[Local dermonecrotic loxoscelism in children bitten by the spider Loxosceles reclusa (the "violin" spider)]. / Loxoscelismo local dermonecrótico en niños mordidos por la araña Loxosceles reclusa (araña "violinista").

This is an observational retrospective study. Our goal is to describe the local dermonecrotic reaction occurring after a spider bite in eleven pediatric patients. In seven (63.7%), the spider was identified as Loxosceles reclusa, and in four, bites were presumptive. The main symptoms and signs were pain, erythema, swelling, blisters, and vasculitis in five patients. There was a significant relationship between the time of onset before the treatment and the severity of the lesions (63.4 hours in the severe cases vs 14.4 hours in the mild cases, p < 0.05), as well the time spent in the emergency room (50 hours vs 10 hours respectively, p < 0.05). Treatment with dapsone, 1 mg/kg/24 h, and/or paracetamol and dicloxacillin was successful; one case required surgical treatment. No systemic loxoscelism occurred in this patient.

[Evaluation of the efficacy of N-acetylcysteine administered alone or in combination with activated charcoal in the treatment of acetaminophen overdoses]. / Evaluación de la eficacia de la N-acetilcisteina administrada sola o combinada con carbón activado en el tratamiento de la sobredosis por acetaminofén.

STUDY OBJECTIVE: To evaluate the efficacy of N-acetylcysteine (N-AC) alone or combined with multiple-dose activated charcoal (AC) in the treatment of acetaminophen (ACT) overdose. DESIGN: Prospective observational case series of 14 consecutive pediatric patients. Group A (n = 7) were treated only with N-AC and group B (n = 7) with N-AC combined with AC. Plasma ACT concentrations were measured at 0.0, 24 and 48 h. As a measure of ACT disappearance, half-life of elimination (t1/2 beta) and exogenous body clearance (ClB) were calculated. RESULTS: Group A, Initial and final mean ACT plasmatic levels were 27 micrograms/mL and 4 micrograms/mL; t1/2 beta of 17 h and ClB 0.640 mL.kg.min. Group B, 27 micrograms/mL and 0.66 microgram/mL; t1/2 beta of 10 h and ClB 1.092 mL.kg.min. For both t1/2 beta and ClB differences, p < 0.05 (SS). CONCLUSION: N-AC significantly decreased the plasma ACT levels in both treatments; however, there were several advantages with the combined therapy: AC enhanced the efficacy of N-AC according with the higher eliminatión of the overdosed drug (97.6% vs. 85.2%), the t1/2 beta decreased 42%, and the ClB increased 70% in relation to the group A. Data of this study suggested that N-AC plus AC is more effective than N-AC alone in enhancing ACT elimination in overdosed patients and that it provided additional hepatoprotective benefit.