Slower response to treatment of iron-deficiency anaemia in pregnant women infected with HIV: a prospective cohort study.

OBJECTIVE: Antenatal anaemia is associated with increased peripartum transfusion requirement in South Africa. We studied whether HIV was associated with the response to treatment of iron-deficiency anaemia. DESIGN: Prospective cohort study. SETTING: Hospital-based antenatal anaemia clinic in South Africa. SAMPLE: Equal-sized cohorts of pregnant women testing positive for HIV (HIV+) and testing negative for HIV (HIV-) with iron-deficiency anaemia. METHODS: Haemoglobin trajectories of women with confirmed iron-deficiency anaemia (ferritin < 50 ng/ml) were estimated from the initiation of iron supplementation using mixed-effects modelling, adjusted for baseline HIV status, ferritin level, maternal and gestational ages and time-varying iron supplementation. MAIN OUTCOME MEASURES: Haemoglobin trajectories. RESULTS: Of 469 women enrolled, 51% were HIV+, 90% of whom were on antiretroviral therapy (with a mean CD4+ lymphocyte count of 403 cells/mm3 ). Anaemia diagnoses did not differ by HIV status. A total of 400 women with iron-deficiency anaemia were followed during treatment with oral or intravenous (6%) iron therapy. In multivariable analysis, haemoglobin recovery was 0.10 g/dl per week slower on average in women who were HIV+ versus women who were HIV- (P = 0.001), 0.01 g/dl per week slower in women with higher baseline ferritin (P < 0.001) and 0.06 g/dl per week faster in women who were compliant with oral iron therapy (P = 0.002). CONCLUSIONS: Compared with women who were HIV-, women who were HIV+ with iron-deficiency anaemia had slower but successful haemoglobin recovery with iron therapy. Earlier effective management of iron deficiency could reduce the incidence of peripartum blood transfusion. TWEETABLE ABSTRACT: Among pregnant women with iron-deficiency anaemia in South Africa, HIV slows haemoglobin recovery in response to oral iron therapy.

Analysis of different levels of positive end-expiratory pressure during lung retrieval for transplantation: an experimental study.

Atelectasis and inadequate oxygenation in lung donors is a common problem during the retrieval of these organs. Nevertheless, the use of high positive end-expiratory pressure (PEEP) is not habitual during procedures of lung retrieval. Twenty-one Sprague-Dawley male consanguineous rats were used in the study. The animals were divided into 3 groups according to the level of PEEP used: low (2 cmH2O), moderate (5 cmH2O), and high (10 cmH2O). Animals were ventilated with a tidal volume of 6 mL/kg. Before lung removal, the lungs were inspected for the presence of atelectasis. When atelectasis was detected, alveolar recruitment maneuvers were performed. Blood gasometric analysis was performed immediately. Finally, the lungs were retrieved, weighed, and submitted to histological analysis. The animals submitted to higher PEEP showed higher levels of oxygenation with the same tidal volumes PO2=262.14 (PEEP 2), 382.4 (PEEP 5), and 477.0 (PEEP 10). The occurrence of atelectasis was rare in animals with a PEEP of 10 cmH2O, which therefore required less frequent recruitment maneuvers (need for recruitment: PEEP 2=100%, PEEP 5 =100%, and PEEP 10=14.3%). There was no change in hemodynamic stability, occurrence of pulmonary edema, or other histological injuries with the use of high PEEP. The use of high PEEP (10 cmH2O) was feasible and probably a beneficial strategy for the prevention of atelectasis and the optimization of oxygenation during lung retrieval. Clinical studies should be performed to confirm this hypothesis.

