A pilot study of safety of sulfamethoxazole, trimethoprim and guaifenesin in pediatric and adult patients with acute bronchitis.

OBJECTIVE: This exploratory study assessed the safety of the combination of sulfamethoxazole, trimethoprim and guaifenesin (STG) in adult and pediatric patients with acute bronchitis according to local labelling in Peru. RESULTS: We enrolled 51 pediatric and 52 adult participants diagnosed with acute bronchitis and indication of STG. The mean ages were 7.6 years (SD ± 3.2 years) and 42.8 years (SD ± 16.1) and the proportion of female patients were 51% and 65%, respectively. The duration of treatment in pediatric patients was < 5 days in 2% of patients, 5 days in 13.7%, 6-7 days, in 82.4% and > 7 days in 2% while in adults patients it was < 5 days in 17%, 5 days in 69.2%; 6-7 days in 28.8% of patients. Adverse events (AEs) were registered in 9.6% and 19.2% of pediatric and adult patients, respectively. These AEs had definite relation of causality with the study drugs in 2 adults (20% of AEs) and possible causality with the study drugs in 4 pediatric (80% of AEs) and 2 adult cases (20% of AEs). Our results provide valuable data to develop trials of pharmacovigilance where different statistical parameters should be considered to calculate an adequate sample size in studies evaluating STG in pediatric or adult patients. Trial registration NCT02879981 and NCT02902640.

Contextual fear induced by unpredictability in a human fear conditioning preparation is related to the chronic expectation of a threatening US.

The present study was set up to investigate cued and contextual fear in situations of (un)predictability in a human fear conditioning paradigm. Forty-nine participants were presented with two different contexts (switching on and off the central lighting of the experimental room). In the predictable context, a visual cue (CS1) was systematically followed by an electrocutaneous stimulus (US). In the unpredictable context, CS2 was presented explicitly unpaired with the US. Dependent variables were online US-expectancy ratings and fear-potentiated startle. First, in both measures, the results showed significantly more fear elicited by CS1 than by CS2. Second, larger startle amplitudes during the intertrial intervals demonstrated more contextual fear in the unpredictable than in the predictable context. Hence, these findings illustrate that unpredictability increases contextual fear. Moreover, the US-expectancy ratings during the intertrial intervals were also higher in the unpredictable than in the predictable context. This last finding suggests that a chronic expectation of the threatening US is responsible for sustained levels of anxiety in unpredictable situations.

The development of cued versus contextual conditioning in a predictable and an unpredictable human fear conditioning preparation.

In this human fear conditioning study, the online development of conditioned US-expectancy to discrete cues and background contexts was measured in two groups. In the paired group (n=30), the CS was systematically followed by an aversive shock (US). In the unpaired group (n=30), CS and US were presented explicitly unpaired. Using US-expectancy ratings, we replicated the basic finding already illustrated in humans with startle modulation. In the paired group, the CS elicited more US-expectancy than the context, whereas in the unpaired group, the context elicited more US-expectancy than the CS. Interestingly, we also observed a trial-by-trial development of conditioning to the context in the unpaired group as indicated by a significant linear trend. This gradual development and the evidence for the role of US-expectancy in contextual fear add to the idea that cued and contextual fear rely on the same basic associative processes.

The repeated confrontation with videotapes of spiders in multiple contexts attenuates renewal of fear in spider-anxious students.

In a treatment-analogue experiment, extinction of fear of spiders was investigated in a group of spider-anxious students. Two groups were created: in the single extinction group the extinction trials consisted of repeated presentations of a videotaped spider in one specific location of a house, whereas in the multiple extinction group the trials consisted of videotapes of the same spider in three different locations of a house. Also a control group was included that was exposed to videotapes of the location but without the spider. As reflected in skin conductance responses and self-report data, fear of spiders was significantly reduced in the two extinction groups compared to the control group. Moreover, when the extinction groups were confronted with the videotape of the spider in a new location, the single extinction group did not show generalisation of extinction, whereas the multiple extinction group did. These results corroborate the existing evidence for context dependence of extinction of fear and provide new evidence that the use of multiple contexts during extinction might improve the generalisability of extinction in humans. Implications for exposure therapy are discussed.

Increasing predictive estimations without further learning: the peak-shift effect.

