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INTRODUCTION AND AIMS: Helicobacter pylori (H. pylori) infection remains the leading cause of several gastroduodenal diseases. Despite the fact that multiple antibiotic regimens have been used to change its associated morbidity and mortality, the prevalence of this bacterial infection continues to be disproportionately high worldwide, mainly due to antibiotic resistance. To assess the noninferiority efficacy and safety of 210-day triple regimens on H. pylori eradication, we evaluated clarithromycin 500mg, lansoprazole 30mg, and amoxicillin 1g, all bid (standard triple therapy or CLA, Group 1) vs. pantoprazole 80mg, levofloxacin 500mg and azithromycin 500mg, all od (PLA, Group 2). Both regimens were compared in treatment-naïve patients. MATERIALS AND METHODS: An open label phase IIIb randomized and noninferiority trial comparing CLA vs. PLA was carried out for a 10-day period, within the time frame of June 2012 and March 2014. Eradication was verified with 13C-urea breath testing. Gastric biopsies were tested for fluorescence in situ hybridization (FISH)-clarithromycin resistance prior to any antibiotic administration. Efficacy and safety results were analyzed according to the noninferiority methodological approach. RESULTS: From the 227 H. pylori positive subjects that were randomized, 194 were finally analyzed as per-protocol. The group 2 eradication rate was 63% and was noninferior to the group 1 eradication rate of 58.5% (upper limit 95% CI: 0.11608; below the noninferiority margin: 0.1200). FISH clarithromycin-resistance was found in 28.2% of the cases. Adverse events, all minor and self-limited, were significantly higher in group 1 than in group 2 (86 vs. 65.4%; p=0.001). CONCLUSIONS: First-line H. pylori eradication with pantoprazole/levofloxacin/azithromycin combination therapy is as effective as the standard triple therapy, with better tolerability and easier dosing. Clarithromycin resistance should be considered when selecting antibiotics in Helicobacter pylori eradication treatments. ClinicalTrials.gov identifier NCT02726269.
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Antibacterianos/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Levofloxacino/uso terapêutico , Adulto , Idoso , Testes Respiratórios , Claritromicina/farmacologia , Combinação de Medicamentos , Farmacorresistência Bacteriana , Quimioterapia Combinada , Feminino , Infecções por Helicobacter/microbiologia , Infecções por Helicobacter/patologia , Helicobacter pylori/efeitos dos fármacos , Humanos , Masculino , México , Pessoa de Meia-Idade , Inibidores da Bomba de Prótons/uso terapêutico , Estômago/microbiologia , Estômago/patologiaRESUMO
INTRODUCTION: Ivermectin, a 22'23 dihydro derivative of avermectins beta-1a, is a highly effective veterinary and human anti parasitic, used to treat endoparasites of difficult control such as filariasis and onchocerciasis, with a median plasma life of at least of 16 hours. The recommended therapeutic doses range from 0.05 to 0.40 mg/kg, without undesirable effects or risk to human life. It went from being a great success in animal health to its application in humans, where it has had great impact. Studies in basic sciences have shown that ivermectin has anticonvulsive effects in different epileptic animal models, where five different mechanisms of action have been described. PATIENTS AND METHODS: Descriptive, prospective observational study, performed between 2013 and 2015, with 32 refractory epileptic patients, who received ivermectin as an a dose of adjunctive treatment of 10 mg/day three or seven times a week, controlled every three months, followed by 12-24 months, without withdrawal of anticonvulsant medications that they received previously. RESULTS: Progressively, patients entered into crisis control, at the end of the programmed follow-up period, the total percentage of crisis reduction was 97%, of which 57% did not return to crisis from the beginning of treatment, all patients being free of crisis according to International League Against Epilepsy criteria. CONCLUSION: Ivermectin has been useful as an adjuvant, achieving a significant decrease in seizures in this group of drug resistant patients.
