RESUMEN
We initiated a program for early detection of diabetes and hypertension, the main causes of kidney failure in Guyana, South America. We trained local high school students with the goal that these students would stay in the villages for long-term, become health advocates and shift the reliance away from physicians. This project involved 7 high school students who were taught to monitor the health of one village of 1000-1500 population each. The program will be implemented for 3 years in which the entire population of seven villages (approximately 10,000 people) will be covered. This represents 1.3% population in Guyana. We present data from the pilot study from the sample of 619 people. The prevalence of diabetes mellitus was 13.9%. Among diabetics, 33.7% were using insulin and 86% oral hypoglycemic agents. Prevalence of hypertension was 29.4%, 63.2% were overweight and 17% were obese. About 9.9% patients were unaware about the existence of hypertension. We have shown in our study that high school students can be used to collect health data and monitor diabetes and hypertension. There was also a significant incidence of undetected diabetes and hypertension.
RESUMEN
INTRODUCTION: We describe ethical/moral issues in patient selection in a new living donor kidney transplant program in Guyana, South America. CASE REPORTS: Over 3 years, we screened 450 patients with chronic kidney disease among which 70 were suitable for kidney transplantation. There were five patients whose evaluations raised possible ethical dilemmas: one had nonadherence to dialysis; two of Guyanese origin living abroad wished to have the transplant performed in Guyana; a minor wished to donate to her mother; and another subject was considering commercialization of the transplant process. RESULTS: Since inception of the renal replacement program in 2008, we have completed 13 living kidney transplantations, 17 peritoneal dialysis placements, and 20 vascular access procedures. In the five patients wherein faced ethical dilemmas, three were rejected for consideration despite having living donors: one was nonadherent, the second excluded due to an attempt to commercialize the process, and the third, a minor who wished to donate to the mother. The other two patients were considered Guyanese ex-patriots acceptable for the program. DISCUSSION: The consequence of kidney failure in Guyana prior to introduction of renal replacement therapy was a virtual death sentence. These cases illustrate ethical dilemmas serving to throw into stark relief the implications of decisions made in a developing country versus those in a developing country.
Asunto(s)
Ética Médica , Trasplante de Riñón/ética , Trasplante de Riñón/métodos , Selección de Paciente/ética , Obtención de Tejidos y Órganos/ética , Adolescente , Adulto , Toma de Decisiones , Femenino , Guyana , Humanos , Fallo Renal Crónico/cirugía , Masculino , Cooperación del Paciente , Diálisis Renal/métodosRESUMEN
Cognitive and behavioral effects of phenobarbital in toddlers were assessed in a randomized, placebo-controlled study of patients who had had a febrile seizure. There were no significant differences in IQ (Binet or Bayley Scales) between placebo and phenobarbital groups after eight to 12 months of therapy. However, detrimental effects of phenobarbital were found in memory, for which serum level influenced scores, and in comprehension, in that length of treatment time affected performance. Hyperactivity was not seen. Behavioral changes, reported by parents, were increased fussiness and a characteristic disturbance of sleep. These changes varied in severity and were classified as transient, dose related, or unacceptable. After 12 months in the study, most parents could not distinguish between phenobarbital and placebo. Our data suggest that although most toddlers do not have major side effects from phenobarbital therapy when treated for a year, serum levels and length of time on phenobarbital should be kept at a minimum to reduce negative cognitive and behavioral effects.
Asunto(s)
Trastornos de la Conducta Infantil/inducido químicamente , Trastornos del Conocimiento/inducido químicamente , Fenobarbital/efectos adversos , Preescolar , Ensayos Clínicos como Asunto , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Femenino , Humanos , Lactante , Inteligencia/efectos de los fármacos , Masculino , Memoria/efectos de los fármacos , Fenobarbital/sangre , Fenobarbital/uso terapéutico , Placebos , Pruebas Psicológicas , Convulsiones Febriles/tratamiento farmacológico , Trastornos del Sueño-Vigilia/inducido químicamente , Factores de TiempoRESUMEN
1.Blood was obtained by cardiac puncture from four armadillos (Dasypus novemcinctus). Cellular elemests differed only slightly from their human counterparts; erythrocytes were smaller, platelets more variable in size, and megakaryocytes (bone marow) contained one multilobed nucleus. 2.Total plasma protein and fibrinogen concentrations were higher than average human levels, but serum electrophoretic patterns were similar. 3.The skin bleeding time was short. The blood clotted effectively but the clot retracted poorly. Blood coagulation factors showed greater activity (or higher concentration) than their human counterparts. 4. Armadillo tissues, especially lung and brain, were far more thromboplastic to armadillo than to human plasma. Spontaneous fibrinolytic activity was absent. Streptokinase in high concentration activated armadillo profibrinolysin, at least in part