Interpreting Medicine: Lessons From a Spanish-Language Clinic

Caring for patients is an act of interpretation: we labor to understand the significance of a particular symptom and, when we have reached a diagnosis, we convert our medical jargon into plain language for the benefit of the patient. Caring for patients of limited English proficiency—a population that needs a very literal form of interpretation—underscores this lesson. Working with predominantly Spanish-speaking patients has shown me the importance of bearing witness to patients’ struggles and has brought me to realize that good physicians must work to forge a common language with all their patients, not only with those who do not speak English.     

糖尿病合并尿路感染97例尿细菌培养及药敏试验分析

目的 探讨糖尿病合并尿路感染尿细菌培养及药敏试验情况,为临床合理用药提供依据.方法 对2008年7月～2010年6月97例糖尿病合并尿路感染患者的清洁中段尿进行细菌分离培养及药敏试验.结果 患者尿液革兰阴性杆菌阳性率为72.4%,其中大肠埃氏菌的阳性率为61.2%;革兰阳性球菌阳性率为22.5%,其中肠球菌的阳性率...     

pH and Concentration of Pancreatic Enzymes in Aspirates from the Human Duodenum During Digestion of a Standard Meal in Patients with Intestinal Disorders

The material comprises 25 patients with gluten-induced enteropathy and 16 patients with various intestinal disorders. The intestinal contents were aspirated in four subsequent periods of 20 minutes each after ingestion of a standard meal. The volume, pH, and the concentration of α-amylase, trypsin, chymotrypsin, and lipase were determined in the collections.

Only minor deviations from normal pH-levels were observed.

In both groups of patients, the secretion of lipase, and to a minor degree that of amylase, were more markedly reduced than the secretion of the proteolytic enzymes.

With the exception of the values of trypsin, concentrations of enzymes were seen to be below the lowest normal value in approximately one-third of the patients throughout the period of digestion.

It is concluded that the pancreatic function was genuinely reduced in several patients with enterogenous malabsorption. It may be explained as an unspecific effect of the malabsorption.     

Evaluation of potential synergistic action of a combined treatment with alpha‐methyl‐prednisolone and taurine on the mdx mouse model of Duchenne muscular dystrophy

A. Cozzoli, J.‐F. Rolland, R. F. Capogrosso, V. T. Sblendorio, V. Longo, S. Simonetti, B. Nico and A. De Luca (2011) Neuropathology and Applied Neurobiology 37, 243–256
Evaluation of potential synergistic action of a combined treatment with alpha‐methyl‐prednisolone and taurine on the mdx mouse model of Duchene muscular dystrophy Aims: Glucocorticoids are the sole drugs clinically used in Duchenne muscular dystrophy, in spite of the relevant side effects. Combination of glucocorticoids with synergistic drugs may be one strategy to lower doses and control side effects, meanwhile providing wider control of the complex pathology. This study is a preclinical evaluation of the effect of a combined treatment of α‐methyl‐prednisolone (PDN) with taurine, a safe aminoacid with positive effects on some pathology‐related events. Methods: PDN (1 mg/kg/day i.p.) and taurine (1 g/kg/day orally) were administered either alone or in combination, for 4–8 weeks to male dystrophic mdx mice chronically exercised on a treadmill. Effects were assessed in vivo and ex vivo with a variety of methodological approaches. Results: In vivo, each treatment significantly increased fore limb strength, a marked synergistic effect being observed with the combination PDN + taurine. Ex vivo, PDN + taurine completely restored the mechanical threshold, an electrophysiological index of calcium homeostasis, of extensor digitorum longus myofibres and the benefit was greater than for PDN alone. In parallel, the overactivity of voltage‐independent cation channels in dystrophic myofibres was reduced. No effects were observed on plasma levels of creatine kinase, while lactate dehydrogenase was decreased by taurine and, to a minor extent, by PDN + taurine. A similar histology profile was observed in PDN and PDN + taurine‐treated muscles. PDN + taurine significantly increased taurine level in fast‐twitch muscle and brain, by high‐pressure liquid chromatography analysis. Conclusions: The combination PDN + taurine has additive actions on in vivo and ex vivo functional end points, with less evident advantages on histopathology and biochemical markers of the disease.     

Performance comparison between the mycobacteria growth indicator tube system and L?wenstein-Jensen medium in the routine detection of Mycobacterium tuberculosis at public health care facilities in Rio de Janeiro, Brazil: preliminary results of a pragmatic clinical trial

In view of the fact that the World Health Organization has recommended the use of the mycobacteria growth indicator tube (MGIT) 960 system for the diagnosis of tuberculosis and that there is as yet no evidence regarding the clinical impact of its use in health care systems, we conducted a pragmatic clinical trial to evaluate the clinical performance and cost-effectiveness of the use of MGIT 960 at two health care facilities in the city of Rio de Janeiro, Brazil, where the incidence of tuberculosis is high. Here, we summarize the methodology and preliminary results of the trial. (ISRCTN.org Identifier: ISRCTN79888843 [http://isrctn.org/])     

