Edina Mk da Silva

Probable Transmission of Acute Toxoplasmosis Through Breast Feeding

Studies carried out in human beings and laboratory animals concluded that parasitemia occurs during the initial stage of T. gondii infection but did not elucidate its duration or magnitude. In several animals models toxoplasmosis transmission through infected maternal milk was demonstrated. T. gondii has already been isolated from milk and colostrum of several animals species during experimental or natural infection. In these studies newborn babies fed by infected mothers with milk containing T. gondii developed asymptomatic infection. Milk can be considered a potential vehicle of transmission of toxoplasmosis but it was never clearly demonstrated in human beings. This type of transmission might occur when the mother is infected during the last weeks of gestation or during breast feeding. Langer was the first to isolate T. gondii in maternal milk but the interpretation of the results became difficult because of the possibility of contamination. Rieman et al. (1975) reported a case of toxoplasmosis in a child and the transmission through unpasteurized goat milk was suspected. (excerpt)

A Systematic Review of Treatment of Painful Diabetic Neuropathy by Pain Phenotype versus Treatment Based on Medical Comorbidities

Background Painful diabetic neuropathy (PDN) is a serious, polymorphic, and prevalent complication of diabetes mellitus. Most PDN treatment guidelines recommend a selection of drugs based on patient comorbidities. Despite the large numbers of medications available, most randomized clinical trials (RCTs) conducted so far have yielded unsatisfactory outcomes. Therefore, treatment may require a personalized approach based on pain phenotype or comorbidities. Methods To evaluate whether or not a patient’s pain phenotype or comorbidities can influence the response to a specific PDN treatment, we conducted a systematic review using two different approaches: pain phenotype and associated comorbidities-based treatment. Results Out of 45 identified papers, 7 were thoroughly reviewed. We found four RCTs stratified according to pain phenotype with three main results: (1) paroxysmal pain had a better response to pregabalin; (2) the preservation of thermal sensation or nociception anticipated a positive response to the topical treatment of pain; and, (3) after a failure to duloxetine (60 mg/day), the patients with evoked pain or severe deep pain had a better response to association of duloxetine/pregabalin while those with paresthesia/dysesthesia benefited from duloxetine monotherapy (120 mg/day). By contrast, the other three papers provided weak and even contradictory evidence about PDN treatment based on comorbidities. Conclusion Although more studies are needed to provide an adequate recommendation for clinical practice, our systematic review has provided some evidence that PDN phenotyping may optimize clinical outcomes and could, in the future, lead to both less empirical medicine and more personalized pain therapeutics.

Noninvasive positive pressure ventilation for upper abdominal surgery

This is the protocol for a review and there is no abstract. The objectives are as follows: We aim to determine the effectiveness and safety of noninvasive positive pressure ventilation (NPPV), that is continuous positive airway pressure (CPAP) or bilevel NPPV, in preventing mortality compared to standard therapy (oxygen therapy) and determine the incidence of tracheal intubation in adult patients with acute respiratory failure after upper abdominal surgery. As a secondary objective we will determine the gasometric alterations, hospital and ICU length of stay, gastric insufflation and wound dehiscence.