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Comentar - Enviar para um amigo

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PubMed structured abstracts have been reformatted for easier readability.

PubMed structured abstracts have been reformatted for easier readability.

The PubMed Clinical Queries page was redesigned to automatically search by three clinical research areas.

The PubMed Clinical Queries page was redesigned to automatically search by three clinical research areas.

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Comentar - Enviar para um amigo

Comentar - Enviar para um amigo

Comentar - Enviar para um amigo

Comentar - Enviar para um amigo

Comentar - Enviar para um amigo

In March, 2010, a 15-year-old girl presented to our accident and emergency department with altered mental status, nausea, and vomiting. During the previous evening she had been out with friends, and had consumed a white powdery substance together with alcohol. On the day of admission she had become increasingly unwell, with symptoms that could not be attributed to a hangover and presented to us in the afternoon. Upon arrival, our patient was somnolent with a Glasgow Coma Score of 11 she opened her eyes in response to speech, uttered inappropriate words, and localised to pain. Blood pressure was 108/58 mm Hg; pulse rate was 54 beats per min; respiratory rate was 15 breaths per min; and ear-temperature was 36°C. Arterial blood gas analysis and 12-lead electrocardiogram were normal. There was no evidence of external injury, neck stiffness, or localising neurological signs. Her pupils were dilated but reactive to light; there was no papilloedema. The remainder of the physical examination was normal.

The spread of chloroquine-resistant Plasmodium falciparum in Africa has been a strong stimulus to the development of new antimalarial drugs. Although artemisinin and related compounds have been promising therapies since the 1980s, their low availability and high cost have greatly delayed large-scale use. In the meantime, a logical alternative was to experiment with existing agents, and there was added pressure to do so because of the increasing frequency of resistance to sulfadoxine-pyrimethamine (Fansidar, Roche, Basel, Switzerland), which was the main alternative to chloroquine. Therefore, in the late 1990s, a combination of chlorproguanil (Lapudrine) and dapsone—both low-cost drugs—known as Lapdap (GlaxoSmithKline, London, UK) was introduced. Chlorproguanil, which is similar to proguanil, is a very effective antimalarial, and dapsone, which is chemically related to the sulphonamides, is very effective for treatment of leprosy. Chlorproguanil and dapsone both interfere with folate metabolism but at different biosynthetic stages, thus their combined use was in line with the classic tenet of antimicrobial therapy, which aims to prevent development of resistant organisms.

Endometriosis and infertility are associated clinically. Medical and surgical treatments for endometriosis have different effects on a woman's chances of conception, either spontaneously or via assisted reproductive technologies (ART). Medical treatments for endometriosis are contraceptive. Data, mostly uncontrolled, indicate that surgery at any stage of endometriosis enhances the chances of natural conception. Criteria for non-removal of endometriomas are: bilateral cysts, history of past surgery, and altered ovarian reserve. Fears that surgery can alter ovarian function that is already compromised sparked a rule of no surgery before ART. Exceptions to this guidance are pain, hydrosalpinges, and very large endometriomas. Medical treatment—eg, 3–6 months of gonadotropin-releasing hormone analogues—improves the outcome of ART. When age, ovarian reserve, and male and tubal status permit, surgery should be considered immediately so that time is dedicated to attempts to conceive naturally. In other cases, the preference is for administration of gonadotropin-releasing hormone analogues before ART, and no surgery beforehand. The strategy of early surgery, however, seems counterintuitive because of beliefs that milder non-surgical options should be offered first and surgery last (only if initial treatment attempts fail). Weighing up the relative advantages of surgery, medical treatment and ART are the foundations for a global approach to infertility associated with endometriosis.

Gestational trophoblastic disease encompasses a range of pregnancy-related disorders, consisting of the premalignant disorders of complete and partial hydatidiform mole, and the malignant disorders of invasive mole, choriocarcinoma, and the rare placental-site trophoblastic tumour. These malignant forms are termed gestational trophoblastic tumours or neoplasia. Improvements in management and follow-up protocols mean that overall cure rates can exceed 98% with fertility retention, whereas most women would have died from malignant disease 60 years ago. This success can be explained by the development of effective treatments, the use of human chorionic gonadotropin as a biomarker, and centralisation of care. We summarise strategies for management of gestational trophoblastic disease and address some of the controversies and future research directions.

Peginterferon plus ribavirin achieves sustained virological response (SVR) in fewer than half of patients with genotype 1 chronic hepatitis C virus infection treated for 48 weeks. We tested the efficacy of boceprevir, an NS3 hepatitis C virus oral protease inhibitor, when added to peginterferon alfa-2b and ribavirin.

(No abstract is available for this citation)

(No abstract is available for this citation)

(No abstract is available for this citation)