RESUMEN
Twenty Strongyloides-infected patients were diagnosed at West Virginia's Charleston Area Medical Center in 1997 and 1998. We recommend that strongyloidiasis, which can be fatal, be a reportable disease in West Virginia.
Asunto(s)
Strongyloides/aislamiento & purificación , Estrongiloidiasis/diagnóstico , Animales , Femenino , Hospitales Universitarios , Humanos , Masculino , Esputo/parasitología , Strongyloides stercoralis/aislamiento & purificación , Estrongiloidiasis/parasitología , West VirginiaAsunto(s)
Infecciones Bacterianas/complicaciones , Infección Hospitalaria , Enterococcus/efectos de los fármacos , Strongyloides/aislamiento & purificación , Estrongiloidiasis/complicaciones , Resistencia a la Vancomicina , Animales , Infecciones Bacterianas/microbiología , Diarrea/etiología , Enterococcus/patogenicidad , Heces/microbiología , Humanos , Hipotensión/etiología , Huésped Inmunocomprometido , Diálisis Renal , Strongyloides/patogenicidad , Estrongiloidiasis/microbiologíaRESUMEN
OBJECTIVE: We sought to examine whether use of nonsteroidal antiinflammatory drugs (NSAIDs) in an outpatient inflammatory bowel disease (IBD) population is associated with an increased likelihood of active disease. METHODS: We reviewed records of initial outpatient visits of IBD patients to the principal author from June 1995 to December 1997, with regard to use of aspirin and other NSAIDs and disease activity. RESULTS: Of 40 Crohn's patients seen with active disease, three (7.5%) were using NSAIDs; 14 of 72 (19.4%) Crohn's patients seen with inactive disease were using NSAIDs. Fifty-eight ulcerative colitis patients were seen with active disease, with eight (13.7%) using NSAIDs. Among 21 UC patients initially seen while in remission, five (23.8%) were using NSAIDs. CONCLUSIONS: Among this group of outpatients, NSAID use was not associated with a higher likelihood of active IBD. NSAID use in IBD deserves further study before recommending that patients refrain from their use under all circumstances.
Asunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Antiinflamatorios no Esteroideos/uso terapéutico , Aspirina/uso terapéutico , Colitis Ulcerosa/tratamiento farmacológico , Colitis Ulcerosa/fisiopatología , Enfermedad de Crohn/tratamiento farmacológico , Enfermedad de Crohn/fisiopatología , Utilización de Medicamentos , Humanos , Registros Médicos , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
This paper describes an efficient and effective image similarity calculation method for object-based image comparison at the level of object classes. It uses probabilistic-prediction voting based on the predicted class distribution of each segment of the contour of an object in an image to determine the class of the object. The C4.5 inductive learning algorithm is used to predict the class distribution of object-contour segments. This method is invariant to rotation, scaling and translation of objects. Experimental results show that the method is effective and efficient. It can be used for object-based image retrieval.
Asunto(s)
Giardiasis/epidemiología , Estrongiloidiasis/epidemiología , Anciano , Femenino , Humanos , Masculino , Prevalencia , West Virginia/epidemiologíaRESUMEN
Family physicians should be alert for unusual diseases in patients who are returning from foreign travel. Malaria is a potentially fatal disease that can be acquired by travelers to certain areas of the world, primarily developing nations. Transmitted through the bite of the Anopheles mosquito, malaria usually presents with fever and a vague systemic illness. The disease is diagnosed by demonstration of Plasmodium organisms on a specially prepared blood film. Travelers can also acquire amebic infections, which may cause dysentery or, in some instances, liver abscess. Amebiasis is diagnosed by finding Entamoeba histolytica cysts or trophozoites in the stool. Invasive amebic infections are generally treated with metronidazole followed by iodoquinol or paromomycin. Cutaneous larva migrans is acquired by skin contact with hookworm larvae in the soil. The infection is characterized by the development of itchy papules followed by serpiginous or linear streaks. Cutaneous larva migrans is treated with invermectin or albendazole. Case studies are presented.
Asunto(s)
Amebiasis , Larva Migrans , Malaria Vivax , Viaje , Adulto , Amebiasis/diagnóstico , Amebiasis/tratamiento farmacológico , Amebiasis/epidemiología , Femenino , Humanos , Larva Migrans/diagnóstico , Larva Migrans/epidemiología , Larva Migrans/terapia , Malaria Vivax/diagnóstico , Malaria Vivax/tratamiento farmacológico , Malaria Vivax/epidemiología , Masculino , Persona de Mediana EdadRESUMEN
Family physicians in the United States are increasingly called on to manage the complex clinical problems of newly arrived immigrants and refugees. Case studies and discussions are provided in this article to update physicians on the diagnosis and management of potentially unfamiliar ailments, including strongyloidiasis, hookworm infection, cysticercosis, clonorchiasis and tropical pancreatitis. Albendazole and ivermectin, two important drugs in the treatment of some worm infections, are now available in the United States.
