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Suboptimal lopinavir exposure in infants on rifampicin treatment receiving double-dosed or semi-superboosted lopinavir/ritonavir: time for a change. J Acquir Immune Defic Syndr 2023; 93:42-46. [PMID: 36724434 PMCID: PMC10069754 DOI: 10.1097/qai.0000000000003168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/17/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND While super-boosted lopinavir/ritonavir (LPV/r; ratio 4:4 instead of 4:1) is recommended for infants living with HIV and receiving concomitant rifampicin, in clinical practice many different LPV/r dosing strategies are applied due to poor availability of paediatric separate ritonavir formulations needed to super-boost. We evaluated LPV pharmacokinetics in infants with HIV receiving LPV/r dosed according to local guidelines in various sub-Saharan African countries with or without rifampicin-based tuberculosis (TB)-treatment. METHODS This was a 2-arm pharmacokinetic sub-study nested within the EMPIRICAL trial (#NCT03915366). Infants aged 1-12 months recruited into the main study were administered LPV/r according to local guidelines and drug availability either with or without rifampicin-based TB-treatment; during rifampicin co-treatment they received double-dosed (ratio 8:2) or semi-superboosted LPV/r (adding a ritonavir 100mg crushed tablet to the evening LPV/r dose). Six blood samples were taken over 12 hours after intake of LPV/r. RESULTS In total, 14/16 included infants had evaluable pharmacokinetic curves; 9/14 had rifampicin co-treatment (5 received double-dosed and 4 semi-superboosted LPV/r). The median (IQR) age was 6.4 months (5.4-9.8), weight 6.0kg (5.2-6.8) and 10/14 were male. Of those receiving rifampicin, 6/9 (67%) infants had LPV C trough <1.0mg/L compared to 1/5 (20%) in the control arm. LPV apparent oral clearance was 3.3-fold higher for infants receiving rifampicin. CONCLUSION Double-dosed or semi-superboosted LPV/r for infants aged 1-12 months receiving rifampicin resulted in substantial proportions of subtherapeutic LPV levels. There is an urgent need for data on alternative antiretroviral regimens in infants with HIV/TB co-infection, including twice-daily dolutegravir.
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The CARMA study – children on early suppressive therapy: total HIV-1 DNA quantitation 12 years post ART initiation. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)31041-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Tuberculosis in HIV-infected children in Europe, Thailand and Brazil: paediatric TB-HIV EuroCoord study. Int J Tuberc Lung Dis 2018; 20:1448-1456. [PMID: 27776584 DOI: 10.5588/ijtld.16.0067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Centres participating in the Paediatric European Network for Treatment of AIDS (PENTA), including Thailand and Brazil. OBJECTIVE To describe the incidence, presentation, treatment and treatment outcomes of tuberculosis (TB) in human immunodeficiency virus (HIV) infected children. DESIGN Observational study of TB diagnosed in HIV-infected children in 2011-2013. RESULTS Of 4265 children aged <16 years, 127 (3%) were diagnosed with TB: 6 (5%) in Western Europe, 80 (63%) in Eastern Europe, 27 (21%) in Thailand and 14 (11%) in Brazil, with estimated TB incidence rates of respectively 239, 982, 1633 and 2551 per 100 000 person-years (py). The majority (94%) had acquired HIV perinatally. The median age at TB diagnosis was 6.8 years (interquartile range 3.0-11.5). Over half (52%) had advanced/severe World Health Organization stage immunodeficiency; 67 (53%) were not on antiretroviral therapy (ART) at TB diagnosis. Preventive anti-tuberculosis treatment was given to 23% (n = 23) of 102 children diagnosed with HIV before TB. Eleven children had unfavourable TB outcomes: 4 died, 5 did not complete treatment, 1 had recurrent TB and 1 had an unknown outcome. In univariable analysis, previous diagnosis of acquired immune-deficiency syndrome, not being virologically suppressed on ART at TB diagnosis and region (Brazil) were significantly associated with unfavourable TB outcomes. CONCLUSION Most TB cases were from countries with high TB prevalence. The majority (91%) had favourable outcomes. Universal ART and TB prophylaxis may reduce missed opportunities for TB prevention.
