Percepción de estudiantes de medicina sobre la virtualización de los cursos de patología general y patología especial / Perception of medical students about the virtualization of general pathology and special pathology courses

RESUMEN Objetivo. Describir el proceso de virtualización de los cursos de patología general, especial y la percepción de los estudiantes. Métodos. Estudio no experimental, prospectivo y transversal. Para la enseñanza virtual de los cursos se utilizó la plataforma Moodle y, para las prácticas de histopatología, se utilizó la plataforma Pathpresenter. Participaron 126 estudiantes del curso de patología general y 133 de patología especial. Se utilizó el cuestionario desarrollado por Justin Krawiec y Quality Matters for Higher Education Rubric, conformado por 27 preguntas con respuestas tipo escala de Likert en un rango de 1 a 5, donde 1 se valora como totalmente en desacuerdo y 5 como totalmente de acuerdo. Tiene una confiabilidad de 0,96 según coeficiente de alfa de Cronbach. Las valoraciones globales se establecieron mediante percentiles. Resultados. Uso de Moodle: la claridad del contenido obtuvo una valoración de 3,9 y 4, mientras que la presencia de problemas para acceder al Moodle, obtuvo una valoración promedio de 2,4 y 3. En la dimensión clases y evaluación, la utilidad de las prácticas virtuales obtuvieron una valoración promedio de 3,8 y 3,5. Con respecto, a la tercera dimensión, experiencia en la virtualización de microscopía, la afirmación, la plataforma Pathpresenter es fácil de usar y efectiva para el propósito de los cursos, obtuvo una valoración promedio de 4,1 y 4,2. Conclusión. Los estudiantes valoraron positivamente las prácticas virtuales de patología, la facilidad de acceso y calidad de las imágenes. Sin embargo, manifestaron tener dificultades técnicas para acceder a la plataforma Moodle.

ABSTRACT Objective. Describe the virtualization process of general and special pathology courses and the perception of students. Methods. Non-experimental, prospective, and cross-sectional study. For the virtual teaching of the courses, the Moodle platform was used; and, for histopathology practices, the Pathpresenter platform was used. 126 students from the general pathology course and 133 from special pathology participated. The questionnaire developed by Justin Krawiec and Quality Matters for Higher Education Rubric was used, consisting of 27 questions with Likert scale responses ranging from 1 to 5, where 1 is valued as totally disagree and 5 as totally agree. It has a reliability of 0.96 according to Cronbach's alpha coefficient. The global assessments were established using percentiles. Results. Use of Moodle: the clarity of the content obtained an evaluation of 3.9 and 4, while the presence of problems accessing Moodle, obtained an average evaluation of 2.4 and 3. In the dimension classes and evaluation, the usefulness of the virtual practices obtained an average valuation of 3.8 and 3.5. Regarding the third dimension, experience in microscopy virtualization, the statement, "Pathpresenter platform is easy to use and effective for the purpose of the courses", obtained an average rating of 4.1 and 4.2. Conclusion. The students positively value the virtual practices of pathology, the ease of access and the quality of the images. However, they report having technical difficulties in accessing to Moodle platform.

Sonographic features of pelvic pain among adults in a Nigerian population

Background:Pelvic pain is abdominal pain located below the level of umbilicus, including frequent lower back pain with or without radiation to the thighs. The aim of this study was to evaluate the common ultrasound findings in subjects with pelvic pain. Methods:Itwas a retrospective study and involved collection of information from the folders of the subjects. A total of 820 folders were used for this study. Information collected from these folders included; the age, sex, provisional diagnosis and ultrasound findings. Data collected was arranged and statistical package for social sciences (SPSS) version 20 was used for analysis. Descriptive statistics was used and results arranged in frequency tables and percentages. Results:The result showed that males were 160 (20%) and females were 660 (80%). The age ranged from < 20years to 70 years and above. The mean age of the subjects was 35.66�.82 years. The mean age of the male is 51.83�.56 years and that of the females is 31.77�.02 years. Normal scan was the predominant ultrasound finding. The most common pathological finding was uterine fibroid (21.3%) and followed by pelvic inflammatory disease (15.2%).Conclusions:Ultrasound is an essential tool in the diagnosis of pelvic pain in males and females. Uterine fibroid was the most common pathological finding in females while benign prostate hypertrophy was the most common in males.