Asunto(s)
Antiinfecciosos/uso terapéutico , Clonorquiasis , Cisticercosis , Emigración e Inmigración , Infecciones por Uncinaria , Estrongiloidiasis , Adolescente , Albendazol/uso terapéutico , Antinematodos/uso terapéutico , Antiplatelmínticos/uso terapéutico , Antiprotozoarios/uso terapéutico , Clonorquiasis/diagnóstico , Clonorquiasis/tratamiento farmacológico , Cisticercosis/diagnóstico , Cisticercosis/tratamiento farmacológico , Diagnóstico Diferencial , Femenino , Infecciones por Uncinaria/diagnóstico , Infecciones por Uncinaria/tratamiento farmacológico , Humanos , Ivermectina/uso terapéutico , Masculino , Persona de Mediana Edad , Pancreatitis/terapia , Praziquantel/uso terapéutico , Estrongiloidiasis/diagnóstico , Estrongiloidiasis/tratamiento farmacológico , Clima Tropical , Estados UnidosRESUMEN
Previous studies have suggested that diethylcarbamazine (DEC), a drug used for filariasis control, may be useful in the treatment of mycobacterial infections. In this experiment, Mycobacterium tuberculosis was added to blood samples from two groups (healthy and diabetic) of adult non-smoking donors. Portions of each sample were tested with and without DEC at clinically achievable levels. Statistically significant DEC-related percentage decreases in BACTEC growth index counts were noted for each group (Wilcoxon one-sample signed-rank tests, alpha = 0.05, two-tailed). These results suggest that administration of DEC for filariasis control could have a positive impact on tuberculosis control.
Asunto(s)
Antituberculosos/farmacología , Dietilcarbamazina/farmacología , Mycobacterium tuberculosis/efectos de los fármacos , Recuento de Colonia Microbiana , Diabetes Mellitus/sangre , Humanos , Tuberculosis/tratamiento farmacológicoRESUMEN
OBJECTIVES: The objectives of this study were to determine the pharmacokinetics of milrinone lactate in pediatric patients with septic shock and to determine whether a relationship exists between steady-state plasma milrinone concentrations and changes in hemodynamic variables. STUDY DESIGN: This was a randomized, double-blind, placebo-controlled, interventional study. In study phase 1 patients were randomized and underwent loading and infusion with milrinone lactate (50 microg/kg, then 0.5 microg/kg/min), and invasive hemodynamic values were determined. Steady-state was determined by obtaining plasma samples at 30, 15, and 0 minutes before the end of the milrinone infusion. Study phase 2 started when milrinone was discontinued by the patient care team. Steady-state was reaffirmed and plasma samples were obtained at 0.5, 1, 2, 4, 6, and 8 hours after the end of the infusion. RESULTS: The average plasma concentration at steady-state (Css avg) and total body clearance for phase 1 were 81.3+/-38.6 ng/ml (mean +/- SD) and 0.0106+/-0.0053 L/kg/min, respectively (n = 9). All but two patients underwent reloading with milrinone. In phase 2 Css avg and total body clearance were 65.8+/-42.1 ng/ml and 0.0110+/-0.0096 L/kg/min, respectively (n = 11). The average time of infusion was 51+/-21 hours. Eight patients were evaluated for phase 2 elimination. The mean elimination rate constant was 0.0091+/-0.0061 min(-1) (n = 8). The median half-life was 1.47 hours (range, 0.62 to 10.85 hours). All patients had creatinine clearances greater than 61 ml/min/1.73 m2. The volume of distribution at steady-state was 1.47+/-1.03 L/kg. No correlation existed between age and the elimination rate constant or the volume of distribution at steady-state. All patients achieved at least a 20% change in cardiac index and systemic vascular resistance index while maintaining a Css avg of 35 to 160 ng/ml. No adverse effects were noted. All patients achieved primary hemodynamic end points (cardiac index and systemic vascular resistance index) during the milrinone infusion. CONCLUSIONS: Loading doses of 75 microg/kg milrinone lactate and starting infusion rates of 0.75 to 1.0 microg/kg/min for patients with normal renal function should be used; the infusion rate should then be titrated to effect. We recommend that for every increase of 0.25 microg/kg/min, a 25 microg/kg bolus dose be given. Because the median half-life is 1.47 hours, immediate hemodynamic effects may not be seen unless appropriate loading doses and infusion adjustments are made.
