Archives of medical research
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Toxoplasmosis of the central nervous system (CNS) is the most common cause of intracerebral lesions in patients with AIDS. It is now standard clinical practice to treat empirically, based on clinical and radiographic findings, and to perform a biopsy of the lesion only in those patients who fail to have a clinical and radiographic response after two weeks of therapy. This study describes the presentation and response to therapy of central nervous system toxoplasmosis in patients with AIDS at a private practice in Mexico City. ⋯ The probability of surviving 6 months after the diagnosis of toxoplasmosis was 60%. The findings of these authors are similar to those reported in other series where toxoplasmosis of the CNS is a late complication of HIV infection associated with a CD4+ cell count of < 100 cells/microL. However, survival was short in spite of a good response to therapy.
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Clinical Trial
PRISM score evaluation to predict outcome in pediatric patients on admission at an emergency department.
This study was undertaken in order to evaluate for the first time the usefulness of PRISM score to predict outcome in pediatric patients in the Intensive Care Area of the Emergency Department at the Instituto Nacional de Pediatría in Mexico City. A prolective evaluation of PRISM score was done using 100 consecutive pediatric patients admitted to INP-ED between July and November 1992 and considered critically ill by the attending pediatricians to calculate by a lineal logistic model the expected mortality and compare with the observed one. Using a cut-off of r = 0, we evaluated at the same time the sensitivity, specificity and efficiency of this score. ⋯ The sensitivity, specificity and efficiency in general were 1.0, 0.98 and 0.98, respectively. The PRISM is an objective and efficient method which helps physicians to predict patients' outcome and risk of mortality, providing the medical staff with an epidemiological criteria. Additionally, it may be helpful in decision-making for ICU admissions and correct identification of patients who can benefit from that level of care.
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The authors report a case of a 54-year-old white male with a coronary fistula associated with double mitral valve disease. The patient was studied by invasive and non-invasive cardiac methods including coronary angiogram in order to reach the correct diagnosis and to define the successful surgical treatment that included the closure of the fistula, partial resection of the left atrium and insertion of a mechanical mitral valve prosthesis. It is concluded that this case represents a very rare association between coronary fistula and double mitral valve disease.
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Comparative Study
Comparison between Sprague-Dawley and Wistar rats as an experimental model of pharmacokinetic alterations induced by spinal cord injury.
Two strains of rats, Sprague-Dawley and Wistar, were assayed in order to determine which strain is the more suitable experimental model for the study of pharmacokinetic alterations induced by spinal cord injury. Animals were submitted to spinal cord contusion at the T8-T9 level by the weight drop method. A single acetaminophen oral dose (100 mg/ kg) was administered 24 h after injury and blood samples were drawn for a period of 4 h. ⋯ For both strains, Cmax and AUC were significantly lower, whereas tmax remained unchanged, in injured animals compared to sham-injured controls. Circulating acetaminophen concentrations were higher; therefore, pharmacokinetic alterations were more easily discerned, in Sprague-Dawley than in Wistar rats. It is concluded that the Sprague-Dawley strain is a more suitable model for the study of pharmacokinetic alterations induced by spinal cord injury.