Comparison of transarterial n-BCA and Onyx embolization of brain arteriovenous malformations: A single-center 18-year retrospective analysis

Objective@#Brain arteriovenous malformations (AVM) are commonly treated with endovascular embolization. Due to the rapid evolution of endovascular technology and lack of consistent practice guidelines regarding AVM embolization, further study of AVM embolization outcomes is warranted. @*Methods@#We conducted a retrospective review of AVMs embolized at a single center from 2002-2019. Patient demographics, AVM characteristics, intention of embolization, and angiographic and clinical outcome after embolization were recorded. We compared the embolization results of those treated with n-butyl cyanoacrylate (n-BCA) and Onyx. @*Results@#Over an 18-year period at our institution, 30 (33%) of 92 AVMs were treated with embolization. n-BCA was used in 12 cases and Onyx in 18 cases. Eighty-seven pedicles were embolized over 47 embolization sessions. Fifty percent of AVMs treated with n-BCA underwent more than one embolization session compared to 22% when Onyx was used. The median total percent volume reduction in the n-BCA AVMs was 52% compared to 51% in Onyx AVMs. There were 2 periprocedural complications in the n-BCA cohort and none in the Onyx cohort. @*Conclusions@#In this small retrospective series, Onyx and n-BCA achieved similar occlusion results, although n-BCA required more sessions and pedicles embolized to do so.

Determination of the efficacy of okra seed powder in aqueous solution as a glucose lowering agent compared to acarbose in STZ diabetic rats / The Health Sciences Journal

INTRODUCTION@#Okra is reported to have anti-diabetic effects, but the literature shows conflicting results. The experiment aimed to determine the efficacy of three doses of okra seed powder suspension as a glucose lowering agent on streptozotocin-induced diabetic rats and its cellular effects on the liver and pancreas. @*METHODS@#Twenty-five Sprague Dawley rats that were given streptozotocin 60 mg/kg intraperitoneally were randomly allocated to one of five treatment groups: okra seed powder at 100 mg/kg, 150 mg/kg and 200 mg/kg, acarbose (positive control) and vehicle only (negative control). The treatments were given as a 1.5 mL oral gavage daily for 21 days. Significant differences in blood glucose were determined between treatment groups in terms of relative change from baseline, using One-Way ANOVA with Dunnett’s method with acarbose as the referent group. Repeated measures ANOVA was used to analyze the blood glucose levels across the time point collections (baseline, T1 and T2). Histopathologic changes on the liver and pancreas were described using counts and proportions.@*RESULTS@#Mean blood glucose values increased from baseline to T2 in all treatment groups. Increasing trend was observed only up to T1 in the 150 mg/kg and the 200 mg/kg okra seed treatment groups. Comparing okra treatment groups to acarbose, the percentage increase of mean blood glucose from baseline to T2 was lowest in the 200 mg/kg okra group (p = 0.040). The okra-treated rats had no fatty change and a dose-dependent decrease in cellular degeneration in the liver and none for the 200 mg/ kg treatment group. @*CONCLUSION@#The 200 mg/kg okra suspension has a potential lowering effect on blood glucose and a hepatoprotective effect. A longer period of observation with higher doses of okra suspension is recommended to study these effects further.