Analysis of different levels of positive end-expiratory pressure during lung retrieval for transplantation: an experimental study

Atelectasis and inadequate oxygenation in lung donors is a common problem during the retrieval of these organs. Nevertheless, the use of high positive end-expiratory pressure (PEEP) is not habitual during procedures of lung retrieval. Twenty-one Sprague-Dawley male consanguineous rats were used in the study. The animals were divided into 3 groups according to the level of PEEP used: low (2 cmH2O), moderate (5 cmH2O), and high (10 cmH2O). Animals were ventilated with a tidal volume of 6 mL/kg. Before lung removal, the lungs were inspected for the presence of atelectasis. When atelectasis was detected, alveolar recruitment maneuvers were performed. Blood gasometric analysis was performed immediately. Finally, the lungs were retrieved, weighed, and submitted to histological analysis. The animals submitted to higher PEEP showed higher levels of oxygenation with the same tidal volumes PO2=262.14 (PEEP 2), 382.4 (PEEP 5), and 477.0 (PEEP 10). The occurrence of atelectasis was rare in animals with a PEEP of 10 cmH2O, which therefore required less frequent recruitment maneuvers (need for recruitment: PEEP 2=100%, PEEP 5 =100%, and PEEP 10=14.3%). There was no change in hemodynamic stability, occurrence of pulmonary edema, or other histological injuries with the use of high PEEP. The use of high PEEP (10 cmH2O) was feasible and probably a beneficial strategy for the prevention of atelectasis and the optimization of oxygenation during lung retrieval. Clinical studies should be performed to confirm this hypothesis.

Health information technologies for sexual and reproductive health: Mapping the evidence in Latin America and the Caribbean.

In Latin America and the Caribbean (LAC), the sexual and reproductive health (SRH) of populations is a high priority for governments. Health information technologies (HITs) have been proposed as tools to close access gaps for SRH services. We developed an "evidence map" through a systematic search of articles published between 2005 and 2015 about the use of HITs to enhance SRH services in LAC countries. Two hundred and thirty-two registries were identified and screened. Thirty-one were eligible for full-text assessment. Most of the documents retrieved correspond to information provided by technology developers, targeting primarily the prevention of sexually transmitted infections and adolescent health. Although there has been clear progress in the use of HITs for SRH in the region, many institutional and technological challenges persist. Further studies should be carried out to test the beneficial effects of HITs on improving access to SRH services.

Exceptional points and non-Hermitian degeneracy of resonances in a two-channel model.

We study the mixing and degeneracy of two unbound energy eigenstates (resonances) in a two coupled channel model of scattering and reactions. We derive the necessary and sufficient conditions for existence of an exceptional point in the extended spectrum of bound and resonance energy eigenvalues in this model and show that these are not the same as in the single channel case. When these conditions are satisfied, in the complex energy plane, the two simple resonance poles of the scattering matrix merge into one double pole at the exceptional point. In parameter space, the surface of the eigenenergies has a branch point of square root type and branch cuts in its real and imaginary parts that start at the exceptional point and extend in opposite directions. The rich phenomenology of crossings and anticrossings of energies and widths of the doublet of unbound states, as well as the changes of identity of the poles of the scattering matrix observed when one control parameter is varied while the other is kept constant, is fully explained in terms of sections of the eigenenergy surfaces.

Cribado por ultrasonidos de la displasia de desarrollo de la cadera: experiencia aplicando un programa semi-universal / Screening by ultrasound of dysplasia of hip development: experience applying a semi-universal program

Objetivos: Exponer los resultados de la implantación de un cribado ecográfico "semiuniversal" para el diagnóstico precoz de la displasia de desarrollo de la cadera (DDC) que incluye a todas las niñas y a los varones con factor de riesgo. Material y método: De los 16.943 recién nacidos en nuestro hospital en 4 años, se estudiaron por ecografía 8.596 (7.892 niñas y 744 varones). El cribado se realizó a las 5 semanas de vida e incluyó seguimiento de las caderas con inmadurez fisiológica. Resultados: Se detectaron 76 niños con DDC resultando una incidencia del 4,4 por mil. La edad media de detección fue de 1,4 meses y la duración media de los tratamientos 3 meses. Se consiguieron bajos índices de displasias tardías (0,2 por mil) y de cirugía (0,3 por mil). Todos los niños curaron sin secuelas. Conclusión: Consideramos al cribado semiuniversal una opción válida al cribado universal, con resultados similares y menor coste

