Medicina
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The efficacy of new pharmacological agents for the prevention of osteoporotic fractures and the clinical decision to intervene with that purpose in daily medical practice have been guided by the evaluation of bone mineral density (BMD). However, given the multifactorial nature of the proposed endpoint, a new calculator has been proposed: Fracture Risk Assessment Tool FRAX, which follows the same objectives of previous models, but integrates and combines several of those factors according to their relative weight. It can estimate absolute risk of hip fracture (or a combination of osteoporotic fractures) for the following 10 years. ⋯ This instrument has been presented as a new paradigm to assist in clinical and therapeutic decision-making. In the present review some of its characteristics are discussed, such as: the purported applicability to different populations, the convenience of using 10-year absolute fracture risk for the whole age range under consideration, and whether the efficacy of pharmacological treatment for the prevention of bone fractures in osteoporotic patients can be expected to be equally effective among patients selected for treatment on the basis of this model. Finally, we would like to call attention to the fact that risk thresholds for intervention are not yet clearly defined; those thresholds can obviously be expected to have a profound impact on the number of patients amenable to treatment.
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Biography Historical Article
[Genetic characterization of the fungus involved in the first case of coccidioidomycosis described by Alejandro Posadas in 1892].
In 1892 Alejandro Posadas described the first worldwide case of coccidioidomycosis in a patient named Domingo Escurra. A preserved necropsy piece from the patient's remains is conserved in the Museum of Pathology of the Medical School, Buenos Aires University. Paraffin-embedded specimens obtained from this piece served to identify the fungus involved in the case. ⋯ A single point C(R)G difference in position 1228 was observed with respect to sequence of strain C. posadasii Silveira. For the first time, Coccidioides DNA is recovered from a museum piece which is more than 100-year-old. Our results confirm that the original case of Posadas's disease was caused by the recently described C. posadasii.
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Amebiasis caused by Entamoeba histolytica is a problem of public world health. The most frequent clinical presentation are the dysentery and the amebic liver abscess. Fifty millions of cases and more than 100.000 deaths for this disease are reported annually worldwide. ⋯ The 50% of growth inhibition of ivermectin was 6.40 mg/ml. This dose was higher than for other anti parasitic drugs. Its activity in vivo in animal models remains to be demonstrated.
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Research suggests that patients spend most of the last year of their life at home and that this is the place where they often choose to stay. Family caregiving has become an important issue of palliative care. The purposes of this study were: 1) to identify salient issues of caregiving for family members of palliative care patients and 2) to propose a classification based on different profiles of caregivers. ⋯ Quantitative data were collected with a self-completion questionnaire and were analyzed with SPSS (12.01). Three dimensions were evaluated: a) attitudes of the caregiver towards the treatments, b) perceptions of the caregivers of the needs and wishes of the patient and c) evaluation of their own role as caregiver. Four types of informal caregivers were identified: 1) satisfactory carers, based on a well-organized system of relatives and friends involved in the caring situation, 2) potentially vulnerable carers, those involved in situations apparently controlled, but with factors which could trigger a spiral of deterioration, 3) overwhelmed carers, who explicitly express difficulties in being able to achieve the daily goals for the patients' comfort and 4) isolated carers, composed by lonely wives wishing "not to bother" others.
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Case Reports
[Geographic expansion of hantavirus pulmonary syndrome in Argentina. The southernest case report].
Since 1995 more than 1000 cases of hantavirus pulmonary syndrome (HPS) were reported in Argentina, a severe disease and often fatal to humans. Most cases were associated with Andes virus (AND) that caused few events of person-to-person transmission. Several lineages of pathogenic AND viruses have been described, including AND South, hosted by the rodent Oligoryzomys longicaudatus which affects the Patagonian region of Argentina and Chile. ⋯ The clinical presentation of the case was the classical and moderate, caused by AND South virus. Its viral nucleotide sequence was compared with cases from Southern Argentina and Chile. This case was found to be the most Southern (48 degrees 46' 1.2'' S; 70 degrees 15' O) case reported and involved a new Argentinean province.