Revista Medica Herediana

Theoretical Medicine

Two therapeutics plans for management asthmatic crisis in children

Objetivo: Comparar los efectos terapéuticos y colaterales de dos esquemas de tratamiento en la crisis asmática: la asociación de fenoterol 100 ug en microdosificador inhalatorio (MDI) con aerocámara más dexametasona endovenosa vs salbutamol 100 ug en MDI con aerocámara más hidrocortisona endovenosa. Materiales y métodos: En un estudio prospectivo, randomizado, multicéntrico y abierto, se incluyó 60 niños con crisis asmática leve-moderada (30 para cada grupo). Ambos grupos fueron comparables al ingreso. Resultados: En la evolución no hubo diferencia significativa en la frecuencia respiratoria, puntaje clínico, pico respiratorio forzado (PEF) y tremor (p>0.05), hallándose mayor taquicardia en los primeros 30 y 60 minutos en el grupo que recibió Fenoterol - Dexametasona. No se encontró diferencia significativa en la proporción de altas al final del estudio. Conclusiones: Se concluye que la asociación Fenoterol - Dexametasona y Salbutamol - Hidrocortisona son igualmente efectivas en el manejo de la crisis asmática leve - moderada en niños (Ref Med Hered 1997; 8: 5-10)

Objective: To compare the clinical and side effects of two therapeutics schedules in the treatment of asthmatic crisis: The association of fenoterol 100 ug Metered Dose Inhaler (MDI) with spacer device plus dexamethasone IV and salbutamol 10 ug MDI with spacer device plus hydrocortisone IV. Material and Methods: In a ramdomized, prospective, longitudinal, open and multicentric trial we included 60 children with mild-moderate asthmatic crisis (30 for each group). Both groups were comparables at initial evaluation. Results: There were no significative difference in respiratory rate, clinical score, peak expiratory flow rate (PEF), and tremor (p>0.05). We found more heart rate at first 30 and 60 minutes in Fenoterol - Dexamethasone group (p<= 0.05). There were no significative differences in the amount of discharges from hospital at the end of the study (4 hours). Conclusions: We conclude that the association Fenoterol-dexamethasone and Salbutamol-Hydrocortisone are equally effective in the management of mild to moderate asthmatic crisis in children. (Rev Med Hered 1997; 8: 5-10).

Prevalence of glucose 6-phosphate dehydrogenase deficiency in the blood of voluntary givers at Cayetano Heredia and Arzobispo Loayza nationals hospitals Lima-Peru

Objetivos: El presente trabajo tuvo como objetivo, conocer la Prevalencia de la deficiencia de la G-6-PDH, en la población masculina mestiza, aparentemente sana que acude a los Bancos de Sangre de los hospitales nacionales Cayetano Heredia (HNCH) y Arzobispo Loayza (HNAL). Material y métodos: Se examinó 140 muestras de hemodonadores entre junio y julio, 60 (42.85%) correspondieron al HNCH y 80 (57.15%) al HNCH. Se aplicó un cuestionario a todos los donantes indagando por: raza en los ancestros y antecedentes patológicos compatibles con episodios de hemólisis enzimopática. En todas las muestras se empleó el método cualitativo de Brewer (tamizaje) y posteriormente fueron sometidos a la prueba cuantitativa SIGMA. Resultados: Con el método de Brewer resultaron 9 casos positivos (6.42%) de los cuales sólo uno resultó positivo con el método confirmatorio, lo cual da una prevalencia de 0.71%. La totalidad de los participantes fueron de raza mestiza, carecían de antecedentes importantes, las edades estuvieron comprometidas entre los 18 y 58 años y el hematocrito entre 40 y 48%. Conclusiones: Se confirma que la prevalencia de esta deficiencia, en nuestra población es bastante baja. (Rev Med Hered 1997; 8: 11-18).

