RESUMEN

BACKGROUND: Hantavirus cardiopulmonary syndrome (HCPS) is caused by new world hantaviruses, among which Andes hantavirus (ANDV) is endemic to Chile and Southern Argentina. The disease caused by ANDV produces plasma leakage leading to enhanced vascular permeability and has a high case fatality rate (35%), mainly due to respiratory failure, pulmonary edema and myocardial dysfunction, hypoperfusion and shock. Host sociodemographic and genetic factors might influence the course and outcome of the disease. Yet, they have not been thoroughly characterized. AIM: To evaluate sociodemographic factors as risk factors in severity of HCPS. PATIENTS AND METHODS: Study period: 2004-20013, attending in eight collaborative centers, etiological diagnosis was performed by serology or molecular biology, mild and severe HCPS were compared.139 Chilean patients were analyzed, 64 (46%) with severe disease among which 12 (19 %) died. RESULTS: European ethnicity had 5,1 times higher risk than Amerindian ethnic group to develop a severe HCPS, greater seriousness that was also associated with an urban residence. CONCLUSION: It was observed that ethnicity and type of residence were significant risk factors for HCPS severity. Hypotheses explaining these findings are discussed.

Asunto(s)

Síndrome Pulmonar por Hantavirus/mortalidad , Adolescente , Adulto , Anciano , Niño , Chile/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , Adulto Joven

RESUMEN

Resumen Introducción: El síndrome cardiopulmonar por hantavirus (SCPH) es causado en Chile y en el sur de Argentina por el Andes hantavirus (ANDV), el que es endémico en esta zona. La enfermedad causada por ANDV produce un aumento de permeabilidad vascular y filtración de plasma con una alta tasa de letalidad (35%), debido principalmente a insuficiencia respiratoria por edema pulmonar y al desarrollo en los casos graves de compromiso miocárdico, hipoperfusión y shock. Aunque se sabe que los factores socio-demográficos del hospedero pueden influir en el curso y el resultado de la enfermedad, estos no se han caracterizado previamente en la población chilena. Objetivo: Evaluar la relación entre los factores socio-demográficos y la gravedad del SCPH. Pacientes y Métodos: Período de análisis 2004-20013, pacientes atendidos en ocho centros colaboradores, diagnóstico etiológico serológico o por biología molecular, se comparan SCPH leve y grave. Se analizaron 139 pacientes chilenos, 64 (46%) con enfermedad grave, entre los cuales 12 murieron (19%). Resultados: La etnia europea tuvo un riesgo 5,1 veces mayor de desarrollar un SCPH grave que la etnia amerindia, gravedad mayor que también se asoció a una residencia urbana. Conclusiones: Se observó una asociación estadísticamente significativa entre etnia, lugar de residencia y evolución de SCPH. Se discuten hipótesis que expliquen estos hallazgos.

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Background: Hantavirus cardiopulmonary syndrome (HCPS) is caused by new world hantaviruses, among which Andes hantavirus (ANDV) is endemic to Chile and Southern Argentina. The disease caused by ANDV produces plasma leakage leading to enhanced vascular permeability and has a high case fatality rate (35%), mainly due to respiratory failure, pulmonary edema and myocardial dysfunction, hypoperfusion and shock. Host sociodemographic and genetic factors might influence the course and outcome of the disease. Yet, they have not been thoroughly characterized. Aim: To evaluate sociodemographic factors as risk factors in severity of HCPS. Patients and Methods: Study period: 2004-20013, attending in eight collaborative centers, etiological diagnosis was performed by serology or molecular biology, mild and severe HCPS were compared.139 Chilean patients were analyzed, 64 (46%) with severe disease among which 12 (19 %) died. Results: European ethnicity had 5,1 times higher risk than Amerindian ethnic group to develop a severe HCPS, greater seriousness that was also associated with an urban residence. Conclusion: It was observed that ethnicity and type of residence were significant risk factors for HCPS severity. Hypotheses explaining these findings are discussed.

Asunto(s)

Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Síndrome Pulmonar por Hantavirus/mortalidad , Factores Socioeconómicos , Índice de Severidad de la Enfermedad , Chile/epidemiología , Factores de Riesgo

RESUMEN

Los embarazos múltiples se consideran una entidad de alto riesgo obstétrico. Su incidencia ha ido en aumento debido a la utilización de técnicas de reproducción asistida y el aumento de la edad materna. Se presentan 2 casos de embarazos triples monocoriales triamnióticos, de sexo femenino y masculino. En ambos embarazos se manifestaron complicaciones, principalmente fetales y neonatales, atribuidas a embarazos múltiples descritas en la literatura.

