Biomedical subjects
Publications and source records attributed to C Loza Cortina.
Hyponatremia is a relatively common postoperative complication which sometimes has dramatic consequences. A case of severe hyponatremia is reported. Although unrelated with the surgical technique, this complication is potentially life-threatening.
OBJECTIVE: The objective of this study was to know the incidence of adverse drug reactions in a group of children sent to our office by their pediatrician under the suspicion of having suffered a drug reaction. PATIENTS AND METHODS: Ninety-eight children were retrospectively studied. Family background, clinical picture, drugs involved, time elapsing between the onset of symptoms and the date of the study, association to other allergic conditions and diagnostic methods used "in vivo" and "in vitro" were evaluated. RESULTS: Mean age of the patients was 4 years with 53.5% being female and 46.5% male. Positive drug allergy in the family background was found in 22%. The clinical picture showed urticaria and angioedema in 36%, morbiliform eruption in 31%, urticaria in 20%, only angioedema in 9% and other symptoms in 4%. Drugs involved included betalactams (78%), macrolides (17.5%) and others (less than 9%). The mean time elapsed between the onset of symptoms and the date of study was 2 years. There was association to other allergic conditions in 18% (50% in the cases in which the drug allergy was confirmed). RAST to penicillin G and V, amoxicillin and ampicillin was done in 28 cases (betalactams), being negative in all of them. Skin tests were carried out in 21 cases (betalactams), being positive in 19% (66% among the confirmed cases). In all but two cases a controlled provocation test was carried out, being positive only in 8. CONCLUSIONS: 1) The presence of adverse drug reactions is confirmed in only 9% of the cases. 2) Confirmation of the clinical history and the provocation test as the most reliable diagnostic methods currently available. 3) Acceptable sensitivity of the skin tests in the case of betalactams. 4) Null sensitivity of the RAST in the case of betalactams.
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Patients with severe asthma pose a dilemma to the physician since the treatment they need, namely high doses of oral steroids, has serious side effects, especially among the pediatric population. Deficiency in one or more of the IgG subclasses has been associated with abnormal pulmonary function, as well as with recurrent sinopulmonary infections in adults and children. In the last years attention has been focused on alternative therapies for these patients. One of these alternatives is the treatment with intravenous immunoglobulin (IVIG). We report an 11-year-old boy with severe asthma since the age of two years and multiple hospital admissions due to asthmatic crisis even more frequent and severe, to the point of needing, in the last year, daily treatment with high doses of oral steroids (20 mg). During six months the patient was given high doses of intravenous immunoglobulin. After one month of treatment a clinical and spirometric improvement was apparent allowing to taper down the oral steroids until their complete substitution by inhaled budesonide (1,600 microg/day). The only side effects noted were severe headaches after gammaglobulin infusions which responded well to oral paracetamol. This improvement was sustained throughout the treatment period, but few weeks after the IVIG was suspended the clinical and spirometric parameters started to worsen again.