Association of non-alcoholic fatty liver disease with incident dementia later in life among elder adults

Background/Aims@#Accumulating evidence suggests a link between non-alcoholic fatty liver disease (NAFLD) and brain health. However, population-based evidence on the association between NAFLD and dementia remains unclear. This study was conducted to determine the association between NAFLD and incident dementia. @*Methods@#The study population included 608,994 adults aged ≥60 years who underwent health examinations between 2009 and 2010. Data were collected from the Korean National Health Insurance Service database. NAFLD was assessed using the fatty liver index (FLI). A Cox proportional hazards regression model was used to determine the association between NAFLD and dementia. @*Results@#During the 6,495,352 person-years of follow-up, 48,538 participants (8.0%) developed incident dementia. The participants were classified into low (FLI <30), intermediate (FLI ≥30 and <60), and high (FLI ≥60) groups. In the overall study population, the FLI groups were associated with a risk of dementia (P for trend <0.001). After propensity score matching, a low FLI was associated with a reduced risk of dementia (adjusted hazard ration [aHR], 0.96; 95% confidence interval [CI], 0.93–0.98; P=0.002), whereas a high FLI (NAFLD) was associated with an increased risk of dementia (aHR, 1.05; 95% CI, 1.02–1.08; P=0.001). A higher risk of dementia in the high FLI group than in the intermediate FLI group was attributed to Alzheimer’s disease (aHR, 1.04; 95% CI, 1.01–1.07; P=0.004) rather than vascular dementia (aHR, 0.94; 95% CI, 0.75–1.18; P=0.602). @*Conclusions@#NAFLD was associated with an increased risk of dementia, which was attributed to an increased risk of Alzheimer’s disease.

A locally advanced papillary thyroid carcinoma in a thyroglossal duct cyst presenting as a benign cervical mass: A case report

@#<p style="text-align: justify;">Thyroglossal duct cyst is the most commonly encountered midline and upper cervical mass that can also be a rare form of malignancy of about <1%. This is a rare case without well-defined management and staging criteria and as such, it has been a cause of debates regarding optimal management as well as the extent of completeness of surgery from Sistrunk procedure only to Sistrunk procedure with total thyroidectomy.<br /><strong>Conclusion:</strong> This is a case report of a rare occurrence of a locally advanced papillary thyroid carcinoma of thyroglossal duct cyst presenting as a benign cervical mass. The management dilemma and ultimate surgical approach was carefully drawn with the patient.</p>

Endoscopic management of a large tornwaldt cyst: A case report

@#Objective: To report successful marsupialization of a large Tornwaldt cyst using combined transnasal and transoral endoscopic surgery in a 7-year-old girl who presented with nasal obstruction. Methods: Design: Case Report Setting: Tertiary Government Training Hospital Patient: One Result: A 7-year-old girl presented with an 11-month history of recurrent yellowish nasal discharge gradually associated with nasal obstruction. Examination revealed a large, well encapsulated, broad-based cystic mass in the nasopharynx immediately adjacent to the posterior choanae, continuing posterior to the soft palate (pushing the uvula anteriorly) and extending inferiorly to the epiglottic area. Computerized Tomography (CT) demonstrated a well-circumscribed, midline hypodense mass with fluid attenuation obstructing the nasopharyngeal area extending inferiorly to the oropharyngeal area. Endoscopic marsupialization via transnasal and transoral approach was successful, and a respiratory epithelium-lined cyst consistent with a Tornwaldt cyst was confirmed by histopathologic examination Conclusion: Combined transnasal and transoral endoscopic marsupialization is possible a for a large symptomatic Tornwaldt cyst in a pediatric patient with relatively smaller and complex nasal cavities.

A narrative analysis on stories of underage smoking initiation among public school children / The Health Sciences Journal

INTRODUCTION@#Smoking is one of the most common preventable risk factors for disease and continues to be a burden on public health, especially in developing countries like the Philippines. This study aims to provide an understanding of underage Filipino smokers that is sensitive to the context within which they are found. @*METHODS@#The narrative approach was used to understand events across time and in a way that gave meaning to the storied experience of the participants. Core story creation and emplotment were used to flesh out the narratives of smoking initiation. The stories of six residents of Barangay Doña Imelda were analyzed to understand the significance of smoking initiation in their context. @*RESULTS@#The overarching narrative found was “putting meaning into time” and from this, three themes emerged: 1) time is meaningful when shared, 2) finding solace from the struggles of daily living, and 3) resisting oppressive structures. Using these insights, the discussion was grounded on anti-smoking campaigns such as the DOH Annual No Smoking Month, the Sin Tax Law, and the Nationwide Smoking Ban.@*CONCLUSION@#This paper concludes that a more proactive approach to smoking initiation is warranted by making meaningful alternative activities available to public school children.