Asunto(s)
Cardiotónicos/farmacología , Piridonas/farmacología , Choque Séptico/tratamiento farmacológico , Vasodilatadores/farmacología , Adolescente , Cardiotónicos/sangre , Cardiotónicos/farmacocinética , Cardiotónicos/uso terapéutico , Niño , Preescolar , Estudios Cruzados , Método Doble Ciego , Semivida , Hemodinámica/efectos de los fármacos , Humanos , Lactante , Milrinona , Estudios Prospectivos , Piridonas/sangre , Piridonas/farmacocinética , Piridonas/uso terapéutico , Choque Séptico/fisiopatología , Vasodilatadores/sangre , Vasodilatadores/farmacocinética , Vasodilatadores/uso terapéuticoRESUMEN
BACKGROUND: Meningococcal sepsis remains an important cause of morbidity and mortality. We hypothesised that children with severe meningococcaemia might benefit from inhibition of the inflammatory processes thought responsible for fulminant disease. rBPI21 is a recombinant, N-terminal fragment of human bactericidal/permeability-increasing protein, which kills meningococci and binds to and clears bacterial endotoxin, these being the primary inducers of the systemic inflammation. The aim of this study was to determine the safety and kinetics of rBPI21 in children with severe meningococcaemia and to make a preliminary assessment of clinical outcome. METHODS: In this open-label, dose-escalation, phase I/II trial in severe meningococcaemia (Glasgow meningococcal prognostic septicaemia score [GMSPS] > or = 8), 26 patients aged 1-18 years, who had received their first dose of antibiotics no more than 8 hours earlier were given rBPI21 by infusion at total doses of 1.0, 2.0, and 4.0 mg/kg. FINDINGS: The patients had significantly raised plasma concentrations of bacterial endotoxin and cytokines. Peak and steady state BPI concentrations were comparable with pharmacokinetic data in healthy adults. All complications were compatible with the expected pattern for severe meningococcal sepsis. Only one patient died. This outcome was found to compare favourably with a predicted mortality of > or = 30% by GMSPS, > or = 15% by plasma endotoxin values, > or = 28% by plasma interleukin-6 concentrations, 29-49% by severity of coagulopathy, and 20% (11/54) by comparison with recent historical patients consecutively treated in participating centres before this study. INTERPRETATION: This, the first clinical trial or rBPI21, shows that rBPI21 can be safely administered to children with severe meningococcaemia and that the pharmacokinetics are consistent with patterns seen in healthy adults. Predicted mortality, on the basis of GMSPS, laboratory indices of inflammation and coagulopathy, and historical controls, was for between four and eight deaths. These findings have prompted a phase III randomised trial.
Asunto(s)
Antiinfecciosos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Proteínas Sanguíneas/uso terapéutico , Proteínas de la Membrana , Infecciones Meningocócicas/tratamiento farmacológico , Adulto , Antiinfecciosos/efectos adversos , Antiinfecciosos/farmacocinética , Péptidos Catiónicos Antimicrobianos , Bacteriemia/microbiología , Bacteriemia/mortalidad , Actividad Bactericida de la Sangre , Proteínas Sanguíneas/efectos adversos , Proteínas Sanguíneas/farmacocinética , Niño , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Masculino , Infecciones Meningocócicas/mortalidad , Proteínas Recombinantes/efectos adversos , Proteínas Recombinantes/farmacocinética , Proteínas Recombinantes/uso terapéutico , Resultado del TratamientoAsunto(s)
Bacteriemia , Infecciones Meningocócicas , Bacteriemia/diagnóstico , Bacteriemia/epidemiología , Bacteriemia/fisiopatología , Bacteriemia/terapia , Humanos , Infecciones Meningocócicas/diagnóstico , Infecciones Meningocócicas/epidemiología , Infecciones Meningocócicas/fisiopatología , Infecciones Meningocócicas/terapia , PronósticoAsunto(s)
Criptococosis/terapia , Inmunoterapia , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/terapia , Adyuvantes Inmunológicos/uso terapéutico , Animales , Criptococosis/complicaciones , Dietilcarbamazina/uso terapéutico , Humanos , Técnicas In Vitro , RatonesRESUMEN
