Medicina
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Non-invasive ventilation (NIV) is nowadays increasingly used. The significant decrease in tracheal intubation related complications makes it particularly attractive in patients with moderately acute respiratory failure (ARF) who still have some degree of respiratory autonomy. It has also been used to support patients with chronic respiratory failure. ⋯ An improved quality of life in chronic respiratory failure and a longer survival in restrictive disorders has also been shown (Recommendation B) while its benefit in stable COPD patients is still controversial (Recommendation C). NIV should be performed according to pre-established standards. A revision of NIV related complications is performed and the cost-benefit comparison with invasive MV is also considered.
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Fetal arrhythmia is an unusual cause of admission in critical care unit. We report three cases of pregnant patients with gestational age of 27 to 32 weeks, with diagnosis of fetal sustained supraventricular tachyarrhymias; which were resistant to digoxin as first line therapy. ⋯ A remaining hydropic fetus suffering atrial flutter with 2:1 auriculo-ventricular conduction, failed to restore sinus rhythm with digoxin alone or in association with flecainide nor amiodarone, and required premature c-section at 30a week of gestation. Due to amiodarone administration the neonate suffered transient neonatal hypothyroidism.
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Shiga toxin (Stx)-producing E. coli causing watery diarrhea, hemorrhagic colitis and hemolytic-uremic syndrome (HUS). In Argentina, HUS is the most common cause of acute renal failure in children. The purpose of the present study was to examine the cytotoxicity of Stx type 2 (Stx2) and its B subunit (Stx2B) on human renal tubular epithelial cells (HRTEC), in the presence and absence of inflammatory factors. ⋯ Results show that Stx2 regulates the passage of water through the HRTEC within an incubation period of 1h. Within longer periods, up to 72 hours, the study of morphology, viability, protein synthesis and apoptosis shows that HRTEC were sensitive to the cytotoxic action of Stx2 and Stx2B in a dose- and time-dependent manner. These effects were potentiated by lipopolysaccharides (LPS), IL-1beta, and butirate.
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Case Reports
[Regional transient osteoporosis, and reflex sympathetic dystrophy: the same disease?].
Complex regional pain syndrome, reflex sympathetic dystrophy, regional, transient and migratory osteoporosis, are known as a spectrum of medical conditions that present with pain, edema, erythema, localized osteoporosis and sometimes sympathetic dysfunction. Many factors which are present in these conditions, such as clinical presentation, radiologic findings and a variety of still unclear physiopathologic mechanisms are correlated. We propose that all these conditions are different periods of the same pathology.
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Pharmaceutical companies invest large sums of money promoting their products. They use a multifaceted approach to drug promotion, incorporating techniques such as hospital and office detailing by pharmaceutical representatives. Although these practices are commonly used, little has been published about the attitude of physicians concerning their interaction with the pharmaceutical industry. ⋯ Most of the participants consider appropriate receiving these benefits, although 35% think that they affect the final price of medications. In conclusion, there is a high level of interaction between the pharmaceutical industry and our medical population. Although the latter recognize the influence of these interactions on prescriptions and the elevation of the cost of the final product, they find it appropriate to receive benefits.