TITLE: Ivermectina como coadyuvante en la epilepsia refractaria.Introduccion. La ivermectina es un 22'23 dihidroderivado de las avermectinas beta-1a, un antiparasitario de uso veterinario y humano de gran eficacia, utilizado para tratar endoparasitos de dificil control, como la filariasis y la oncocercosis. Tiene una vida media plasmatica de al menos 16 horas. Las dosis terapeuticas recomendadas varian entre 0,05 y 0,40 mg/kg, sin efectos indeseados ni riesgo para la vida humana. Paso de ser un gran exito en sanidad animal a su aplicacion en seres humanos, donde ha tenido gran impacto. Estudios en ciencias basicas han demostrado que la ivermectina tiene efectos anticonvulsionantes en diferentes modelos animales epilepticos, donde se han descritos cinco diferentes mecanismos de accion. Pacientes y metodos. Estudio descriptivo, observacional prospectivo, realizado entre 2013 y 2015, con 32 pacientes epilepticos refractarios, quienes recibieron ivermectina como tratamiento coadyuvante en dosis de 10 mg/dia, tres o siete veces por semana, controlados cada tres meses, seguidos durante 12-24 meses, sin retirada de los medicamentos anticonvulsionantes que recibian previamente. Resultados. Progresivamente, los pacientes entraron en control de las crisis. Al final del periodo de seguimiento programado, el porcentaje total de reduccion de las crisis fue del 97%. El 57% de estos pacientes no volvio a presentar crisis desde el inicio del tratamiento, y todos los pacientes se encontraron libres de crisis segun los criterios de la Liga Internacional contra la Epilepsia. Conclusion. La ivermectina ha sido util como coadyuvante y ha logrado una significativa disminucion de crisis en este grupo de pacientes farmacorresistentes.
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Epilepsia Resistente a Medicamentos/tratamento farmacológico , Ivermectina/uso terapêutico , Adulto , Idoso , Quimioterapia Adjuvante , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto JovemRESUMO
INTRODUCTION: Landau-Kleffner syndrome is characterised by acquired aphasia and encephalographic alterations that may or may not be accompanied by epileptic seizures. AIM. To analyse the clinical and encephalographic features and response to treatment of 10 patients with Landau-Kleffner syndrome. PATIENTS AND METHODS: We reviewed the patient records, encephalograms and treatment administered to patients catalogued as having Landau-Kleffner syndrome. RESULTS: The mean age of the patients was 44 months. Of these cases, 60% presented epilepsy when the diagnosis was established and 70% were found to have epileptic status during slow-wave sleep in the encephalographic study. Results showed that 40% corresponded to variants of Landau-Kleffner syndrome. No cause of the disease could be established in any of the patients. In the neuroimaging study, only one patient displayed abnormalities in the magnetic resonance imaging of the brain. All the patients received adrenocorticotropic hormone (ACTH)-based treatment, at a dose of 1 IU/kg/day for one month, administered together with antiepileptic drugs such as valproic acid and clobazam. Convulsive seizures and epileptic status during slow-wave sleep disappeared in all the patients. In the patients without epileptic status, epileptic activity became less frequent, although it did not completely disappear. Aphasia improved considerably, which meant that all the patients were able to enroll in normal schools. CONCLUSIONS: We believe that early diagnosis, together with suitable and timely management of aphasic patients with encephalographic alterations that allow ACTH to be used at low doses, make it possible to offer an early education so as to provide maximum recovery from the disease.
