Síndrome nefrótico secundario a sífilis

El síndrome nefrótico se caracteriza por proteinuria importante, hipoalbuminemia, edema generalizado e hiperlipidemia. Según su etiología se clasifica en primario y secundario, siendo este último raramente encontrado en pediatría, cuyas causas pueden ser múltiples como enfermedades sistémicas, fármacos, neoplasias o enfermedades infecciosas. Se presenta el caso clínico de una adolescente femenina con síndrome nefrótico secundario a sífilis, quien recibió manejo antibiótico apropiado con resolución del cuadro clínico. (provisto por Infomedic International)

Nephrotic syndrome is characterized by significant proteinuria, hypoalbuminemia, generalized edema, and hyperlipidemia. According to its etiology, it is classified as primary and secondary, the latter being rarely found in pediatrics, whose causes can be multiple such as systemic diseases, drugs, neoplasms, or infectious diseases. A clinical case is presented of a female adolescent with nephrotic syndrome secondary to syphilis, who received appropriate antibiotic management with resolution of the clinical condition. (provided by Infomedic International)

Biodistribution and pharmacokinetics of uniform magnetite nanoparticles chemically modified with polyethylene glycol.

The influence of polyethylene glycol (PEG) grafting on the pharmacokinetics, biodistribution and elimination of iron oxide nanoparticles is studied in this work. Magnetite nanoparticles (12 nm) were obtained via thermal decomposition of an iron coordination complex as a precursor. Particles were coated with meso-2,3-dimercaptosuccinic acid (DMSA) and conjugated to PEG-derived molecules by 1-ethyl-3-[3-dimethylaminopropyl]carbodiimide (EDC) chemistry. Using a rat model, we explored the nanoparticle biodistribution pattern in blood and in different organs (liver, spleen and lungs) after intravenous administration of the product. The time of residence in blood was measured from the evolution of water proton relaxivities with time and Fe analysis in blood samples. The results showed that the residence time was doubled for PEG coated nanoparticles and consequently particle accumulation in liver and spleen was reduced. Post-mortem histological analyses showed no alterations in the liver and confirm heterogeneous distribution of NPs in the organ, in agreement with magnetic measurements and iron analysis. Finally, by successive magnetic resonance images we studied the evolution of contrast in the liver and measured the absorption, time of residence and excretion of nanoparticles in the liver during a one month period. On the basis of these results we propose different metabolic routes that determine the fate of magnetic nanoparticles.

Manejo odontológico del paciente con cardiopatías congénitas / Dental management of patients with congenital heart defects

El propósito de este artículo es brindar al odontólogo una explicación sencilla sobre la clasificación y fisiopatología de las cardiopatías congénitas más comúnes con el fin de que éste pueda interactuar con el cardiólogo al momento de realizar una interconsulta. Además revisar los protocolos de tratamiento actuales sobre el manejo odontológico de los pacientes que presentan estas patologías.

Atrofia cortical en pacientes con anemia de células falciformes. Estudio por imágenesde resonancia magnética / Cortical atrophy in patients with stickle cell anemia. Magnetic resonance imaging studies

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[Seroprevalence of viral hepatitis A in France in homosexuals and intravenous drug users]. / Séroprévalence de l'hépatite virale A en France métropolitaine chez les homosexuels et les toxicomanes intraveineux.

OBJECTIVES: In industrialized countries with a high level of sanitation, immunity against hepatitis A (HVA) is not acquired during childhood, and infection typically occurs in adults, mainly in travelers returning from developing countries where infection is endemic. However, the introduction of hepatitis A virus (HAV) among certain population groups, such as intravenous drug users (IVDU) or homosexual men, leads to a significant increase in the disease. We conducted a retrospective analysis of seroprevalence of anti-HAV antibodies. METHODS: The study group included 296 patients (174 homosexual men and 122 IVDU) for comparison with 76 control subjects (nurses in pediatric wards and workers in hospital kitchen). RESULTS: We found a significantly higher anti-HAV seroprevalence among less than 35-year old IVDU, HIV positive or negative, in comparison with control subjects but not among homosexual men, whatever their HIV status. CONCLUSION: Our experience illustrates that HVA is a health risk for IVDU in industrialized nations, and given its morbidity among adults population, IVDU should receive HVA vaccine.

Solid-phase enzyme-linked immunosorbent assay for hepatitis E virus IgG and IgM antibodies utilizing recombinant antigens and synthetic peptides.