The peak of learned responding normally occurs at the learning stimulus itself, but can shift to a different stimulus after discriminative learning. This provides important information about the nature of the generalization mechanism, and reveals alternative pathways through which learned responses can increase. Over two experiments, we established the peak-shift effect in a human predictive learning paradigm. Participants were asked to predict the occurrence of a neutral outcome (drawing of a lightning bolt) based on preceding geometrical figures (rings of different sizes). During learning, the middle-sized ring was sometimes followed by the outcome, whereas a larger ring was never followed by the outcome. At test, we presented larger and smaller rings (Experiment 1), or only a slightly smaller ring (Experiment 2). We consistently observed highest prediction of the outcome to the slightly smaller ring. Predictive estimations in humans can reach their height to stimuli that have never actually participated in the learning experiences. We argue that the results are most in line with an associative learning account, rather than an adaptation-level or a rule-learning account.

Resistencia antibiótica de bacterias causantes de infecciones en unidades de cuidados intensivos del Perú: Revisión sistemática / Antibiotic resistance of casing bacterium of infections im Peru intensive care units: Systematic review

Con el propósito de elaborar un mapa bacteriológico y su resistencia antibiótica en las Unidades de Cuidados Intensivos (UCI) del país se llevó a cabo una revisión sistemática. De los artículos identificados, ocho fueron evaluados por su calidad de información a través de una lista de cotejo adaptada para estudios de prevalencia. De un total de 830 muestras para prevalencia distribuidas en 611 de vías respiratorias bajas, 61 de hemocultivos, 52 de heridas infectadas y 87 de punta de catéter, y 589 muestras para resistencia distribuidas en 261 para Pseudomonas sp. y 328 para Sthaphylococcus aureus, resultó que S. aureus y el género Pseudomonas fueron los microorganismos más prevalentes en UCI, excepto en vías urinarias. La resistencia de S. aureus a oxacilina fue de 62,8 por ciento, y a vancomicina 0,9 por ciento de resistencia intermedia. La resistencia de P. aeruginosa a imipenen fue de 13,8 por ciento. Se determinó que los estudios no son lo suficientemente representativos y que deberían ajustar sus criterios metodológicos. Asimismo, se sugiere adoptar un consenso uniforme de todas las unidades para futuros trabajos en el país.

Evaluación de la broncofibroscopía flexible en el Hospital Nacional Daniel Alcides Carrión Callao junio-octubre 2000 / Evaluation of the flexible broncofibroscopy in the Hospital Nacional

Se realizó estudio descriptivo prospectivo para evaluar la utilidad de la broncofibroscopia en el diagnóstico de las enfermedades neumológicas prevalentes en nuestro medio. Se realizaron 141 broncofibroscopias. Resultados bacteriológicos: de 84 pacientes (con sospecha de TBC) resultaron 20 pacientes (23.8 por ciento) con baciloscopias positivas; de 48 muestras para cultivo de gérmenes comunes se identificaron: pseudomonas 20 muestras (46.5 por ciento), estreptococos 08 muestras (18.6 por ciento), estafilococos 04 muestras (9.3 por ciento), Neisseria 03 muestras (7 por ciento), y 08 muestras (18.4 por ciento) de otros gérmenes y en examen para hongos, de 71 muestras se obtuvo 04 (5.6 por ciento) cultivos positivos (3:candida albicans, 1:aspergillus fumigatus). Resultados citológicos: En 36 pacientes se realizó papanicolao (PAP) en 5 (13.9 por ciento) se evidenciaron células sospechosas de neoplasia. Resultados histológicos: En 86 pacientes se realizaron biopsias; los resultados fueron bronquitis crónica 43 (46.7 por ciento), Inflamación crónica 15 (16 por ciento), bronquitis aguda 07 (7.6 por ciento), metaplasia epidermoide 07 (7.6 por ciento, granuloma tuberculosos 02 (2.2 por ciento) y otros más. Conclusiones: Se demostró la importancia del uso de la broncofibroscopia flexible en el diagnóstico de enfermedades infecciosas en nuestro medio, siendo el mayor aporte en la detección precoz de la TBC posibilitando su tratamiento con los mas importantes beneficios epidemiológicos, sin dejar de mostrar su aporte importante en el diagnóstico de neoplasias pulmonares.

