Anfotericina B Liposomal, Tratamiento Pediátrico en Leishmaniasis Cutánea con Falla Terapéutica

Resumen La leishmaniasis cutánea en Bolivia, es menos frecuente en niños. Su presencia probablemente responde a la domesticación del vector en áreas de asentamientos humanos. La anfotericina B, está indicada para el tratamiento de la leishmaniasis en adultos, sin respuesta a los antimoniales pentavalentes o sin una cura clínica de las úlceras. Esta serie de casos, tiene por objetivo compartir experiencias del empleo de anfotericina B liposomal en pacientes pediátricos con leishmaniasis cutánea y falla terapéutica a los antimoniales. Seis pacientes con estas características ingresados al servicio de Infectología del Hospital Pediátrico Manuel Asencio Villarroel, recibieron Anfotericina B liposomal 2 a 3 mg/Kg peso día, en un periodo promedio de 18 días. Se observó remisión progresiva de las úlceras durante el tratamiento y cicatrización completa a los tres meses post tratamiento. Ninguno presentó efectos adversos y las pruebas bioquímicas renales y hepáticas, se encontraban dentro de valores normales.

Abstract The cutaneous leishmaniasis in Bolivia is less frequent in children. Its presence probably responds to the domestication of the vector in areas of human settlements. Amphotericin B is indicated for the treatment of leishmaniasis in adults, without response to pentavalent antimonials or without a clinical cure for ulcers. The objective of this series of cases is to share experiences of the use of liposomal amphotericin B in paediatric patients with cutaneous leishmaniasis and therapeutic failure of antimonials. Six patients with these characteristics admitted to the Infectology service of the Manuel Asencio Villarroel paediatric hospital, received liposomal Amphotericin B, 2 to 3 mg / kg weight day, in a mean period of 18 days. Progressive remission of the ulcers was observed during treatment and complete healing at three months of post-treatment. None had adverse effects, and the kidney and liver biochemical tests were within normal values.

Antecedentes de adherencia a tratamiento en pacientes hipertensos de un centro de salud chileno / History of adherence to treatment in hypertensive patients of a chilean health center / Antecedentes de aderência a tratamento em pacientes hipertensos dum centro de saúde chileno

Objetivo: Esta investigación se propuso analizar el rol predictor de variables sociodemográ cas, antecedentes de salud, autoe cacia y estrés en la adherencia a tratamiento de pacientes con hipertensión arterial de un centro de salud de atención primaria chileno. Materiales y Método: Estudio de abordaje cuantitativo de tipo correlacional realizado desde marzo a agosto del 2017. La muestra estuvo constituida por 141 pacientes hipertensos, seleccionada de forma aleatoria e intencionada. Se crearon instrumentos para recoger información sociodemográ ca y antecedentes de salud, y se utilizaron las escalas Cuestionario de Conductas de Salud de Miller, SEMCD-S del Stanford Patient Education Research Center y subescala de estrés del DASS-21 de Lovibond y Lovibond para medir adherencia, autoe cacia y estrés respectivamente. Para el análisis de datos se utilizaron medidas de tendencia central y dispersión, comparación entre grupos, análisis de correlación y regresión lineal múltiple con apoyo de los programas SPSS versión 21 y R. Resultados: La adherencia total se relacionó de manera débil pero signi cativa con autoe cacia (r=, 224) y de manera negativa con estrés (r=-,170*). La edad, el no consumo de cigarrillos y el conocimiento de que la enfermedad es una condición crónica resultaron ser predictoras de adherencia al tratamiento. Conclusión: Los resultados refuerzan la importancia de variables personales como predictoras de conductas de salud y el rol de la información y educación en la adherencia al tratamiento de personas con hipertensión. Se exploran las implicancias prácticas de estos hallazgos para el funcionamiento del programa cardiovascular.