Objective: The purpose of this article is to describe the findings of our semiuniversal ultrasound screening for the early diagnosis of developmental dysplasia of the hip (DDH) including all newborn females and males with risk factors. Materials and methods: 8596 newborn (7852 females and 744 males) underwent sonography from a total of 16943 newborn in our hospital over a four year period. The screening ultrasound was performed when the infant was five weeks old and included follow-up of the hips with physiological immaturity. Results: 76 infants with hip dysplasia were detected with a resulting incidence of 4.4 per thousand. Mean age at diagnosis was of 1.4months and the mean length of treatment was of 3 months. With this strategy low rates of late dysplasias (0.2 per thousand) and surgical treatment (0.3 per thousand) were achieved All infants recovered without secuelae. Conclusion: We consider the semiuniversal screening to represent a valid alternative to the universal screening, with similar results and reduced costs

Energy eigenvalue surfaces close to a degeneracy of unbound states: crossings and anticrossings of energies and widths.

The rich phenomenology of crossings and anticrossings of energies and widths, as well as the sudden change in shape of the S(E)-matrix pole trajectories, observed in an isolated doublet of resonances when one control parameter is varied, is fully explained in terms of sections of the energy eigenvalue surfaces in parameter space close to a degeneracy point.

Evaluación nutricional de una fórmula parcialmente hidrolizada / Nutritional assessment of a partially hydrolized formula

Objetivo: Evaluar nutricionalmente una fórmula de bajo grado de hidrólisis proteica (FBGH). Material y métodos: Se realiza un estudio comparativo de un grupo de lactantes alimentados con una fórmula FBGH a base de hidrolizado de proteínas del suero (grupo FBGH) (n= 31) con un grupo control alimentado con lactancia materna (grupo LM) (n= 16). Se compara entre ambos grupos el peso, talla, perímetro craneal (PC) y braquial (PB) a la edad de recién nacido, 1, 2 y 4 meses. Asimismo, se llevó a cabo un estudio bioquímico del estado nutricional proteico a la edad de 4 meses mediante determinación de prealbúmina, proteína por cientofiadora del retinol, fibronectina y somatomedina-C, y nivel de aminoácidos en sangre. Resultados: No se encontraron diferencias significativas en la evaluación antropométrica entre el grupo FBGH y el LM. Las proteínas de vida media corta investigadas eran más elevadas en el grupo FBGH, siendo esto especialmente significativo para la prealbúmina (17,8 ñ 5,7 frente al 14,7 ñ 4 mg/100 mL del grupo LM; p= 0,025). Por otra parte, se han registrado diferencias significativas en el nivel de metionina en sangre a la edad de 4 meses entre el grupo FBGH (22,3 ñ 16,8 umol/ L) y el LM (14,7 ñ 10,6 umol/L) (p= 0,025). Asimismo, se observa una diferencia casi significativa entre la cifra de treonina en el grupo FBGH (125,9 ñ 61,9 umol/L) y el LM (103,83 ñ 52 umol/L) (p= 0,08). Conclusiones: Las diferencias encontradas en los niveles de aminoácidos y de proteínas de vida media corta entre el grupo FBGH y el LM hacen necesario que la administración de estos alimentos especiales se controle desde el punto de vista nutricional y se restrinja su indicación a las situaciones clínicas que lo precisen (AU)

Efficacy and safety of amoxycillin/clavulanate (Augmentin) twice daily versus three times daily in the treatment of acute otitis media in children. The Augmentin 454 Study Group.