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Report from the First EPIICAL (Early-treated Perinatally HIV-infected Individuals: Improving Children's Actual Life with Novel Immunotherapeutic Strategies) General Assembly meeting, 9-11 November 2017, Rome, Italy. J Virus Erad 2018; 4:51-54. [PMID: 29568555 PMCID: PMC5851186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Report from the First EPIICAL (Early-treated Perinatally HIV-infected Individuals: Improving Children's Actual Life with Novel Immunotherapeutic Strategies) General Assembly meeting, 9–11 November 2017, Rome, Italy. J Virus Erad 2018. [DOI: 10.1016/s2055-6640(20)30240-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Discovery and spectroscopy of the young jovian planet 51 Eri b with the Gemini Planet Imager. Science 2015; 350:64-7. [DOI: 10.1126/science.aac5891] [Citation(s) in RCA: 391] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 08/03/2015] [Indexed: 11/02/2022]
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Documento de Consenso SEIP-SERPE-SEOP sobre etiopatogenia y diagnóstico de la osteomielitis aguda y artritis séptica no complicadas. An Pediatr (Barc) 2015; 83:216.e1-10. [DOI: 10.1016/j.anpedi.2014.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022] Open
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SEIP-SERPE-SEOP consensus document on aetiopathogenesis and diagnosis of uncomplicated acute osteomyelitis and septic arthritis. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.anpede.2015.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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[Response to the letter to the editor from SEOP as regards the SEIP-SERPE-SEOP consensus document on the treatment of uncomplicated acute osteomyelitis and septic arthritis]. An Pediatr (Barc) 2015; 83:224. [PMID: 26318251 DOI: 10.1016/j.anpedi.2015.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022] Open
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The EPIICAL project: an emerging global collaboration to investigate immunotherapeutic strategies in HIV-infected children. J Virus Erad 2015; 1:134-139. [PMID: 26893908 PMCID: PMC4755515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The EPIICAL (Early-treated Perinatally HIV-infected Individuals: Improving Children's Actual Life with Novel Immunotherapeutic Strategies) project arises from the firm belief that perinatally infected children treated with suppressive antiretroviral therapy (ART) from early infancy represent the optimal population model in which to study novel immunotherapeutic strategies aimed at achieving ART-free remission. This is because HIV-infected infants treated within 2-3 months of life have a much reduced viral reservoir size, and rarely show HIV-specific immunity but preserve normal immune development. The goal of EPIICAL is the establishment of an international collaboration to develop a predictive platform using this model to select promising HIV therapeutic vaccine candidates, leading to prioritisation or deprioritisation of novel immunotherapeutic strategies. To establish this platform, the EPIICAL Consortium aims to: develop predictive models of virological and immunological dynamics associated with response to early ART and to treatment interruption using available data from existing cohorts/studies of early-treated perinatally HIV-infected children; optimise methodologies to better characterise immunological, virological and genomic correlates/profiles associated with viral control; test novel immunotherapeutic strategies using in vivo proof-of-concept (PoC) studies with the aim of inducing virological, immunological and transcriptomic correlates/profiles equivalent to those defined by the predictive model. This approach will strengthen the capacity for discovery, development and initial testing of new therapeutic vaccine strategies through the integrated efforts of leading international scientific groups, with the aim of improving the health of HIV-infected individuals.
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SEIP–SERPE–SEOP Consensus document on the treatment of uncomplicated acute osteomyelitis and septic arthritis. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.anpede.2014.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Heart Transplantation With Generic Immunosuppression: A Developing Country Experience. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Clinical and virologic follow-up in perinatally HIV-1-infected children and adolescents in Madrid with triple-class antiretroviral drug-resistant viruses. Clin Microbiol Infect 2015; 21:605.e1-9. [PMID: 25680310 DOI: 10.1016/j.cmi.2015.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/29/2014] [Accepted: 02/01/2015] [Indexed: 11/16/2022]
Abstract
Drug resistance mutations compromise the success of antiretroviral treatment in human immunodeficiency virus type 1 (HIV-1)-infected children. We report the virologic and clinical follow-up of the Madrid cohort of perinatally HIV-infected children and adolescents after the selection of triple-class drug-resistant mutations (TC-DRM). We identified patients from the cohort carrying HIV-1 variants with TC-DRM to nucleoside reverse transcriptase inhibitors, nonnucleoside reverse transcriptase inhibitors and protease inhibitors according to IAS-USA-2013. We recovered pol sequences or resistance profiles from 2000 to 2011 and clinical-immunologic-virologic data from the moment of TC-DRM detection until December 2013. Viruses harbouring TC-DRM were observed in 48 (9%) of the 534 children and adolescents from 2000 to 2011, rising to 24.4% among those 197 with resistance data. Among them, 95.8% were diagnosed before 2003, 91.7% were Spaniards, 89.6% carried HIV-1-subtype B and 75% received mono/dual therapy as first regimen. The most common TC-DRM present in ≥50% of them were D67NME, T215FVY, M41L and K103N (retrotranscriptase) and L90M (protease). The susceptibility to darunavir, tipranavir, etravirine and rilpivirine was 67.7%, 43.7%, 33.3% and 33.3%, respectively, and all reported high resistance to didanosine, abacavir and nelfinavir. Despite the presence of HIV-1 resistance mutations to the three main antiretroviral families in our paediatric cohort, some drugs maintained their susceptibility, mainly the new protease inhibitors (tipranavir and darunavir) and nonnucleoside reverse transcriptase inhibitors (etravirine and rilpivirine). These data will help to improve the clinical management of HIV-infected children with triple resistance in Spain.