Objective: This research aimed to analyze the predictive role of sociodemographic and health variables, self-ef cacy and stress in adherence to the treatment of patients with hypertension of a cardiovascular program at a Chilean primary care health center. Materials and Methods: A quantitative correlational study carried out from March to August 2017. The sample consisted of 141 hypertensive patients selected randomly and intentionally. The instruments to collect sociodemographic information and health antecedents were developed, and the Miller Health Behavior Questionnaire, SEMCD-S from the Stanford Patient Education Research Center and Lovibond and Lovibond DASS-21 stress subscale were applied to measure adherence, self-ef cacy and stress respectively. For data analysis, measures of central tendency and dispersion, comparison between groups, correlation analysis and multiple linear regression were used with the support of the SPSS software version 21 and R. Results: Total adherence was weakly though signi cantly related to self-ef cacy (r =, 224) and negatively related to stress (r = -, 170). Age, non- consumption of cigarettes and knowledge that the disease is a chronic condition turned out to be predictors of adherence to treatment. Conclusion: The results reinforce the importance of personal variables as predictors of health behaviors and the role of information and education in adherence to the treatment of people with hypertension. The practical implications of these ndings for the functioning of the cardiovascular program are explored.

Objetivo: Esta pesquisa se propôs analisar o rol preditor de variáveis sociodemográ cas, antecedentes de saúde, autoe cácia e estresse na aderência ao tratamento de pacientes com hipertensão arterial dum centro de saúde de atenção primária chileno. Materiais e Métodos: Estudo de abordagem quantitativo de tipo correlacional realizado desde março a agosto de 2017. Amostra Esteve constituída por 141 pacientes hipertensos, selecionada de forma aleatória e intencionada. Criaram se instrumentos para recolher informação sociodemográ cas e antecedentes de saúde, e se utilizaram as escalas Questionário de Condutas de Saúde de Miller, SEMCD-S do Stanford Patient Education Research Center e subescala de estresse do DASS-21 de Lovibond e Lovibond para medir aderência, auto- e cácia e estresse respectivamente. Para o analise de dados se utilizaram medidas de tendência central e dispersão, comparação entre grupos, analise de correlação e regressão lineal múltiple com apoio dos programas SPSS versão 21 e R. Resultados: A aderência total se relacionou de maneira fraca, mas signi cativa com auto- e cácia (r=, 224) e de maneira negativa com estresse (r=-,170*). A idade, no consumo de cigarros e o conhecimento do que a doença é uma condição crônica resultaram ser antecedentes de aderência ao tratamento. Conclusão: Os resultados reforçam a importância de variáveis pessoais como antecedentes de condutas de saúde e o rol da informação e educação na aderência ao tratamento de pessoas com hipertensão. Exploram-se as implicâncias práticas destes descobrimentos para o funcionamento do programa cardiovascular.

Cochlear Implants in Patients with Large Vestibular Aqueduct Syndrome / 听力学及言语疾病杂志

Objective To study the feasibility of the cochlear implantation and effects in the treatment of large vestibular aqueduct syndrome.Methods A total of 37 patients(74 ears)diagnosed with large vestibular aque-duct syndrome received cochlear implants since 2002 at the Renmin Hospital of Wuhan University.We made a retro-spectively analysis of these 37 patients(37 ears).While 37 patients(37 ears)with normal cochlear structures were considered as the control group.After activation,their speech perception at pre-operation and at 3,6,9,12 months affer the operation were evaluated.Their CAP and SIR scores were collected through questionnaires at each assess-ment interva1 .Results In LVAS group,5 patients(5 ears)had serious gusher,while no gusher was abserved in the control group.The two groups of the electrodes were all inserted in the cochlea.No serious complications occurred after implantation in the two groups.The impedance of the electrodes,the T level,C level and the hearing thresholds were similar with the normal group with cochlear implantations.The results had no significant differences when compared with the normal cochlear group (P>0.05).The speech perception ability,CAP and SIR scores were im-proved along with the increase time of implant use.At the same recovery time,the results had no significant differ-ence in the two groups(P>0.05).At the same group,the results between pre-operation and 3,6,9,12 months post-operation after device activation had significant differences (P<0.05).Conclusion Cochlear implants could be performed safely in patients with large vestibular aqueduct syndrome.The primary outcomes for patients with large vestibular aqueduct syndrome were similar to those with normal cochlear structure following the cochlear im-plantation.