The Use of Dexterity Tests in Hand Rehabilitation

A battery of American standardized tests for assessing dexterity was used in 15 patients undergoing rehabilitation after hand injuries and in 15 healthy controls. Our purpose was to identify tests that would discriminate healthy from non-healthy individuals with respect to functional motor skills in the hand. Out of the test battery including 4 tests and 10 subtests, the Crawford small parts dexterity test, the Purdue pegboard test, the Minnesota manual dexterity test and Valpar no. 4, two tests, the Crawford pin test and the Purdue right and left test, found to make a clear distinction between subjects with impaired hand function and those in the healthy group. The Purdue right/left/bilateral test, the Minnesota picking and turning tests, the Crawford screw test, the Purdue bilateral test and Valpar no. 4 also appeared useful, but had less capacity to discriminate between the two groups compared with the two tests already mentioned. We conclude that the tests presented in this study deserve a place in our current arsenal of instruments for evaluating dexterity, but a larger material is needed in order to make a more precise evaluation of these tests.     

儿童患者耐碳青霉烯肠杆菌的分布及药物敏感性分析

摘要： 目的 了解我院儿童患者2013—2017年临床分离的耐碳青霉烯肠杆菌 （CRE） 的分布及耐药情况， 为控制和治疗此类菌引起的感染提供用药依据。方法 采用VITEK 2 Compact全自动微生物鉴定药敏仪对该类细菌进行药敏实验， 参考CLSI-M100折点标准， WHONET5.6软件进行结果分析， 采用χ2 检验进行统计分析。结果 2013— 2017年， 临床共分离出687株CRE菌株， 总检出率10.64%。主要为肺炎克雷伯菌 （302株）、 大肠埃希菌 （213株）、 奇异变形杆菌 （72株）。5年的CRE检出率基本呈上升趋势， 标本主要来源于尿液 （38.14%）， 其次为呼吸道 （30.13%）。 CRE菌株对氨基糖苷类和喹诺酮类抗菌药物耐药率<30%， 但对其他β-内酰胺类药物耐药率则基本在70%以上。结论 CRE菌株在儿童患者感染中呈逐年上升趋势， 并大多表现为多药耐药菌株。     

In-Vitro Platelet Hyperaggregation and Hypersecretion Associated with the Use of Fish Oil in Healthy Children

Objective: The aim of this study is to evaluate how fish oil supplementation in children affects platelet function tests in vitro. Materials and Methods: The study included 62 children (20 healthy children without any medications and 42 healthy children who volunteered to take fish oil supplementation) aged between 2 and 12 years. In the group of children taking fish oil supplementation, the baseline, fourth week, and eighth week values for platelet function tests were obtained. Results: In the platelet aggregation tests induced by high dose of ADP after 8 weeks, the values were significantly higher compared with the values measured before the use of fish oil. The fish oil-supplemented group's values showed an increase in the fourth-week measurements compared with the control group and the baseline measurements in terms of platelet secretion test induced by collagen, standard dose of thrombin, and high-dose thrombin. Platelet secretion tests induced by standard dose of ADP at the end of the eighth week showed an increase compared with baseline test values. Conclusion: This study was done in in-vitro conditions wherein the platelet function in the pediatric age group was analyzed and it was found that eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) present in fish oil especially exhibit in-vitro hyperaggregation and increase the secretion of platelets. As a result of this, we consider that it is necessary to be careful while using fish oil supplementation in children as an antithrombotic agent and for a variety of other indications.     

Markers for early sensitization and inflammation in relation to clinical manifestations of atopic disease up to 2 years of age in 133 high-risk children

BACKGROUND: The combination of genetic susceptibility and environmental factors induce allergic sensitization and subsequently local inflammation, resulting in atopic manifestations. OBJECTIVE: To examine whether immunological features reflecting sensitization (total and specific IgE levels, allergen-induced proliferative responses and skin tests) and markers of inflammation (plasma sE-selectin and blood eosinophils) are related to the clinical expression of atopy and whether they precede atopic disease in children up to 2 years of age. METHODS: The development of these markers during the first 2 years of life was studied prospectively in 133 newborns at high risk to develop atopic disease. RESULTS: The prevalence of atopic disease increased from 25% at 12 months to 32% at 24 months of age. The children with food allergy at 12 months, who all had atopic dermatitis (AD), turned out to have asthma-like disease in 40% and AD in 100% at the age of 24 months. Total IgE levels increased with time and from 12 months onward levels started to differ markedly between atopics and nonatopics. Food-specific IgE antibodies were significantly associated with AD (relative risk [RR] = 2.39), food (RR = 1.32) and upper-airway allergy (RR = 1.20), and house dust mite-specific IgE antibodies with upper-airway allergy (RR = 5.00). A positive skin test was significantly associated with AD (RR = 2.90) and food allergy (RR = 1.36). The inflammation markers investigated, were not related to the clinical expression or preceded atopic disease at 2 years of age in high-risk children. CONCLUSION: Positive skin tests and specific IgE to food or inhalant allergens were related to the clinical expression of different atopic diseases. The combination of AD and food allergy at 12 months reflected the strongest risk factor in this high risk cohort for the development of asthma-like disease at 24 months of age.