Efficacy of artesunate plus chloroquine for uncomplicated malaria in children in Sao Tome and Principe: a double-blind, randomized, controlled trial.

We conducted a double-blind, randomized, placebo-controlled trial in Sao Tome and Principe to investigate the safety, tolerability and efficacy of chloroquine (CQ) combined with artesunate (AS) over CQ monotherapy. Four hundred children, aged 6-59 months, with acute uncomplicated Plasmodium falciparum malaria were randomized to receive a standard dose of CQ (25 mg/kg bodyweight) over 3 d or CQ + AS (4 mg/kg bodyweight) daily for 3 d. Children were followed-up for 28 d. The combined treatment was well tolerated and there were no serious drug-related adverse events. By day 2 parasite clearance was significantly faster for children treated with CQ + AS compared with CQ alone (29/194 [14.9%] vs. 168/190 [88.4%] still parasitaemic, P< 0.0001). Day 14 parasitological failure rates were 153/191 (80.1%) for CQ alone compared with 32/193 (16.6%) in the CQ + AS group (odds ratio [OR] =20.2, 95% CI 11.7-35.4, P< 0.001). Corresponding clinical failure rates were 128/161 (67.0%) and 12/193 (6.2%) (OR = 30.6, 95% CI 15.3-62.7, P< 0.001). By day 28 the parasitological failure rates (new infections excluded) were 155/191 (81.1%) in the CQ group and 63/194 (32.4%) in the CQ + AS group (OR = 8.9, 95% CI 5.4-14.7, P< 0.001). Symptoms resolved faster in children who received AS. They were also less likely to be gametocytaemic after treatment. The combination treatment was well tolerated and considerably improved treatment efficacy. However, the current levels of CQ resistance preclude its use in Sao Tome where CQ should be abandoned as first-line drug. However, CQ + AS may be an option in areas where CQ resistance is lower.

Factor tisular en células mononucleares y resistencia a la proteína C en pacientes con preeclampsia / Tissue factor in mononuclear cells and resistance to protein C among patients with pre-eclampsia

Hay evidencia de la presencia de alteraciones en la coagulación que pueden agravar el estado de preeclampsia. Por una parte se ha involucrado a las células mononucleares y por tanto a la generación de factor tisular y por otra a la resistencia a la proteína C como mecanismos en la etiopatogenia de problemas trombóticos. El objetivo del presente trabajo fue evaluar estos factores en una muestra de 20 mujeres embarazadas con preeclampsia y 20 mujeres embarazadas sanas. Estadísticamente no se encontraron diferencias con relacion a uno y otro grupo, con la salvedad de 2 mujeres del grupo con preeclampsia que mostraron resistencia a la proteína C. (AU)

Portal hypertension due to extensive hepatic cysts in autosomal dominant polycystic kidney disease.

Liver cysts are a well-recognized feature of autosomal dominant polycystic kidney disease (ADPKD) and occur in 77% of patients more than 60 years old. Serious sequelae, however, are rare, the two most common complications being pain and cyst infections. Portal hypertension has been reported in ADPKD due to the rare presence of congenital hepatic fibrosis. We report a case of ADPKD in a patient who had portal hypertension due to distortion of portal vein and venules by extensive hepatic cysts.

Increased arterial stiffness in children with a parental history of hypertension.

The vascular dynamics of children with a parental history of hypertension has not been defined. The purpose of the current study was to determine whether or not these children have different arterial stiffness compared to the offspring of normotensive parents. One hundred healthy, nonobese subjects (ages 10-21 years) were divided into two groups of 50. Group A included the offspring of hypertensive patients and group B the offspring of normotensive parents. The variables studied were body surface area, blood pressure, and systolic and diastolic diameters of the aortic and carotid arteries as well as maximum velocity flow of these vessels. Carotid and aortic stiffness were calculated. Children and adolescents with a parental history of hypertension had higher carotid stiffness and smaller carotid diameters. These differences continued to be significant when correcting for body surface area. A higher blood pressure and a greater body surface area were also found.

Lectin activity from the cattle tick (Boophilus microplus) saliva.