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Síndrome de Landau-Kleffner , Convulsões , Hormônio Adrenocorticotrópico/uso terapêutico , Anticonvulsivantes/uso terapêutico , Afasia/diagnóstico , Afasia/tratamento farmacológico , Afasia/fisiopatologia , Pré-Escolar , Eletroencefalografia , Humanos , Lactente , Síndrome de Landau-Kleffner/complicações , Síndrome de Landau-Kleffner/diagnóstico , Síndrome de Landau-Kleffner/tratamento farmacológico , Síndrome de Landau-Kleffner/fisiopatologia , Estudos Retrospectivos , Convulsões/tratamento farmacológico , Convulsões/etiologia , Convulsões/fisiopatologiaRESUMO
Although, decreasing in incidence with the disconnection systems, the first complication is still peritonitis in patients with chronic renal failure and the second is infection of Tenckhoff catheter exit-site. All efforts made to diminish the frequency of exit-site infection lower the possibility of peritonitis. The pediatric population is well-known to have a major risk of infectious complications, and making easy and safe the care of the exit-site will prevent the peritonitis that follows. The aim of the study was to evaluate the efficacy of the Amuchina 10% solution vs. pH neutral soap in children with chronic renal failure, on preventing exit-site infection. There were 60 patients who were assigned randomly to one of two groups. One group used Amuchina 10% solution for the daily cleaning of the exit-site, and the other used pH neutral soap, with 14 months of follow-up. Before the study they have to be free of infection for at least 30 days. All were taught by the same nurse how to clean their exit-site. Groups were almost identical in years, sex, and time on dialysis. We had nine infections in the soap group and none in the Amuchina 10% solution group, with an OR: 17 (p = 0.004). From these nine infections, the bacteria isolated were: 4 (13%) were caused by Pseudomona aeruginosa, 1 (3.3%) by Staphylococcus aureus, coagulase-positive staphylococci in 2 (6.6%) and Serratia marcensens in 1 (3.3%). In conclusion, Amuchina 10% solution is effective in preventing infection on the exit-site, without any secondary topical reaction.
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Anti-Infecciosos Locais/uso terapêutico , Ácido Hipocloroso/uso terapêutico , Controle de Infecções/métodos , Falência Renal Crônica/terapia , Diálise Peritoneal/métodos , Peritonite/prevenção & controle , Cloreto de Sódio/uso terapêutico , Adolescente , Cateteres de Demora/microbiologia , Criança , Contaminação de Equipamentos/prevenção & controle , Feminino , Seguimentos , Humanos , Incidência , Controle de Infecções/estatística & dados numéricos , Masculino , México/epidemiologia , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/estatística & dados numéricos , Peritonite/epidemiologia , Infecções por Pseudomonas/epidemiologia , Infecções por Pseudomonas/prevenção & controle , Infecções por Serratia/epidemiologia , Infecções por Serratia/prevenção & controle , Higiene da Pele/métodos , Sabões , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/prevenção & controleRESUMO
INTRODUCTION: Alternating hemiplegia (AH) of childhood is a rare disease that gives rise to transient attacks of hemiplegia that may affect either side of the body indistinctly, or even both sides at the same time. Onset occurs before the age of 18 months and in some cases there are neonatal symptoms such as abnormal eye movements, especially nystagmus, and dystonic or tonic seizures. Attacks of hemiplegia, which disappear during sleep, begin before the age of one year. These symptoms can initially be taken for an epileptic disorder. CASE REPORTS: We describe the study of two male patients whose clinical symptoms appeared at the age of 6 months, with tonic seizures, upward deviation of gaze, without loss of consciousness, which occurred with a recurrence rate of between one and two attacks a week or several times a day. They were initially treated with antiepileptic drugs (AED), although the complementary tests, including electroencephalogram (EEG), computerised axial tomography (TAC), magnetic resonance (MR) scans and metabolic tests, were all normal. CONCLUSIONS: Since, to date, no specific test has been confirmed for the disease, diagnosis is essentially clinical and by exclusion. Treatment is symptomatic using flunarizine. In one of our cases, administration of a single 10 mg/day dose this drug at night lowered the frequency of the attacks of hemiplegia. The possibility of treating a patient who is a carrier of an AH with AED makes early knowledge and identification of this disease necessary in order to be able to improve the patient's prognosis.
