Medicina
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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.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Diagnosis and treatment of Helicobacter pylori infection. Its relationship with gastrointestinal ulcer and antimicrobial resistance].
Reliable data regarding the efficacy of different schemes of triple therapy for the eradication of Helicobacter pylori in our country, are not available. Patients with Helicobacter pylori infection and non-ulcer dyspepsia or active peptic ulcer disease were randomized in three different groups for therapy with, omeprazole 20 mg, clarithromycin 500 mg and amoxicillin 1000 mg, twice daily for one week (OCA 1, 40 patients) and the same treatment but for two weeks in a second group (OCA 2, 40 patients). The third group received omeprazole 20 mg, clarithromycin 500 mg and metronidazole 500 mg twice daily during one week (OCM, 40 patients). ⋯ Primary resistance to amoxicillin and clarithromycin was not demonstrated, while 20% of cultured strains were resistant to metronidazole. In patients with peptic ulcer disease or non-ulcer dysplasia, triple therapy with omeprazole and two antibiotics is highly effective in the eradication of Helicobacter pylori. One week of OCA therapy is as effective as two weeks of OCA or one week of OCM, with less side effects.
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The purpose of this article is to review the etiological and pathophysiological aspects of chronic severe hypoxemia (CSH) and to determine the indications of long-term oxygen therapy (LTOT). Three hypothesis are presented and analyzed: 1) CSH is harmful to the economy; 2) LTOT is therefore useful; 3) LTOT is not toxic and does not imply major risks than the benefits that it offers. ⋯ Chronic obstructive pulmonary disease is the most common cause of CSH; these patients have a poor prognosis associated to the hypoxemia and its effects, being a PaO2 below 60 mmHg one of the most precise factors of mortality. Patients selection criteria for LTOT different sources for home oxygen therapy, methods of administration and finally an update of LTOT situation in our country and abroad are discussed.
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Multicenter Study
[Association between soybean dust exposure, allergic sensitivity and profile of respiratory symptoms].
The purpose of this study was to correlate soybean dust (SD) exposure, skin reactivity to soybean hull (SH) allergens, and symptoms of asthma and/or allergic rhinitis. A group of 365 subjects with asthma and/or allergic rhinitis and a control group of 50 individuals without respiratory symptoms were studied. The level of exposure to SD is defined as follows: 1) direct (DE); 2) indirect (ID), and 3) urban (UE). ⋯ This fact determines a high risk of sensitization and triggering of respiratory symptoms in atopic subjects. This study demonstrates that there is: 1) a high prevalence of skin reactivity to SH in subjects with asthma and/or allergic rhinitis from Argentina and that this prevalence is associated with the level of exposure to SD, and 2) an association between sensitivity to SH and severity of asthma. Measures to avoid release and inhalation of SD in rural areas from Argentina are needed.