Entrenamiento en habilidades sociales en pacientes esquizofrénicos crónicos: estudio piloto / Social skill training in chronic schizophrenic patients: pilot study

Con el propósito de corroborar la efectividad y aplicabilidad del "Entrenamiento grupal en habilidades Sociales" con pacientes psiquiátricos desarrollado por R.P. Liberman et al, en nuestro medio, fueron seleccionados cinco pacientes esquizofrénicos crónicos de Consulta Externa del Servicio de Adultos y Geriatría del Instituto Nacional de Salud Mental "H. Delgado - H. Noguchi" en base a ciertos criterios de inclusión tales como: repertorio de conductas básicas (atención, discriminación, seguimiento de instrucciones), repertorio verbal mínimo, y ausencia de síntomas positivos prominentes de la enfermedad. Los resultados, en base a 20 conductas evaluadas, antes y después del entrenamiento, revelan un incremento en el número de habilidades sociales en los cinco sujetos. En general, los datos analizados de los cambios observados en el grupo son estadísticamente significativos ( p <. 05).

The purpose of this study is to confirm the efficacy and applicability of R.P. Liberman's "Group Training in Social Skills" for psychiatric patients in our milieu. Five outpatients with DSM-III-R diagnoses of chronic schizophrenia were selected from the Adult and Geriatrics Outpatient Service of the National Institute of Mental Health "H. Delgado - H. Noguchi". Inclusion criteria such as: a list of basic behaviors (attention, discrimination, following instructions), minimal speech reportoire and no positive symptoms of the disorder where considered. The results over 20 behaviors assessed, before and after the training, reveal an increase in the number of social skills in all the subjects at the end of the trial. In general, the analysed data showed that the observed changes in the group were statistically significant (P < .05).

Utilidad de broncofibroscopia flexible en el diagnóstico de las causas de hemoptisis / Utility of broncofibroscopia flex in the diagnosis of the reasons of hemoptisis

Se realizó estudio descriptivo prospectivo para evaluar la utilidad de la broncofibroscopia flexible en el diagnóstico de las causas de hemoptisis. Se realizaron 60 broncofibroscopias. Las hipótesis planteadas como primera posibilidad fueron de etiología Infecciosa 52 (86.7 por ciento), de etiología neoplßsica 6 (10 por ciento) y de otras causas 2 (3.3 por ciento). Resultados Bacteriológicos: de 48 pacientes con sospecha de tuberculosis 12 (25 por ciento) resultaron con baciloscopias positivas; obteniéndose el mejor rendimiento mediante el aspirado bronquial (100 por ciento). De 17 pacientes con sospecha de otra causa infecciosa 11 (64.7 por ciento) resultarón positivas para gérmenes comunes y hongos y 6 (35.3 por ciento) negativas. De 14 pacientes con estudio citológico de papanicolau (PAP)13 (92.9 por ciento) no presentaron Células Sospechosas de Neoplasias (NCSN) y en 1 (7.1 por ciento) se evidenciaron Células Sospechosas de Neoplasia (CSN). En 41 pacientes con biopsias bronquiales los resultados fueron: bronquitis crónica 25 (61 por ciento), bronquitis crónica y aguda 07 (17.1 por ciento), metaplasia epidermoide 02 (4.9 por ciento), granuloma tuberculoso 02 (4.9 por ciento), y 5 (12 por ciento) fueron informadas como muestra insuficiente. Conclusiones: Se demostró la importancia de la broncofibroscopía flexible en el diagnóstico de las causas de hemoptisis en nuestro medio, siendo el mayor aporte en la detección precoz de enfermedades infecciosas posibilitando su tratamiento oportuno con importantes beneficios epidemiológicos.

A descriptive and prospective study to evaluate utility of fiberoptic bronchoscopy in the diagnosis in hemoptisis was undertaken. Sixty fiberoptic bronchoscopy were done.The raised hypotheses as first possibility were of infectious etiology 52 (86.7 per cent) of neoplasic etiology 6 (10 per cent) and of other causes 2 (3,3 per cent). Bacteriological results: among 48 patients (with suspect tuberculosis), 12 patients (25 per cent) had positive acid fast bacilli smears. Among 17 samples that under went routine bacterial culture testing, 11 samples grew bacteria and fungal culture were positive, in 6(35.3 per cent) were negative. Cytological results: papanicolao smears were done in 14 patients, in 1 patients (7.1 per cent) suspicious neoplastic cells were detected. Histological results: In 41 patients, biopsy specimens were obtained, the following results were seen :: chronic inflammation in 25 (61 per cent), chronic and acute bronchitis in7 (17,1 per cent), epidermoid metaplasia 2 (4,9 per cent ), tuberculous granuloma in 2 (4,9 per cent), and 5 (12 per cent) were informed, as it shows insufficient specimens. Conclusions: The importance of the use of the flexible fiberoptic bronchoscopy was demoustrated in the diagnosis of the causes of hemoptisis, contributing the most to the early diagnosis of infectious diseases which results inopportune treatment and epidemiologic benefit.