 46.9%. El grado de positividad de los leucocitos fecales se asoció de manera directamente proporcional al uso de antibióticos (P<0.0001). El grupo positivo a rotavirus presentó un mayor riesgo de hospitalización que el grupo negativo a este agente (21.9% vs. 6.3%, P<0.0001). No se registraron muertes atribuibles a diarrea. CONCLUSIONES: La disponibilidad de un diagnóstico rápido y preciso de rotavirus en menores de 5 años con diarrea aguda, redujo significativamente el uso de antibióticos.

OBJECTIVE: To determine the impact of a rapid and accurate rotavirus test in the emergency ward on the reduction of antibiotic prescription in children under 5 years old with acute diarrhea at ôArzobispo Loayza National Hospitalõ, Lima, Peru. MATERIAL AND METHODS: We performed an observational prospective randomized controlled study, from July 2008 to January 2009. Stool samples from patients with diarrhea lasting less than 5 days were analyzed. Out of 201 cases, 101 were classified in Group A (with fecal leukocytes test performed) and 100 in Group B (with fecal leukocytes test and rotavirus/adenovirus test performed). We aimed to associate the signs and symptoms with the decision of prescribing antibiotics and with hospitalization risk. RESULTS: Both groups were comparable with regard to age, weight and illness duration. In patients with rotavirus infection, fecal leukocytes were positive in 46.9% of cases. Frequency of antibiotic use was directly associated with the number of fecal leukocytes (P<0.0001). There was a higher risk of admission in the group positive to rotavirus than in the group negative to this agent (21.9% vs. 6.3, P<0.0001). No diarrhea-attributable deaths were reported. CONCLUSION: The use of rotavirus test in the pediatric emergency room decreased antibiotic prescription in children with diarrhea.

Serum starvation and growth factor receptor expression in vascular smooth muscle cells.

BACKGROUND: Smooth muscle cell (SMC) proliferation in atherosclerosis is regulated through the interaction of growth factors like platelet-derived growth factor-BB (PDGF-BB) and insulin-like growth factor-1 (IGF-1) and their receptors (R). We hypothesized that serum starvation of SMCs may affect PDGFbeta-R and IGF-1-R expression and, consequently, the effect of their cognate ligands on SMC survival/proliferation. METHODS AND RESULTS: Serum starvation significantly increases PDGFbeta-R but not IGF-1-R mRNA and protein expression in SMCs. PDGF-BB stimulates cell survival but not proliferation in serum-starved SMCs of the synthetic phenotype, whereas SMCs of the contractile phenotype respond to PDGF-BB by a significant increase in proliferation. Immunohistochemical analysis of coronary atherosclerotic lesions reveals PDGFbeta-R expression in SMCs in the lamina fibromuscularis, but not in the media and in healthy parts of the arterial wall. No such differential expression was observed for IGF-1-R. CONCLUSIONS: Differential regulation of PDGFbeta-R and IGF-1-R expression by serum starvation might represent a mechanism for the control of SMC survival/proliferation in atherogenesis and restenosis. The distribution of PDGFbeta-Rs and IGF-1-Rs in atherosclerotic lesions may indicate an effect of serum starvation on SMCs in the arterial wall.

Protein kinase C pathway is involved in transcriptional regulation of C-reactive protein synthesis in human hepatocytes.

OBJECTIVE: C-reactive protein (CRP) is the prototype acute phase protein and a cardiovascular risk factor. Interleukin-1beta (IL-1beta) and IL-6 stimulate CRP synthesis in hepatocytes. We searched for additional pathways regulating CRP expression. METHODS AND RESULTS: Primary human hepatocytes (PHHs) were treated with IL-1beta, IL-6, and protein kinase C (PKC) activator phorbol 12,13-dibutyrate (PDBu). CRP was analyzed by quantitative RT-PCR and ELISA. PDBu significantly induced CRP transcription by 21.0+/-9.24-fold and protein release by 2.9+/-0.5-fold. Transcriptional regulation was studied in detail in hepatoma G2 (HepG2) cells stably transfected with the 1-kb CRP promoter (HepG2-ABEK14 cells). In these cells, PDBu significantly induced CRP transcription by 5.39+/-0.66-fold. Competitive inhibition with bisindolylmaleimide derivative LY333531 abolished PDBu-mediated promoter activation. Competitive inhibition with IkappaB kinase inhibitor I229 also inhibited PDBu effects. Importantly, IL-8 significantly induced CRP release in PHHs by 58.675+/-19.1-fold, which was blockable by LY333531. CONCLUSIONS: This study describes a novel PKC-dependent transcriptional regulation of CRP gene expression, which, in analogy to the classical IL-1beta and IL-6 pathways, is operational in hepatocytes only. It also identifies IL-8 as a potential physiological PKC activator. HepG2-ABEK14 cells may be useful for high throughput screening to identify inhibitors of CRP synthesis for the prevention of cardiovascular disease.