Megacolon tóxico en una paciente con colitis seudomembranosa / Toxic megacolon in a patient with colitis pseudomembranous

La colitis seudomembranosa es una patología relacionada con el uso de antibióticos. En raras ocasiones, evoluciona a megacolon tóxico que podría requerir resolución quirúrgica. Comunicamos el caso de una mujer de 22 años, que recibió amoxicilina/ácido clavulánico unos días antes de la consulta. Presentó diarrea, fiebre y vómitos. Radiografía y tomografía computarizada de abdomen: distensión de colon derecho >6 cm. Toxina para Clostridium: positiva. Comienza con el tratamiento médico y requiere cirugía por megacolon tóxico. El megacolon tóxico es una complicación infrecuente de la colitis seudomembranosa. Es rara en pacientes jóvenes y sin comorbilidades. Se llega al diagnóstico mediante los criterios de Jalan. La tasa de mortalidad se aproxima al 70%. Se debe mantener alto nivel de alerta ante signos de toxicidad sistémica y la dilatación colónica es diagnóstica de la entidad. El uso indiscriminado de antibióticos constituye un serio factor de riesgo.(AU)

Pseudomembranous colitis is a condition associated with the use of antibiotics. On rare occasions, it evolves to toxic megacolon which may require surgical resolution. We report the case of a 22-year-old woman who received amoxicillin/clavulanic acid a few days before the consultation. She referred diarrhea, fever and vomiting. Radiography and computed tomography of abdomen: distension of the right colon >6 cm. Clostridium toxin: positive. Medical treatment is administered and surgery is needed for toxic megacolon. Toxic megacolon is an infrequent complication of pseudomembranous colitis. It is rare in young patients without comorbidities. The diagnosis is reached using the Jalan criteria. The mortality rate approaches 70%. A high level of alertness should be maintained for signs of systemic toxicity and colonic dilation is diagnostic of the entity. Indiscriminate use of antibiotics is a serious risk factor.(AU)

Wild dengue virus types 1, 2 and 3 viremia in rhesus monkeys

Among the flaviviruses, dengue, with its four serotypes, has spread throughout the tropics. The most advanced vaccines developed so far include live attenuated viruses, which have been tested in humans but none has been licensed. Preclinical testing of dengue vaccine candidates is performed initially in mice and in nonhuman primates. In the latter the main criteria used to assay protection are neutralizing antibodies elicited by the vaccine candidate and the magnitude and duration of peripheral viremia upon challenge of previously immunized animals. Towards the identification of wild-type viruses that could be used in challenge experiments a total of 31 rhesus monkeys were inoculated subcutaneously of wild dengue types 1, 2, and 3 viruses. The viremia caused by the different viruses was variable but it was possible to identify dengue viruses useful as challenge strains.

Attenuation and immunogenicity of recombinant yellow fever 17D-dengue type 2 virus for rhesus monkeys

A chimeric yellow fever (YF)-dengue serotype 2 (dengue 2) virus was constructed by replacing the premembrane and envelope genes of the YF 17D virus with those from dengue 2 virus strains of Southeast Asian genotype. The virus grew to high titers in Vero cells and, after passage 2, was used for immunogenicity and attenuation studies in rhesus monkeys. Subcutaneous immunization of naive rhesus monkeys with the 17D-D2 chimeric virus induced a neutralizing antibody response associated with the protection of 6 of 7 monkeys against viremia by wild-type dengue 2 virus. Neutralizing antibody titers to dengue 2 were significantly lower in YF-immune animals than in YF-naive monkeys and protection against challenge with wild-type dengue 2 virus was observed in only 2 of 11 YF-immune monkeys. An anamnestic response to dengue 2, indicated by a sharp increase of neutralizing antibody titers, was observed in the majority of the monkeys after challenge with wild-type virus. Virus attenuation was demonstrated using the standard monkey neurovirulence test. The 17D-D2 chimera caused significantly fewer histological lesions than the YF 17DD virus. The attenuated phenotype could also be inferred from the limited viremias compared to the YF 17DD vaccine. Overall, these results provide further support for the use of chimeric viruses for the development of a new live tetravalent dengue vaccine.

Otoplastia pela técnica combinada Stenstrõm-Mustardé-Furnas: Análise de 44 casos / Otoplasty by a combined Stenstrom-Mustardé-Furnas technique: An analysis of 44 cases

Em um estudo retrospectivo, foram analisados 44 pacientes operados pela técnica combinada de Stenstrõm-Mustardé-Furnas para correção de orelhas em abano, durante o período de julho de 2001 a julho de 2002, no Hospital São Lucas, da PUCRS. O seguimento pós-operatório foi de 6 a 12 meses sendo encontrados 3 casos de assimetrias (6,82), 5 de extrusão de pontos (11,36), 3 casos de necrose parcial de pele da antihélix (6,82) e nenhum caso de hematoma ou infecção. 42 pacientes (95,45) encontravam-se satisfeitos com a cirurgia. Os resultados são comparados com dados de literatura, concluindo-se ser um procedimento seguro, de aplicação simples e com bom resultados estéticos e baixo índice de recidiva e complicações, correspondendo aos achados descritos na literatura.