Environmental cadmium exposure: a possible factor in the pathogenesis of preeclampsia

Cadmium is a toxic metal, an environmental contaminant and a multi-organ poison which has been implicated in the derangement of a number of biological and molecular systems. Exposure to cadmium is a serious global health threat particularly in developing countries and pregnant women are at great risk, This is because they have increased gastrointestinal absorption and retention of cadmium and the tendency for increased risk of complications owing to its toxic effects. Preeclampsia is a pregnancy complication characterized by the development of onset of hypertension and significant proteinuria after 20 weeks of gestation or during labour and/or within 48 hours of delivery. This pregnancy-specific syndrome is a leading cause of maternal death particularly in developing countries. Several reports have provided evidence of remote association between preeclampsia and cadmium but the mechanism of the involment of this toxic metal in this disease is still surrounded with uncertainty. Some possible mechanistic pathways such as induction of oxidative stress, acting as an antimetabolite to zinc and deregulation of epigenetic mechanisms have been elucidated in this article may be interconnected, work synergistically or act independently. However, pertinent to understand them in a bid to possibly prevent the disease or forestall its devastating consequences. Environmental cadmium exposure may be considered a factor that merits further serious attention in the continuous search for the precise an etiology of preeclampsia particularly in developing countries that experience uncontrolled cadmium release into the environment.

Caloric Substitution of Diets with Apple Pomace was Determined to be Safe for Renal and Bone Health Using a Growing Rat Model

Aims: To determine the safety of caloric substitution with 10% (g/kg) apple pomace to a healthy or Western diet. Study Design: Growing (age 22-29 days) female Sprague-Dawley rats were randomly assigned (n=8 rats/group) to consume a purified standard rodent diet (AIN-93G), AIN-93G/10% g/kg apple pomace (AIN/AP), Western diet, or Western/10% g/kg apple pomace (Western/AP) diets for 8 weeks. Results: Histological evaluation showed renal interstitial hypercellularity in rats fed AIN/AP, Western, and Western/AP diets. However, there were no effects on renal expression of oxidative stress and inflammatory genes or serum measures of kidney damage and function among diet groups. Apple pomace was also high in calcium which can affect calcium balance. Dietary calcium consumption was highest (P < .001) in rats consuming Western/AP. However, there were no significant differences in calcium absorption and retention among diet groups. Further, there was no evidence of renal calcification. There were also no impacts on femoral calcium, total mineral content, size or strength. Conclusions: Based on the results, apple pomace consumption was safe for renal and bone health in a rodent model, regardless of diet quality. Future preclinical studies should be conducted to further determine the efficacy and safety of apple pomace.

A new and improved electric fish finder with resources for printed circuit board fabrication

We describe the circuit design, construction, and operation of a field-portable electric fish finder (an AC-coupled wide-band differential bio-amplifier with loudspeaker output). This device permits detection and monitoring of the electric organ discharges generated by neotropical gymnotiform fishes (as well as the mormyroid fishes of tropical Africa). Our design is modified from earlier versions to optimize detection performance and stability over a wider range of ambient water conductivity, including under conditions of extremely low conductivity (< ca. 10 μScm-1). Our new electric fish finder design also incorporates complete waterproofing and longer battery autonomy. We provide Gerber and Eagle files made with the electronic design automation software 'Autodesk Eagle' to allow researchers to order printed circuit boards directly from commercial manufacturers.(AU)