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Epilepsia/diagnóstico , Hemiplegia/diagnóstico , Hemiplegia/tratamento farmacológico , Erros de Diagnóstico , Humanos , Lactente , MasculinoRESUMO
The effect of population density of Tetranychus urticae Koch on CO2 assimilation, transpiration and stomatal behaviour in rose leaves and on the diameter and length of stems and flower buds was investigated under greenhouse conditions. The investigation was performed in order to gain more insight into integrated control systems in rose crops grown under greenhouse conditions. Physiological processes, such as photosynthesis and transpiration, as well as stomatal behaviour and chlorophyll content, were studied as they form part of the plant's nutrition mechanism and therefore affect the quantity and quality of the flowers. Information related to the effect of spider mite population density on bloom quality, diameter and length of stems and flower buds was also collected. The data indicate that increased mite density coincides with a decrease in the net photosynthetic rate, transpiration and chlorophyll content. Higher mite densities on leaves cause stomata to remain open for longer periods, which allows a greater loss of water. Spider mite densities of 10 and 50 mites per leaf cause a reduction in flower stem length of 17 and 26%, respectively, as compared to plants with no mites present.
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Dióxido de Carbono/metabolismo , Folhas de Planta/metabolismo , Folhas de Planta/parasitologia , Rosa/metabolismo , Rosa/parasitologia , Tetranychidae/crescimento & desenvolvimento , Animais , Clorofila/metabolismo , Feminino , Fotossíntese/fisiologia , Transpiração Vegetal/fisiologiaRESUMO
INTRODUCTION: Organic acidurias have long been known to cause neurological problems, such as convulsions, stupor, coma, and psychomotor and mental retardation. The organic acidurias include propionic aciduria, methylmalonic aciduria (MMA), isovaleric acidemia, lactic acidemia and glutaric acidemia type I. However, the association of MMA with electrical activity of the brain characterised by a hypsarrhythmic pattern, refractory convulsions and psychomotor retardation is very rare. CASE REPORTS: Two patients, one male and one female, were seen to have psychomotor retardation, erratic attacks of myoclonic convulsions, hypsarrhythmic encephalographic pattern and an increase in the urinary excretion of methylmalonic acid, as shown by gas chromatography and mass spectrometry, all of which supported a diagnosis of MMA in both cases. In one patient, the brain MRI with gadolinium showed lesions compatible with brain atrophy. Protein restrictions, the administration of vitamin B12 and l carnitine re established the normal neurological state and reduced the urinary excretion of methylmalonic acid in one of them. CONCLUSIONS: To the best of our knowledge these are the first cases of MMA that have been seen accompanied by hypsarrhythmia. The rareness of this clinical presentation with the characteristics described above make us suspect that we are dealing with a new clinical syndrome.
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Ácido Metilmalônico/urina , Mioclonia/urina , Transtornos Psicomotores/urina , Espasmos Infantis/urina , Encéfalo/patologia , Pré-Escolar , Diagnóstico Diferencial , Eletroencefalografia , Feminino , Humanos , Lactente , Masculino , Mioclonia/fisiopatologia , Transtornos Psicomotores/fisiopatologia , Espasmos Infantis/fisiopatologiaRESUMO
El propósito de este estudio fue el de establecer una clasificación de huellas labiales en una muestra en la ciudad de Bogotá (Colombia), y compararlo con los resultados que se han encontrado en otros países con el fin de verificar diferencias o similitudes basadas en la clasificación de Renaud (1972) para determinar su aplicabilidad como método de identificación. Se tomaron 260 marcas de labios en hombres y mujeres entre 18 y 60 años de edad en diferentes zonas de Santafé de Bogotá. La muestra fue recogida por medio de una impresión de la huella labial desplazando un formato de cartulina entre los labios, posteriormente se hizo el revelado de la misma y quedando evidente el queilograma para realizar el análisis encontrando que en hombres y mujeres todos los queilogramas son diferentes, siendo la letra C la que se encuentra con mayor frecuencia y observando un nuevo tipo de surco labial al cual se le denominó K demostrando de ésta forma que puede servir como un método adicional, para la identificación de individuos en Colombia.