This multicenter, randomized, single-blind study compared the efficacy and safety of a new, twice-daily formulation of amoxycillin/clavulanate (Augmenting) with the standard three-times-daily formulation. Children with a clinical diagnosis of acute otitis media, aged between 2 months and 12 years, received either amoxycillin/clavulanate 45/6.4 mg/kg/day twice-daily (b.d.) (range 38.3/5.5-76.2/10.9 mg/kg/day) or amoxycillin/clavulanate 40/10 mg/kg/day three-times-daily (t.d.s.) (range 25/6.25-56/14 mg/kg/day) for 7 or 10 days. Patients were evaluated during therapy (Days 3-5), at the end of therapy (Days 7-12) and at follow-up (Days 38-42). At the end of therapy, for the intent-to-treat and per-protocol populations, respectively, clinical success (cure) was achieved by approximately 94% of patients in both treatment groups. A successful bacteriological response at the end of therapy (Visit 3) was documented in 7/9 patients (77.8%) in the twice-daily group and in 11/13 patients (84.6%) in the three-times-daily group. At follow-up (Visit 4), 93.3% of patients in the twice-daily group and 87.9% in the three-times-daily group continued to have a clinically successful response. Both treatment regimens were well tolerated, with most adverse events being of a mild-moderate and transient nature. The most common treatment-related adverse event was diarrhea, occurring in 7.2% of patients in the twice-daily group and in 10.7% of the three-times-daily group. In total, 173 patients (82.8%) in the twice-daily group and 151 patients (73.3%) in the three-times-daily group were compliant with medication. In conclusion, this study confirms that b.d. amoxycillin/clavulanate is an effective treatment for pediatric acute otitis media and demonstrates that the b.d. and t.d.s. formulations of amoxycillin/clavulanate produce equivalent efficacy. Furthermore, there was a trend towards a higher level of compliance and a lower incidence of drug-related adverse events in the twice-daily compared with the three-times-daily treatment group.

The cost of diabetes mellitus and its impact on health spending in Mexico.

BACKGROUND: The objective of this study was to determine the cost of diabetes mellitus, its impact on health spending in Mexico, and its percentage of the gross domestic product (GDP). METHODS: There was a four-stage approach: identification of the epidemiology of the use of health services; estimate of treatment cost; determination of the diabetic population, and calculation of the percentage of health spending. RESULTS: The average annual cost per diabetic patient was $708 U.S. dollars (USD), the total annual cost of diabetics was $2,618,000 USD, the percentage of health spending was 15.48%, and the percentage of the GDP was 0.79%. CONCLUSIONS: It is necessary to seek strategies that allow for a more efficient use of resources designated for type 2 diabetes treatment.

[Weight-loss drugs: composition of diet pills prescribed in Navarra]. / Fármacos adelgazantes: Composición de preparados magistrales prescritos en Navarra.

BACKGROUND: The prescription, dispensation and sale of "Magisterial formulas" for weight loss is a very extended practice in Spain, in spite of being strongly unadvised by different Administration Department as well as by medical and sanitary groups. The composition of these preparations is not labelled if so only in a generic way. METHODS: The content of 54 capsules from 6 different origins (3 medical consultations, 1 pharmacist consultation, 1 free sale in pharmacies and 1 free sale in stores) was analysed in 2 laboratories. The presence and quantity of 29 active principles was searched by spectrophotometry, chromatography and radioimmunoassay. RESULTS: The presence of some of the 12 following substances was confirmed in 42 samples (77.8%): hormones (levothyroxine, cortisol and cortisone), appetite suppression phenetilamines (amphetamine, amphepranone, fenfluramine and fenproporex), benzodiazepines (diazepam, clorazepato and chlordiazepoxide) and diuretics (triamterene and ciclotiazide). The quantities of active principles was very variable in and among the six groups. In 13 of the capsules 1 active principle and in 29 combinations of two or more was found. None component of the labels, when available, corresponded with their analysed components. In 12 samples (22.2%) none of the which may correspond to some substances different from the 29 sought ones. CONCLUSIONS: The usage of formulas as the studied here on the overweight and obesity treatment should be obviously unadvised.

Screening of some Cuban medicinal plants for antimicrobial activity.