Nós descrevemos o projeto de circuitos eletrônicos e as instrucões para a construção e uso de um detector de peixes elétricos portátil (bio-amplificador diferencial de banda-larga com acoplamento AC). Este aparelho permite a detecção e o monitoramento das descargas de órgãos elétricos gerados por peixes neotropicais da ordem Gymnotiformes (assim como dos peixes mormirídeos da África Tropical). Nosso projeto é modificado a partir de versões anteriores para otimizar o desempenho e a estabilidade sob uma faixa de condutividades ambientais mais ampla, incluindo condições de condutividade extremamente baixa (< ca. 10 μScm-1). Nosso detector de peixes elétricos novo também foi otimizado a fim de proporcionar impermeabilização completa e vida longa para as baterias. Nós fornecemos arquivos 'Gerber' e 'Eagle' preparados com o software de automação de projeto eletrônico 'Autodesk Eagle' para permitir aos pesquisadores a possibilidade de efetuar encomendas de nossa placa de circuito impresso direitamente das empresas de fabricação.(AU)

Association between perceived family functionality and teenage pregnancies

Background@#Teenage pregnancy is a public health concern because of its increasing incidence and its dire consequences. Numerous studies document the role of family in initiating sexual activity and teenage pregnancy, but there is a lack of studies that assess the effects of families and peers on teenage sexual behavior in the Philippines.@*Objective@#To determine the association between perceived family functionality as measured by the Family APGAR and teenage pregnancy in selected barangays in District 2, Quezon City, Philippines@*Methodology@#The study enrolled 233 women who are residents of Barangays Commonwealth and Payatas in Quezon City. Cases consisted of 133 women aged 18 to 24 years at the time of the interview who have become pregnant in 2011-2016, while they were 13 to 19 years old, while controls (N=100) were similar but had never been pregnant before age 20. Consecutive respondents who consented to participate in the study were enrolled and interviewed using the Filipino version of the Family APGAR. Respondents were then classified as having functional or dysfunctional families. Odds ratio was computed to determine the relationship between family functionality and teenage pregnancy.@*Results@#Family dysfunction based on the Family APGAR score was significantly associated with increased risk of teenage pregnancy with an OR 16.69, 1.93-144 (p=0.010) along with having both parents as caregivers with an OR of 29.69, 2.46-345, and teenage pregnancy in the mother with an OR of 15.87, 2.006-125.@*Conclusion@#Perception of dysfunction in the family based on the Family APGAR score, having both parents as caregivers and teenage pregnancy in the mother are associated with teenage pregnancy. Future researches should investigate the interactions of these factors but targeting family functionality may be key to curbing teenage pregnancies.

Effect of soybean ureases on seed germination and plant development

Abstract Urease catalyzes the hydrolysis of urea to ammonia and carbon dioxide. The ammonia (nitrogen (N) product of urease activity) is incorporated into organic compounds. Thus, urease is involved in N remobilization, as well as in primary N assimilation. Two urease isoforms have been described for soybean: the embryo-specific, encoded by the Eu1 gene, and the ubiquitous urease, encoded by Eu4. A third urease-encoding gene was recently identified, designated Eu5, which encodes the putative protein product SBU-III. The present study aimed to evaluate the contribution of soybean ureases to seed germination and plant development. Analyses were performed using Eu1/Eu4/Eu5-co-suppressed transgenic plants and mutants of the Eu1 and Eu4 urease structural genes, as well as a urease-null mutant (eu3-a) that activates neither the ubiquitous nor embryo-specific ureases. The co-suppressed plants presented a developmental delay during the first month after germination; shoots and roots were significantly smaller and lighter. Slower development was observed for the double eu1-a/eu4-a mutant and the eu3-a single mutant. The N content in transgenic plants was significantly lower than in non-transgenic plants. Among the mutants, eu3-a presented the lowest and eu1-a the highest N content. Altogether, these results indicate that increased ureolytic activity plays an important role in plant development.