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Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV-1 infection 2015: optimizing health in preparation for adult life. HIV Med 2015; 19:e1-e42. [PMID: 25649230 PMCID: PMC5724658 DOI: 10.1111/hiv.12217] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 02/06/2023]
Abstract
The 2015 Paediatric European Network for Treatment of AIDS (PENTA) guidelines provide practical recommendations on the management of HIV‐1 infection in children in Europe and are an update to those published in 2009. Aims of treatment have progressed significantly over the last decade, moving far beyond limitation of short‐term morbidity and mortality to optimizing health status for adult life and minimizing the impact of chronic HIV infection on immune system development and health in general. Additionally, there is a greater need for increased awareness and minimization of long‐term drug toxicity. The main updates to the previous guidelines include: an increase in the number of indications for antiretroviral therapy (ART) at all ages (higher CD4 thresholds for consideration of ART initiation and additional clinical indications), revised guidance on first‐ and second‐line ART recommendations, including more recently available drug classes, expanded guidance on management of coinfections (including tuberculosis, hepatitis B and hepatitis C) and additional emphasis on the needs of adolescents as they approach transition to adult services. There is a new section on the current ART ‘pipeline’ of drug development, a comprehensive summary table of currently recommended ART with dosing recommendations. Differences between PENTA and current US and World Health Organization guidelines are highlighted and explained.
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[SEIP-SERPE-SEOP Consensus document on the treatment of uncomplicated acute osteomyelitis and septic arthritis]. An Pediatr (Barc) 2014; 82:273.e1-273.e10. [PMID: 25444035 DOI: 10.1016/j.anpedi.2014.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 10/02/2014] [Indexed: 11/30/2022] Open
Abstract
This is a Consensus Document of the Spanish Society of Paediatric Infectious Diseases (Sociedad Española de Infectología Pediatrica), Spanish Society of Paediatric Rheumatology (Sociedad Española de Reumatología Pediátrica) and the Spanish Society of Paediatric Orthopaedics (Sociedad Española de Ortopedia Pediátrica), on the treatment of uncomplicated acute osteomyelitis and septic arthritis. A review is presented on the medical and surgical treatment of acute osteoarticular infection, defined as a process with less than 14 days of symptomatology, uncomplicated and community-acquired. The different possible options are evaluated based on the best available scientific knowledge, and a number of evidence-based recommendations for clinical practice are provided.
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Thoratec Centrimag VAD for cardiogenic shock – a developing country experience. J Cardiothorac Surg 2013. [PMCID: PMC3844583 DOI: 10.1186/1749-8090-8-s1-o156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Heart transplantation with generic immunosuppression – a developing country experience. J Cardiothorac Surg 2013. [PMCID: PMC3844460 DOI: 10.1186/1749-8090-8-s1-o157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Red Optical Planet Survey: A radial velocity search for low mass M dwarf planets. EPJ WEB OF CONFERENCES 2013. [DOI: 10.1051/epjconf/20134705002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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[Massive eosinophilia in an oncology/haematology patient]. An Pediatr (Barc) 2012. [PMID: 23206976 DOI: 10.1016/j.anpedi.2012.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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The Calan-Hertfordshire extrasolar planet search. EPJ WEB OF CONFERENCES 2011. [DOI: 10.1051/epjconf/20111602004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Panton-Valentine leukocidin-positive Staphylococcus aureus skin and soft tissue infections among children in an emergency department in Madrid, Spain. Clin Microbiol Infect 2010; 16:74-7. [PMID: 19519839 DOI: 10.1111/j.1469-0691.2009.02830.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Fifty-three children who attended the emergency department with community-associated (CA) Staphylococcus aureus skin and soft tissue infections (SSTIs) were enrolled in the study. Seven cases of infection (13.2%) were due to methicillin-resistant S. aureus (MRSA). Twelve of 46 available isolates (26.1%) were Panton-Valentine leukocidin (PVL)-positive. PVL-positive S. aureus SSTIs were more frequently associated with abscesses and cellulitis (75% vs. 38%, p 0.028), and more commonly required incision and drainage (75% vs. 21%, p 0.001). Most PVL-positive CA-MRSA isolates belonged to a single multilocus sequence type (ST8). In contrast, PVL-positive methicillin-susceptible S. aureus isolates belonged to four different sequence types (ST8, ST30, ST80, ST120).
