Multifocal avascular necrosis after liver transplantation: an unusual presentation of the antiphospholipid syndrome.

We describe the case of a 31-year-old man who presented with an antiphospholipid syndrome (APS), which manifested as multifocal avascular necrosis (AVN) one year after orthotopic liver transplantation. The patient developed multiple AVN affecting hips, left knee, humerus and tarsal bones just after withdrawal of corticosteroid therapy. Three years later when lupus anticoagulant was detected, he began anticoagulant treatment and no further AVN episodes were observed. It is important to be aware of this clinical manifestation of APS, especially in these cases where it can be easily overlooked because of corticosteroid therapy.

Experiencia clínica prospectiva con glimepirida en pacientes con Diábetes Mellitus tipo 2 en Venezuela / Prospective clinical experience with Glimipiride tolerance in patient with diagnosis of diabetes mellitus type 2 in Venezuela

El objetivo del trabajo fue evaluar la eficacia y tolerancia de glimepirida en pacientes con diagnóstico de Diábetes Mellitus tipo 2 en Venezuela. Mediante un estudio multicéntrico abierto, no randomizado, prospectivo, de Glimepirida en pacientes diabéticos tipo 2. Dosis de inicio: 1 mg de glimepirida, de acuerdo a las respuesta se aumenta la dosis en 1 mg cada 2 semanas hasta alcanzar una glicemia en ayunas menor o igual a 140 mg/dl. El período total de observación fue de 12 semanas. Se realizó un control cada dos semanas. Se estudió una muestra de 258 pacientes diabéticos tipo 2 que no estaban controlados adecuadamente con dieta, ejercicios y/o tratamiento hipoglicemiante, quienes recibieron glimepirida por primera vez o cambiaron su tratamiento a glimepirida. Todos los datos se analizaron mediante la prueba T de Student con dos colas. Se consideró resultado estadísticamente significativo a los valores de p<0.05 en lo que se refiere a disminución de glicemia por cada consulta. Al inicio del estudio la glicemia en ayunas se encontraba en valores de 225,55 ñ 67 mg/dl. Al término del estudio la glicemia obtenida fue 127,80 ñ 42 mg/dl. La glicemia disminuyo en promedio un 44 por ciento luego de 12 semanas de tratamiento. 93 por ciento de casos lograron control adecuado de la glicemia. No se presentaron efectos secundarios en 91 por ciento de los casos. Ocurrieron reacciones adversas en 21 pacientes (9 por ciento de los casos), de los cuales 11 casos corresponden a episodios de hipoglicemia. La hipoglicemia fue leve o moderada en todos los casos no ameritando hospitalización. Glimepirida demostró eficacia terapéutica al disminuir los niveles de glicemia en ayunas a valores menores o iguales a 140 mg/dl en el 79,53 por ciento de los pacientes, significativo estadísticamente, con un excelente perfíl de seguridad (91 por ciento de los casos no reportaron efectos secundarios

Accuracy of an infrared tympanic thermometer.

BACKGROUND: The use of infrared thermometry to measure temperatures in hospitalized patients is increasing. Although infrared thermometers have been proven to be accurate when they are used by well-trained personnel, no previous studies have examined their accuracy during routine hospital use. OBJECTIVE: To determine the accuracy and observer variability of temperatures measured with an infrared tympanic thermometer (TT). DESIGN: Prospective, observational study. SETTING: ICUs of a 300-bed teaching community hospital. PATIENTS: Fifty-one critically ill patients. MEASUREMENTS: The mean of three tympanic temperatures measured with the infrared TT (tempTTs) was compared to temperatures simultaneously measured with the thermistor of right heart catheters and rectal mercury thermometers for the following three groups of observers who had been certified in the use of the infrared TT: a single critical care nurse (CCN)/educator (Ed); CCNs, and floor nurses (FNs)/clinical care practitioners (CCPs). RESULTS: Two rounds of measurements were given to 51 patients by 153 observers. Temperatures of the pulmonary artery (PA) measured with the thermistor of right heart catheters (tempPAs) ranged from 96.5 to 102.6 degrees F, with a mean (-/+ SD) of 99.3+/-1.1 degrees F. The intraobserver variabilities (correlation coefficients) of the tempTTs ranged from 0.90 for those measured by FNs/CCPs, to 0.92 for those measured by CCNs, to 0.98 for those measured by the CCN/Ed. Accuracy, arbitrarily defined as within a deviation of -/+0.5 degrees F of the tempPA, was 100% for the rectal mercury thermometer and 98.0% for the infrared TT when used by the CCN/Ed. The accuracy of the infrared TT was 80% when measured by CCNs and 61% when measured by FNs/CCPs. Differences between tempPAs and tempTTs measured by the CCN/Ed ranged from 0 to 0.7 degrees F, with a mean of 0.2 degrees F. Similarly, differences between tempPAs and tempTTs measured by CCNs ranged from 0 to 2.4 degrees F, with a mean difference of 0.3 degrees F. However, differences between tempPAs and tempTTs measured by FNs/CCPs ranged from 0 to 3.0 degrees F, with a mean of 0.6 degrees F (greater differences than those obtained by the CCNs; p < 0.01). The accuracy of rectal mercury thermometry was 100%. If a temperature > or = 101.0 degrees F had been considered as the threshold at which a fever is present, and if the mean of three measurements had been used to designate temperature, workups that were either inappropriately performed or omitted would have resulted from 2% of tempTTs measured by the CCN/Ed, 1% of those measured by CCNs, and 4% of those measured by FNs/CCPs. CONCLUSION: When used properly, both tympanic and rectal thermometry are very accurate. However, the infrared TT produced measurements that were both less accurate and less reproducible when used by nurses who routinely used it in clinical practice.