Sweet's syndrome with pulmonary involvement: Case report and literature review.

A 74 year old female presented with fever, associated with papules and plaque in her upper and lower extremities. Exams revealed blood leukocytosis and a positive urine culture. Antibiotic therapy was initiated with no clinical response. After 1 week, chest X-ray showed right upper lobe alveolar infiltrate. A skin biopsy of the lesion showed infiltration by neutrophils, consistent with Sweet's Syndrome. Patient's condition progressively worsened, requiring oxygentherapy. Bronchoscopy and bronchoalveolar lavage were normal, transbronchial biopsies suggested lung involvement of Sweet 's syndrome. Antibiotic therapy was stopped. Corticosteroid were started. Therapy resulted in rapid clinical and radiological improvement.

Chronic diseases: what are they? How are they inherited?

BACKGROUND: Chronic diseases (CD), miasms or reactional modes, remain one of the darkest concepts of homeopathy. They are supposed to be heritable and originate after suppression of other diseases. Besides this nothing is known about how they might produce the large number of diseases mentioned in homeopathic books. They have been described in a variety of terms, ranging from Kent and Gathak's spiritual or metaphysic conception; the biological-allergic by Paschero, and, Robert's materialist-nutritional point of view. Flores-Bejar et al have outlined an approach to CD from a cellular and bioenergetic point of view. RESULTS: Cellular pathology has led to an understanding of the basic repair mechanisms of every cell and tissue. These mechanisms exist in order to avoid necrosis or cell death. The main mechanisms are molecular repair, apoptosis and cell proliferation. Failure of these mechanisms leads to 'dysrepair'. Consequences of these 'dysrepair' mechanisms resemble the homeopathic reactional modes or miasms. These abnormal or 'dysrepair' mechanisms are probably the basis of miasms or reactional modes. A new interpretation of miasms is proposed: Psora corresponds to the dysmolecular reactional mode. Syphilis corresponds to dysapoptotic reactional mode. Sycosis corresponds to dysproliferative reactional mode.

Chronic diseases: what are they? How are they inherited?

Chronic diseases(CD), miasms o reactional modes, remain one of the darkest concepts of homeopathy. They are supposed to be heritable and orignate after suppression of other diseases. Bisedes this nothing is known about how they might produce the large number of diseases mentioned in homeopathic books. They have been described in a variety of terms, ranging from Kent and Gathak's ... (AU)

Validation of a prognostic index in the critically ill newborn.

OBJECTIVE: Elaborate and assess the degree of validity of a prognostic model for evaluating patients admitted to the Neonatal Intensive Care Unit (NICU). DESIGN: Cases and controls nested in a cohort. SETTING: NICU of two tertiary hospitals and another second level hospital. PATIENTS: The study was carried out in two phases. During the first phase (elaboration of a model), 336 newborns were studied; 112 belonged to the case group (dead patients) and 224 to the control group (live patients discharged). For the second phase (model validation), 300 patients were included that did not participate in the first phase, 100 cases and 200 controls. MEASUREMENTS: For each patient admitted to the study, clinical, paraclinical, perinatal and comorbidity factors were determined within the first 12 hours. Variables of statistical significance in the bivariate analysis were included in a logistic regression model with the objective of identifying a prognostic model. RESULTS: The variables that constituted the prognostic index were gestational age x birth weight, the paO2/FiO2 ratio x O2 saturation, arrest cardiac, major congenital malformations, septicemia and base excess. The model showed to have a sensitivity of 70% and a specificity of 91% during the elaboration cohort. In the validation cohort, sensitivity was 68% and specificity was 92%, a positive predictive value of 80%, negative predictive value of 85% and a correct classification rate was 84%. CONCLUSIONS: The Neonatal Mortality Prognostic Index (NMPI) developed in this study showed to be useful for the evaluation of hospital mortality for severely ill newborns admitted to NICU.

Comparison of systemic cytokine levels in patients with acute respiratory distress syndrome, severe pneumonia, and controls.

