ABSTRACT
Spontaneous coronary artery dissection (SCAD) is an underdiagnosed cause of myocardial infarction (MI), and its prevalence among women is increasing. Epidemiological information indicates that SCAD is responsible for one-third of MI cases in women of reproductive age. Little information is described on SCAD in elderly patients. The patient in the case presented here was an 81-year-old woman with a history of SCAD who presented with oppressive thoracic chest pain associated with electrical changes that derailed into ventricular fibrillation. Coronary angiography confirmed a SCAD recurrence, and conservative medical treatment was established. Different pathophysiological pathways have been proposed for SCAD extension or recurrence. Nonetheless, there is yet much to be discovered about this disease and its presentation in different age groups.
ABSTRACT
Lactoferrin is a milk protein that reportedly protects infants from gut-related, systemic infection. Proof for this concept is limited and was addressed during in vivo and in vitro studies. Neonatal rats pretreated orally with recombinant human lactoferrin (rh-LF) had less bacteremia and lower disease severity scores (P < 0.001) after intestinal infection with Escherichia coli. Control animals had 1,000-fold more colony-forming units of E. coli per milliliter of blood than treated animals (P < 0.001). Liver cultures from control animals had a twofold increase in bacterial counts compared with cultures from rh-LF-treated pups (P < 0.02). Oral therapy with rh-LF + FeSO(4) did not alter the protective effect. In vitro studies confirmed that rh-LF interacted with the infecting bacterium and rat macrophages. An in vitro assay showed that rh-LF did not kill E. coli, but a combination of rh-LF + lysozyme was microbicidal. In vitro studies showed that rat macrophages released escalating amounts of nitric oxide and tumor necrosis factor-alpha when stimulated with increasing concentrations of rh-LF. The in vitro studies suggest that rh-LF may act with other "natural peptide antibiotics" or may prime macrophages to kill E. coli in vivo.
Subject(s)
Animals, Newborn/physiology , Escherichia coli Infections/prevention & control , Immediate-Early Proteins , Intestines/microbiology , Lactoferrin/pharmacology , Animals , Cell Death , Colony Count, Microbial , DNA-Binding Proteins/metabolism , Drug Combinations , Early Growth Response Protein 1 , Escherichia coli/drug effects , Escherichia coli/isolation & purification , Escherichia coli/physiology , Escherichia coli Infections/physiopathology , Female , Humans , Liver/microbiology , Macrophages/drug effects , Macrophages/metabolism , Muramidase/pharmacology , NF-kappa B/drug effects , NF-kappa B/physiology , Nitric Oxide/metabolism , Rats , Rats, Sprague-Dawley , Recombinant Proteins/pharmacology , Severity of Illness Index , Transcription Factors/metabolism , Tumor Necrosis Factor-alpha/metabolismABSTRACT
The authors report on a neonate with gastroschisis repaired at birth who later had abdominal distension, emesis, feeding intolerance, and an abnormal stooling pattern. Total colon and partial small bowel aganglionosis (TCAS), or Hirschsprung's disease, was diagnosed subsequently. This is the first report of this combination of gastrointestinal anomalies. J Pediatr Surg 36:638-640.
Subject(s)
Abnormalities, Multiple/surgery , Gastroschisis/complications , Gastroschisis/surgery , Hirschsprung Disease/complications , Hirschsprung Disease/surgery , Abnormalities, Multiple/diagnosis , Biopsy, Needle , Digestive System Surgical Procedures/methods , Female , Follow-Up Studies , Gastroschisis/diagnostic imaging , Hirschsprung Disease/diagnosis , Humans , Infant, Newborn , Pregnancy , Treatment Outcome , Ultrasonography, PrenatalABSTRACT
BACKGROUND: Head lice infestation (HLI) is a vexing problem for pediatricians and families because lice are becoming resistant to approved antipediculosis agents. OBJECTIVE: This study compared the efficacy of 3 different treatments for HLI and determined whether combination therapy reduced treatment failures. DESIGN AND SETTING: A randomized, clinical trial performed in 3 private practices. PARTICIPANTS: The population was children ranging in age from 2 to 13 years. METHODS: HLI was diagnosed by direct inspection of the hair and scalp. Children were assigned to 1 of 3 groups: 1) 1% permethrin creme rinse (1% PER; n = 39); 2) oral administration of trimethoprim/sulfamethoxazole (TMP/SMX; n = 36); and 3) a combination of 1% PER and TMP/SMX (n = 40). Follow-up visits were done 2 and 4 weeks later, and parents or caregivers of those who did not return were interviewed by telephone. If HLI was present at the 2-week follow-up, the child was retreated per their protocol. We defined successful treatment as the absence of adult lice and nymphal stage or eggs (nits). The presence of nits alone was not considered a treatment failure. RESULTS: At the 2-week follow-up visit, successful treatment for groups 1, 2, and 3 was 79.5%, 83%, and 95%, respectively. At the 4-week follow-up, successful treatment was 72%, 78%, and 92.5% for groups 1, 2, and 3, respectively. The absolute risk reduction for recurrence comparing group 1 versus group 2 was 6%, group 2 versus group 3 was 14%, and group 1 versus group 3 was 20%. No major adverse complications were seen in any treatment group. CONCLUSION: Our findings indicate that a combination of 1% PER and TMP/SMX is an effective alternative therapy for HLI. We recommend that the dual therapy with 1% PER and oral TMP/SMX be used and reserved in cases of multiple treatment failures or suspected cases of lice-related resistance to therapy.