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Multiple pregnancies are considered a high-risk obstetric entity. Their incidence has been increasing due to the use of assisted reproductive techniques and increased maternal age. Here, we describe two cases of triamniotic monochorionic triplet pregnancies, female and male respectively. Both pregnancies demonstrated complications, mainly fetal and neonatal, attributed to multiple pregnancies reported in the literature.

Asunto(s)

Humanos , Adulto , Complicaciones del Embarazo , Embarazo Triple , Trillizos , Resultado del Embarazo , Embarazo Múltiple

RESUMEN

BACKGROUND: Seasonal variation of Dermatophagoides allergens and its influence in allergic respiratory airway diseases has not been investigated in Andean cities. The objective of this study was to evaluate those parameters in a city located in the Andean mountains. METHODS: Der p1 and Der f1 were measured in dust samples from mattresses in 13 houses in Quito (2800 m above sea level). Samples were collected monthly from August 2004 to July 2005. Patients presenting to a local outpatient allergy clinic with asthma and rhinitis and isolated allergy to Dermatophagoides were analysed to determine if a correlation existed between seasonal Der allergen levels and the number of patients presenting with allergies. RESULTS: High levels of dust mites and humidity were observed throughout the year. The highest geometrical mean values of allergens were detected in April (Der p1, 10.15 µg/g) and May (Der f1, 13.03 µg/g), whilst the lowest levels were detected in August (Der p1, 4.26 µg/g), and September (Der f1, 1.4 µg/g). Of the 361 patients examined, 182 were allergic to Dermatophagoides, (45.6% asthmatics, 97.8% rhinitics, and 43.4% with both diseases). Patient presentation spiked in August, and from February to May. However, there was not a significant correlation between mite allergen concentrations and humidity or the number of patients presenting with allergies. CONCLUSIONS: Dust samples from mattresses in Quito revealed high concentrations of Der p1 and Der f1. We observed a trend towards increased presentation of asthmatic and rhinitic patients in the months with highest levels of allergens.

Asunto(s)

Alérgenos/efectos adversos , Alérgenos/análisis , Antígenos Dermatofagoides/efectos adversos , Antígenos Dermatofagoides/análisis , Exposición a Riesgos Ambientales/efectos adversos , Exposición a Riesgos Ambientales/análisis , Estaciones del Año , Adolescente , Adulto , Altitud , Proteínas de Artrópodos , Asma/epidemiología , Asma/inmunología , Ropa de Cama y Ropa Blanca , Niño , Preescolar , Cisteína Endopeptidasas , Polvo/análisis , Ecuador/epidemiología , Femenino , Humanos , Humedad , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios/estadística & datos numéricos , Rinitis/epidemiología , Rinitis/inmunología , Adulto Joven

Asunto(s)

Antígenos Dermatofagoides/inmunología , Asma/epidemiología , Pyroglyphidae/inmunología , Control de Ácaros y Garrapatas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Altitud , Animales , Antígenos Dermatofagoides/aislamiento & purificación , Antígenos Dermatofagoides/metabolismo , Proteínas de Artrópodos , Asma/diagnóstico , Asma/inmunología , Lechos/parasitología , Niño , Preescolar , Cisteína Endopeptidasas , Ecuador , Exposición a Riesgos Ambientales/efectos adversos , Composición Familiar , Femenino , Humanos , Inmunización , Lactante , Masculino , Persona de Mediana Edad , Grupos de Población , Factores de Riesgo

Asunto(s)

Antígenos Dermatofagoides/inmunología , Asma/epidemiología , Dermatophagoides farinae/inmunología , Dermatophagoides pteronyssinus/inmunología , Adolescente , Animales , Proteínas de Artrópodos , Asma/inmunología , Niño , Cisteína Endopeptidasas , Ecuador/epidemiología , Femenino , Humanos , Inmunización , Masculino , Prevalencia , Instituciones Académicas/estadística & datos numéricos , Estudiantes , Adulto Joven

Asunto(s)

