Two cases of infections due to Scedosporium apiospermum in renal transplant recipients, one localized in the central nervous system, the other in the skin, are presented, and a literature review of 21 cases of central nervous system and cutaneous infections due to Pseudallescheria boydii/Sc. apiospermum is given.
INTRODUCCIÓNLa convocatoria en la primavera del año 2006 de "macrobotellones" en una veintena de ciudades españolas, degenerando en algunas en verdaderas batallas campales, fue la expresión más visible de un creciente fenómeno social. La elevada prevalencia del abuso de alcohol entre jóvenes, unida a la alta siniestralidad de tráfico asociada a su consumo, lo han convertido en un problema prioritario de salud pública, además de un conflicto de orden público (1,2). Tanto las sucesivas Encuestas Nacionales sobre Drogas, como los últimos datos disponibles en escolares muestran datos muy preocupantes. Por ejemplo, entre los escolares españoles de 14 a 18 años, el 66% lo ha probado en los últimos 30 días, el 58% admite haberse emborrachado alguna vez y la edad de inicio es de 13,8 años. En el fin de semana la ingesta se hace preferentemente en forma de cerveza (28%) o como combinadoscubatas (58%) (3). Así pues, en conjunto, y según otros estudios, 6 de cada 10 jóvenes de 12 a 18 años admite ser consumidor. Incluso más alarmante es el hecho de que hasta el 4,5% de jóvenes menores de 10 años admite haberlo probado alguna vez (4).Se ha demostrado que la publicidad del alcohol es, al menos, un factor moderado de incitación a probarlo entre los [0212-7199 (2007) 24: 3; pp 109-112] ANALES DE MEDICINA INTERNA
AimThe objective of the study reported here was to describe dose equivalence and hemoglobin (Hb) stability in a cohort of unselected hemodialysis patients who were switched simultaneously from epoetin alfa to darbepoetin alfa.MethodsThis was a multicenter, observational, retrospective study in patients aged ≥18 years who switched from intravenous (IV) epoetin alfa to IV darbepoetin alfa in October 2007 (Month 0) and continued on hemodialysis for at least 24 months. The dose was adjusted to maintain Hb within 1.0 g/dL of baseline.ResultsWe included 125 patients (59.7% male, mean [standard deviation (SD)] age 70.4 [13.4] years). No significant changes were observed in Hb levels (mean [SD] 11.9 [1.3] g/dL, 12.0 [1.5], 12.0 [1.5], and 12.0 [1.7] at Months −12, 0, 12 and 24, respectively, P=0.409). After conversion, the erythropoiesis-stimulating agent (ESA) dose decreased significantly (P<0.0001), with an annual mean of 174.7 (88.7) international units (IU)/kg/week for epoetin versus 95.7 (43.4) (first year) and 91.4 (42.7) IU/kg/week (second year) for darbepoetin (65% and 64% reduction, respectively). The ESA resistance index decreased from 15.1 (8.5) IU/kg/week/g/dL with epoetin to 8.1 (3.9) (first year) and 7.9 (4.0) (second year) with darbepoetin (P<0.0001). The conversion rate was 354:1 in patients requiring high (>200 IU/kg/week) doses of epoetin and 291:1 in patients requiring low doses.ConclusionIn patients on hemodialysis receiving ESAs, conversion from epoetin alfa to darbepoetin alfa was associated with an approximate and persistent reduction of 65% of the required dose. To maintain Hb stability, a conversion rate of 300:1 seems to be appropriate for most patients receiving low doses of epoetin alfa (≤200 IU/kg/week), while 350:1 would be better for patients receiving higher doses.
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