BACKGROUND: The inflammatory response has been widely investigated in patients with acute respiratory distress syndrome (ARDS) and pneumonia. Studies investigating the diagnostic values of serum cytokine levels have yielded conflicting results and only little information is available for the differential diagnosis between ARDS and pneumonia. METHODS: Clinical and physiological data, serum concentrations of tumour necrosis factor (TNF)-alpha, interleukin (IL)-1beta and IL-6, and quantitative cultures of lower respiratory tract specimens were obtained from 46 patients with ARDS and 20 with severe pneumonia within 24 hours of the onset of the disease and from 10 control subjects with no inflammatory lung disease. Cytokine concentrations were compared between groups and determinants in addition to the diagnosis were tested. RESULTS: Serum TNF-alpha levels were significantly higher in ARDS patients (67 (57) pg/ml) than in patients with severe pneumonia (35 (20) pg/ml; p = 0.031) or controls (17 (8) pg/ml; p = 0.007). For IL-1beta and IL-6 the observed differences were not statistically significant between patients with ARDS (IL-1beta: 34 (65) pg/ml; IL-6: 712 (1058) pg/ml), those with severe pneumonia (IL-1beta: 3 (4) pg/ml, p = 0.071; IL-6: 834 (1165) pg/ml, p = 1.0), and controls (IL-1beta: 6 (11) pg/ml, p = 0.359; IL-6: 94 (110) pg/ml, p = 0.262). TNF-alpha (standardised coefficient beta = 0.410, p<0.001) and IL-1beta (standardised coefficient beta = 0.311, p = 0.006) were most strongly associated with the degree of lung injury, even when the diagnostic group was included in the statistical model. CONCLUSIONS: Serum TNF-alpha levels were higher in patients with ARDS than in those with severe pneumonia or in control subjects. Multivariate results suggest that the levels of systemic TNF-alpha and IL-1beta reflect the severity of the lung injury rather than the diagnosis.

Clinical diagnosis of ventilator associated pneumonia revisited: comparative validation using immediate post-mortem lung biopsies.

BACKGROUND: A study was undertaken to assess the diagnostic value of different clinical criteria and the impact of microbiological testing on the accuracy of clinical diagnosis of suspected ventilator associated pneumonia (VAP). METHODS: Twenty five deceased mechanically ventilated patients were studied prospectively. Immediately after death, multiple bilateral lung biopsy specimens (16 specimens/patient) were obtained for histological examination and quantitative lung cultures. The presence of both histological pneumonia and positive lung cultures was used as a reference test. RESULTS: The presence of infiltrates on the chest radiograph and two of three clinical criteria (leucocytosis, purulent secretions, fever) had a sensitivity of 69% and a specificity of 75%; the corresponding numbers for the clinical pulmonary infection score (CPIS) were 77% and 42%. Non-invasive as well as invasive sampling techniques had comparable values. The combination of all techniques achieved a sensitivity of 85% and a specificity of 50%, and these values remained virtually unchanged despite the presence of previous treatment with antibiotics. When microbiological results were added to clinical criteria, adequate diagnoses originating from microbiological results which might have corrected false positive and false negative clinical judgements (n = 5) were countered by a similar proportion of inadequate diagnoses (n = 6). CONCLUSIONS: Clinical criteria had reasonable diagnostic values. CPIS was not superior to conventional clinical criteria. Non-invasive and invasive sampling techniques had diagnostic values comparable to clinical criteria. An algorithm guiding antibiotic treatment exclusively by microbiological results does not increase the overall diagnostic accuracy and carries the risk of undertreatment.

Bacterial colonization of distal airways in healthy subjects and chronic lung disease: a bronchoscopic study.

In contrast to the healthy population, distal airway bacterial colonization may occur in patients with chronic lung diseases, who often have altered pulmonary defences. However, the information dealing with this issue is insufficient and is based mainly on nonspecific samples, such as sputum cultures. Using quantitative cultures of bronchoscopic protected specimen brush (PSB) and bronchoalveolar lavage (BAL) samples, we studied the bacterial colonization of distal airways in 16 healthy subjects, 33 patients with bronchogenic carcinoma, 18 with chronic obstructive pulmonary disease (COPD), 17 with bronchiectasis, and 32 with a long-term tracheostomy due to laryngeal carcinoma. All patients were without exacerbation, and free from antibiotic treatment at least 1 month before the study protocol. Thresholds for quantitative cultures to define colonization were > or = 10(2) colony-forming units (cfu) x mL(-1) for PSB and > or = 10(3) cfu x mL(-1) for BAL. Only one healthy subject was colonized by a potential pathogenic microorganism (PPM) (Staphylococcus aureus 4x10(2) cfu x mL(-1) in a PSB culture). Colonization was observed in 14 (42%) bronchogenic carcinoma patients (19 non-PPMs, and 10 PPMs); in 15 (83%) COPD patients (22 non-PPMs and 7 PPMs); in 15 (88%) bronchiectasis patients (20 non-PPMs and 13 PPMs); and in 15 (47%) long-term tracheostomy patients (5 non-PPMs and 13 PPMs). The two most frequent non-PPMs isolated in all groups studied were Streptococcus viridans and Neisseria spp. Haemophilus spp., Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis were the most frequent PPMs isolated in bronchogenic carcinoma, COPD, bronchiectasis and long-term tracheostomized patients, respectively. Pseudomonas aeruginosa colonization was infrequent in all the groups. Our results show that distal airway bacterial colonization is a frequent feature in stable patients with chronic lung diseases and also in patients with long-term tracheostomy. However, the pattern of colonization differs among groups studied. The knowledge of different colonization patterns may be important for future antibiotic prophylactic strategies and for the empirical antibiotic regimens when exacerbations occur in these patients.