A retrospective study analysed 44 patients undergone to corrective otoplasty with the Stenstrõm-Mustardé-Furnas technique, between July 2001 and July 2002, in the Hospital São Lucas da PUCRS. Follow-up range from 6 to 12 months. Were found 3 cases of assimetry (6,82), 5 cases of suture extrusion (11,36) 3 cases of antihelix skin necroses (6,82) and neither case of hematoma or infection. 42 patients (95,45) were satisfied with the surgery. The results are compared with the literature data, and concluded to be a safety surgery, with good results and low recidive rate.

Bioequivalence evaluation of two roxithromycin formulations in healthy human volunteers by high performance liquid cromatography coupled to tandem mass spectrometry

The bioequivalence of two different formulations containing roxithromycin (SPE-712-1). Oral suspension 300mg/ 15mL as test formulation and Rotram©, tablets 300mg as reference formulation, both by Schering Plough S.A., Brazil) was evaluated in 24 healthy volunteers of both sexes (12 male and 12 female). The study was conducted open with randomized two-period crossover design and a 14-day washout period. Each subject received 300 mg of each roxithromycin formulation. Plasma samples were obtained over a 72-hour interval and roxithromycin concentrations were analyzed by combined LC-MS/MS with positive ion electrospray ionization using selected ion monitoring method. From the plasma roxithromycin concentration vs time curves the following pharmacokinetic parameters were obtained: AUC(0-72h), AUC(0-oo), Cmax,t1/2 ratios and tmax individual differences. The 90 percent for confidence interval (CI) of geometric mean SPE-712-L/ Rotram© individual percent ratio were 105.0-128,3 percent for AUC(0-72h), and 78.4-96.9 for Cmax. Although this 90 percent Cl were marginally outside the interval proposed by the Food and Drug Administration, the probability assessed by the two-one sided West for ratios was included in the 0.8-1.25 interval, as we concluded that SPE-712-L oral suspension formulation was bioequivalent to Rotram tablet formulation for the extent and rate of absorption.

Serum concentration and increased temperature alter Mayaro virus RNA and protein synthesis in Aedes albopictus (mosquito)-infected cells

We have previously shown the inhibition of Mayaro virus multiplication in Aedes albopictus-infected cells maintained at a supraoptimal temperature for growth (37§C) and a stimulation of virus production in response to high serum concentrations in the incubation medium. In the present study, we addressed the question of how the effect of continuous heat stress and high serum concentration soon after infection interfere with virus macromolecule synthesis. Cells maintained at 28§C in the presence of 2 percent serum synthesized a viral genomic RNA of 12 kb and a subgenomic RNA of 5.2 kb 6 h post-infection. Analysis of the protein profile showed the presence of the viral nucleocapsid protein of 34 kDa (P34). However, if infected cells were maintained at 37§C, a smear starting immediately below the 5.2-kb RNA was noticed and the viral P34 was not detected by SDS-PAGE. Addition of 10 percent serum to the growth medium of infected cells maintained at 37§C results in a viral RNA profile and proteins synthesis similar to those observed in cultures kept at 28§C, i.e., the smear was not observed and the P34 protein was detected. The results suggest that the inhibition of virus multiplication by temperature may be related to the inhibition of viral nonstructural protein synthesis early during infection. The presence of high serum levels in the incubation medium protects macromolecule synthesis against heat stress

Ceratofitose negra / Tinea nigra

É apresentada uma atualizaçäo bibliográfica sobre ceratofitose negra, uma dermatose pouco diagnosticada em nosso meio e de tratamento relativamente fácil. O fungo é estudado quanto à sua morfologia e modo de esporulaçäo, que motivaram a troca da sua classificaçäo taxonômica por diversas vezes

Nuevo aporte a la induccion de ovulacion con hormona liberadora de gonadotrofinas por via intravenosa y subcutanea. / A new contribution to the ovulation induce with gonodotrophin releasing hormone by intravenous and subcutaneous administration

La introduccion de la hormona liberadora de gonadotrofinas en forma pulsatil subcutanea o intravenosa ofrece una alternativa nueva en el tratamiento de la esterilidade de causa hipotalamica. Este trabajo agrega un caso mas a los ya descriptos en la literatura, donde se logro ovulacion y embarazo en una paciente con amenorrea y esterilidad primaria de causa hipotalamica, mediante estimulacion pulsatil con GnRH. En el primer cicle se hicieron 15 dosis diarias de 20 micrograma de GnRH por pulso, via subcutanea durante 13 dias, obteniendose ovulacion y sangrado menstrual.En el segundo ciclo se administraron 15 dosis diarias de 6,7 micrograma cada una, por via intravenosa, durante 14 dias, lograndose el embarazo.El seguimiento se hizo con temperatura basal, citologia, moco cervical y biopsia de andometrio, en el primer ciclo. En el segundo ciclo no se realizo biopsia pero se llevo a cabo el monitoreo ecografico. Remarcamos las ventajas de la via intravenosa sobre la subcutanea (menores dosis, menor costo) y la necesidad de respetar el ritmo pulsatil (90-120 min) tanto diurno como nocturno

Comparacao entre diatermia e crioterapia em esclera delaminada na cirurgia de descolamento de retina. / Comparison between diathermy and criotherapy in laminal scleral bed in retinal detachment surgery

Os autores apresentam um estudo retrospectivo a respeito de duas tecnicas cirurgicas que diferem basicamente no uso de diatermia ou crioterapia em esclera delaminada, para a cirurgia de descolamento de retina em 49 pacientes. Concluem que o numero de curas anatomicas e de complicacoes pos-operatoria foi semelhante utilizando uma ou outra tecnica