Altitud , Antígenos Dermatofagoides/inmunología , Polvo/análisis , Hipersensibilidad/inmunología , Pyroglyphidae/inmunología , Animales , Antígenos Dermatofagoides/metabolismo , Polvo/inmunología , Ecosistema , Ecuador , Humanos , Hipersensibilidad/epidemiología , Hipersensibilidad/parasitología , Estadios del Ciclo de Vida , Salud Pública , Pyroglyphidae/crecimiento & desarrollo , Refugiados , Erupciones Volcánicas

Asunto(s)

Síndrome Pulmonar por Hantavirus , Chile/epidemiología , Síndrome Pulmonar por Hantavirus/diagnóstico , Síndrome Pulmonar por Hantavirus/epidemiología , Síndrome Pulmonar por Hantavirus/terapia , Humanos

Asunto(s)

Humanos , Medicina Basada en la Evidencia , Endoscopía Gastrointestinal/métodos , Enfermedades Intestinales/cirugía , Enfermedades Intestinales/diagnóstico , Endoscopios Gastrointestinales , Enfermedades Intestinales/complicaciones , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiología , Intestino Delgado/patología , Sangre Oculta

RESUMEN

Natural orifice transluminal endoscopic surgery (notes), is a novel approach to the peritoneal cavity, that has been used for both diagnostic and surgical procedures. Aims: to evaluated the safety and feasibility of per-oral transgastric route for peritoneal approach and for several basic surgical techniques in a porcine experimental model. Material and methods: five pigs entered in the study. Under general anesthesia , a conventional endoscope was passed into the stomach, the gastric wall was punctured by mean of a sphincterotome and the size of the gastric incision was increased with a cholecystectomy and intestinal loops mobilization were attempted. Gastric incision closure was performed with endoloops. Results: a good observation of the peritoneal cavity was achieved. Liver samples were obtained in all procedures as well as mobilization of small intestinal loops. Cholecystectomy was possible in only three cases. Conclusion: transgastric approach to the peritoneal cavity seems to be a potential alternative to the classical laparotomy and laparoscopic technique.

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La cirugía endoscópica transluminal por orificios naturales (NOTES) es un nuevo abordaje a la cavidad peritoneal que ha sido utilizada ya sea como procedimiento diagnóstico o quirúrgico. Objetivos: Evaluar la seguridad y factibilidad de la ruta per-oral transgástrica para el acceso a la cavidad peritoneal , y para la realización de técnicas quirúrgicas básicas en un modelo experimental porcino. Material y métodos: Se utilizaron cinco cerdos. Bajo anestesia general mediante un endoscopio convencional se accedió al estómago y se puncionó la pared gástrica mediante un papilótomo. La abertura se amplió ya sea con papilótomo o con balón. Se exploró la cavidad peritoneal y se intentó realizar: biopsias hepáticas en todos los procedimientos, lo mismo ocurrió con la movilización de asas intestinales. La colecistectomía fue posible en sólo tres ocasiones. Conclusión: el abordaje transgástrico de la cavidad peritoneal pareciera ser una potencial alternativa a la laparotomía clásica y laparoscópica.

Asunto(s)

Animales , Cirugía Asistida por Video , Endoscopía Gastrointestinal/métodos , Colecistectomía , Hígado/patología , Porcinos , Reproducibilidad de los Resultados

RESUMEN

Background: New vaccination strategies are needed to control the increasing problem of pertussis in teenagers and adults. Aim: To determine the immunogenicity and reactogenicity of a diphtheria-tetanus-acellular pertussis (dTpa) vaccine with reduced antigen content. Material and Methods: A single dose of the dTpa vaccine was administered to 60 children 10 to 11 years old and 60 healthy adults. At the moment of vaccination and one month later, antibody levels were measured against 3 B pertussis antigens: anti-pertussis toxin (PT), anti-pertactin (PRN) and anti-filamentous hemagglutinin (FHA), as well as anti-tetanus and anti-diphtheria antibodies. Local and general symptoms were registered during 14 days following vaccine administration. Results: Antibody response for PT, FHA and PRN was 98.3 percent, 100 percent and 100 percent in adults and 98.2 percent, 100 percent and 98.2 percent in children. Seropositivity for all pertussis antigens was 100 percent in adults and in children one month after vaccination. Geometric mean titers (GMT) significantly increased in adults and children. The seroprotection level achieved for tetanus and diphtheria antibodies one month after vaccination was 96.7 percent for adults and 100 percent for children, respectively. No serious adverse events were reported during the study. Among local symptoms pain was the most frequent (88-90 percent), but it was mostly mild or moderate. Solicited general symptoms observed for children and adults, respectively, included headache (37 percent and 53 percent), fatigue (18 percent and 35 percent) gastrointestinal symptoms (18 percent and 25 percent) and fever (8 percent and 3 percent). Only one vaccinee had fever above 39­C. Conclusions: the dTpa vaccine showed an adequate safety profile and induced an intense immunological response to all antigens in adults and children aged 10-11

