A randomized, clinical trial of ketorolac tromethamine vs ketorolac trometamine plus complex B vitamins for cesarean delivery analgesia.

BACKGROUND: Ketorolac is widely used for postoperative analgesia in patients who undergo cesarean delivery. In countries where the use of opioids is considerably restricted, alternatives to narcotics are required. AIM: We hypothesize that the addition of complex B synergize the analgesic effect of ketorolac in postoperative cesarean patients, thus requiring a smaller dose of the anti-inflammatory agent, and therefore decreasing the potential side effects of ketorolac. METHODS: A randomized clinical trial with 100 patients undergoing a primary elective cesarean delivery enrolled in the study. Pain was assessed in the recovery room and then they were randomized to receive ketorolac 30 mg intramuscular (i.m.) or 15 mg of ketorolac plus complex B vitamin (CBV). The pain score with an analog scale was assessed 1, 2, 6, 12, 18, and 24 h after the baseline. The student's t test was performed to compare the demographic differences between the 2 means. RESULTS: 100 patients were included in the study, showing no statistical differences in the demographics. The patient's pain score at 1, 2, 6, 12, 18 and 24 hours showed no statistical differences between the control group (ketorolac 30mg) compared to the group of ketorolac 15mg and complex B vitamins. No changes in the coagulation studies were found in both groups. CONCLUSION: The present study demonstrates that ketorolac 30 mg and ketorolac 15 mg plus complex B vitamins can provide acceptable analgesia in many patients with severe pain.

Immunophenotypic aspects of cylindroma and nodular hidradenoma.

BACKGROUND: Some adnexal tumours have many controversies about their histogenesis. OBJECTIVES: To evaluate the eccrine and/or apocrine differentiation phenotype in cases of cylindroma and clear cell hidradenoma with CD15 and p63 antibodies. METHODOLOGY: Slides and blocks of six cases of cylindroma and seven cases of nodular hidradenoma (clear cells) were analyzed by the technique of immunohistochemistry with CD15 and p63 antibodies. RESULTS: In all cases of cylindroma we obtained negative results for CD15 antibody and positive for p63 antibody. In five of seven cases of nodular hidradenoma (clear cell), we could easily observe clear cells between 20% and 50% of tumour cells. In the two other cases, cystic lesions were present and occasional clear cells could be seen. The reaction with CD15 antibody was positive in granular and cytoplasmic pattern in six of seven cases, especially in cells with suggestive clear cytoplasm in lower proportion than this clear cells could be seen in haematoxylin and eosin. The positivity for p63 antibody, nuclear pattern, was observed in six of seven cases, in the major part of tumour cells. In only one case, the positivity was in 20% of cells. Limitation Samples are in small number because these are relatively rare tumours. CONCLUSIONS: The present study suggests eccrine origin for both tumours: cylindroma and clear cell hidradenoma.

Impact of protease inhibitor therapy on HIV-related oropharyngeal candidiasis.

OBJECTIVE: To determine the relationship between antiretroviral therapy and changes in prevalence and amount of oropharyngeal candidiasis (OPC) and skin test reactivity for delayed type hypersensitivity. DESIGN: Observational cohort. SETTING: University-based public hospital AIDS clinic. PATIENTS: Adults with advanced HIV infection who had been taking nucleoside transcriptase inhibitor drugs but had not taken a protease inhibitor and who started antiretroviral treatment with ritonavir. MAIN OUTCOME MEASURES: OPC lesions score, oral candidal colonization, oral candidal quantification, skin test reactivity for delayed type hypersensitivity (purified protein derivative, candidal and streptokinase antigens), plasma HIV RNA and CD4 cell count at weeks 8, 16 and 48 weeks. RESULTS: In the 99 patients who entered the study, there was a significant reduction in the HIV plasma RNA (mean log decrease from baseline at 48 weeks 0.88) and a significant increase in CD4 cell counts (mean CD4 cell increase from baseline at 48 weeks 128 x 10(6) cells/l). Only 17% of patients had < 200 copies/ml HIV RNA at 48 weeks. There were significant decreases in the prevalence of OPC lesions (31% at baseline to 1% at 48 weeks; P < 0.001), and in oral candidal loads [2226 to 811 colony-forming units (CFU)/ml; P = 0.0171]. The percentage of patients with at least one positive skin test increased significantly (6 to 28%; P < 0.05). Patients whose CD4 lymphocyte count was > 200 x 10(6) cells/l at 48 weeks had significantly lower oral candidal loads and were more likely to have a positive skin test than patients whose CD4 cell count was < 200 x 10(6) cells/l. CONCLUSION: In patients with advanced HIV infection, antiretroviral treatment including a protease inhibitor has a positive impact in the natural history of OPC. This positive impact appears to be correlated with a better immunological function and occurs despite continuous HIV replication.

[Balance of the TH1/TH2 immune response in the materno-fetal interphase in normal and preterm pregnancy. Preliminary results]. / Balance de la respuesta inmune TH1/TH2 en la interfase materno-fetal de pacientes con embarazo normal y pretérmino. Resultados preliminares.

The subpopulations don's speak directly of the answers Th1 or Th2 in the compartment, as the are only reflexion of prevalent citocines in the microenvironment: However. It is important its exploration to the taken as starting point of this project.

