Paradoxical responses in a cohort of HIV-1-infected patients with mycobacterial disease.

SETTING: Paradoxical worsening or relapse of opportunistic infections has been described after initiation of highly active anti-retroviral therapy (HAART) in human immunodeficiency virus (HIV) infected patients. DESIGN: Retrospective study of a group of 33 HIV-infected patients with mycobacterial disease analysing the incidence and characteristics of patients with and without paradoxical response after starting HAART and/or mycobacterial treatment. RESULTS: Nine patients in the group had paradoxical response. No significant difference of baseline characteristics was observed in these patients. The decrease in viral load was significantly greater among patients with paradoxical response than in patients without. CONCLUSION: No clinical difference was found in the evolution of HIV-infected patients with mycobacterial disease after the resolution of the episode of paradoxical response.     

Successful selective termination at 17 weeks' gestation in monochorionic monoamniotic twin pregnancy affected by twin-twin transfusion syndrome and discordant for hypoplastic left heart syndrome

OBJECTIVES: To report a successful selective feticide in a complicated monochorionic monoamniotic (MCMA) pregnancy. METHODS: A case of MCMA pregnancy with severe twin-twin transfusion syndrome and discordant for hypoplastic left heart syndrome was diagnosed at 16 weeks' gestation. A complete ultrasound and fetoscopic surveillance was performed, ruling out cord entanglement and, thus, precluding the necessity of transecting the cord. RESULTS: The selective feticide was successfully performed by bipolar coagulation of the umbilical cord of the abnormal fetus under ultrasound guidance. The survivor twin developed normally during the rest of the pregnancy and was born at term. At 6 months of age, the infant was healthy. CONCLUSION: Selective feticide in complicated monoamniotic pregnancies can be safely performed. Cord entanglement can be confidently excluded by both ultrasound and fetoscopy, thus making the systematic transection of the umbilical cord unnecessary.     

Hematuria and sharp renal failure as debut of secondary bladder amiloidosis. Presentation of a new case and revision of the literature

The primary bladder amiloidosis is an uncommon pathology, not existing in the world more than 150 published cases, being even more exceptional the secondary bladder amiloidosis being described around 25 cases. The secondary bladder amiloidosis associates in most from the patients to arthritis reumatoide of long evolution. The diagnoses clinical it is difficult, being necessary the differential diagnosis with the bladder tumour. The pathological study and inmunohistochemics, confirm the diagnosis. We present the case of a patient that I debut with frank hematuria, hemodynamic uncertainty and renal inadequacy that it required combined treatment, doctor and surgical for the resolution of their square.     

Resource distribution for the Basic Care Plan with equity approach, Bogotá 2002

OBJECTIVE: To apply a technique that will guide financial resources distribution for the Basic Care Plan for carrying out collective actions according to different health conditions. METHODS: A prior estimation of a global health index was performed by means of the analysis of major components prioritizing areas of Bogotá according to their health condition: "poor", "intermediate," and "good". A square minimum technique was applied to minimize difference between observed and expected global health index after resource investment. RESULTS: Resource distribution for the Basic Care Plan was achieved for twenty areas of Bogotá and a higher amount than the district median was allocated in areas with "poor" health conditions. Also, areas lacking universal health coverage were identified using the per capita resource allocation. CONCLUSIONS: This technique puts in evidence the disparity in health conditions between areas of "poor" health condition and those with "good" condition, in spite of the increased coverage of the Basic Plan of Attention, indicating the need of intersectorial social investment in these areas.