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Abstract
OBJECTIVES We undertook a prospective study to estimate the prevalence of gestational diabetes mellitus (GDM) and associated risk factors in a cohort of 669 HIV-1 infected women. METHODS The O'Sullivan and glucose tolerance tests were performed during regular visits of 609 mothers. RESULTS The median age of the cohort was 30.7 years (range 16-44), with most women having had heterosexual contact (67%). The majority were in Centers for Disease Control (CDC) category A (71%) and 53% exhibited hepatitis C co-infection. Median viral load and CD4 count at third trimester were 545 cells/microL (range 139-1690 cells/microL) and 1.9 log (range 1.7-5.4), respectively. Seventy-four per cent of the patients were treated with highly active antiretroviral therapy (HAART), of whom 41% received a protease inhibitor (PI). An above-average prevalence of 7% [95% confidence interval (CI) 5.2-9.5] for positive GDM diagnosis was found. Risk factors associated with GDM in univariate analysis included older age, hepatitis C co-infection, stavudine and PI exposure. However, only older age [adjusted odds ratio (AOR) 1.09, 95% CI 1-1.1] and PI exposure (AOR 2.4, 95% CI 1-5.3) remained as independent risk factors for GDM development in multivariate analysis. CONCLUSIONS In our cohort, the prevalence of GDM appears to be increased, with older age and PI exposure contributing as significant independent risk factors.
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Abstract
An 18-year-old man without previous clinical problems developed a left traumatic carotid-cavernous fistula after a traffic accident. An endovascular embolization with coils was performed without success. The drainage was derived to the superior ophthalmic vein solely and clinical worsening occurred. Left eye proptosis, chemosis and intraocular pressure increased. Complete ophthalmoplegia developed and visual acuity decreased due to a central retinal vein obstruction. After a second embolization attempt the fistula was closed successfully but proptosis, chemosis and intraocular pressure remained uncontrolled despite medical treatment. Therefore an orbital decompression surgery was performed. Ophthalmoplegia, proptosis and chemosis improved and intraocular pressure was controlled. Although retinal hemorrhages persist, no neovascularization has developed. Central retinal vein occlusion in young patients seems to have a different etiology than in the elderly. In young patients, local factors are more frequently identified than systemic vascular diseases. Early detection of central retinal vein obstruction may prevent deterioration of visual acuity.
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[Effectiveness of antiretroviral therapy in HIV-1 infected children. A cross-sectional study]. An Pediatr (Barc) 2005; 62:32-7. [PMID: 15642239 DOI: 10.1157/13070178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION There are few cross-sectional studies describing the current situation of HIV-1-infected children. Such studies would be useful to determine patients' clinical and immunologic and virologic status, currently prescribed therapies and their associated toxicity. OBJECTIVES To perform a descriptive analysis of the clinical, immunological and virological status of HIV-1-infected children followed-up in the pediatric unit of a tertiary hospital and describe the current antiretroviral therapies used to treat them. MATERIAL AND METHODS A cross-sectional study was performed. Data were collected from all HIV-1-infected children followed-up until January 2002 in a large pediatric referral hospital (Hospital 12 de Octubre in Madrid). Clinical evaluation and laboratory investigations were scheduled to be performed every 3 months. The most recent CD4 and plasma viral loads were evaluated. Viral loads were considered undetectable when there were less than 300 copies/ml at the last evaluation. RESULTS Sixty-six HIV-1-infected children who were followed-up to January 2002 were analyzed. All the children acquired the infection through vertical transmission except one, in whom the mode of transmission was unknown. The median age was 111 months (18-216). Twenty children were category C. The median CD4 cell count was 953 cells/mm3 (276-3137), 28 % +/- 8 (12.42). One child was receiving no therapy, four were on combination therapy with two nucleoside reverse transcriptase inhibitors (NRTI) and 61 were receiving highly active anti-retroviral therapy (HAART). Twenty-seven children (44 %) were receiving the first HAART regimen, 23 the second, and 11 had already been switched more than twice. Overall, 37 of the 61 patients receiving HAART had an undetectable plasma viral load. CONCLUSIONS Most children in our study had gone through several antiretroviral regimens, although not all children were being treated with HAART. Fifty-six percent of the patients with HAART had an undetectable plasma viral load. However, new complications associated with this therapy have begun to appear.