The capability of Boophilus microplus saliva (BmS) and lectins to induce immunosuppression in mice and to agglutinate erythrocytes from distinct animal species were compared. CD-1 mice were distributed into groups (two for each substance) of 4-5 animals/group and treated intraperitoneally (i.p.) with 50 mg and 150 mg of BmS; concanavalin A (Con A); potato's lectin (PL), striped bean lectin (SBL) or 0.1 ml of phosphate buffered saline (PBS). All mice were immunized i.p. with 2 x 108 sheep erythrocytes (SE) 48 hours after treatment. Five days after immunization sera was obtained from mice to determine anti-SE antibody titer by direct hemagglutination. The mean antibody titers (Log2) obtained was 5.5 and 4.2 for BmS, 4.4 and 0 for Con A, 5.2 and 4.8 for PL, 4.6 and 0 for SBL and 7.4 for PBS. BmS and lectins were tested to agglutinate mouse (M), rat (Rt), rabbit (Rb), sheep (S) and human A (HA), human B (HB) and human O (HO) erythrocytes. BmS agglutinated Rb, S, HA, HB and HO erythrocytes at titer (Log2) of 1, 1, 6, 1 and 2 respectively. Con A and PL agglutinated erythrocytes from all species tested, while SBL agglutinated M, S and HA erythrocytes. A 50% inhibition of agglutination of HA erythrocytes by BmS was observed when D(+) Galactosamine and D(+) Glucosamine, at 0.2 M, were used. The results obtained indicate that BmS contains a weak nonspecific lectin which is inhibited by aminated sugars, and that induces immunosuppression in mice as other lectins.

Vascular dynamics in isolated systolic arterial hypertension.

With a growing elderly population, the incidence of isolated systolic hypertension (ISH) has increased. This study characterizes dynamic vascular changes that occur with advanced age and with ISH. Fifty-five healthy individuals and seven with ISH were distributed in seven age groups from the second to the seventh decade. An index of aortic stiffness (delta P/delta V) was derived using a mercury sphygmomanometer to obtain pulse pressure, and ultrasonographic measurements were used to estimate aortic volumes applying the "cylinder formula." The mathematic derivation of this formula is explained in detail. Pulse pressure showed no significant change with age, but showed a significant increase with ISH. A decrease in volume change from systole to diastole was found with advanced age. Normotensive subjects aged 65 +/- 2 years had a 2.6-fold increase in aortic stiffness compared with young individuals. Elderly patients with ISH had a 7-fold increase in aortic stiffness compared with Group 1 (15 +/- 2 years) (p < 0.001) and a 2.7-fold increase compared with Group 6 (normotensive subjects aged 65 +/- 2 years). A strong correlation between systolic pressure and arterial stiffness was observed (r = 0.953) (p < 0.001). The proposed stiffness index was compared with the one described by Hirai, obtaining a high correlation, that is, r = 0.989 (p < 0.001). When compared with Stefanadis' index of distensibility, our index showed a correlation of r = 0.932 (p < 0.003). It is concluded that while systolic pressure is a main determinant of arterial stiffness, the delta P/delta V is a more sensitive method to estimate dynamic changes in elastic arteries such as the aorta.

Structural and dynamic changes in the elastic arteries due to arterial hypertension and hypercholesterolemia.

Five groups of 20 patients each were studied to analyze the vascular dynamics and structure of the elastic arteries. Group I consisted of healthy young individuals (27 +/- 4 years); Group II of healthy adults (46 +/- 9 years); Group III of normotensive hypercholesterolemic adults (45 +/- 12 years and serum cholesterol > 239 mg/dl); Group IV of hypertensive normocholesterolemic adults (56 +/- 13 years); and Group V of hypertensive hypercholesterolemic adults (56 +/- 9 years). The differential arterial pressure was estimated and divided by the volume change (delta P/delta V) of the aorta and the carotid and brachial arteries. The volume change was calculated using the "cylinder formula", measuring the radius from the ultrasonographic vessel image and assigning the cylinder a height of 1 cm. The A/E index of the Doppler transmitral spectrum and the maximum velocity flow using Doppler in the above arteries were calculated. The presence of carotid atherosclerosis was observed and given an arbitrary scoring grade of 0, 1, or 2. A higher arterial and ventricular stiffness was found in the hypertensive patients regardless of the presence of hypercholesterolemia. A higher fall in Doppler velocity and an increase in atherosclerosis lesions were found in Group V. Based on the results of this study, it was concluded that vascular and left ventricular stiffness have a close relationship with arterial hypertension but not with hypercholesterolemia. The hypercholesterolemic patients had a higher prevalence of carotid atherosclerosis and a higher scoring grade of severity.

[Hospitalized psychiatric population in the Mexican Institute of the Social Security, 1971-1976]. / Estudio comparativo de población psiquiátrica hospitalaria en el Instituto Mexicano del Serguro Social, 1971-1976.

This paper emphasizes the importance of having an objective registration system for clinical cases in a psychiatric hospital. For this purpose, special sheets were designed to register all cases comparing the years 1971 and 1976. During these years, 1 202 and 1 835 cases were obtained. Data included: age, sex, marital status, schooling, occupation, diagnosis, psychiatric family history and therapy. The results for those years are shown.