Four recombinant antigens representing two distinct antigenic domains from two different strains of hepatitis E virus (HEV), were used individually to develop four ELISAs designed to detect antibodies to HEV. Both IgG and IgM class antibodies to HEV were detected in 7 of 8 pedigreed serum/plasma from known outbreaks of HEV in Mexico, Burma, Somalia and Pakistan. In addition, specific HEV-antibodies were detected in cynomolgus macaques following inoculation with various HEV strains. Anti-HEV was also detected in 8 of 386 (2.1%) randomly selected American blood donors. Supplemental tests utilizing both synthetic peptides and specific blocking assays provided additional serologic data confirming the presence of anti-HEV. Similar prevalence studies on a limited number of available sera from other geographical regions (Alaska, Japan, Germany, New Zealand, Thailand and Mexico) confirmed the presence of anti-HEV in at least 1.1 to 7.6% of the specimens.

Cardiovascular changes in infants with beta-hemolytic streptococcus sepsis.

Sequential hemodynamic and biochemical changes were studied in 24 infants with sepsis due to beta-hemolytic streptococcus to define the temporal patterns of physiologic events and to compare them in surviving (n = 11) and nonsurviving (n = 13) infants. Septicemia was documented by positive blood culture in all. Biophysical and biochemical measurements were obtained before and hourly, for 11 h after antibiotic therapy was initiated. Surviving infants had significantly higher Hct and systolic and mean arterial pressures than nonsurvivors. In nonsurvivors, low BP was associated with a concomitant rise in CVP and severe metabolic acidosis refractory to therapy. Although there were no differences in PaO2 or PaCO2 between survivors and nonsurvivors, arterial-alveolar oxygen gradients were significantly greater in nonsurviving infants. These data show cardiorespiratory and metabolic alterations that differentiate surviving and nonsurviving infants with beta-hemolytic streptococcal septicemia.

Hepatitis B-like infection in a Pacific white-sided dolphin (Lagenorhynchus obliquidens).

A Pacific white-sided dolphin (Lagenorhynchus obliquidens) developed clinical signs, serum biochemical values, and serologic viral markers consistent with chronic persistent hepatitis caused by a hepatitis B-like virus. The hepatitis had a sporadic cyclical pattern of lethargy, inappetance, and icterus, with leukocytosis and increased serum activities of alanine transaminase, aspartate transaminase, and gamma-glutamyltransferase. The serum from this dolphin contained hepatitis B virus core antibodies, hepatitis B surface antibodies, and hepatitis B viral DNA. Supportive treatment consisted of administration of antibiotics, cimetidine, menadiol sodium diphosphate, and vitamin/dextrose supplementation. A clinically normal killer whale (Orcinus orca) housed in the same pool had serum hepatitis B surface antibodies, suggesting immunologic responsiveness and that this disease was not species-specific.

Quantitation of hepatitis B viral DNA by solution hybridization: comparison with DNA polymerase and hepatitis B e antigen during antiviral therapy.

Serological markers of hepatitis B virus (HBV) replication were assessed in a randomized, controlled trial of prednisone withdrawal followed by alpha-interferon in the treatment of chronic hepatitis B. HBV DNA levels in more than 700 serial serum samples from 41 patients were determined by a sensitive and quantitative solution hybridization assay. Results were compared with HBV DNA polymerase (DNAp) activity and hepatitis B e antigen (HBeAg) in 21 untreated controls and 20 treated patients. Among treated patients, the mean pretherapy HBV DNA values were higher in nonresponders than in responders. During prednisone treatment, DNA levels increased an average of 2.1-fold in responders and 1.4-fold in nonresponders. During the 2-week rest interval between prednisone and interferon, DNA values fell an average of 57% in responders. In contrast, the mean DNA values in nonresponders did not change during the same interval. This early distinction between responders and nonresponders was not apparent from DNAp or HBeAg results. During interferon treatment, HBV DNA became undetectable in responders and remained negative during a 1-year follow-up. DNA in nonresponders declined to 14% of baseline during interferon treatment but increased to pretherapy levels after treatment. DNAp values generally paralleled HBV DNA values, but DNAp activity showed more variability and lower sensitivity than did the hybridization assay results. HBeAg values varied independently of HBV DNA and DNAp with a much delayed decline in responders. These results indicate that HBV DNA, when measured quantitatively by a sensitive solution hybridization assay, is an early predictor of the effects of antiviral agents on replication.