ABSTRACT
AIM: To evaluate the effectiveness of botulinum toxin in the treatment of upper and lower limb spasticity in pediatric patients in a real clinical setting. PATIENTS AND METHODS: A retrospective study was conducted based on information from clinical records of 79 pediatric patients with spasticity in different clinical forms and severity treated with botulinum toxin type A. The improvement of rigidity and mobility was estimated by the attending physician through physical examination, evaluating the gait, rating on the Ashworth scale and measurement of joint mobility angles using a goniometer. The number of injections, the interval between them, the site of application and the dose were recorded, considering the reduction of at least one point on the Ashworth scale or an increase in the degrees of joint mobility as treatment response. RESULTS: Patients received injections in a mean of 10 ± 7 muscles at intervals of 4 to 50 weeks (average: 13 ± 9 weeks). A 90% also received rehabilitation. The knee, ankle and wrist showed presented a higher percentage of improvement. An improvement in the degrees of movement was found in 24% of patients. CONCLUSION: The application of botulinum toxin type A was effective for the treatment of spasticity in the pediatric population.
TITLE: Dosis y eficacia de la toxina botulinica en pacientes pediatricos con espasticidad.Objetivo. Evaluar la efectividad de la toxina botulinica en el tratamiento de la espasticidad de los miembros superiores e inferiores en pacientes pediatricos en un entorno clinico real. Pacientes y metodos. Se realizo un estudio retrospectivo basado en el historial clinico de 79 pacientes pediatricos con espasticidad en diferentes formas clinicas y grados de afectacion tratados con toxina botulinica tipo A. La mejoria de la rigidez y movilidad fue estimada por el medico tratante mediante exploracion fisica, evaluando la marcha, la calificacion en la escala de Ashworth y la medicion de los angulos de movilidad articular mediante un goniometro. Se registro el numero de inyecciones, el intervalo entre ellas, el sitio de aplicacion y la dosis, y se considero una respuesta positiva al tratamiento la disminucion del al menos un punto en la escala de Ashworth o un incremento en los grados de movilidad articular. Resultados. Los pacientes recibieron inyecciones en 10 ± 7 musculos diferentes en intervalos de 4 a 50 semanas (media: 13 ± 9 semanas). Un 90% de los pacientes recibio rehabilitacion. Las articulaciones de la rodilla, el tobillo y la muñeca presentaron un mayor porcentaje de mejoria. En el 24% de los pacientes se encontro mejoria en los grados de movimiento articular. Conclusion. La aplicacion de toxina botulinica tipo A fue efectiva para el tratamiento de la espasticidad en la poblacion pediatrica.
Subject(s)
Botulinum Toxins, Type A/administration & dosage , Muscle Spasticity/drug therapy , Neuromuscular Agents/administration & dosage , Child , Child, Preschool , Female , Humans , Male , Retrospective Studies , Treatment OutcomeABSTRACT
The aim of this multicentered, prospective and open study was to determine the clinical and bacteriological efficacy and safety of piperacillin/tazobactam (4g/500 mg IV tid) in the treatment of 79 adult patients with complicated urinary tract infections (UTI) requiring hospitalization. Forty-seven women and 32 men (mean age 54.2 years, and range 21-91) from 4 Argentinean and 6 Mexican hospitals were enrolled. Sixty-one clinically and bacteriologically evaluable patients were treated for a mean of 9.1 days (range 5-15). A favorable clinical response was seen in 83.6% and 80% at early and late assessment, respectively. Bacteriological eradication was achieved in 85.3% and 80% at early and late estimation, respectively. Escherichia coli was isolated in 33 cases, Klebsiella pneumoniae in 8, Enterococcus spp. in 7, Proteus mirabilis in 6, Pseudomonas aeruginosa in 3, Enterobacter spp. and Morganella morganii in 2. While 21% of all the clinical isolates were resistant to piperacillin, none of them was initially resistant to piperacillin/tazobactam. However, one female patient with a persistent UTI caused by E. coli developed resistance to piperacillin/tazobactam during treatment. A 64-year-old man with frontal meningioma developed purulent meningitis due to Enterobacter cloacae after neurosurgery. He was initially treated with ciprofloxacin, rifampin and amikacin and because of persistence of fever, he was moved to piperacillin/tazobactam. After 5 days of therapy, he developed coma secondary to intracranial hemorrhage and died. By then, the platelet count was normal (220,000/microliters), but the prothrombin time (19.5 seconds) and the partial thromboplastin time (63 seconds) were significantly prolonged. Our data suggest that piperacillin/tazobactam is a reliable therapy for complicated, non-complicated, community or hospital-acquired UTI.
