Objective To assess whether dexamethasone (DXM) decreases the time to recovery in patients with parapneumonic pleural effusion. Study design This was a multicenter, randomized, double blind, ...parallel-group, placebo-controlled clinical trial of 60 children, ranging in age from 1 month to 14 years, with community-acquired pneumonia (CAP) and pleural effusion. Patients received either intravenous DXM (0.25 mg/kg/dose) or placebo every 6 hours over a period of 48 hours, along with antibiotics. The primary endpoint was the time to recovery in hours, defined objectively. We also evaluated complications and adverse events. Results Among the 60 randomized patients (mean age, 4.7 years; 58% female), 57 (95%) completed the study. Compared with placebo recipients, the patients receiving DXM had a shorter time to recovery, after adjustment by severity group and stratification by center (hazard ratio, 1.95; 95% CI, 1.10-3.45; P = .021). The median time to recovery for patients receiving DXM was 68 hours (2.8 days) shorter than patients receiving placebo (109 hours vs 177 hours; P = .037). In exploratory subgroup analysis, the median time to recovery for patients with simple effusion receiving DXM was 76 hours (3.1 days) shorter than for patients with simple effusion receiving placebo ( P = .017). The median time to recovery for patients with complicated effusion receiving DXM was 14 hours (0.5 days) shorter than for patients with complicated effusion receiving placebo ( P = .66). The difference in the effect of DXM in the 2 severity groups was not statistically significant ( P = .138 for interaction). There were no significant differences in complications or adverse events attributable to the study drugs, except for hyperglycemia. Conclusion In this trial, DXM seemed to be a safe and effective adjunctive therapy for parapneumonic pleural effusion. Trial registration ClinicalTrials.gov : NCT01261546.
The increasing demand for growth media for greenhouse horticultural uses, the rising new uses of substrates, and the scarcity and cost of traditional sources, such as sphagnum peat moss in ...Mediterranean countries, have focused research on new substrate materials. Use of composted sewage sludges as a component of growth media could be a feasible alternative, with the benefit of their high availability and their very low cost. In this study, the effects of composted sewage sludge, blended with sphagnum peat moss in growth media, on germination and trace element extraction of cauliflower (Brassica oleracea var italica Plenc cv. Tenere), broccoli (Brassica oleracea var. Botryti cv. Marathon), and lettuce (Lactuca sativa c.v. Malta) were studied. Four treatments were established, on the basis of the addition of increasing quantities of composted sewage sludge to peat (0, 15, 30, and 50%, v/v). Germination percentage and trace elements (Fe, Cu, Mn, Zn, B, Pb, Ni, Cd, and Cr) extraction and differential root/aerial part distribution were studied. Increasing sewage sludge treatments (especially 30 and 50%) reduced germination of lettuce and broccoli. In cauliflower seedlings, an increment of germination was observed for the 15 and 30% treatments compared with the control. The contents of Fe, Cu, Mn, and Zn in plant tissues increased with the increasing rate of sewage sludge in the media. The highest micronutrient extraction efficiency was observed in broccoli (roots) and lettuce (leaves). Fe and Zn were the micronutrients extracted to a higher degree in all plants. Mn was mainly accumulated in aerial parts. Heavy metal extraction was very low in relation to micronutrients. Cd, Pb, and Cr were mainly accumulated in roots and Ni in the aerial parts.
A number of feed additives, such as As, Co, Cu, Fe, Mn, Zn, and Se are added to enhance pig growth and performance, but most of these micronutrients pass directly through the animal, which leads to ...elevated levels in the manure. An accumulation of P and trace elements, especially Zn and Cu, typically occurs with repeated swine manure application on soil. The potential environmental hazard associated with the loading of these elements in amended soils could actually be a positive fact in calcareous soils that usually show a high deficiency in available micronutrients. In this experiment, we analyzed the effect of the application of the solid phase of pig slurry to agricultural calcareous soils on the input and availability of Fe, Mn, Cu, and Zn. The experimental design was based on a field experiment using, as fertilizers two manures derived from the solid phase of pig slurry (composted, C and noncomposted NC). Two application rates were established to supply to the soils 300 and 450 kg N ha(-1), respectively, using a nonamended soil as a control. Soil samples were taken at 0, 14, 33, 53, 73, and 103 days. Available Fe, Cu, Mn, and Zn were extracted with DTPA (0.005 M DTPA, 0.01 N CaCl2, and 0.1 N TEA at pH 7) and determined by using atomic absorption spectrophotometry. A significant effect of manure application on available Fe, Cu, Mn, and Zn was observed. Zn and, to a lesser degree, Fe DTPA contents in amended soils were increased by composted and noncomposted pig manure, and Mn was increased by the noncomposted material. Extractable Cu was lower in amended soils, than in the controls. In general, the composted pig manure induced less variation of the studied micronutrient contents in amended soils than the noncomposted manure.