Asunto(s)

Humanos , Masculino , Adulto , Femenino , Vacuna contra Difteria, Tétanos y Tos Ferina , Vacunas Atenuadas , Vacuna contra Difteria, Tétanos y Tos Ferina , Formación de Anticuerpos/inmunología

RESUMEN

Grass pollen is an important cause of asthma and rhinoconjunctivitis in Europe and the United States. In the high Andes however, the role this pollen plays in respiratory allergies is unknown. In this study, we tested the prevalence of grass pollen sensitization in comparison to other aeroallergens on 433 asthmatic children living in Quito, Ecuador (the Andes mountain range, 2,800 m above sea level). The skin prick test technique was used. We found that the least sensitizing allergens of all were grass pollen (12.2%) and molds (7.4%) with p < 0.0001. A clear predominance of sensitization to the house dust mite Dermatophagoides pteronyssinus (77.8%) and Dermatophagoides farinae (76.9%), in comparison to the other aeroallergens tested, in terms of sensitization (p = 0.00000) and papule size (p < 0.0002), was observed. The most highly sensitized group consisted of asthmatics between 5 and 15 years of age (D. pteronyssinus 90.7%, D. farinae 87.5%, dog hair 37.4%, cat hair 43%, grass pollen 15.9% and molds 9.9%). In the total study group, males were only more sensitive than females to D. pteronyssinus (82.1% vs. 71.6%, p = 0.0009). We concluded that in the group of asthmatic children studied, grass pollen showed a low capacity of sensitization, even though it is widely found all over our city. The most sensitizing allergens were D. pteronyssinus and D. farinae, followed by cat and dog hair.

Asunto(s)

Alérgenos/inmunología , Asma/inmunología , Ácaros/inmunología , Poaceae/inmunología , Polen/inmunología , Hipersensibilidad Respiratoria/diagnóstico , Adolescente , Distribución por Edad , Animales , Asma/epidemiología , Gatos , Niño , Preescolar , Comorbilidad , Perros , Ecuador/epidemiología , Femenino , Humanos , Incidencia , Lactante , Masculino , Hipersensibilidad Respiratoria/epidemiología , Pruebas Cutáneas

RESUMEN

Background: Diseases produced by Streptoccocus pyogenes are still a problem in Chile, as in the rest of the world. It exhibits in vitro susceptibility to different antimicrobials, but penicillin continues to be the treatment of choice. Alternative drugs have been developed for allergic patients, such as erythromycin, new macrolides and cephalosporins. Nevertheless, resistant strains are appearing due to the indiscriminate use of macrolides. Aim: To assess present antimicrobial susceptibility of S Pyogenes strains isolated from chilean patients. Material and Methods: The susceptibility to penicillin, macrolides, clindamycin, cephalotin and vancomycin of 153 S Pyogenes strains, obtained from different health centers of the Metropolitan Region and isolated between 1996 and 1998, was assessed using the Kirby-Bauer method. Agar dilution minimal inhibitory concentration was then determined to macrolide resistant strains. Results: All strains were susceptible to penicillin. There was a 7.2 percent cross-resistance to macrolides. Conclusions: These results confirm that S Pyogenes resistance to macrolides has increased considerably in the Metropolitan Region of Chile during the last years

Asunto(s)

Streptococcus pyogenes/efectos de los fármacos , Antibacterianos/farmacocinética , Técnicas In Vitro , Penicilinas/farmacocinética , Farmacorresistencia Microbiana , Clindamicina/farmacocinética , Vancomicina/farmacocinética , Pruebas de Sensibilidad Microbiana , Cefalosporinas/farmacocinética , Eritromicina/farmacocinética , Roxitromicina/farmacocinética

