Comparison of cefepime versus ceftriaxone-amikacin as empirical regimens for the treatment of febrile neutropenia in acute leukemia patients.

BACKGROUND: High-intensity regimes of chemotherapy have led to longer and more severe episodes of neutropenia with a resulting increase in morbidity and mortality due to infections. Which empiric antibiotic regimen to use in these cases is still under debate. METHODS: We performed a randomized comparative study to evaluate the efficacy of cefepime versus ceftriaxone plus amikacin as the initial treatment in an escalating, empirical, antibiotic therapy regimen in febrile neutropenic patients. Both adults and children were included. All patients had less than 500 neutrophils/microl at the time of infection. Patients were randomized to receive either cefepime or ceftriaxone plus amikacin. If infection continued 72 h later, patients in both groups received vancomycin, and if infection had not disappeared 7 days after starting antibiotics, amphotericin B was started. RESULTS: Twenty patients were included in each group. Both treatment and control groups were comparable for age and sex, among other factors. There were 18 cures in the cefepime group and 17 in the ceftriaxone plus amikacin group (p = 0.9). No patient discontinued therapy because of toxicity. CONCLUSIONS: Cefepime is a safe and very effective therapy for patients with acute leukemia and febrile neutropenia; in addition, it is a cheaper regimen in our country, and lacks the potential toxicity of the aminoglycosides.

Gender differences in medical presentation and detection of patients with a history of alcohol abuse or dependence.

Women and men with alcohol use disorders differ in many respects. A retrospective medical record review of 132 patients was performed to determine outpatient clinic utilization, presentation patterns and physician actions related to patient gender and lifetime DIS-status. Women, irrespective of DIS-status, utilized out-patient health care services more often than did DIS-positive or negative men. Of 16 specific alcohol-related complaints, gender differences were only detected for trauma. DIS-positive men were more likely to have had an alcohol history taken during the preceding 12 months than were DIS-positive women. Sedatives/minor tranquilizers were most often prescribed to DIS-positive women. This study supports the need in primary care settings for more screening to detect and diagnose alcohol-abusing patients, particularly women. Physicians should routinely screen for alcohol abuse before prescribing sedatives or minor tranquilizers.

[A psychosocial analysis of community experiences of health education]. / Análisis psicosocial de experiencias comunitarias de educación en salud.

Four experiences in health education in communities located in the state of Lara in Venezuela were analyzed from a sociopsychological perspective. Under a qualitative approach, the information was obtained from three sources: documentary analysis of didactic material; participant observation in workshops, and interviews to leaders and participants.

La lepra en Santa Cruz de Tenerife: estudio de 25 años de su endemia 1960-1985

Se estudia la endemia hanseniana en la provincia de Santa Cruz de Tenerife, con cifras parciales cada 5 años. Analizamos los datos de enfermos activos en control, fallecidos, nuevos casos por año, índices de prevalencia e incidencia así como las formas clínicas. Después de 25 años, los índices de prevalencia han disminuido en un 50 por ciento. Todavia seguimos observado casos nuevos, en número de 4 a 6 por año, con una incidencia actual del 0'004 X 1.000.