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Odontologia LegalRESUMO
Se presenta el primer caso de miopatía hipertiroidea en autopsia en el Hospital General de México. Se trata de un hombre de 33 años con enfermedad de Graves-Basedow, quien 30 días antes de su muerte presentó debilidad muscular importante de miembros pélvicos y torácicos, además de disfagia y disfonía. Murió con datos de insuficiencia respiratoria. En los exámenes de laboratorio presentó hipopotasemia. En la autopsia se encontró adelgazamiento, exoftalmos leve, bocio hiperplásico difuso, así como atrofia, infiltración grasa y vacuolación focal en los músculos. Las miopatías relacionadas con hipo e hiperfunción tiroidea son poco frecuentes y recuerdan otras alteraciones musculares primarias y secundarias
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Humanos , Masculino , Adulto , Doença de Graves/complicações , Doença de Graves/patologia , Hiperplasia/patologia , Miastenia Gravis/etiologia , Miastenia Gravis/mortalidadeRESUMO
BACKGROUND: The most widely used treatment of portal-systemic encephalopathy (PSE) is the administration of oral, non-absorbable disaccharides. Theoretically, the inhibition of intestinal disaccharidases should induce malabsorption of disaccharides and increase delivery of undigested carbohydrates to the colon, thus stimulating the effects of lactulose and other non-absorbable disaccharides (that is, lactitol and lactose). AO-128 is an N-substituted derivative of valeolamine, an aminocyclitol that selectively inhibits intestinal disaccharidases. This study was performed to investigate whether AO-128 could be used as adjuvant therapy for the treatment of mild PSE in cirrhotic patients. METHODS: A double-blind, randomized, controlled trial was performed in 35 cirrhotic patients with PSE. Patients were given a 2-week treatment consisting of AO-128 (2 mg three times daily) or an identical placebo. The following features of PSE syndrome were assessed in a semiquantitative fashion before and after I and 2 weeks of therapy: mental state, asterixis, number connection test (NCT), venous blood ammonia concentration, electroencephalogram (EEG), and overall PSE index (PSEI). More patients receiving AO-128 than patients receiving placebo showed >40% improvement in the PSEI (83% versus 35%; P < 0.05). The mean stool pH decreased from 5.8+/-0.3 to 5.5+/-0.3 (P < 0.004) after AO-128 treatment, whereas no changes were observed in the placebo group. The EEG and nitrogen balance did not show significant changes in any of the two groups. A significant improvement was seen in the NCT performance after AO-128 (from grade 2.0+/-1.04 to grade 1.25+/-0.87; P < 0.05). Seven patients treated with AO-128 developed diarrhea, as compared with none in the placebo group (P < 0.05). CONCLUSION: These results suggest that AO-128 may be useful in the treatment of PSE, although further studies are required to establish the benefit of AO-128 and determine adequate individual doses.
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Cicloexanóis/uso terapêutico , Dissacaridases/antagonistas & inibidores , Dissacarídeos/farmacocinética , Inibidores Enzimáticos/uso terapêutico , Encefalopatia Hepática/tratamento farmacológico , Cicloexanóis/efeitos adversos , Dissacarídeos/uso terapêutico , Método Duplo-Cego , Inibidores Enzimáticos/efeitos adversos , Feminino , Encefalopatia Hepática/diagnóstico , Humanos , Absorção Intestinal/efeitos dos fármacos , Masculino , Pessoa de Meia-IdadeRESUMO
En este trabajo presentamos nuestra experiencia en el manejo de pacientes con toxidad hepática en un período de 4 años en dos instituciones de Santafé de Bogotá. Presentamos dos grupos de pacientes, uno toxicidad hepática aguda y el otro crónica, su forma de presentación, evolución y morbimortalidad asociadas. Encontramos que la toxicidad hepática por fármacos y otros hepatotóxicos, algunos no identificados, continúa siendo una causa importante y poco diagnosticada de consulta y hospitalización
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Humanos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Cirrose Hepática/etiologia , Hepatite/complicações , Hepatite/etiologiaRESUMO
According to epidemiological studies, gallstone disease is a very common disease in Mexican-Americans and Mexicans. However, the major risk factors for cholelithiasis in Mexicans have not been identified. We designed a case-control study in a group of Mexican subjects with and without gallstone disease confirmed by ultrasound. These subjects were prospectively studied over a three-year period. Clinical and epidemiological data were collected by means of a questionnaire. A total of 1500 subjects were included in this study: 1000 with and 500 without gallstone disease. The major risk factor in both men and women was body mass index [odds ratio (OR) 1.64 and 1.96, respectively; P < 0.008 and 0.001]. In addition, parity was an important factor in women (OR 2.17, P < 0.001), whereas age was associated with gallstone disease in men (OR 1.43, P < 0.001). We found that body mass index, parity, and age were the principal risk factors for gallstone disease in this group of Mexican subjects. These results are similar to those found in Mexican-American populations.
