Dear Sirs:The aim of anti-HIV treatment in pregnancy is the suppression of the HIV-1 RNA viral load in the plasma before delivery [1] to prevent mother-to-child transmission of the infection. The achievement of this outcome may be complicated in pregnant women who have been treated with multiple drugs by the lack of active drugs available. Although there are limited data on the use of the integrase inhibitor raltegravir in pregnancy, the availability of this drug is important in the management of multidrug-resistant virus in pregnant women.We describe a case of a 22-year-old woman who acquired the infection via vertical transmission and who has been followed up at our Centre since March 2009. Past antiretroviral treatments include numerous drugs; the historical genotypic resistance test showed mutations in the regions of reverse transcriptase (41L, 74V, 101Q, 103N, 103S, 108I, 115F, 179I, 184V, 215D, 215N, 215S, 215Y) and protease (36I, 63P). These mutations confer resistance or poor efficacy to all the nucleoside/nucleotide reverse transcriptase inhibitors and non-nucleoside reverse transcriptase inhibitors except etravirine.Since April 2009 the patient has received treatment with tenofovir/emtricitabine (fixed dose combination) plus darunavir/ritonavir (600/100 mg twice daily) plus raltegravir (400 mg twice daily). At the time of conception she presented HIV-RNA <20 cp/mL. Despite safety and pharmacokinetics data of raltegravir in pregnancy being insufficient to recommend its use during pregnancy, it was decided to continue the treatment with tenofovir/emtricitabine (fixed dose combination) plus raltegravir (400 mg twice daily); only darunavir/ ritonavir had been discontinued since the 4th week of pregnancy and substituted with lopinavir/ritonavir (400/100 mg twice daily), the gold standard for protease inhibitors in pregnant women [2]. Therapeutic drug monitoring was performed by a validated HPLC-UV method [3] in the third trimester, which demonstrated good adherence; at that time lopinavir, ritonavir and raltegravir plasma levels were 9.59 μg/mL (minimum target trough concentration 1 μg/mL) [3], 0.81 μg/mL and 0.21 μg/mL (median trough concentration from clinical trials 0.029-0.118 μg/mL) [2].At 39 weeks' gestation a 2.4-kg neonate was delivered by elective caesarean section without complications; at the time of delivery the HIV-RNA viral load in plasma was <20 cp/mL. Despite the low birth weight the infant was healthy; the Apgar scores were 9 and 10 at 1 and 5 min respectively. The mother received zidovudine intravenous prophylaxis during labour and the newborn received 4 weeks of oral zidovudine; the HIV-RNA was undetectable at birth and at 1 and 3 months of age. At delivery the raltegravir level in cord and in maternal plasma was the same (0.19 μg/mL) with a cord/maternal plasma ratio of 1. The lopinavir levels were 1.3 μg/mL and 8.05 μg/mL and the ritonavir levels were 0.26 μg/mL and 0.94 μg/mL, corresponding to a ratio of 0.16 and 0.28 respectively.The low plasma cord concentration of lopinavir can be ex...

Mesalazine therapy for ulcerative colitis has been reported to be effective and safe. Rare cases of mesalazine-induced renal, pancreatic, myo-pericardial, pleuro-pulmonary and haematological toxicity have been described separately. We report a case characterized by the simultaneous presence of fever, pericarditis, peripheral eosinophilia, eosinophilic pneumonia, anaemia and haematuria (together with proteinuria and leukocyturia) due to mesalazine treatment in a patient with ulcerative colitis. No clinical response had been obtained with corticosteroids and various antibacterial agents. When mesalazine treatment was suspended, all symptoms rapidly and totally disappeared, confirming the direct responsibility of this drug in causing these adverse events. We conclude that mesalazine can induce multi-organ hypersensitivity, which must always be considered as a possible adverse effect during treatment with this drug. To resolve this adverse event it is essential to discontinue mesalazine treatment.

Although the impact of naturally occurring NS5A RASs might be limited with upcoming pan-genotypic treatment regimens, this information is still useful to map naturally occurring HCV variants in different geographic areas in the context of current HCV therapy.

Mesalazine therapy for ulcerative colitis has been reported to be effective and safe. Rare cases of mesalazine-induced renal, pancreatic, myo-pericardial, pleuro-pulmonary and haematological toxicity have been described separately. We report a case characterized by the simultaneous presence of fever, pericarditis, peripheral eosinophilia, eosinophilic pneumonia, anaemia and haematuria (together with proteinuria and leukocyturia) due to mesalazine treatment in a patient with ulcerative colitis. No clinical response had been obtained with corticosteroids and various antibacterial agents. When mesalazine treatment was suspended, all symptoms rapidly and totally disappeared, confirming the direct responsibility of this drug in causing these adverse events. We conclude that mesalazine can induce multi-organ hypersensitivity, which must always be considered as a possible adverse effect during treatment with this drug. To resolve this adverse event it is essential to discontinue mesalazine treatment.

RESUMODefeitos na parede abdominal incluem diástase dos músculos retos abdominais, hérnias da linha média (umbilical e epigástrica) e hérnia incisional. Essas patologias podem surgir de forma isolada ou, muito frequentemente, de maneira simultânea. Diante disso, o presente trabalho tem como objetivo descrever a técnica de abordagem subcutânea pré-aponeurótica, originalmente denominada de SCOLA (Subcutaneous Onlay Laparoscopic Approach) para a correção de hérnias ventrais combinada com a plicatura da diástase dos músculos retos abdominais.

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As urgências traumáticas são causas de mortalidade frequentes no Brasil, tornando-se fundamental o conhecimento da população leiga acerca da maneira correta de como agir nesses determinados cenários. Desse modo, este trabalho objetivou analisar o conhecimento de leigos acerca de urgências traumáticas, identificando as principais lacunas do entendimento geral sobre o assunto. O estudo foi desenvolvido por meio da aplicação de um questionário online, composto por questões que abordaram temas como acidentes por animais peçonhentos, queimaduras, afogamento, engasgo, intoxicação por álcool, politrauma e hemorragias, a fim de obter informações sobre como os leigos entrevistados reagiriam a cada uma das situações. Assim, foram analisadas as respostas coletadas e os resultados para cada uma das perguntas acerca das urgências traumáticas, chegando-se a identificação das situações com maior ou pior índices de acertos. Dessa forma, mostra-se imprescindível a capacitação da população em geral sobre como agir em determinadas situações.

L'accesso vascolare per emodialisi nel paziente affetto da scompenso cardiaco è un tema clinico complesso, che necessita di competenze tecniche nefrologiche e cardiologiche per una sua piena comprensione. In tali pazienti infatti il confezionamento di un accesso vascolare nativo prossimale presenta una lunga serie di effetti sulla funzione cardiaca, potenzialmente in grado di peggiorare la performance e la prognosi del paziente. In tali pazienti è quindi possibile che il posizionamento di un catetere venoso centrale rappresenti una soluzione meno problematica. Questo articolo presenta una casistica monocentrica ed alcuni casi clinici esemplificativi, utili ad indagare tale peculiare condizione.