RESUMEN

La estenosis y atresia jejunoileal (AYI) es la malformación congénita más común del tubo digestivo, siendo el síndrome de intestino corto congénito su consecuencia más extrema. Se realiza una revisión de las fichas de 26 pacientes con el diagnóstico de AYI en nuestro hospital entre los años 1980 y 1999 registrando el método de diagnóstico, el tratamiento quirúrgico y sus resultados. En esta serie el diagnóstico se realizó principalmente con los hallazgos clínicos, complementados con radiología simple del abdomen, y en algunos casos mejoró con ultrasonido prenatal. El 42 por ciento de los pacientes presentó eliminación de meconio o deposiciones; esta observación refuerza la teoría de un evento tardío en la gesta ción como mecanismo etiopatogénico. Se presenta una proporción mayor del tipo IIIb comparado con otras series. La nutrición patenteral total es fundamental como parte del tratamiento pero tiene complicaciones infecciosas y metabólicas que deben ser prevenidas, en especial en los menores con intestino corto

Asunto(s)

Humanos , Femenino , Masculino , Recién Nacido , Atresia Intestinal/diagnóstico , Servicio de Cirugía en Hospital/estadística & datos numéricos , Síndrome del Intestino Corto/etiología , Anastomosis Quirúrgica , Atresia Intestinal/complicaciones , Atresia Intestinal/etiología , Atresia Intestinal/cirugía , Ultrasonografía Prenatal

RESUMEN

Background: the computer program WHONET generates a common database to analyze local or general antimicrobial resistance of bacteria. A surveillance of agents causing urinary tract infections in Chile has been performed using this program. Aim: to report the results after 12 months of urinary tract infection agent surveillance. Material and methods: since november, 1997, a surveillance of in vitro antimicrobial resistance, using agar diffusion techniques, has been performed in 20 to 40 bacterial strains per month, isolated from 11 hospitals in the country. Results have been analyzed using WHONET program. Results: in first 12 months, 3144 strains, 1625 coming from outpatients, have been studied. Seventy four percent of isolated strains were E. coli, 19 percent were other enterobacteria, 4.1 percent were non fermenting bacilli and 2.1 percent were Gram (+) cocci. Sixty five percent of E coli strains were resistant to ampicillin, 11 percent to cefazolin, 2.5 percent to cefuroxime, 19 percent to ceftriaxone, 9 percent to ceftazidime, 4.2 percent to gentamicin 1.3 percent to amikacin, 5.6 percent to ciprofloxacin, 8.4 percent to grepafloxacin, 4.3 percent to nitrofurantoin and 43 percent to trimeproprim/sulphamethoxazole. Eighty two percent of other enterobacteria strains were resistant to ampicillin, 45.5 percent to cefazolin, 33.5 percent to cefuroxime, 26.6 percent to ceftriaxone, 21.5 percent to ceftazidime, 30.3 percent to gentamicin 17.2 percent to amikacin, 21 percent to ciprofloxacin, 16.3 percent to grepafloxacin, 48.2 percent to nitrofurantoin and 44.6 percent to trimeproprim/sulphamethoxazole. There were differences in betalactamic resistance among hospitals. Conclusions: noteworthy is the high resistance rates to third generation cephalosporins, evidenced when the new cutoff values for E coli and klebsiella spp are used. This national surveillance provides updated information on antimicrobial resistance of agents causing urinary tract infections

Asunto(s)

Humanos , Masculino , Femenino , Adolescente , Preescolar , Lactante , Adulto , Persona de Mediana Edad , Infecciones Urinarias/tratamiento farmacológico , Farmacorresistencia Microbiana , Infecciones Urinarias/etiología , Ceftriaxona/farmacología , Resistencia a la Ampicilina , Factores de Edad , Enterobacteriaceae/efectos de los fármacos , Escherichia coli/efectos de los fármacos , Ampicilina/farmacología , Hospitales Públicos

RESUMEN

A 63-year-old man with chronic, nonallergic rhinoconjunctivitis presented immediate adverse reactions, such as intense itching, burning, redness and severe swelling of both conjunctivae after using disodium cromoglycate eye drops. Skin prick tests and conjunctival provocation tests were positive with pure disodium cromoglycate. Circulating IgE-specific antibodies to disodium cromoglycate in serum were demonstrated by RAST. We suggest that the acute ocular reaction was caused by disodium cromoglycate and that the underlying mechanism was probably an IgE-mediated immunological reaction.