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[Voltage sources analysis in studies with foramen ovale electrodes]. Rev Neurol 2004; 38:209-16. [PMID: 14963846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Paroxysmal activity in medial temporal lobe epilepsy is originated in either hippocampal or parahippocampal regions. This activity can be directly recorded by foramen ovale electrodes. That paroxysmal activity will start from irritative or ictal areas. However, anatomo-functional relations between both regions are still debated. OBJECTIVE We describe a new physical very simple model which allows to directly analysis the anatomo-physiological relations between sources for interictal and ictal areas. RESULTS 1) The mathematical model allows to fit with minimum error and great precision the voltage sources originated from monopoles. 2) We can obtain this degree of precision with a matrix using an internodal distance of 0.1 mm (300x200 nodes) 3) Triplets of potentials with double sources with equal or specially with inverse charges have bigger error than monopolar charges. 4) Fitting real data obtained from a patient shows an error of 0.29 +/- 0.17% for interictal and 0.54 +/- 1.22% and 2.84 +/- 3.00% for two seizures (mean +/- SD). CONCLUSIONS This model allows directly to know the relative anatomo-physiological relations between interictal and ictal sources in MTLE, which have a very important implications so for patho-physiological as therapeutics and outcome implications.
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Abstract
Every year infectious diseases kill about 13 million people, about 30.000 deaths a day. Almost half of the victims are children younger than 5 years old, most of them belong to developing countries. Most of the premature deaths and the incapacity cases associated to infectious diseases could be avoided if the poor had access to medicines. In the developing world, the poverty of the families, the inappropried public expense and the lack of sanitary infrastructures get together to leave out of the reach of the poor the possibility of an adequate medical treatment. According to World Health Organization (WHO) in the developing countries about 2,000 million people lack access to essential medicines. The new patent rules of the World Trade Organization (WTO) will reduce even more access to essential medicines to the poor. Granting trade exclusivity rights to the owners of the patents for a period of at least 20 years limits the right of the governments to allow production, trade and importation of low cost copies (generics) of patented drugs. It is not a theoretical or far away menace. The application of these more strict rules has all ready caused serious problems to developing countries producers of generics as India or Brazil or to importers of these as South Africa or Kenya. They have been press, taken to court and threaten of sanctions by the pharmaceutical industry and some developed countries governments. The decision of some developing countries to fight for their most needed people's health added to the international campaign for the access to essential medicines defended by some non governmental organizations like Act Up, Treatment Action Campaign, Doctors Without Borders and Intermon Oxfam have implied small victories on behalf of the poor countries access to medicines. But deeper changes in the patent rules and the investigation of the diseases of the developing world are needed to improve health in the developing countries.
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Abstract
PURPOSE To evaluate the results of implantation of a tubular prosthesis between the medial palpebral canthus and the nasal fossa, through the soft tissues of the face, in cases of irrecuperable damage of the lacrimal canaliculi. MATERIAL AND METHODS Fifty eyes with canalicular destruction were operated, placing a silicone and Pyrex tubular prosthesis between the lacrimal caruncle and the nasal vestibulum, running almost vertically through the soft tissues of the face, without osteal perforation. RESULTS Lacrimal flow was restored in 47 cases. There were three cases of dislocation of the prosthesis, three infections and five papillomata. CONCLUSIONS Vertical conjunctivo-rhinostomy without osteal perforation is an easy and efficient solution for irrecuperable occluded canaliculi.
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[Localization of the epileptogenic zone by analysis of electroencephalographic dipole]. Rev Neurol 2001; 32:315-20. [PMID: 11333384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
INTRODUCTION In partial epilepsy with seizures which are resistant to drug treatment, better results may be obtained with surgery. This follows thorough assessment to identify the area of the brain responsible for the origin of the seizures, or the epileptogenic zone (EZ), and show that surgical operation will not cause neurological or cognitive damage which might handicap the patient. OBJECTIVE This study analyses the value in diagnosis of electroencephalographic dipoles in delimitation of the EZ in patients with refractory partial epilepsy who are candidates for surgical treatment. PATIENTS AND METHODS In 43 patients we made EEG recordings whilst at rest with their eyes shut during 15 minutes. The signal was analysed by digital EEG apparatus and a map drawn of cerebral electrical activity based on the maximum average amplitude of the epileptic spikes. The electric dipole equivalent to epileptiform activity between seizures was obtained using the programme for analysis of electroencephalographic sources BESA. The localization of the EZ by means of the dipole was compared with the results of EEG, MR, SPECT and seizure video-EEG using intracranial electrodes. RESULTS The results of this study show that the dipole model used is highly sensitive for localization of EZ, and in cases in which the dipole and MR coincided, its sensitivity is similar to that of video-EEG during seizures. CONCLUSIONS The model of dipole used in this study is of great help when indicating surgery for patients with drug-resistant epilepsy.
