Medicina
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Practice Guideline Guideline
[Guidelines for the management of bone and joint infections due to methicillin resistant staphylococci].
Bone and joint infections are a group of complicated diseases with high morbidity. Emerging resistant microorganisms and the use of prosthetic devices have increased the difficulty in the medical treatment of patients. ⋯ The guidelines mainly point to the rational use of diagnostic methods and describe the new treatment modalities. A group of experts analyzed the different strategies for diagnosing and treating bone and joint infections due to methicillin resistant staphylococci and attempted at setting a level of evidence level and the strength of each recommendation.
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Beriberi (BB), thiamine deficiency, has been described in the Asian literature in the 17th century and is characterized by peripheral neuropathy and muscle weakness, also called "dry" beriberi (BB) to differentiate it from "wet" BB, with essentially cardiovascular manifestations. Wet can be either "classic" wet BB in which signs and symptoms of right-sided heart failure with normal or high cardiac output are the presenting features or the "shoshin" BB variant with severe biventricular failure and metabolic acidosis, which must be treated early to prevent the rapid development of low cardiac output failure and sudden death. In this case, we report a 58 year old alcoholic woman who developed dyspnea, oliguria, edema, cardiac failure with high output, metabolic acidosis, renal tubular dysfunction and serum lactate level of 5.6 mEq/L. ⋯ She was treated with a loading dose of 100 mg of intravenous thyamine and responded with a marked increase in urine output, correction of acidosis, reduction in pulmonary-capillary wedge pressure and a change of the hemodynamic pattern. We conclude that shoshin-BB is uncommonly encountered but not widely recognized. In lactic acidosis and/or hyperdynamic circulation without any other apparent etiology in patients with possible vitamin B1 deficiency, the diagnosis of BB must be considered and thiamine should be administered.
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Many infectious bacteria export soluble proteins which can damage the plasma membrane of eukaryotic cells. Most often they are directed against leukocytes for the purpose of reducing the immune response of the host. In some cases, these toxins are also hemolytic. ⋯ These molecules increase the cell susceptibility to chemotherapy and also can be employed to destroy specifically cancer cells. On the other hand, it is possible to incorporate toxin molecules in liposomes, transforming them in to biosensors or as controlled drug delivery systems. This aspect has not been extensively explored in Escherichia coli alpha-hemolysin, in which the presence of different functional and structural domains in this molecule could be taken advantage of.