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Colelitíase/etnologia , Adulto , Fatores Etários , Idoso , Índice de Massa Corporal , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Americanos Mexicanos , México/epidemiologia , Pessoa de Meia-Idade , Paridade , Fatores de RiscoRESUMO
Se realizo un estudio prospectivo, abierto, para comparar la seguridad y eficacia de los tratamientos analgésicos de Butorfanol por vía intranasal (n=52) y Buprenorfina sublingual (n=48) en el manejo del dolor postoperatorio por un período de 72 horas. Se incluyeron en el estudio a pacientes hombres y mujeres de 18 a 60 años. El dolor se evaluó con escalas analógica visual y verbal, además se investigaron la escala de mejoría, los signos vitales, saturación de oxígeno por oximetria de pulso y la incidencia de eventos adversos. Ambos grupos tuvieron disminuciones importantes en las puntuaciones del dolor y tuvieron evoluciones similares. La puntuación en la escala de mejoría se incremento en los dos grupos y también tuvo un desarrollo similar. La presión diastólica fue menor en el grupo de Butorfanol a lo largo del estudio mientras que el resto de los signos vitales fue similar en ambos grupos. Los pacientes en el grupo de Butorfanol tuvo mayores niveles de saturación de oxígeno a lo largo del estudio. Un mayor porcentaje de pacientes en el grupo de Butorfanol tuvo sedación a lo largo del estudio y el resto de los eventos adversos fue parecido en ambos grupos. Se concluye que butorfanol por vía intranasal es una buena opción para el tratamiento del dolor postoperatorio
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológico , Buprenorfina/administração & dosagem , Buprenorfina/farmacologia , Butorfanol/administração & dosagem , Butorfanol/farmacologia , Analgesia , Administração Oral , Administração por InalaçãoRESUMO
La hepatitis viral por virus C (HVC) constituye un serio problema de salud en el mundo dada su frecuente tendencia a la cronicidad (80 por ciento) con prevalencia serológicas de 0,5 a 5 por ciento. Con el fin de establecer la trascendencia de un resultado serológico positivo se estudia dos grupos de pacientes: Grupo 1 corresponde a seis pacientes adultos asintomáticos detectados en un estudio de prevalencia en donantes (0,56 en una muestra de 5.000 individuos) mediante la utilización de una prueba de ELISA II disponible comercialmente. Grupo 2 constituido por seis pacientes con diagnósticos establecido de hepatitis crónica con serología reactiva para HCV mediante la misma técnica de ELISA II y con aminotransferasas elevadas por más de seis meses. Todos los pacientes fueron sometidos a estudio que incluyó biopsia hepática guiada por laparoscopia, pruebas confirmatorias para HCV (RIBA III y bDNA Quantiplex, Chiron Corporation, Emeryville, CA), seguimiento clínico y enzimático mensual por un período de un año. Resultados: Grupo 1: Los 6 pacientes permanecieron sin alteraciones de las aminotransferasas y estuvieron asintomáticos durante el período de seguimiento. Cinco no tenía factores de riesgo conocidos para infección por virus hepatitis c (VHC), y fueron negativos a las pruebas confirmatorias además de presentar estudio histológico hepático normal...