Diagnóstico de un vistazo. Solución del caso

TRICHINELLA SPIRALIS.
En las imágenes previas se podía ver un corte histológico de la lengua. En los haces musculares se veía el parásito. Aquí más de cerca. se identifica mejor.

Primer niño tratado con efuvirtide en el Mercante

Efuvirtide, también conocido como T20, es el primero de un nuevo grupo de anti-retrovirales que inhibe la fusión del virus HIV, con la membrana del linfocito CD4. Impidiendo la entrada del virus. Este producto debe ser administrado por vía subcutánea, dos veces por día. Debe combinarse con otros fármacos. El paciente de la foto ( la imagen del rostro fue difuminada, para preservar su identidad) fue entrenado para auto-aplicarse la medicación. En la foto el enfermero especializado, Lino, ( Lab. Roche) controlando los sitios de aplicación. Agradecemos la colaboración de la Dra. Gabriela Manonelles, infectóloga pediátrica del hospital, por la realización de esta nota.

Diagnóstico de un vistazo. Más imágenes

Aquí ven más imágenes de la misma patologia.

Horarios del Servicio

* Lunes: 9 a 11 hs. Infectología Adultos
* Lunes: 10 a 13 hs. Infectología Pediátrica.
* Martes: 15 a 17 hs. Infectología Pediátrica
* Martes: 13 a 16 hs. Infectología Adultos
* Miércoles: 13 a 16 hs. Infectología Adultos
* Viernes: 15 a 17 hs. Infectología Pediátrica
* Lunes, Miércoles y Viernes: Asesoría, solicitud y entrega de análisis de hiv.

Caso Clínico. Diagnóstico TBC

Foto de archivo

Caso presentado en el VI Congreso Argentino de SADI, por Vázquez M.; Maldonado P.; Fink V.; Bonney B. ; Ortemberg M.; Cahn P. del Hospital Fernández


Paciente oriundo de Bolivia,de 50 años de edad, antecedentes de TBC pulmonar en la infancia; insuficiencia renal crónica en hemodiálisis. Bacteriemia por Stafilococcus asociada a catéter. Consulta en agosto de 2005 por tumor de partes blandas con tumefacción, en pie derecho de 1 mes de evolución.En la Rx presenta aumento de partes blandas con osteólisis y luxación de primer metatarsiano derecho.Se realiza drenaje por punción de material purulento. Rx de torax: sin infiltrados. Se interpreta como osteomielitis e inicia tratamiento con Trimetoprima- sulfametoxazol y rifampicina.
A las 72 hs. se recibe el informe del directo del material de punción: BAAR(+). Se inició tratamiento con Rifampicina, isoniazida, pirazinamida, etambutol y ciprofloxacina. El cultivo de partes blandas fue positivo para Mycobacterium Tuberculosis.

Diagnóstico de un vistazo.

Inauguramos una "nueva sección" en el Blog. Presentaremos imágenes sin más datos. Los que quieran pueden dejar su opinión en comments, solo tienen que registrarse. Es gratis, y pueden usar un seudónimo si es que son tímidos. En el próximo publicaremos la respuesta correcta.




Esta belleza no es un cuadro de E. Munch.
Su diagnóstico?

La FDA aprobó Atripla

HIV/AIDS Patients Get 1st Once-Daily Pill
FDA approves drug allowing HIV/AIDS patients to get first once-daily, 3-in-1 pill

WASHINGTON, Jul. 12, 2006
By ANDREW BRIDGES Associated Press Writer
(AP)


(AP) People infected with the virus that causes AIDS will soon be able to take a once-a-day pill that combines three drugs in a "cocktail" therapy that can be swallowed in a single dose.

The pill, called Atripla, includes three Food and Drug Administration-approved medicines that already form one of the most widely prescribed treatments for HIV and AIDS. The FDA approved the combination version Wednesday.

The medicine will still be expensive: more than $1,100 for a month's supply.

Atripla can replace the two or more pills HIV-positive patients now must take each day to keep the human immunodeficiency virus in check, making it simpler to stick to a treatment regimen. The new pill is expected to be available within seven business days.

"As a physician, I know _ whether in dealing with cancer or dealing with infection _ that's an opportunity to significantly improve compliance. And compliance with therapy is as important as the therapy itself for a successful outcome," said Dr. Andrew von Eschenbach, the FDA's acting commissioner.

If the single pill does help patients stick to their pill-taking regimen, that in turn could slow the emergence _ and ultimately, transmission _ of drug-resistant strains of the virus. Those strains can evolve when patients take less than 95 percent of their pills, said John Martin, head of Gilead Sciences Inc., the manufacturer of two of the drugs in Atripla.

"The fewer pills, the better they are able to achieve that 95 percent threshold," Martin said.

Atripla won't do away with the multiple other drugs that AIDS patients often must take to fend off infections and other complications of their weakened immune systems, said Frank Oldham Jr., executive director of the National Association of People with AIDS. And some patients will have to take other HIV drugs along with Atripla to combat the virus effectively.

Atripla combines Viread (tenofovir), Emtriva (emtricitabine) and Sustiva (efavirenz). Viread and Emtriva, both made by Gilead of Foster City, Calif., are now sold in combination under the brand name Truvada. Sustiva is made by New York-based Bristol-Myers Squibb Co.

The pill will be just as expensive as Truvada and Sustiva when purchased separately: The wholesale price will be $1,150 for a 30-day supply. Switching to the combo pill would require insured patients to make just one, rather than two, co-payments, saving some money.

Several initial attempts by the two companies to combine the three drugs failed. The two companies then settled on a process called "bi-layer" technology to join them in a single pill.

"The fact that innovator companies in the U.S. have actually heeded the call to collaborate on this is just an amazing happening," said Veronica Miller, director of the Forum for Collaborative HIV Research. The effort, Miller said, could lead to future collaborations on better drug combinations formulated for use in infants and children.

The FDA approved last month the first three-drug combination pill to treat HIV as part of foreign AIDS relief efforts. Atripla also will be available for use in the 15 countries covered by that program, the President's Emergency Plan for AIDS Relief. Unlike Atripla, the other combo pill must be taken twice daily and is for sale only outside the United States.

Interest in Atripla as the first once-daily, three-drug pill may be greatest in developing countries, for both medical and logistical reasons, said Dr. Murray Lumpkin, deputy commissioner for international and special programs at the FDA.

"The idea of having a fixed-dose combination has been one of the, as you might say, one of the holy grails," Lumpkin said.

About 40 million people worldwide, including 1 million Americans, are HIV positive. Each year, roughly 5 million people are infected with HIV and 3 million die from AIDS, according to the World Health Organization.

The three drugs inhibit the replication of HIV within the body but are not a cure. Nor will the new pill be suitable for all patients: Sustiva, for instance, can cause birth defects. Serious psychiatric symptoms including severe depression, suicide attempts, aggressive behavior, delusions and paranoia also have been reported in patients taking the drug.

Gilead, Bristol-Myers Squibb and Merck & Co. Inc. intend to seek approval to sell the pill outside the U.S.

Merck, based in Whitehouse Station, N.J., is involved because it has rights to market one of the three drug ingredients, efavirenz, under the brand name Stocrin in many foreign countries, including most of the developing world.

___

On the Net:

Food and Drug Administration: http://www.fda.gov/

Gilead: http://www.gilead.com

Bristol-Myers Squibb Co.: http://www.bms.com/

Merck & Co. Inc.: http://www.merck.com/