Background: High-intensity regimes of chemotherapy have led to longer and more severe episodes of neutropenia with a resulting increase in morbidity and mortality due to infections. Which empiric antibiotic regimen to use in these cases is still under debate. Methods: We performed a randomized comparative study to evaluate the efficacy of cefepime versus ceftriaxone plus amikacin as the initial treatment in an escalating, empirical, antibiotic therapy regimen in febrile neutropenic patients. Both adults and children were included. All patients had less than 500 neutrophils/µl at the time of infection. Patients were randomized to receive either cefepime or ceftriaxone plus amikacin. If infection continued 72 h later, patients in both groups received vancomycin, and if infection had not disappeared 7 days after starting antibiotics, amphotericin B was started. Results: Twenty patients were included in each group. Both treatment and control groups were comparable for age and sex, among other factors. There were 18 cures in the cefepime group and 17 in the ceftriaxone plus amikacin group (p = 0.9). No patient discontinued therapy because of toxicity. Conclusions: Cefepime is a safe and very effective therapy for patients with acute leukemia and febrile neutropenia; in addition, it is a cheaper regimen in our country, and lacks the potential toxicity of the aminoglycosides.
El objetivo del presente trabajo fue estudiar el efecto del polimorfismo genético de la Apolipoproteína E (Apo E) sobre los niveles plasmáticos de lípidos y lipoproteínas en una cohorte de 200 individuos adultos sanos (20-65 años) residentes en Bogotá D.C. La frecuencia de los alelos de la Apo E fue 0.05 para el alelo e2; 0.87 para el e3 y 0.08 para el alelo e4. Los individuos se clasificaron de acuerdo al genotipo de la ApoE en: E3/2, E3/3, E4/3, E4/4 y E4/2, el genotipo de mayor frecuencia fue el E3/3 (77.1%). Al comparar la colesterolemia entre los sujetos E3/2, E3/3 y E4/3 se observaron niveles incrementados significativamente (p<0.05) en el grupo E4/3 (172.1±16.9) comparados con los del grupo E3/2 (148.7±32.1). Los niveles de triglicéridos presentaron una tendencia hacia niveles más altos en los individuos con genotipo Apo E4/3 al cómpralos con E3/3 y E3/2. En la población estudiada, el polimorfismo de la ApoE es un importante determinante genético de los niveles plasmáticos de lípidos y lipoproteínas, es así como la presencia del alelo e4 de la Apo E puede influir en el incremento de los niveles de colesterol total, colesterol-LDL y triglicéridos siendo un factor de riesgo de enfermedad cardiovascular.
Aims: We have shown that autologous transplant of CD34 + -enriched peripheral-blood mononuclear cells (PBMSC) could restore depressed myocardial function, and sustain adequate myocardial function 12 months after surgery in patients with old (>one yearold) myocardial infarction. Our aim is to report the long-term morbidity and mortality efficacy of this procedure. Methods and results: Seventy patients with an old anteroseptal myocardial infarction were followed for 2 to 7 years, 35 had a revascularization procedure and received an intra-myocardial injection of autologous CD34 + -enriched PBMSC (8 × 10 8 mononuclear cells/ml including 3 × 10 7 CD34 + cells/ml)(Group A). Group B patients only had the revascularization. Abnormal pre-surgical values of LVEF (33.2% ± 4.8%), LVDV (178 ± 13.7 ml), LVSV (120 ± 16 m), LVDD (58.9 ± 3.84 mm), E and A waves without contractility in infarction area in group A patients improved to approximate normal values (50% ± 3% for LVEF; 90 ± 9.3 ml for LVDV; 80 ± 9.9 ml for LVSV; 55.3 ± 3 mm for LVDD; 5.2 ± 0.5 cm/s for E wave and 4.18 ± 0.3 cm/s for A wave) 1 year after the procedure and have remained unaltered for all the follow-up period. All the patients remain alive. Only seven patients have been readmitted to the hospital for non-myocardial related events. Group B only 11 patients continued alive to 5 years after surgery and LEVF never increased more than 6%, all of them with many hospitalizations (n ≥ 10) by heart failure events. Conclusion: Intramyocardial injection of CD34 + highly enriched PBSC represent an encouraging alternative for patients with severely scarred and dysfunctional myocardium.
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