Primary hyperoxaluria type 1 (PH-1) is a rare autosomal recessive disease caused by the absence or deficiency of the liver-specific intermediary metabolic enzyme alanine glyoxylate aminotransferase. The prognosis of this metabolic disease is poor. Theoretically, the primary metabolic defect can be cured by liver transplantation. However, controversy exists around the age and stage of the disease that liver transplantation should be performed. We report on a patient who presented at the early age of 2 months with nephrocalcinosis. Isolated liver transplantation was performed at the age of 21 months. Eight years later, the estimated glomerular filtration rate was 85 ml/min/1.73 m(2), and imaging studies did not reveal nephrocalcinosis. This case report supports the strategy of early isolated liver transplantation in patients with PH-1.
We studied 113 patients treated with intravenous amikacin to determine the value of determining serial trough and peak amikacin levels in plasma for predicting nephrotoxicity. Thirteen patients (11.5%) developed renal toxicity, with significant increases from 48 to 96 h in both peak and trough amikacin levels (6.7 ± 4.7 [standard deviation] days before the serum creatinine rose). The nontoxicity group had no change or even showed decrements iit amikacin levels in plasma. A higher nephrotoxicity risk was seen in patients with increments greater than 1 ,g/ml between 48 and 96 h, with odds ratios of 16.4 for trough, 8 for peak, and 7.2 for both levels. We suggest that an increment of at least 1 ,ug/ml in amikacin levels in plasma from 48 to 96 h may predict the appearance of renal toxicity.The aminoglycosides are commonly used in the treatment of severe gram-negative-bacillus infections (13). Unfortunately, nephrotoxicity is a common complication that requires discontinuation of therapy (14). Clinical studies have identified several risk factors, such as the underlying conditions of the patient or complications owing to the aminoglycoside itself (8,11,15,18,19).The aminoglycosides have a narrow therapeutic margin; patients given similar doses showed a wide disparity in levels in serum (12). The serum immunoassay has been accepted as a useful tool for enhancing drug efficacy, but its value in foretelling renal toxicity is controversial. This prospective study was designed to estimate the value of serial trough and peak levels in predicting renal toxicity in patients treated with intravenous amikacin.All hospitalized patients treated with intravenous amikacin for a minimum of 48 h, alone or in combination with other antibiotics, were included in this 3-month prospective study (April to June 1988). Patients with shock (systolic blood pressure less than 90 mm Hg and signs of hypoperfusion for more than 6 h); acute renal failure; hepatorenal syndrome (chronic liver disease plus oliguria, azotemia, and urinary sodium concentration lower than 10 meq/liter); end-stage renal disease under dialysis; and renal, liver, or bone marrow transplantation treated with cyclosporine were excluded from the study.Amikacin has been the only arninoglycoside used in our hospital since 1981 (17), and it is usually administered intravenously (5 mg/kg [body weight], three times per day) in a 30-min period; the dose was corrected according to the creatinine clearance (CLCR) calculated with the formula described by Cockcroft and Gault (male CLCR = 140 -age x weight/72 x serum creatinine; female CLCR = 0.9 x male CLCR) (5).The following data were obtained for each patient: age, sex, weight, underlying disease, control serum creatinine, * Corresponding author. trough and peak amikacin levels in plasma, calculated and given amnikacin in milligrams per day, and other antibiotics used. The serum creatinine was determined two times per week until cessation of therapy. The trough and peak amikacin levels in plasma were determined at 48 and 96 h after ...
Peñailillo, L, Aedo, C, Cartagena, M, Contreras, A, Reyes, A, Ramirez-Campillo, R, Earp, JE, and Zbinden-Foncea, H. Effects of eccentric cycling performed at long vs. short muscle lengths on heart rate, rate perceived effort, and muscle damage markers. J Strength Cond Res XX(X): 000-000, 2018-It is possible that the magnitude of muscle damage in eccentric cycling is dependent on seat position that could affect the muscle length changes during eccentric contractions. However, no previous study has investigated the effect of seat position on muscle damage and metabolic demand in eccentric exercise. Thus, this study compared 2 seating positions; seat forward in which knee extensor muscles were stretched longer (LONG) and seat back in which the muscles were stretched shorter (SHORT). Young men performed 30 minutes of eccentric cycling at 80% of maximal concentric power output at either LONG (n = 10) or SHORT (n = 10) condition. Heart rate and rate perceived effort (RPE) during exercise, changes in maximal voluntary isometric contraction (MVC) strength of the knee extensors, muscle soreness assessed by a visual analog scale (VAS), and pressure-pain threshold (PPT) before, immediately after, and 24-72 hours after exercise were compared between conditions. Heart rate and RPE were significantly greater in LONG than SHORT group (9.5 and 19.0%, respectively). Post-exercise reduction in MVC was 8.4-14.0% greater in LONG than SHORT group from immediately after to 48 hours after exercise. In addition, VAS was greater in LONG than SHORT group from 48 to 72 hours after exercise, and vastus medialis PPT was greater in SHORT than LONG group from 24 to 72 hours after exercise (p < 0.05). These results suggest that muscle damage and metabolic demand are greater when seat is set back than forward. Thus, when prescribing eccentric cycling to individuals who are unaccustomed to eccentric cycling, it is better to set the seat far from the pedals.
<p><strong>Objetivo:</strong>determinar la prevalencia de úlceras por presión en pacientes en el Hospital General de Zona no. 30 del Instituto Mexicano del Seguro Social, en Baja California, México. <strong>Metodología:</strong> se realizó un estudio transversal, mediante la revisión y recolección de datos de los pacientes con reporte de úlceras por presión en el registro de la Clínica de Heridas. Los datos fueron analizados mediante estadística descriptiva, se utilizó el programa spss v. 21; se obtuvieron medidas de tendencia central, porcentajes y frecuencias. <strong>Resultados:</strong> se encontraron 470 casos de úlceras por presión. Predominó el sexo femenino y la mayoría de casos se registraron en pacientes >70 años. El servicio de Medicina Interna tuvo el mayor número de casos, 79.15% (n=372). La localización anatómica más frecuente fue en la región sacra 58.94% (n=277). El grado de severidad más común fue el grado ii en 61.06% de pacientes (n=287). El rango de estancia hospitalaria con mayor número de casos fue de dos a siete días con 37.87% casos reportados (n=178). <strong>Conclusiones:</strong> las úlceras por presión afectaron con mayor frecuencia a personas de la tercera edad. Su localización y grado de severidad son complicaciones recurrentes en este tipo de padecimientos. La prevención y las estrategias de identificación temprana deben ser implementadas para disminuir su incidencia.</p>
We propose a mandatory invasive mechanical ventilator prototype for severe COVID-19 patients with volume and pressure control operation modes. This system comprises basic pneumatic elements and sensors. Its performance is similar to commercial equipment, and it presents robustness to external disturbances and parametric uncertainties. To develop a control strategy, we propose a mathematical model with a variable structure that incorporates the dead zone phenomenon of the proportional valve, and considers external disturbances and parametric uncertainties. Based on this model, we propose a global control strategy that is based on pressure and flow regulation controllers, which use the active disturbances rejection control structure (ADRC). In this strategy, we propose robust state observers to estimate disturbances and the signals necessary for implementing the controllers. We illustrate the performance of the prototype and the control strategy through numerical simulations and experiments. We also compare its performance with PID controllers. These results corroborate its effectiveness and the possibility of its application in invasive mechanical ventilators with a simple structure, which can significantly help critical care of COVID-19 inpatients.
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