A taxonomic revision of the Neotropical electric fish genus Brachyhypopomus (Ostariophysi: Gymnotiformes: Hypopomidae), with descriptions of 15 new species

The bluntnose knifefish genus BrachyhypopomusMago-Leccia, 1994, is diagnosed from other Rhamphichthyoidea (Rhamphichthyidae + Hypopomidae) by the presence of a disk-like ossification in the anterior portion of the palatoquadrate, and by the following external characters: short snout, 18.7-32.6% of head length (vs. 33.3-68.6% in Hypopomus, Gymnorhamphichthys, Iracema, and Rhamphichthys), absence of a paired accessory electric organ in the mental or humeral region (vs. presence in Hypopygus and Steatogenys), presence of 3-4 pectoral proximal radials (vs. 5 in Akawaio), presence of the antorbital + infraorbital, and the preopercular cephalic lateral line canal bones (vs. absence in Racenisia). Brachyhypopomus cannot be diagnosed unambiguously from Microsternarchus or from Procerusternarchus on the basis of external characters alone. Brachyhypopomus comprises 28 species. Here we describe 15 new species, and provide redescriptions of all 13 previously described species, based on meristic, morphometric, and other morphological characters. We include notes on ecology and natural history for each species, and provide regional dichotomous keys and distribution maps, based on the examination of 12,279 specimens from 2,787 museum lots. A lectotype is designated for Brachyhypopomus pinnicaudatus (Hopkins, Comfort, Bastian & Bass, 1990). Brachyhypopomus species are abundant in shallow lentic and slow-flowing freshwater habitats from southern Costa Rica and northern Venezuela to Uruguay and northern Argentina. Species diversity is highest in Greater Amazonia, where 20 species occur: B. alberti, new species, B. arrayae, new species, and B. cunia, new species, in the upper rio Madeira drainage; B. batesi, new species, in the central Amazon and rio Negro; B. beebei, B. brevirostris, B. regani, new species, B. sullivani, new species, and B. walteri, widespread through the Amazon and Orinoco basins and the Guianas; B. belindae, new species, in the central Amazon basin; B. benjamini, new species, and B. verdii, new species, in the upper Amazon basin; B. bennetti, in the upper, central, and lower Amazon, lower Tocantins, and upper Madeira basins; B. bullocki in the Orinoco, Negro and Essequibo drainages; B. diazi in the Orinoco Llanos; B. flavipomus, new species, and B. hamiltoni, new species, in the central and upper Amazon basin; B. hendersoni, new species, in the central Amazon, lower Negro and Essequibo basins; B. pinnicaudatus in the central and lower Amazon, lower, upper Madeira, lower Tocantins and Mearim basins, and coastal French Guiana; and B. provenzanoi, new species, in the upper Orinoco and upper Negro basins. Five species are known from the Paraná-Paraguay-Uruguay basin and adjacent southern Atlantic drainages: B. bombilla in the lower Paraná, upper, central, and lower Paraguay, Uruguay and Patos-Mirim drainages; B. brevirostris in the upper Paraguay basin; B. draco in the lower Paraná, lower Paraguay, Uruguay, Patos-Mirim, and Tramandaí basins; B. gauderio in the lower Paraná, upper, central, and lower Paraguay, Uruguay, Patos-Mirim and Tramandaí basins; and B. walteri in the lower Paraná and upper Paraguay basins. Two species occur in small Atlantic drainages of southern Brazil: B. janeiroensis in the São João, Paraíba and small intervening drainages; and B. jureiae in the Ribeira de Iguape and Una do Prelado. One species occurs in the middle and upper São Francisco basin: B. menezesi, new species. Three species occur in trans-Andean drainages: B. diazi in Caribbean drainages of northern Venezuela; B. occidentalis in Atlantic and Pacific drainages of southern Costa Rica and Panama to Darién, and the Maracaibo, Magdalena, Sinú and Atrato drainages; and B. palenque, new species, in Pacific drainages of Ecuador.(AU)