STUDY OBJECTIVE: To determine the hemodynamic effects of i.v. milrinone lactate in pediatric patients with nonhyperdynamic septic shock. Specifically we tested the hypothesis that i.v. milrinone would increase cardiac index by 20% and decrease systemic vascular resistance index by 20% during a 2-h study period. DESIGN: Prospective, double-blinded, randomized, placebo-controlled, descriptive, interventional study. SETTING: Twenty-six-bed pediatric ICU at Children's Medical Center of Dallas and a 10-bed pediatric trauma ICU at Parkland Memorial Hospital. PATIENTS/PARTICIPANTS: Twelve patients (age range, 9 months to 15 years) with nonhyperdynamic septic shock despite administration of catecholamines (cardiac index [CI] normal [3.5 to 5.5 L/min/m2] or low [< or =3.5 L/min/m2]; systemic vascular resistance index [SVRI] normal [800 to 1,600 dyne.s.cm5/m2] or high [> or =1,600 dyne.s.cm5/m2]; and pulmonary capillary wedge pressure [PCWP] normal [8 to 12 mm Hg] or higher) with clinical signs of poor perfusion were enrolled, randomized, and treated in a blinded fashion with i.v. milrinone and placebo. INTERVENTIONS: Patients were randomized into two groups. Group A received a loading dose of 50 micrograms/kg i.v. of milrinone followed by a continuous i.v. infusion of 0.5 microgram/kg/min while group B received an equal volume loading dose and continuous infusion of placebo. After 2 h, group A received an equal-volume loading dose followed by a continuous infusion of placebo while the milrinone infusion continued, while group B received a 50 micrograms/kg loading dose of milrinone followed by a continuous infusion of 0.5 microgram/kg/min while the placebo infusion remained. Outcome variable were measured at baseline, 0.5, 1.0, 2.0, 2.5, 3.0, and 4.0 h. Echocardiographic measurements were taken at baseline, hour 2, and hour 4 in all subjects. No changes in other inotropic or mechanical ventilatory support were allowed during the study period. MEASUREMENTS AND MAIN RESULTS: Milrinone significantly increased CI, stroke volume index (SVI), right and left ventricular stroke work index, and oxygen delivery (Do2) at 0.5, 1.0, and 2.0 h postloading dose (p < 0.05) while significantly decreasing SVRI, pulmonary vascular resistance index, and mean pulmonary arterial pressure at 0.5, 1.0, and 2.0 h postloading dose (p < 0.05). No clinically or statistically significant changes in heart rate, systolic and diastolic BP, mean systemic arterial pressure, or PCWP were observed during milrinone treatment compared to placebo. CONCLUSIONS: CI, SVI, and Do2 significantly increased while SVRI significantly decreased when compared to placebo after i.v. administration of milrinone to pediatric patients with nonhyperdynamic septic shock. No adverse effects were observed. In a volume-resuscitated pediatric patient with septic shock, when administered in addition to catecholamines, milrinone will improve cardiovascular function.
Asunto(s)
Hemodinámica/efectos de los fármacos , Inhibidores de Fosfodiesterasa/administración & dosificación , Piridonas/administración & dosificación , Choque Séptico/tratamiento farmacológico , Adolescente , Gasto Cardíaco/efectos de los fármacos , Niño , Preescolar , Método Doble Ciego , Femenino , Humanos , Lactante , Infusiones Intravenosas , Masculino , Milrinona , Estudios Prospectivos , Presión Esfenoidal Pulmonar/efectos de los fármacos , Choque Séptico/fisiopatología , Resistencia Vascular/efectos de los fármacosAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones Bacterianas/tratamiento farmacológico , Dietilcarbamazina/uso terapéutico , Filaricidas/uso terapéutico , Micosis/tratamiento farmacológico , Adulto , Candidiasis/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Neumonía por Pneumocystis/tratamiento farmacológico , Infecciones por Pseudomonas/tratamiento farmacológicoRESUMEN
This article describes two cases of esophagitis in immunocompetent adults associated with herpes simplex virus type 1 (HSV-1) infection. One case presented with pharyngitis and the other with whitlow. A review of the literature revealed 21 other cases in immunocompetent adults; and, of these 21 patients, odynophagia was noted in 19, nine experienced fever, and oral lesions were found in five of these individuals. Barium swallow was positive in 8 of 20 patients tested, whereas esophagoscopy showed ulcers in 17 of the 20 cases. Specimens obtained during esophagoscopy revealed viral inclusions in 13 of the 20 patients tested, and viral cultures were positive in 11 of the 15 patients tested. Although upper gastrointestinal hemorrhage occurred in one patient, symptoms generally resolved within a few weeks whether or not acyclovir was administered.