RESUMEN
Celiac disease is an autoimmune systemic disorder. It presents gastrointestinal and nongastrointestinal manifestations as well as associated conditions. We report a 16-year-old Down syndrome girl who presented psychosis symptomatology, and she was diagnosed as having silent celiac disease. Olanzapine treatment and gluten-free diet were satisfactory. It is necessary to consider celiac disease in Down syndrome patients with psychiatric symptoms, mainly psychotic symptomatology.
RESUMEN
INTRODUCTION: Baclofen is frequently used in the management of spasticity. When the therapeutic benefit of oral baclofen is not satisfactory, intrathecal administration should be considered. This method reduces side effects due to a reduction in dosage compared to oral administration. CASE DESCRIPTION: This study presents a 52-year-old man with tetraplegia after a brainstem stroke. Four days after the placement of a Synchromed II infusion pump (100 mcg per day), the patient presented a paralytic ileus. The treatment was conservative and the dosage of intrathecal baclofen was reduced to lowest drug flow. After 15 days of treatment the ileus was resolved and the dosage progressively increased without incident. CONCLUSION: Ileus should be considered as a rare side effect after intrathecal baclofen administration, especially in cases of brainstem injury because baclofen seems to act directly over vegetative brainstem nuclei. Based on this case, it is strongly recommended to decrease the dose of intrathecal baclofen as one of the main therapeutic options.
Asunto(s)
Baclofeno/efectos adversos , Seudoobstrucción Intestinal/inducido químicamente , Relajantes Musculares Centrales/efectos adversos , Infartos del Tronco Encefálico/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Espasticidad Muscular/tratamiento farmacológico , Espasticidad Muscular/etiologíaRESUMEN
OBJECTIVE: To identify the risk factors related to invasive disease caused by Haemophilus influenzae type b (Hib), Neisseria meningitidis, and Streptococcus pneumoniae. METHODS: Case-control study. All hospitals of the region of Valencia in Spain (covering 95% of the population of Valencia). The patients are children aged less than 15 years in whom Hib, N. meningitidis or S. pneumoniae are isolated from normally sterile sites. RESULTS: From 1995 to 1998, 275 cases of invasive disease were analysed, and 243 hospital controls were selected in the month after the onset of the case. The paediatrician completed a survey administered to the relatives at the time of admission. The risk factors related to invasive disease by Hib were exposure to tobacco smoke (number of smokers, adjusted OR (aOR) 1.74, 95% confidence interval (CI) 1.02-2.96) and living with more than four people (aOR 3.72, 95% CI 1.3-3.7). For N. meningitidis, there is a dose-response relationship; if more than 60 cigarettes are smoked daily at home, the aOR is 3.61 (95% CI 1.04-12.57). If there are more than four people living in the household, aOR 1.69 (95% CI 1.01-2.85). In children under two years of age, having siblings less than 15 years of age (OR 1.76, 95% CI 0.75-4.17) and attending a day nursery represents a risk for suffering invasive pneumococcal disease (aOR 4.21, 95% CI 1.28-13.83). CONCLUSIONS: Among the variables tested, the modifiable risk factor is smoking; if smoking was reduced at home, the number of cases of invasive disease could be reduced in children, mainly in those under 5 years of age. Identification and vaccination of these risk groups would significantly reduce these diseases.