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[Pleural effusion due to Listeria monocytogenes. A case report and review of the literature]. ANALES DE MEDICINA INTERNA (MADRID, SPAIN : 1984) 1999; 16:463-5. [PMID: 10609360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
The infection caused by Listeria monocytogenes is a relatively common condition in immunosuppressed patients. The most frequent presentation in adults are sepsis and meningitis. Pleural fluid infection due to this pathogen is a rare finding in the literature. Most cases are found in immunosuppressed patients, particularly in those with haematologic malignancies. We report one case of pleural fluid infection due to Listeria monocytogenes in a patient with hepatic cirrhosis (the third case in the literature). We also review the seventeen cases previously reported and describe the clinical manifestations, its immunosuppression states relationship, the treatment of choice and the mortality.
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Abstract
The frontotemporal fasciocutaneous island flap is a useful source of tissue for correcting aesthetic units of the face. The quality of the tissue may be enhanced, and a successful color and texture match may be achieved. This flap is based on the temporal vessel system and its own fascia. Its provides excellent venous drainage and its pedicle length and arc of rotation may be increased. The donor scar is hidden under the hair-bearing area. The frontotemporal fasciocutaneous island flap was used in patients with inferior eyelid defects, for cheek reconstruction, for providing coverage of superior and inferior lip defects, for restoring the normal anatomy of columellar defects, and for reestablishing the contour of menton defects. The frontotemporal fasciocutaneous island flap was employed successfully in 9 patients at the Hospital Gea Gonzalez. The wide treatment possibilities for the reconstruction of aesthetic units in the face with the frontotemporal fasciocutaneous island flap are illustrated.
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[Transient bacteremia caused by Aeromonas jandaei]. Enferm Infecc Microbiol Clin 1997; 15:336-7. [PMID: 9376410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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32
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[Alloiococcus otitidis: a more common microorganism than we thought?]. Enferm Infecc Microbiol Clin 1997; 15:174-5. [PMID: 9235069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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33
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[Infectious endocarditis: prognostic factors of mortality in 131 cases]. Rev Med Chil 1997; 125:165-73. [PMID: 9430936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Global hospital mortality for infective endocarditis ranges from 13 to 40%. AIM To compare clinical, microbiological, echocardiographic factors and complications between patients that died during an episode of infective endocarditis and those who survived. PATIENTS AND METHODS We followed during their hospital stay, 129 patients, aged 14 to 74 years old, who had 131 episodes of infective endocarditis. Clinical assessment, echocardiography and microbiological study was done to all patients. Surgical indications were those derived from complications. RESULTS Thirty three patients died during hospital stay (25.2%). There were no differences between survivors and deceased patients in the lapse between onset of symptoms and hospital admission, presence of fever, dyspnea or heart murmurs. Skin and mucosal septic manifestations occurred with higher frequency in deceased patients (57.1 and 24.3% respectively). Blood cultures were positive in 55% in survivors and 48% in those who died. The most frequent infecting organisms were staphilococci and streptococci. Vegetations were found with greater frequency in aortic position in both groups of patients. Deceased patients had a higher frequency of cardiac failure (84 and 65% respectively) and embolic episodes (77 and 46% respectively) than survivors. Antimicrobial treatment was successful in 94% of survivors and 15% of those who died. Forty percent of survivors and 54% of deceased patients were subjected to surgical procedures. CONCLUSIONS The most important predictor of hospital mortality in this series of patients with infective endocarditis was antimicrobial treatment failure.
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[Isolation of Campylobacter sputorum biovar sputorum from a bed sore]. Enferm Infecc Microbiol Clin 1997; 15:43. [PMID: 9147509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Abstract
Mandibular reconstruction is a condition in which both bone defect and function must be restored. A wide range of approaches--from grafts to distant bone flaps--have been used for correcting bony defects. However, adequate mastication has been restored in only a few cases. In this article the results of three different techniques for mandibular reconstruction after hemimandibulectomy were studied. Sixteen patients underwent a second mandibular reconstruction after hemimandibulectomy and were monitored at least 1 year. Three different techniques were used: (1) full-thickness galeoparietal bone flap (eight patients), (2) free iliac crest graft (three patients), and (3) free fibular grafts (five patients). Occlusion on the nonoperated side and the possibility and function of osseointegrated denture in the vascularized bone transfer were evaluated. The full-thickness galeoparietal flap and free iliac crest bone flap appeared to be good options. However, only acceptable or poor occlusion could be achieved on the normal side. The fibular free flap demonstrated good results and good occlusion. Nonetheless, dental implantation was difficult because a prosthesis for reaching the normal height of the mandible was necessary.