[Treatment of acute poisoning caused by carbamazepine, digoxin, and acetylsalicylic acid, with repeated doses of activated charcoal]. / El tratamiento de las intoxicaciones agudas causadas por carbamazepina, digoxina y ácido acetilsalicílico, mediante la administración de dosis repetidas de carbón activado.

Twelve pediatric patients with acute poisonings caused by carbamazepine, digoxin and acetylsalicylic acid were treated with multiple doses of activated charcoal combined with a saline cathartic (adsorption surface of activated charcoal nearly 950 m2/g). This procedure was effective to shorten the plasmatic levels of the drugs, besides the clinical improvement of the poisoned patients. The average initial and final levels of the drugs were: carbamazepine 21.64 and 0.9 micrograms/ml (lowering 95.81%, p < 0.05), digoxin 5.14 and 1.1 ng/ml (lowering 78.6%, P < 0.05) and acetylsalicylic acid 418.5 and 57.5 micrograms/ml, respectively, (lowering 86.3%, p < 0.05). These results suggest the usefulness of activated charcoal in the clearance of the four overdosed drugs.

[Liaison psychiatry at a neonatal intensive care unit. Interphase between psychiatry of the infant and neonatology]. / Psiquiatría de enlace en una unidad de cuidados intensivos neonatales. Interfase entre la psiquiatría del lactante y la neonatología.

A description is made of the situation of neonates and their families during hospitalization in the Neonatal Intensive Care Unit (NICU). Emphasis is made on the stressful situations faced by the infants, the families and the caregivers as well as on potential interventions to ameliorate their negative impact and to promote a favorable outcome. With the infants, the situation is one of overwhelming aversive stimulation, noncontingent responses and painful procedures, coupled with deprivation of normative experiences, propiciated by their illness and the structure of the unit. With the families, their feelings of impotence, guilt, and separation from their infant are highlighted, and interventions are described that may help them in this situation of crisis. With the staff the intervention consists on education and sensitization to the infant's needs. The liaison psychiatrist is the infant's voices with the families and the staff. The literature is reviewed in terms of the potential effects of favorable stimulation and of the negative experiences of neonates while at the NICU.

[The transfusion of blood and its derivatives in the neonate]. / Transfusiones de sangre y sus derivados en el neonato.

Blood and its products are valuable therapeutic resources for the pediatrician who care for newborns with severe illnesses. The use of blood and its products requires for the hospital personnel working at neonatal care units to be precise and up to date on the indications and complications of total blood, the globular package, albumin, plasma, the concentration of granulocytes, platelets and immunoglobulins for intravenous use. This review gathers, on the one hand, accumulated experiences by the members of the Commission of Blood and its Products from the Pediatric Hospital of the National Medical Center and on the other hand, a selection of the more important concepts which have been judged so by the authors and expressed in the current medical literature.

[The antihypertensive response to prazosin, a selective vascular alpha blocker. A multicenter study]. / Respuesta antihipertensiv a al prazosin, un alfa bloqueador vascular selectivo. Estudio multicéntrico.

The efficacy and safety of oral prazosin was assessed in 108 ambulatory mild (91-104 mmHg diastolic pressure) to moderate (104-114 mmHg) essential hypertensive patients. After a 2 week no-drug control period, prazosin, 2, 4, 8 or 10 mg per day was given in 2 weeks periods as needed to obtain control of blood pressure. A seating diastolic pressure of < or = 90 mmHg was defined as adequate response. Satisfactory blood pressure response was obtained in 86% of patients, with doses of 4 mg or less in 70%. Treatment results were not related to initial blood pressure level, but obese patients were more resistant to drug effect (p < 0.05). Heart rate and laboratory parameters did not change. Adverse effects, mainly headache, dizziness and palpitations, were noticed in 46 patients (43%) and occurred with the lower dose in 78% of them. Adverse effects were slight or moderated and lasted from 1 day to 2 weeks in most patients. Treatment was discontinued in 2 patients, one because of persistent dizziness which was promptly relieved after stopping the drug and another due to syncope occurring immediately after a dose increase. We conclude that oral prazosin at low doses is an effective and well-tolerated drug which should be considered in the treatment of mild to moderate hypertension.