RESUMEN
OBJECTIVE: To evaluate maternal and neonatal cord blood levels at delivery in patients receiving 900 mg of clindamycin intravenous (IV) every 8 h. STUDY DESIGN: Prospective study consented every mother that entered labor with a positive group B streptococcal culture, a high-risk penicillin allergy, and sensitivity to clindamycin and erythromycin. Maternal and cord blood clindamycin levels were obtained at delivery. Time from last dose completion to delivery, number of doses administered and body mass index (BMI) were assessed. RESULTS: Twenty-three patients were consented. All maternal clindamycin values were therapeutic and 22 (96%) of the 23 cord blood samples were therapeutic. The mean maternal level was of 4.46 µg ml-1 (range of 0.7 to 8.4 µg ml-1). The mean cord blood level was 3.35 µg ml-1 (range of <0.5 to 6.4 µg ml-1). CONCLUSION: These data show that the current dosing recommendation of 900 mg of clindamycin IV every 8 h produces therapeutic maternal and cord blood levels.
Asunto(s)
Antibacterianos/sangre , Clindamicina/sangre , Sangre Fetal/química , Intercambio Materno-Fetal , Antibacterianos/administración & dosificación , Antibacterianos/farmacocinética , Clindamicina/administración & dosificación , Clindamicina/farmacocinética , Parto Obstétrico , Esquema de Medicación , Femenino , Humanos , Recién Nacido , Embarazo , Estudios Prospectivos , Infecciones Estreptocócicas/prevención & controlRESUMEN
Advanced practice nurses in obstetric settings are frequently required to diagnose premature rupture of fetal membranes; co-management of care with physicians is becoming more common in many health care facilities. Therefore, Advanced practice nurses must have an in-depth understanding of this potentially severe obstetric complication. This article presents a review of the current literature focusing on the epidemiology, physiology, pathophysiology, prevention measures, subjective and objective assessment, diagnostic tests, and management of premature rupture of membranes. Psychosocial aspects of this event, often upsetting for the family, are also discussed.
Asunto(s)
Rotura Prematura de Membranas Fetales/enfermería , Evaluación en Enfermería , Complicaciones del Embarazo/enfermería , Femenino , Rotura Prematura de Membranas Fetales/etiología , Rotura Prematura de Membranas Fetales/fisiopatología , Edad Gestacional , Humanos , Embarazo , Complicaciones del Embarazo/etiología , Complicaciones del Embarazo/fisiopatología , Factores de RiesgoAsunto(s)
Medicina Familiar y Comunitaria , Examen Físico , Adulto , Anciano , Humanos , Investigación , Estados UnidosRESUMEN
La actinomicosis torácica pulmonar, rara de ver en la actualidad, ha cambiado considerablemente su presentación clínica, siendo infrecuente ver los antiguos cuadros con destrucción de la pared del tórax y trayectos sinuosos de drenaje. En los últimos tres años en la literatura médica nacional hay sólo algunas publicaciones con 1 ó 2 casos. Presentamos 3 pacientes atendidos en los 2 últimos años en nuestro Servicio con forma de presentación diferente. El diagnóstico definitivo en los tres pacientes se efectuó por el estudio histopatológico de las muestras enviadas. Se analiza las características del germen, formas clínicas de presentación, dificultades diagnósticas y terapia más convenientes
Asunto(s)
Adulto , Humanos , Masculino , Femenino , Actinomicosis/complicaciones , Enfermedades Pulmonares Parasitarias/tratamiento farmacológico , Penicilinas/uso terapéuticoRESUMEN
The reliability of the most important methods to determine protein-binding of drugs was compared. Applying these methods to different drugs solved in bovine plasma or in protein-free solutions the incidence of errors specific for each method was examined. Certain limits are found for the applicability of each method. If these limitations are observed reproducibility differs only slightly within the four methods. Considering all the results, however, the values achieved by equilibrium dialysis appear to come closest to the real extent of binding.
Asunto(s)
Preparaciones Farmacéuticas/metabolismo , Unión Proteica , Adsorción , Proteínas Sanguíneas/metabolismo , Cromatografía en Gel , Diálisis/instrumentación , Difusión , Estudios de Evaluación como Asunto , Métodos , Metilcelulosa , Concentración Osmolar , Preparaciones Farmacéuticas/sangre , Factores de Tiempo , Ultracentrifugación , UltrafiltraciónRESUMEN
Asthmatics are usually instructed to use pressurized bronchodilator aerosols by delivering a bolus of drug at the beginning of a full inspiration. Because airways are better dilated near total lung capacity, the delivery of the drug near the end of a full breath might allow better penetration of particles into the lung and greater bronchodilatation. To test this hypothesis, 13 asthmatic subjects inhaled 400 mug of isoproterenol at 20 per cent (low) and at 80 per cent (high) vital capacity. The studies were done on 2 separate days when the severity of asthma was the same. Forced vital capacity, 1-sec forced expiratory volume, specific airway conductance and maximal flow at 50 per cent of viral capacity were measured at frequent intervals after drug administration. Ten min after drug delivery, there was a significantly greater (P less than 0.05) improvement in 1-sec forced expiratory volume after the drug was inhaled at the high lung volume compared to the response after delivery at the low lung volume. The differences in forced vital capacity, specific conductance, and maximal flow at 50 per cent of vital capacity were not significant. We concluded that inhaling a bronchodilator drug at the end of a full inspiration causes relatively greater bronchodilatation than inhaling the same dose at the beginning of inspiration.
Asunto(s)
Asma/tratamiento farmacológico , Isoproterenol/administración & dosificación , Terapia Respiratoria/métodos , Capacidad Vital , Adolescente , Adulto , Dilatación , Femenino , Volumen Espiratorio Forzado , Humanos , Pulmón/fisiopatología , Mediciones del Volumen Pulmonar , MasculinoRESUMEN
The success of malaria eradication campaigns depends on the use of all methods that make for a better understanding of the biology and behaviour of mosquito vectors. One such method is precipitin testing, by which it is possible to identify the human or animal origin of blood-meals of mosquitos and thereby to determine their host preferences and vectorial importance, both generally and locally.In 1955 the World Health Organization, in agreement with the Lister Institute of Preventive Medicine, Elstree, England, set up a precipitin test service available to national research institutions and field staff of malaria eradication projects. The results of the tests carried out in 1959-64 are now presented in summary form; the data were obtained from nearly 41 000 blood smears collected from 79 species of Anopheles. In addition, the previously published results of the 1955-59 period are retabulated and data are presented on nearly 27 000 tests carried out independently at the National Institute of Communicable Diseases, Delhi, India, on Anopheles from Ceylon, India and Nepal. Altogether the review covers some 124 000 precipitin tests on 92 Anopheles species; about 93% of the tests gave a positive result with one or other of the antisera used, but attention is chiefly paid to the proportion of blood-meals taken on man.There are practical difficulties in achieving representative sampling of Anopheles populations for determination of the human blood index, but some can be overcome by increased care in sampling from a representative selection of biotopes. In areas that have been sprayed with insecticide, an attempt should be made to include mosquitos knocked down by the insecticide after feeding.