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Abstract
Crossed facial nerve grafts for treating unilateral permanent facial palsy in association with hemifacial microsomia were studied in 18 patients, ages ranging from 2 months to 10 years. Patients were divided into groups according to the age at the time of indication of surgery. It is concluded that crossed nerve grafting for facial palsy associated with hemifacial microsomia appears to be an adequate procedure especially when the surgery is indicated soon after birth.
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Overexpression of basal c-fos and c-jun but not of ras oncogenes after Theiler's murine encephalomyelitis virus infection of glial cells. J Neurovirol 1996; 2:167-74. [PMID: 8799209 DOI: 10.3109/13550289609146879] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Constitutive expression of the cellular proto-oncogenes c-fos and c-jun, and in a lesser extent ras, was demonstrated in the glioma cell line C-6 by flow cytometry analysis using specific mono and polyclonal antibodies. Basal expression of the products of the early response genes c-fos and c-jun were increased 66 and 50% when Theiler's murine encephalomyelitis virus (TMEV) infected these cells. No increase in ras transcription could be demonstrated after infection. This activation follows a kinetic reaching maximum values after 60 min and was proportional to the multiplicity of infection used. The described effect was completely abrogated by rabbit antibodies to TMEV but was not altered by normal rabbit serum. Furthermore, an intact infectious virion is needed to detect this effect. Fetal calf serum and lipopolysaccharide stimulation slightly increases c-fos and c-jun expression following a slower kinetics. Cytokine treatment (IL-1 alpha, IL-6, IFN-gamma and TNF alpha), did not induce oncogene over-expression. Therefore, this stimulation seems to be linked to the TMEV infectious process.
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39
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[Disseminated histoplasmosis in a patient infected with the HIV]. Enferm Infecc Microbiol Clin 1996; 14:60-1. [PMID: 8714191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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40
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Abstract
Crossed facial nerve grafts for treating congenital or acquired permanent facial palsy were studied in 23 patients, ages ranging from 2 months to 38 years. Patients were divided into groups according to time after onset of paralysis. It is concluded that although crossed facial nerve grafts offered the possibility of reinnervation after facial palsy, the degree of recovery was critically dependent upon the time after onset of the facial palsy before the reinnervation procedure.
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Aesthetic treatment of Romberg's disease: experience with 35 cases. BRITISH JOURNAL OF PLASTIC SURGERY 1993; 46:194-200. [PMID: 8490697 DOI: 10.1016/0007-1226(93)90168-b] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Our experience with dermis-fat free flaps and conventional reconstructive procedures for 35 patients with Romberg's disease over a 7-year period is presented. The groin flap was used for increasing volume in 33 cases, the scapular flap in 3 cases, and 2 were treated with the latissimus dorsi free flap. To achieve better contour, secondary procedures such as defatting of the flap, pedicled temporal fascial flaps, cartilage and bone grafts, orthognathic surgery, and other conventional aesthetic procedures were performed in 32 patients. Excellent results were achieved in 9 mildly deformed patients, in 12 out of 16 moderately, and in 3 out of 10 severely affected patients. Four moderate and 5 severe cases were classified as good results. Poor results were achieved in 2 severe cases.
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42
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[Diagnosis of anaerobic infection of the pleural fluid using gas-liquid chromatography]. Enferm Infecc Microbiol Clin 1993; 11:84-9. [PMID: 8481441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND An assessment of the efficacy of the detection of volatile and non-volatile fatty acids that are produced by microorganisms aimed at the possible diagnosis of pleural empyema. METHODS 106 pleural fluids were examined by gas-liquid chromatography in contrast to conventional aerobic and anaerobic cultures. The sample previously prepared (1 microliter) was injected in an Hewlett-Packard 5890 chromatograph, that was equipped with a fused silica capillary column and a flame ionization detector. RESULTS Growth of aerobic or anaerobic microorganisms was obtained in 13 (12.3%) of the samples, and volatile or non-volatile fatty acids were detected in all of them (sensitivity = 1). No growth was obtained in the 93 samples, but volatile or non-volatile fatty acids were detected in 64 (68.8%) of them (specificity = 0.31). A positive predictive value of 0.17 and a negative predictive value of 1 were obtained. Growth of anaerobic microorganisms was obtained in 9 samples (8.5%) and volatile fatty acids were detected in all of them (sensitivity = 1). Anaerobic microorganisms did not grow in 97 samples, however volatile fatty acids were detected in 2 (2.1%) of them. A positive predictive value of 0.82 and a negative of 1 were obtained. CONCLUSIONS Referring to pleural fluid samples, the detection of volatile and non-volatile fatty acids by gas-liquid chromatography is a highly sensitive method, that may be used to quickly reject negative samples in about 30 mins. Furthermore, when anaerobic microorganisms exist, the high specificity of gas-liquid chromatography will make it possible to confirm their presence in the sample, mainly if there is a clinical suspect of anaerobic infection. Thus, the utilization of this sensitive method may also change the therapeutic behaviour.