Use of animal by-products for crop production has the potential to be an economical way for our society to protect the environment and to conserve natural resources. Swine farms are an important ...source of animal manure production. In this experiment, the effect of swine manure and mineral fertilisation on the mass yield of different parts of the cucumber plant (Cucumis sativus L.) was studied. Fertilizer treatments were fresh and composted solid fractions of swine manure slurry fertilization (FSF and CSF, respectively) at two different rates (300 and 450 kg N ha(-1)), mineral fertilization (MF, equivalent to 300 kg N ha(-1)), and a control (C) without fertilization. All fertilizing scenarios produced a higher biomass yield of the different plant parts analyzed than the control. The aerial total biomass (expressed on both a fresh and dry mass basis) from CSF at 300 kg N ha(-1) plots was the greatest. In the first sampling, the leaf biomass production was greater, in general, for the organic fertilization treatments. However, in the second sampling, in most cases, differences were not found in the leaf biomass production between organic and inorganic fertilization. Shoot mass of plants fertilized at 300 kg N ha(-1) swine manure was similar to that of the MF plots. The application rate of swine manure did not affect the shoot yield, except in plants with FSF treatment at the first sampling. The fruit production by plants fertilized with FSF and CSF at 300 and 450 kg N ha(-1), respectively, was not different from fruit production produced by the MF. The greatest cucumber yield was observed in plots with CSF at 300 kg N ha(-1) treatment. The fruit size was smaller in plants fertilised with CSF at 300 kg N ha(-1) than in the other fertilization treatments. These plants had the greatest number of fruits.
The name epidermal nevus syndrome could be applied to a group of clinically and histopathologically different entities as has been pointed out by Happle. Phacomatosis pigmentokeratotica is a further ...type of epidermal nevus syndrome distinguished by the presence of a sebaceous nevus and a contralateral speckled lentiginous nevus of the papular type, associated with skeletal or neurological abnormalities. Three new cases of this recently delineated syndrome are presented. A common origin may account for the temporal and spatial relationship between the epidermal and the speckled lentiginous nevus. The concept of melanocytic-epidermal twin spotting similar to the interpretation of vascular twin spotting could explain the pathogenesis of this entity.
To update antiretroviral recommendations in antiretroviral therapy (ART) in HIV-infected children and adolescents.
Theses guidelines have been formulated by a panel of members of the Plan Nacional ...sobre el SIDA (PNS) and the Asociacion Espanola de Pediatria (AEP) by reviewing the current available evidence of efficacy, safety, and pharmacokinetics in pediatric studies. Three levels of evidence have been defined according to the source of data: Level A: randomized and controlled studies; Level B: Cohort and case-control studies; Level C: Descriptive studies and experts' opinion.
When to start ART should be made on an individual basis, discussed with the family, considering the risk of progression according to age, CD4 and viral load, the ART-related complications and adherence. The ART goal is to reach a maximum and durable viral suppression. This is not always possible, even with clinical and immunologic improvement. The difficulties of permanent adherence and side-effects are resulting in a more conservative trend to initiate ART, and to less toxic and simpler strategies. Currently, combinations of at least three drugs are of first choice both in acute and chronic infection. They must include 2 NA 1 1 NN or 2 NA 1 1 PI. ART is recommended in all symptomatic patients and, with few exceptions, in all infants in the first year of life. Older asymptomatic children should start ART according to CD4 count, especially CD4 percentage, that vary with age. Despite potent salvage therapies, it is common not to reach viral undetectability. Therapeutical options when ART fails are scarce due to cross-resistance. The cause of failure must be identified. Occasionally, there exists clinical and/or immunological progression, and a change of therapy with at least two new drugs still active for the patient, is warranted with the aim of increasing the CD4 count to a lower level of risk. Toxicity and adherence must be regularly monitored. Some aspects about post exposure prophylaxis and coinfection with HCV or HBV are discussed.
A higher level of evidence with regard to ART effectiveness and toxicity in pediatrics is currently available, leading to a more conservative and individualized approach. Clinical symptoms and CD4 count are the main determinants to start and change ART.