Peixes elétricos do gênero Brachyhypopomus Mago-Leccia, 1994, são diagnosticados dos outros Rhamphichthyoidea (Rhamphichthyidae + Hypopomidae) pela presença de uma ossificação discóide na porção anterior do palatoquadrado, e pelos seguintes caracteres externos: focinho curto, 18,7-32,6% do comprimento da cabeça (vs. 33,3-68,6% em Hypopomus, Gymnorhamphichthys, Iracema e Rhamphichthys), ausência de um órgão elétrico acessório pareado na região mental ou humeral (vs. presença em Hypopygus e Steatogenys), presença de 3-4 proximais peitorais radiais (vs. 5 em Akawaio), presença do antiorbital + infraorbital, e dos canais ossificados da linha lateral da região cefálica do pré-opérculo (vs. ausência em Racenisia). Brachyhypopomus não pode ser diagnosticado de maneira não-ambígua de Microsternarchus ou Procerusternarchus, com base em caracteres de morfologia externa. Brachyhypopomus compreende 28 espécies válidas. Aqui nós descrevemos 15 espécies novas, e fornecemos a redescrição de 13 espécies previamente descritas, baseado em caracteres merísticos, morfométricos e outros caracteres morfológicos. Nós incluímos notas sobre à ecologia e história natural para cada uma das espécies, e fornecemos chaves dicotômicas regionais e mapas de distribuição baseado no exame de 12.279 espécimes de 2.787 lotes de museus. Um lectótipo é designado para Brachyhypopomus pinnicaudatus (Hopkins, Comfort, Bastian & Bass, 1990). Espécies de Brachyhypopomus são abundantes em habitats de águas rasas lênticas e com correntes fracas, ocorrendo do sul da Costa Rica e norte da Venezuela ao Uruguai e norte da Argentina. A diversidade de espécies é maior na Grande Amazônia, onde 20 espécies ocorrem: B. alberti, espécie nova, B. arrayae, espécie nova e B. cunia, espécie nova, na drenagem do alto rio Madeira; B. batesi, espécie nova, na Amazônia central e rio Negro; B. beebei, B. brevirostris, B. regani, espécie nova, B. sullivani, espécie nova e B. walteri, amplamente distribuídas nas bacias Amazônicas e do Orinoco, e nas Guianas; B. belindae, espécie nova, bacia Amazônica central; B. benjamini, espécie nova e B. verdii, espécie nova, na bacia do alto Amazonas; B. bennetti, no alto, médio e porções baixas da bacia Amazônica, baixo Tocantins e alto rio Madeira; B. bullocki nas drenagens do Orinoco, Negro e Essequibo; B. diazi nos Llanos do Orinoco; B. flavipomus, espécie nova e B. hamiltoni, espécie nova, no médio e alto Amazonas; B. hendersoni, espécie nova, na Amazônia central, baixo Negro e Essequibo; B. pinnicaudatus no médio e baixo Amazonas, baixo e alto Madeira, baixo Tocantins, bacia do Mearim e rios costeiros da Guiana Francesa; e B. provenzanoi, espécie nova, nas bacias do alto Orinoco e alto Negro. Cinco espécies são conhecidas das bacias Paraná-Paraguai-Uruguai e bacias adjacentes das drenagens do sul do Brasil: B. bombilla no alto, médio e baixo Paraguai, baixo Paraná, Uruguai e drenagens Patos-Mirim; B. brevirostris da bacia do alto Paraguai; B. draco das bacias do baixo Paraguai, baixo Paraná, Uruguai, Patos-Mirim e Tramandaí; B. gauderio das bacias do alto, médio e baixo Paraguai, baixo Paraná, Uruguai, Patos-Mirim e Tramandaí; e B. walteri das bacias do alto Paraguai e baixo Paraná. Duas espécies ocorrem nas drenagens costeiras do sudeste do Brasil: B. janeiroensis no São João, Paraíba e em drenagens menores nas adjacências; e B. jureiae no Ribeira de Iguape e Una do Prelado. Uma espécie ocorre no médio e alto rio São Francisco: B. menezesi, espécie nova. Três espécies ocorrem nas drenagens trans-Andinas: B. diazi nas drenagens do Caribe no norte da Venezuela; B. occidentalis nas drenagens do Atlantico e Pacífico do sul da Costa Rica e Panamá até Darién, e nas drenagens do Maracaibo, Magdalena, Sinú e Atrato; e B. palenque, espécie nova, nas drenagens do Pacífico no Equador.(AU)