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[Bacteremia caused by S. bovis and cirrhosis]. Enferm Infecc Microbiol Clin 1992; 10:557. [PMID: 1489800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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44
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[Bacteremia caused by Corynebacterium jeikeium in an immunocompromised patient]. Enferm Infecc Microbiol Clin 1992; 10:561. [PMID: 1489804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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45
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[Pulmonary infection caused by Mycobacterium szulgai in a patient with hairy-cell leukemia]. Enferm Infecc Microbiol Clin 1992; 10:433-4. [PMID: 1450268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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46
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[Chronic granulomatous disease and pulmonary nocardiosis]. Med Clin (Barc) 1992; 99:27-9. [PMID: 1602896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A 19-years-old male was admitted for left bilobar pneumonia. All microbiologic studies in blood and in several samples obtained by bronchoscopy were negative. The patient worsened progressively despite antibiotherapy of a wide spectrum. A fine needle transparietal puncture was performed. The cultures of the sample were positive for Nocardia asteroides, a positive catalase germ. Immunologic studies initiated after this time showed negative tetrazolium nitroblue test, the results of which led to the diagnosis of chronic granulomatous disease. This disease is very infrequent and the polymorphonuclear leukocytes are genetically incapable of producing peroxides whose absence impedes lysis of the positive phagocytic catalase germs with which a histologic reaction is produced in the form of granulomas from which the name of the disease is derived.
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[Analysis of data from a database of patients submitted to cardiac catheterization]. Rev Med Chil 1992; 120:390-6. [PMID: 1340568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
77 variables with data from clinical, non invasive and invasive findings in 591 adult patients submitted to cardiac catheterization and/or coronary arteriography from 1988 to 1991 were analyzed. 51% had coronary arteriography for suspected coronary artery disease: 15% had no or insignificant disease and 8% had main left disease. Among 92 patients with valvular heart disease, coronary angiography ruled out coronary disease in 80%. In this group, 3 vessel disease was found only in patients older than 62 years of age and main left disease was rare. The etiology of valve disease was rheumatic in 72%. Congenital heart disease was the indication for invasive study in 8% of patients, atrial septal defect being the most common entity.
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48
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[Epidemiologic characteristics of pneumococcal bacteremia in the era of AIDS]. Enferm Infecc Microbiol Clin 1992; 10:138-42. [PMID: 1576186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The HIV infection and the development of penicillin-resistant pneumococci justify the review of the epidemiologic features of pneumococcal pneumonia in the last years. METHOD A retrospective chart review of all patients admitted between 1987 and 1990 with a positive blood culture to Streptococcus pneumoniae was conducted. Different epidemiologic variables were selected ad compared. RESULTS Streptococcus pneumoniae was isolated in 147 blood cultures from 147 patients. The estimated incidence of pneumococcal bacteremia was 10 cases per 100,000 inhabitants/year. The figure increases from 7 to 12 cases during the study period. The risk factors identified were: HIV infection, 27 patients (19%); cancer, 14 patients (10%); cirrhosis of the liver, 13 patients (9%). In 56 cases (38%) no special risk factors were identified. All bacteremic episodes were from a pulmonary source. In 66% of patients, no special complications were recorded. Mortality outcome was related to age (28% if aged more than 60 years, 7% if less; p = 0.001, chi 2, and with the underlying condition (p = 0.034, chi 2). Resistance to penicillin increases from 0.0% to 21% during the study period (p = 0.03, chi 2) but it seems not to have any impact in mortality nor in the nosocomial origin of the bacteremia. CONCLUSIONS In the last 4 years we have observed an increase in the incidence of pneumococcal bacteremia related to an increase in cases among HIV infected patients, and also the emergence of penicillin-resistant strains. However, none of the two mentioned conditions seems to have any impact on mortality.
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[Isolation of Moraxella catarrhalis in a case of postoperative mediastinitis]. Enferm Infecc Microbiol Clin 1992; 10:122-3. [PMID: 1643138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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50
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[Infection of a permanent vascular catheter by Corynebacterium xerosis]. Enferm Infecc Microbiol Clin 1992; 10:57. [PMID: 1498180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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