Treatment of Bolivian mucosal leishmaniasis with miltefosine.

BACKGROUND: Although mucosal leishmaniasis is a prominent disease, it has been studied only to a limited extent. It is classically treated with parenteral antimony or, as a last resort, amphotericin B. METHODS: We treated Bolivian mucosal leishmaniasis due to Leishmania braziliensis with the oral agent miltefosine, 2.5 mg/kg/day for 28 days, and followed-up for 12 months. RESULTS: Seventy-two patients were evaluable. The cure rate for the 36 patients who had "mild" disease (i.e., affecting nasal skin and nasal mucosa) was 83%. The cure rate for the 36 patients who had more extensive disease (involving the palate, pharynx, and larynx) was 58%. Patients refused to be randomized to parenteral agents, but the cure rate for an almost contemporary group who was receiving amphotericin B (45 mg/kg over 90 days) was 7 (50%) of 14. CONCLUSIONS: In this unrandomized trial, oral miltefosine was at least as effective as heroic doses of parenteral amphotericin B. The cure rate for miltefosine was approximately equivalent to historical cure rates using parenteral pentavalent antimony for mild and extensive disease in neighboring Peru. Although gastrointestinal side reactions do occur with miltefosine, its toxicity profile is superior to that of antimony and far superior to that of amphotericin B--in part because of the inherent attractiveness of oral versus parenteral agents. Our results suggest that miltefosine should be the treatment of choice for mucosal disease in North and South America.

Estudio experimental para comprobar la efectividad de los ácidos grasos hiperoxigenados en la prevención de las úlceras por presión en pacientes ingresados / Experimental study to test the effectiveness of hyperoxygenated fatty acids in the prevention of pressure sores in hospitalized patients

Objetivo: Identificar si hay diferencias en la incidencia de úlceras por presión en los enfermos a los que se realiza prevención con aplicación de ácidos grasos hiperoxigenados y a los que no se les aplica. Diseño: Estudio experimental, aleatorizado, controlado, con grupo control y grupo experimental. Ámbito de estudio: Hospital General Vall d'Hebron, entre diciembre de 1999 y mayo de 2000.Sujetos de estudio: Tras calcular el tamaño de la muestra necesario, se estudiaron a 192 pacientes que ingresaron en el centro sin úlceras por presión y que tenían la movilidad y la actividad alteradas (según la escala de riesgo EMINA©). La técnica de muestreo utilizada ha sido accidental, a medida que iban ingresando los pacientes en el hospital. Intervención: Al grupo control se le realizó la prevención habitual para las úlceras por presión que se lleva a cabo en el hospital. Al grupo experimental, además de esta prevención, se le aplicaron ácidos grasos hiperoxigenados según el protocolo establecido para el estudio. La asignación de los pacientes a los 2 grupos se realizó de manera aleatoria. Resultados y conclusiones: Se estudiaron a 192 pacientes (96 por grupo). La incidencia de úlceras por presión en el grupo control fue del 35 por ciento (intervalo de confianza [IC] del 95 por ciento, 27-47 por ciento) y en el grupo experimental del 19 por ciento (IC del 95 por ciento, 12-29 por ciento), siendo esta diferencia estadísticamente significativa (*2 = 6,8; gl = 1; p = 0,007).La incidencia de úlceras por presión es menor en el grupo experimental, lo que indica que los ácidos grasos hiperoxigenados son útiles para prevenir el desarrollo de este tipo de úlceras (AU)

[Characteristics of the introduction of foods into the diets of infants in Cuba]. / Características de la introducción de alimentos al lactante en Cuba.

The purpose of this study was to examine the prevailing pattern of introduction of nonmilk foods into the diets of children in Cuba and to assess the degree to which this pattern deviates from internationally accepted recommendations. A cross-sectional study was carried out using a simple random sample of 6,688 children under 1 year of age from all over Cuba. The data were analyzed through logistic regression. The study was carried out in 1990 using the pyramidal structure of the national public health system for the collection of data. Through the status quo method, information was obtained on consumption of four representative foods--juice, vegetables, meat, and fish--and some data were gathered on the child. Consumption prevalence rates were estimated at the beginning and the end of the age ranges (in days) that WHO considers optimum for the introduction of these foods. A marked divergence was found between recommended and actual practice. The recommendations were followed in 3% of the cases for juice, 9% for vegetables, 4% for meat, and 25% for fish. It is noteworthy that noncompliance with the recommendations basically takes the form of early introduction of these foods. The exception is vegetables, which are introduced considerably later than recommended, a fact that seems to reflect a cultural distaste for this food.