[Need for systematic HIV serological study during pregnancy]. / Necesidad del estudio serológico sistemático del virus de l a inmunodeficiencia humana durante la gestación.

BACKGROUND: To evaluate human immunodeficiency virus (HIV) screening usefulness in pregnancy and to know the prevalence of this infection in an urban area of Spain. PATIENTS AND METHOD: Routine prenatal screening for antibodies to HIV was offered to pregnant women from Fuenlabrada-Leganés Health Care Area (Madrid) from 1992 to 1995. Unlinked anonymous screening of HIV was done with the sera from women refusing the assay or if it had not been offered. RESULTS: HIV prevalence was 0.28% (CI: 95%; 0.19 to 0.40) in the 11.021 pregnant women group studied. 87.1% pregnant seropositive women were detected by consented screening. 55.6% of them recognized risk behavior (73.33% by intravenous drug use) and 44.4% did not do it. With a second anamnesis in this group 75% admitted risk conducts and 25% confirmed their ignorance about them. CONCLUSIONS: HIV seropositive screening in pregnant women selected only by risk behavior may be unsuccessful. For that reason, it is more convenient the perform a routine test for detection of HIV antibodies after informed consent in high prevalence areas of HIV infection.

[Infection by HIV and the hepatitis B, C, and D viruses in intravenous drug addicts. Seroprevalence at 1 year and its follow-up]. / Infección por VIH y por los virus de la hepatitis B, C y D en adictos a drogas por vía parenteral. Seroprevalencia de un año y su seguimiento.

BACKGROUND: The aim of the present article was to study the serology of intravenous drug user patients against the hepatitis B, C, D, and HIV, during 1990 and the follow-up during the same year, and 1991. METHODS: A study of 265 patients (mean age: 25 years, range: 16-45; 206 males and 59 females) was carried out. Forty-two percent came because of detoxication treatment, 30% requested diagnosis for hepatic disturbances and the only data provided in 28% were that they were intravenous drug users. None of the patients was an inmate from prisons. RESULTS: Seroprevalences were 67.5% for the HBV, 75.6% for HCV, 17% for HDV and 50.2% for HIV. In the patients seronegative for HBV (65%) and HIV (58%) no new serologic controls were performed during the study period, while in those who underwent controls the rates of seroconversion were 43.3% and 32%, respectively. In 30% of all seroconversions to HBV coinfection with HDV was found and in 23% antibodies against HIV were observed. CONCLUSIONS: Due to the high rates of infection obtained, the authors believe that serologic follow up of intravenous drug users is advisable.

Fosfomycin and plasmidic resistance.

60 fosfomycin-resistant strains of gram-negative bacilli are submitted to conjugation experiments using as recipient cell E. coli K12 which is nalidixic acid resistant. After mating, the number of fosfomycin-resistant E. coli K2 colonies growing on selection plates containing nalidixic acid and fosfomycin never surpassed the normal rate of mutation for fosfomycin-resistance of the recipient strain. In 65% of the experiments, plasmidic resistance to other antimicrobials was transferred to E. coli K12, but was never accompanied by demonstrable fosfomycin resistance. High rate of normal mutation of recipient strain is signaled as the main problem for detecting the plasmidic nature of fosfomycin resistance. With our criteria regarding this fact we have been unable to confirm the plasmidic nature of fosfomycin resistance.

Antibiotherapy of Serratia marcescens septicemia in children.

The clinical and bacteriological response of 38 treatments performed on 24 children (11 of them neonates) carrying out separate treatments with carbenicillin (2 treatments), gentamicin [4], fosfomycin [6], and associated treatments with gentamicin plus carbenicillin [6], fosfomycin plus gentamicin [18] and fosfomycin plus carbenicillin [2] are considered. The clinical cure was obtained in 21 children (87.5%). The most effective treatment was fosfomycin plus gentamicin; both antibiotics showed synergism in vitro on isolated Serratia strains. A dosage of 75 mg/kg fosfomycin enables serum levels of about 32 mug/ml during 4-5 h, being this level higher to the MIC of all isolated strains of S. marcescens.

[Isolation and intestinal sterilization in prevention of infection in patients with malignant diseases (author's transl)]. / Prevención de infecciones en el tratamiento de hemopatías malignas mediante zonas y cámara estéril

Results obtained by isolation and intestinal sterilization in prevention of infections in 42 patients with malignant diseases are shown. A substantial decrease of infection is observed, as compared with a control group of 33 patients with similar disease, treated in normal hospital conditions. The problem of intestinal sterilization is discussed and literature on this subject revised.

Fosfomycin in Osteomyelitis.

Fosfomycin was exclusively used as antibiotic treatment in 37 patients suffering from osteomyelitis, out ot which 23 were operated for sequestrectomy or fistulectomy, whereas the remaining 14 did not undergo any surgery during fosfomycin treatment. Fosfomycin was adminsitered parenterally, alone or combined with oral administration, and in some cases only orally. The dosage varied from 4 to 8 g/day for an average period of 3 weeks. After one or two treatments the results were 29 definitive cures (78%), 2 failures and 6 relapses (22%).