The antimicrobial activities of 23 extracts of 12 Cuban plant species reported in traditional medicine were tested. The agar diffusion method was used to assess the activity against four bacteria and one yeast: Staphylococcus aureus, Bacillus subtilis, Escherichia coli, Pseudomonas aeruginosa and Candida albicans. The results, evaluated as the diameter of the inhibition zone of microbial growth, showed that nine extracts were active against Gram-positive bacteria but only two of these proved to be also active against Gram-negative bacteria. None of the extracts inhibited the growth of the yeast. The most susceptible bacterium was Staphylococcus aureus and the best antibacterial activity was shown by Schinus terebenthifolius.

Piperacillin/tazobactam in the treatment of hospitalized patients with urinary tract infections: an open non-comparative and multicentered trial.

The aim of this multicentered, prospective and open study was to determine the clinical and bacteriological efficacy and safety of piperacillin/tazobactam (4g/500 mg IV tid) in the treatment of 79 adult patients with complicated urinary tract infections (UTI) requiring hospitalization. Forty-seven women and 32 men (mean age 54.2 years, and range 21-91) from 4 Argentinean and 6 Mexican hospitals were enrolled. Sixty-one clinically and bacteriologically evaluable patients were treated for a mean of 9.1 days (range 5-15). A favorable clinical response was seen in 83.6% and 80% at early and late assessment, respectively. Bacteriological eradication was achieved in 85.3% and 80% at early and late estimation, respectively. Escherichia coli was isolated in 33 cases, Klebsiella pneumoniae in 8, Enterococcus spp. in 7, Proteus mirabilis in 6, Pseudomonas aeruginosa in 3, Enterobacter spp. and Morganella morganii in 2. While 21% of all the clinical isolates were resistant to piperacillin, none of them was initially resistant to piperacillin/tazobactam. However, one female patient with a persistent UTI caused by E. coli developed resistance to piperacillin/tazobactam during treatment. A 64-year-old man with frontal meningioma developed purulent meningitis due to Enterobacter cloacae after neurosurgery. He was initially treated with ciprofloxacin, rifampin and amikacin and because of persistence of fever, he was moved to piperacillin/tazobactam. After 5 days of therapy, he developed coma secondary to intracranial hemorrhage and died. By then, the platelet count was normal (220,000/microliters), but the prothrombin time (19.5 seconds) and the partial thromboplastin time (63 seconds) were significantly prolonged. Our data suggest that piperacillin/tazobactam is a reliable therapy for complicated, non-complicated, community or hospital-acquired UTI.

Utilidad de biopsia transbronquial y lavado bronquioloalveolar a través del broncofibroscopio en las enfermedades pulmonares / Transbronchial biopsy and bronchoalveolar lavage utility bronchofiberoscope in pulmonary diseases

Durante el período de Mayo de 1995 a Diciembre de 1995 se realizaron en la Clínica San Pablo - Instituto del Corazón de Lima - Perú 52 procedimientos broncofibroscópicos (BFF) en 26 pacientes de sexo masculino y 26 pacientes de sexo femenino, con una edad media de 61,74 (con un rango de 21-88 años) y 54,88 (con un rango de 7-74 años) respectivamente. El síntoma fundamental fue tos en 71,15 por ciento, asintomáticos respiratorios en 28,85 por ciento y sombra anormal en la radiografía de tórax en 42,31 por ciento. Por esta razón se realizaron 40 biopsias transbronquiales (76 por ciento) (TBLB) y lavado bronquioloalveolar en 13 pacientes (25 por ciento) (BAL), lográndose una efectividad diagnóstica de 88,46 por ciento (46 casos). Las complicaciones relacionadas a la biopsia transbronquial (TBLB) fueron de 3,85 por ciento (2 pacientes) que requirieron drenaje torácico y sangrado leve que cede con solución vasoconstrictora en 15,38 por ciento (8 pacientes). No hubo mortalidad.