Objective: The goal of this study was to know the prevalence of the Glucose - 6 - phosphate dehydrogenase 8G-6-PDH) deficiency at the Hospital Nacional Cayetano Heredia (HNCH), and Hospital Nacional Arzobispo Loayza (HNAL) of Lima city. Material and methods: It was tested 140 samples of blood donors between June and July of 1996, using the qualitative Brewer method. The quantitative commercial test was done for detected the enzimatic activity in the abnormal cases of the qualitative method. Sixty blood donors (42.85%) belongs to the HNCH and eighty (57.15%) to the HNAL. The average of age was 32.20 and the range of hematocrit was between 40 and 48%. Results: We observed 9 positive cases (6.42%) using the Brewer method, but only one case (0.71%) was confirmed with the quantitative test. Conclusion: We that the prevalence of this enzymatic deficiency is low between our population. (Rev Med Hered 1997; 8: 11-18).

Pleural effusion as a respiratory complication of kerosene ingestion in children.

Objetivo: Determinar la frecuencia de derrame pleural como complicación de la neumonitis química por ingesta de kerosene, en niños menores de 2 años. Material y métodos: Se realizó un estudio retrospectivo en el Hospital Nacional Cayetano Heredia durante el período 1988-1995. Se revisaron las historias clínicas y las radiografías de los pacientes hospitalizados en el Servicio de Lactantes con diagnóstico de derrame pleural asociado a ingesta de kerosene. Además, se revisó el libro de registros de emergencias pediátricas de 1995 consignando el número de pacientes menores de 24 meses que llegaron por ingesta de kerosene y luego se evaluó cuantos de estos pacientes fueron hospitalizados y además presentaron derrame pleural. Resultados: El 14.5% de los hospitalizados durante el período 1988-1995 presentaron derrame pleural como complicación a la neumonitis; durante el año 1995, el 10.9% de los pacientes que llegaron a emergencia por ingesta de kerosene se hospitalizaron. (Rev Med Hered 1997; 8: 19-22).

Objective: Determinate the frequency of pleural effusion as a complication after kerosene ingestion by children under two years old. Material and methods: A retrospective study was done at the Hospital Nacional Cayetano Heredia, between 1988 and 1995. We reviewed medical and radiographic records of all children hospitalized with diagnosis of pleural effusion following pneumonitis by hidrocarbons after kerosene ingestion. Also, we reviewed the pediatric emergency book, looking for the number of children, 24 month old or youngest, that ask for attention after kerosene ingestion, at 1995; how many of these were hospitalized, and how many of these have had pleural effusion. Results: The 13.5% of hospitalized children between 1988-1995 have had pleural effusion as a complication of pneumonitis by hidrocarbons; during 1995, 10.9% of all patients that went to pediatric emergency after kerosene ingestion was hospitalized. (Rev Med Hered 1997; 8:19-22)

Recent advances in HIV/AIDS: Antiretroviral therapy

Recent advances in our understanding of HIV infection in patients with the acquired immunodeficiency syndrome (AIDS) are leading us to explore new treatment strategies, including the use of combination antiretroviral therapy. In this review, we present information from recently completed clinical trials explore the use of combination therapy, including ACTG 175, the Delta studies, and the NUCA studies. In addition, we present preliminary about use of protease inhibitors, the newest class of antiretrovirals. (Rev Med Hered 1997; 8: 23-31).

Perspective in curriculum changes for teaching medicine in the third millennium

Symbols of the Universidad Peruana Cayetano Heredia

Tuberculous liver abscess in patients with adquired inmunodeficiency syndrome (AIDS).

We report a AIDS patient with the diagnosis of tuberculous liver abscess. We describe and compare our case with another seven patients reported in the medical literature since AIDS epidemic began. We reviewed the clinical presentations (usually fever and abdominal pain), the diagnostic tests (CT Scanguided needle aspiration or ultrasound) and the outcomes of the treatments. Also we did a review of the current literature available of the types of hepatic compromise related with Mycobacteriun tuberculosis in AIDS patients. (Rev Med Hered 1997; 8: 45-48).