Pharmacological and Safety Profile of Dexlansoprazole: A New Proton Pump Inhibitor - Implications for Treatment of Gastroesophageal Reflux Disease in the Asia Pacific Region

Although gastroesophageal reflux disease is not as common in Asia as in western countries, the prevalence has increased substantially during the past decade. Gastroesophageal reflux disease is associated with considerable reductions in subjective well-being and work productivity, as well as increased healthcare use. Proton pump inhibitors (PPIs) are currently the most effective treatment for gastroesophageal reflux disease. However, there are limitations associated with these drugs in terms of partial and non-response. Dexlansoprazole is the first PPI with a dual delayed release formulation designed to provide 2 separate releases of medication to extend the duration of effective plasma drug concentration. Dexlansoprazole has been shown to be effective for healing of erosive esophagitis, and to improve subjective well-being by controlling 24-hour symptoms. Dexlansoprazole has also been shown to achieve good plasma concentration regardless of administration with food, providing flexible dosing. Studies in healthy volunteers showed no clinically important effects on exposure to the active metabolite of clopidogrel or clopidogrel-induced platelet inhibition, with no dose adjustment of clopidogrel necessary when coprescribed. This review discusses the role of the new generation PPI, dexlansoprazole, in the treatment of gastroesophageal reflux disease in Asia.

Clinical practice guidelines on the diagnosis and treatment of gastroesophageal reflux disease (GERD)

In the last two decades gastroesophageal reflux disease (GERD), initially thought to be a disease only common  in the West, is described  increasingly in Asia, including the Philippines. A recent local report indicated that the prevalence of erosive esophagitis (EE), a common complication of GERD, has more than doubled, i.e., 2.9% to  6.3%,  between the two time periods of 1994-1997 and 2000-2003, respectively. GERD causes recurrent annoying symptoms which are common  reasons  for  clinic  visits  and consultations thus, it is the objective of these guidelines to provide both primary care physicians  (PCPs) and specialists a current, evidence-based, country-specific recommendations for the optimal management  of  GERD.  These  guidelines  are  intended   to   empower   PCPs   to   make   a   clinic-based diagnosis of GERD, to start an empiric acid-suppressive therapy in the appropriate patient,and direct them to select which GERD patient may need to undergo investigations to ascertain further the diagnosis of GERD or to assess outcomes of therapy. We acknowledge that studies published in the future may influence the impact on our confidence on the recommendations enumerated in  these guidelines thus, we commit to update this document when it is deemed appropriate.

The 2014 Hepatology Society of the Philippines consensus statements on the management of chronic hepatitis B

Chorinic hepatitis B virus (CHB) infection is a serious problem that affects over 300 million people worldwide and is highly prevalent in the Asia Pacific region. In the Philippines an estimate 7.3 million Filipinos or 16.7% of adults are chronically infected with HBV, more than twice the average prevalence in the Western Pacific region. In view of the above, the Hepatology Society of the Philippines (HSP) embarked on the development of consensus statements on the management of hepatitis B with the primary objectives of standardizing approach to management, empowering other physicians involved in the management of hepatitis B and advancing treatment subsidy by the Philippine Health Insurance Corporation (PhilHealth). The local guidelines include screening and vaccination general management, indications for assessment of fibrosis in those who did not meet treatment criteria. indications for treatment, on-treatment and post-treatment monitoring and duration of antiviral treatment. Recommendations on the management of antiviral drug resistance, management of special populations including patients with concurrent HIV or hepatitis C infection, women of child-bearing age (pregnancy and breastfeeding), patients with decompensated liver disease, patients receiving immunosuppressive medications or chemotherapy and patients in the setting of hepatocellular carcinoma are also included. However, the guidelines did not include management for patients with liver and other solid organ transplantation, patients on renal replacement therapy, and children. The consensus statements will be amended accordingly as new therapies become available.