Medicina
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Randomized Controlled Trial Clinical Trial
Effect of Lactobacillus strains and Saccharomyces boulardii on persistent diarrhea in children.
The efficacy of probiotics on persistent diarrhea remains uncertain. The purpose of this study was to evaluate the effect of Lactobacillus sp and Saccharomyces boulardii on persistent diarrhea in children. In a double-blind trial eighty-nine children, aged 6-24 months were randomly distributed to receive pasteurized cow milk containing 2 viable lyophilized strains Lactobacillus casei and Lactobacillus acidophillus strains CERELA, (10(10)-10(12) colony-forming units per g) (n = 30), or lyophilized S. boulardii, (10(10)-10(12) colony forming units per g) (n = 30) or pasteurized cow milk as placebo (n = 29); on each diet 175 g was given twice a day for a 5 day period. ⋯ Similarly both significantly (p < 0.002) reduced vomiting as compared with placebo. There was no difference between treatments depending on rotavirus status. In conclusion, L. casei and L. acidophillus strains CERELA and S. boulardii are useful in the management of persistent diarrhea in children.
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Pulmonary arterial hypertension (PAH) is defined as a group of diseases characterised by a progressive increase of pulmonary vascular resistance leading to right ventricular failure and death. A dysregulation of prostacyclin metabolic pathways has been demonstrated in patients with PAH and in experimental models. ⋯ Other modes of prostacyclin therapies are being considered using stable prostacyclin analogues administered by inhalation (iloprost), subcutaneously (treprostinil) or orally (beraprost). Over the last years, different multicenter international double-blind trials have demonstrated the efficacy of those novel prostacyclin analogues in PAH compared to conventional therapy promising a better future for these patients.
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Cutaneous injuries with crepitus suggest infections caused by gas forming organisms. The non infectious causes of subcutaneous emphysema are under recognized, and are usually of good prognosis. A 27 year old man presented a swollen hand and forearm. ⋯ At examination, we found extended subcutaneous emphysema in a radiography and observed subcutaneous air in the hand and forearm; 48 hs later there was no evidence of subcutaneous air. The presence of subcutaneous emphysema is always worrisome and such cases must be considered in the differential diagnosis. The exposition of preexistent wounds to compressed air sources (high pressure pneumatic tools, scuba compressed air tubes, compressed air guns) identifies the cause and prevents unnecessary surgical interventions.
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Comparative Study
[Bacterial resistance to antibiotics in gram-negative rods isolated from intensive care units. Comparative analysis between two periods (1998 and 2001)].
The incidence and drug susceptibility of gram-negative isolates from clinical samples of patients from different intensive care units at the Hospital de Clinicas José de San Martín were analysed. Two hundred isolates during the same five months period, in two different years (1998 and 2001) were obtained and evaluated. Acinetobacter spp., was the most frequently isolated microorganism. ⋯ Klebsiella pneumoniae was not resistant to imipenem, the resistance to 3rd and 4th generation cephalosporins decreased from 71.4 to 30% of isolates (p < 0.05), while ciprofloxacin resistance increased from 5 to 20% (p < 0.05). An increasing resistance to imipenem in Pseudomonas aeruginosa was noted, from 15.4 to 68% (p < 0.05%); to ciprofloxacin, from 31.4 to 66.3% (p < 0.05); to amikacin, from 23 to 60.1% (p < 0.05); and to ceftazidime, from 8.2 to 28.3% (p < 0.05). In conclusion, the alarming rates of resistance found in this study provide compelling evidence of the need for more rational use of antimicrobial agents; ongoing surveillance on the etiology of infections and their resistance profiles is important to guide future antimicrobial chemotherapy.
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HELLP syndrome (Hemolysis, Elevated Liver Enzymes and Low Platelets) was described by Weinstein in 1982. It has a high maternal and perinatal morbi-mortality rate. We undertook this study to evaluate perinatal outcome in patients with HELLP syndrome. ⋯ Four neonates had Apgar score < 7 at the first minute, all had > 7 at 5 minutes. Three neonates had alimentary disorders, one had hypoglucemia and another hyaline membrane disease, patent ductus arteriosus, sepsis and thrombocytopenia. The high maternal and perinatal morbi-mortality of HELLP syndrome requires management in a centre where intensive maternal and neonatal care are available.