Asunto(s)

Conjuntivitis Alérgica/etiología , Cromolin Sódico/efectos adversos , Edema/etiología , Cromolin Sódico/inmunología , Humanos , Inmunoglobulina E/inmunología , Masculino , Persona de Mediana Edad , Prueba de Radioalergoadsorción , Pruebas Cutáneas

RESUMEN

Previous investigations in alpine altitudes suggest a very low etiopathogenic relation between house-dust mites and bronchial asthma in these geographical zones. Our purpose was to analyze the relationship between asthma and sensitization to the house-dust mites D. pteronyssinus and D. farinae in Andean altitudes. We studied 587 asthmatic patients, residents in Quito, Ecuador, (2800 m above sea level), ranging in age from 8 months to 84 years. The patients were divided into five age groups. We investigated the prevalence of house-dust mite sensitization by skin prick tests in each group. Fifty asymptomatic students with ages between 6 to 20 years old were studied as a control group. Three hundred and thirty asthmatic patients (56.2%) were sensitized to house-dust mites while only 15 (30%) of the 50 asymptomatic students were sensitized (p < 0.01). The percentage of asthmatics sensitized followed an age-dependent curve that began with the children under 6 years old (45.1%), reached its maximum between 12 and 19 years old (79.0%) and decreased to 25.8% in asthmatics older than 40 years. The differences among these groups were statistically significant (p < 0.01). Also, we observed a significant prevalence in sensitization (p < 0.01) in males versus females. The mean size of the skin reaction obtained with D. pteronyssinus and D. farinae was larger (p < 0.001) in the 12-19 year olds than in the group of asthmatics over 40 years old. It was also greater in the asthmatics with chronic rhinitis than in the group of asthmatics without nasal symptoms (p < 0.01). We suggest that the house-dust mites D. pteronyssinus and D. farinae are an important source of allergens in the pathogenesis of bronchial asthma in patients who live in the high Andes.

Asunto(s)

Asma/etiología , Ácaros/inmunología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Alérgenos/administración & dosificación , Altitud , Animales , Antígenos Dermatofagoides , Asma/diagnóstico , Asma/inmunología , Niño , Preescolar , Polvo/efectos adversos , Ecuador , Femenino , Glicoproteínas/administración & dosificación , Glicoproteínas/inmunología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Factores Sexuales , Pruebas Cutáneas

RESUMEN

En los últimos años, a nivel mundial se han producido cambios en la etiología de la infección respiratoria y los microorganismos causases muestran resistencia progresiva a los antimicrobianos de uso habitual. Esto ha llevado a la búsqueda de nuevas alternativas terapéuticas. El propósito de este estudio fue comparar la susceptibilidad antimicrobiana in vítro, de 150 cepas bacterianas aisladas durante el primer semestre 1997, de adultos y niños con infeccion respiratoria superior o inferior, frente a la nueva asociación amoxicilina/ sulbactam (amox/sul) y otros 4 antimicrobianos de uso frecuente en Chile en estas patologías. Se determinó la CIM mediante técnica de dilución en agar de amoxicilina (amox), amox/ sul, cefuroxima (cefu), azitromicina (azit) y claritromicina (ciarl) frente a 55 cepas de S. pneumoniae, 44 cepas de H. ínfluenzae, 19 cepas de S. pyogenes y 32 S. aureus. Resultados. De las 55 cepas de S. pneumoniae, 9.1 por ciento fueron resistentes 1 amox, 7,3 por ciento a amox/Sul y cefu y ninguna presentó resistencia a azit o ciarl. Las 19 cepas de S. pyogenes estudiadas fueron sensibles a los 5 antimicrobianos, aunque cepas presentaron CIM límite a azit y ciarl (igual al valor de corte). De las 44 cepas de H. influenzae, 12,3 por ciento presentaron resistencia a amox y 9,1 por ciento a clarí. No se observó resistencia a amox/sul, cefu ni azit. En las cepas de S. aureus se observó resistencia importante a todos los antimicrobianos estudiados: 96 por ciento para amox, 56,3 por ciento para cefu, 59,4 por ciento para ciarl y azit y 46,9 por ciento para amox/sul. Conclusión: De acuerdo a nuestros resultados in vitro, la combinación amoxicilina/sulbactam, frente a bacterias causantes de infecciones respiratorias, tiene una cobertura comparable a otros antimicrobianos en uso e incluidos en este estudio (entre 100 y 54 por ciento) con la excepción de S. aureus que debería ser tratado con antimicrobianos con actividad antiestafilocóccica específica