Actividad antimicrobiana de plantas medicinales cubanas / Antimicrobial activity of Cuban medicinal plants

Se realizaron pruebas de actividad antimicrobiana mediante la técnica de difusión en agar con el objetivo de evaluar el uso, dentro de la medicina tradicional, de los extractos acuosos de diferentes especies de plantas que crecen en Cuba. La evaluación se realizó con una batería mínima de microrganismos que incluye 3 especies de bacterias y 1 de levadura: Staphylococcus aureus, Bacillus subtilis, Escherichia coli y Candida albicans. Los resultados evaluados mediante la medición del halo de inhibición de crecimiento del microorganismo revelan la actividad antimicrobiana de algunos extractos probados, siendo el más activo el de hojas de Schinus terebenthifolius para Staphylococcus aureus y Bacilus subtilis (AU)

Piperacillin/tazobactam in the treatment of lower respiratory tract infections: an open non-comparative and multicentered trial. Latin American Clinical Research Group.

The aim of this study was to determine the clinical and bacteriological efficacy and safety of piperacillin-tazobactam (PT) (4g/500 mg IV tid) in the treatment of 107 adult patients with lower respiratory tract infections (LRTI) requiring hospitalization. Patients included were 66 men and 41 women with a mean age of 55.2 years (range 18-89), enrolled from Mexican (6) and Argentinean (5) hospitals. Ninety-nine clinically evaluable patients (92.5%), 87 with pneumonia and 12 with bronchitis, were treated for a mean period of 9.3 and 7.3 days, respectively. Response to treatment was favorable in 94.3% cases with pneumonia and 100% of cases with bronchitis; 86 cases (80.3%) were bacteriologically evaluable, 77 with pneumonia (eradication 74, persistence 1, superinfection 2), and 9 with bronchitis (eradication in all). Streptococcus pneumoniae was recovered in 24, Klebsiella pneumoniae in 21, Staphylococcus aureus in 8, Haemophilus influenzae in 7, Pseudomonas aeruginosa in 5, Enterobacter spp. in 6, Escherichia coli in 6 and other organisms in 12. Toxicity or intolerance were not observed. Our data suggest that PT is a reliable therapy for severe LRTI.

[Thoracic traumatism in a specialized unit. Its epidemiology and morbimortality]. / Traumatismos torácicos en una unidad especializada. Epidemiología y morbimortalidad.

Two hundred forty-eight cases of thoracic trauma arriving at our hospital between 1990 and 1992 are analyzed in this report. Injuries were only thoracic in 29% of the cases. The remaining patients presented associated lesions, mainly in the extremities, followed by head injuries. Single or multiple rib fracture, in 193 (77.8%) patients, was the most frequent thoracic injury, followed by 94 (37.6%) cases of hemothorax and 80 (30.2%) instances of pneumothorax. Pulmonary contusion in 57 (22.9%) cases was a serious consequence with a mortality rate of 35.7%. Eighty six (34.6%) chest tube were placed and 14 (5.6%) thoracotomies were performed. Death occurred in 34 (13.7%) cases and was mainly related to the presence of associated injuries, in 29 (16.7%) patients as opposed to 5 (6.9%) (p < 0.05), and to pulmonary contusion in 20 (35.7%) patients vs. 13 (6.8%) (p < 0.001).

[Estimation of infection by Aspergillus fumigatus in mice infected experimentally by the respiratory route]. / Estimación de la infección por Aspergillus fumigatus en ratones infectados experimentalmente por vía respiratoria.

BACKGROUND: To evaluate a new chitin detection technique for the quantification of Aspergillus fumigatus infection in organs from air-borne infected mice. METHODS: Different groups of mice were air-borne infected with A. fumigatus spores. The mortality rate was studied as well as the extension of the infection by means of colony counts (UFC) and quantification of chitin . RESULTS: The inhalation of A. fumigatus spores by non-immunosuppressed mice produces a 34% mortality rate, with an initial invasion of lung tissue followed by the spleen, kidneys, heart and liver thereafter. CONCLUSION: The quantification of chitin in involved organs allowed us to estimate the degree of organ-specific fungal infections and perhaps could be an useful method for studying the pathogenesis of A. fumigatus infections.