A propósito de bradicardia e insuficiencia cardiaca secundaria a ivabradina en paciente con VIH. Respuesta / About bradycardia and secondary heart failure induced by ivabradine in a patient with HIV. Response

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Bradicardia sintomática e insuficiencia cardiaca precipitadas por ivabradina a una paciente que recibe tratamiento antirretroviral / Symptomatic bradycardia and heart failure triggered by ivabradine in a patient receiving antiretroviral therapy

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Elevated liver enzymes resulting from an interaction between Raltegravir and Panax ginseng: a case report and brief review.

BACKGROUND: In the last decade, some evidence has arisen supporting the usefulness of Asian ginseng (Panax ginseng, fam. Araliaceae) as a complementary remedy in patients receiving antiretroviral therapy. However, its role in current therapeutics remains unclear. METHODS: The patient was admitted for an acute elevation of liver enzymes, marked jaundice, and significant weight loss after taking ginseng-based tablets starting approximately 39 days prior. His past medical history (PMH) was also significant for HIV+, long-term hepatitis C, an episode of mitochondrial toxicity, and several comorbidities. His outpatient medications included raltegravir 400 mg plus lopinavir/ritonavir 400/100 mg twice daily, aspirin 100 mg daily, and esomeprazole 40 mg daily as needed. RESULTS: The cessation of the ginseng lozenges led to a progressive improvement in the performance status and laboratory values. Both the Hansten and Horn nomogram and the Roussel Uclaf Causality Assessment Method indicated that the association between the ginseng medicine and the liver injury was probable (six points). CONCLUSIONS: We suggest that ginseng is involved in the episode through an interaction resulting in elevated plasma concentrations of raltegravir. As a consequence, clinicians should be alert when managing patients on other CYP3A4-metabolized drugs or previous liver-damaging conditions. However, larger studies are required to explicitly clarify these statements.

[Current epidemiological situation of trichinosis in Chile. 1991-2000]. / Situación epidemiológica actual de la triquinosis en Chile. 1991-2000.

BACKGROUND: Human and animal trichinosis has been recorded in Chile since the late XIX century and is irregularly distributed along the country. From high rates of infection in the early 1900, the frequency of this parasitosis in man has progressively decreased. AIM: To describe and discuss the epidemiological situation of trichinosis in Chile during the decade 1991-2000. MATERIAL AND METHODS: Human infection was assessed using annual incidence and lethality reports provided by the Ministry of Health, periodic photostrichinoscopies in corpses of non selected individuals autopsied at the Medico Legal Service and periodic national serologic surveys. The advise of one of the authors in an epidemic that occurred in 1999 in the VIII Region was also used. Animal infection was assessed using the annual prevalence of infection in pigs slaughtered in abattoirs, furnished by the Ministry of Health. RESULTS: A total of 631 clinical cases with 4 deaths (0.6%) was recorded. A decline in the incidence, from 0.7 x 100,000 in 1991 to 0.2 x 100,000 in 2000 was recorded. The higher frequency of the parasitosis was observed in the Metropolitan, VI, VIII and X regions. Although human trichinosis has been observed in all seasons, its frequency increases in close relation with the higher pork consumption in cold seasons (45.8% in winter and 37.5% in spring). There has been a decrease of infection rates in pigs from 0.17@1000 in 1991 to 0.04@1000 in 1998-2000. CONCLUSIONS: The incidence and prevalence of trichinosis shows a constant decline in Chile. Considering the geographical characteristics of Chile, it is possible that an undetermined number of pigs are home reared and butchered without veterinary control, constituting an important source of human trichinosis.