Clinical effect of entecavir versus tenofovir in treatment of HBeAg-positive chronic hepatitis B patients with a high viral load: a comparative analysis / 中华肝脏病杂志

Objective@#To investigate the clinical effect and safety of entecavir (ETV) versus tenofovir disoproxil fumarate (TDF) in the treatment of previously untreated HBeAg-positive chronic hepatitis B (CHB) patients with a high viral load.@*Methods@#A retrospective analysis was performed for the clinical data of 152 HBeAg-positive CHB patients with a high viral load (HBV DNA≥106 IU/ml) who were firstly treated with ETV (ETV group) or TDF (TDF group), with 76 patients in each group. The serum levels of alanine aminotransferase (ALT), HBV DNA, HBeAg, anti-HBe, creatinine, and creatine kinase were measured at baseline, and the patients were followed up and evaluated at weeks 4, 12, 24, 36, 48, 60, 72, 84, and 96 of treatment. The Kaplan-Meier survival curves were used to analyze cumulative complete virologic response, HBeAg seroconversion, and ALT normalization rate. The Cox proportional hazards regression model was used to identify the influencing factors for virologic response. P < 0.05 was considered statistically significant.@*Results@#There were no significant differences in ALT normalization rate between the ETV group and the TDF group at weeks 4, 12, 24, 48, 72, and 96 of treatment (18.1%/55.6%/83.3%/90.3%/93.1%/97.2% vs 16.0%/53.6%/75.4%/94.2%/100%/100%, P > 0.05). There were also no significant differences in virologic response rate between the ETV group and the TDF group at weeks 48 and 96 of treatment (89.5%/97.3% vs 93.4%/98.7%, P > 0.05). The multivariate analysis showed that the baseline parameters were not predictive factors for virologic response. At week 48 of treatment, the TDF group had a significantly higher HBeAg seroconversion rate than the ETV group (14.5% vs 3.9%, P = 0.048); at week 96 of treatment, there was no significant difference in HBeAg seroconversion rate between the two groups (15.8% vs 7.9%, P = 0.132). The Kaplan-Meier survival analysis showed that there were no significant differences between the two groups in cumulative ALT normalization rate, cumulative HBV DNA undetectable rate, and cumulative seroconversion rate. Only one patient in the ETV group experienced virologic breakthrough from weeks 60 to 72 of treatment, and there were no serious adverse reactions.@*Conclusion@#TDF and ETV had similar clinical effects, HBeAg seroconversion rate, and safety in previously untreated HBeAg-positive CHB patients with a high viral load.

¿A qué llamar eficacia analítica?: Contribuciones a partir del estudio de casos / What is psychoanalytic efficacy?: Contributions from case studies

El siguiente trabajo presenta los principales lineamientos de investigación sobre la eficacia analítica a partir del estudio de casos, pertenecientes al proyecto de investigación homónimo aprobado por UBACyT para el período 2011-2014. El mismo se propone contribuir a esclarecer a qué llamar eficacia en psicoanálisis. Además, se intenta explorar en los casos la eficacia del trabajo analítico en la producción de cambios en la posición del sujeto y en sus respuestas frente al trauma. Por último, se busca dar lugar a que la lógica de cada caso nos enseñe sobre las modalidades que toma la eficacia del trabajo analítico. Como hipótesis se maneja que la eficacia es consecuencia de un trabajo analítico que da lugar a efectos en la posición del sujeto y en sus respuestas frente al trauma; y que la eficacia del trabajo analítico no tiene modelo y puede extraerse de la lógica propia de cada caso.

The purpose of this paper is to present the main lines of research on analytical efficacy from case studies, belonging to the homonym research project UBACyT approved for the period 2011-2014.This project has as objective to help clarify what to call effectiveness in psychoanalysis. In turn, it attempts to explore in cases the effectiveness of analytical work in producing changes in the subject position and his responses to trauma. Finally, it seeks to allow the logic of each case teach us about the modalities that takes the analytical work eficiency. The hypothesis taken is that the analytical eficacy is results from analytical work, resulting effects on the position of the subject and in his responses to the encounter with trauma; and that the effectiveness of the analytical work has no model and only can be extracted from the logic of each case.