Asunto(s)

Humanos , Amoxicilina/farmacocinética , Quimioterapia Combinada/farmacocinética , Técnicas In Vitro , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Sulbactam/farmacocinética , Azitromicina/farmacocinética , Cefuroxima/farmacocinética , Claritromicina/farmacocinética , Haemophilus influenzae/efectos de los fármacos , Staphylococcus aureus/efectos de los fármacos , Streptococcus pneumoniae/efectos de los fármacos , Streptococcus pyogenes/efectos de los fármacos

RESUMEN

Two patients treated with parenteral paramethasone (Triniol) and dexamethasone (Sedionbel) are described. A few minutes after administration of the drugs, they presented urticaria (patients 1 and 2) and conjunctivitis (patient 1). The purpose of our study was to determine the cause of the patients' reactions, the immunological mechanisms involved and whether these patients would be able to tolerate any kind of corticoid. Clinical examinations and skin, oral and parenteral challenges with different corticosteroids and ELISA tests were performed. In the two patients, skin and ELISA tests with paramethasone were negative, as was the prick test with each of its excipients. A single-blind parenteral challenge with Triniol was positive in both patients after the administration of 1 ml of the drug, and negative with its excipients. We also carried out oral and parenteral challenges with other corticosteroids and found intolerance to some of them. These results suggest that paramethasone caused pseudoallergic reactions in our patients. Corticosteroids different from paramethasone also produced hypersensitivity reactions in these patients; however, a few of them were tolerated. The basic mechanisms of those reactions are not yet fully understood. To our knowledge, this is the first report of a pseudo-allergy caused by paramethasone.

Asunto(s)

Angioedema/inducido químicamente , Conjuntivitis Alérgica/diagnóstico , Dexametasona/efectos adversos , Parametasona/efectos adversos , Urticaria/inducido químicamente , Adulto , Angioedema/diagnóstico , Angioedema/terapia , Conjuntivitis Alérgica/inducido químicamente , Conjuntivitis Alérgica/terapia , Dexametasona/administración & dosificación , Dexametasona/inmunología , Femenino , Humanos , Inmunoglobulina E/sangre , Inyecciones Intramusculares , Masculino , Parametasona/administración & dosificación , Parametasona/inmunología , Pruebas Cutáneas , Urticaria/diagnóstico , Urticaria/terapia

RESUMEN

Protective immunity against rotavirus infection is directed against antigenic epitopes on the outer capsid proteins VP7 and VP4. The aim of this study was to characterize the VP7 and VP4 antigenic types circulating in different hospital areas of Santiago, Chile, obtained from children consulting for acute no bloody diarrhea in 5 hospitals representative of the 5 major health areas in Santiago. In addition, 256 rotavirus positive samples, obtained from children with acute diarrhea consulting in the north health area of Santiago between 1985-1987 were studied. All samples were processed for rotavirus by an ELISA and all rotavirus positive samples were selected for VP4 typing by PCR (types P1-P4). A total of 782 rotavirus positive samples were obtained of wich 618 (79 percent) were typeable for one specific VP7 type. VP7 type G1 represented 63 percent of the rotavirus positive samples and predominated in all areas evaluated throughout the entire period of observation. VP7 type G2 represented 13 percent of rotavirus samples, following G1 in predominance. G2 types decreased progressively in all areas in both study periods. G4 types were detected mainly during 1985-1987, and G3 types have so far not been detected. Preliminary analysis of VP4 types suggests that P1 types are predominant and closely associated with VP7 G1 type. These results are relevant for the adoption of appropiate preventive strategies for rotavirus infection, specifically aimed to the development of effective vaccines

Asunto(s)

Rotavirus/genética , Diarrea Infantil/microbiología , Técnicas In Vitro , Manejo de Especímenes , Ensayo de Inmunoadsorción Enzimática , Reacción en Cadena de la Polimerasa , Estudios Prospectivos , Estudios Retrospectivos , Epítopos/aislamiento & purificación