Chronic osteomyelitis in canine penile bone: case report / Osteomielite crônica em osso peniano canino: relato de caso

A 10-year-old male mixed-breed dog was admitted for recurrent signs of urinary tract infection (UTI). Urinary bladder ultrasonography revealed decreased thickness of its wall with floating hyperopic particles within its lumen. Ultrasonography revealed a structure invading the dorsal wall of the penile urethral lumen, located in a segment distal to the bladder. Radiographies showed bone resorption with proliferation at the caudal aspect of the penile bone, stricture of the final aspect of the penile urethra, and no radiopaque images compatible with a urethrolith. Computed tomography showed bone proliferation causing stricture of the urethral lumen at two different sites. Presumptive diagnosis of penile neoplasia was considered more likely and the dog underwent penectomy along with orchiectomy and scrotal urethrostomy. Enterobacter spp. was cultured from the urine sample and antibiotic sensitivity tests revealed that the bacterium was susceptible to amikacin, imipenem, and meropenem. Histopathology revealed severe suppurative urethritis, bone resorption, and hyperostosis, suggestive of osteomyelitis of the penile bone. Neoplastic cells were not observed at any part of the examined tissue. The findings in the present case suggest that osteomyelitis of the penile bone should be included in differential diagnosis for partial and complete urethral obstruction in dogs with recurrent UTI.(AU)

Um cão mestiço, com 10 anos, foi admitido por sinais recorrentes de infecção do trato urinário (ITU). A ultrassonografia da bexiga urinária revelou diminuição da espessura de sua parede com partículas flutuantes dentro de seu lúmen. A ultrassonografia demonstrou estrutura invadindo a parede dorsal do lúmen da uretra peniana, localizada em segmento distal à bexiga. Radiografias evidenciaram reabsorção óssea com proliferação no aspecto caudal do osso peniano, estenose do aspecto final da uretra peniana e ausência de imagens radiopacas compatíveis com uretrólito. Pela tomografia computadorizada, observou-se proliferação óssea causando estreitamento da luz uretral em dois locais diferentes. Diagnóstico presuntivo de neoplasia peniana foi considerado mais provável e o cão foi submetido à penectomia, juntamente com orquiectomia e uretrostomia escrotal. Enterobacter spp. foi cultivada da amostra de urina e testes de sensibilidade revelaram susceptibilidade ao amicacina, imipenem e ao meropenem. A histopatologia revelou uretrite supurativa grave, reabsorção óssea e hiperostose compatível com osteomielite do osso peniano. Células neoplásicas não foram observadas em nenhuma parte do tecido examinado. Os achados do presente caso sugerem que a osteomielite do osso peniano deve ser incluída no diagnóstico diferencial de obstrução uretral parcial e completa em cães com ITU recorrente.(AU)

Frecuencia de genes que codifican factores de virulencia en staphylococcus aureus aislados de niños que concurrieron al hospital general pediátrico niños de acosta ñú, durante el año 2010 / Frequency of gens that codify virulence factors in staphylococcus aureus isolated from children attending the niños de acosta ñú pediatric general hospital in 2010

Staphylococcus aureus es un microorganismo con habilidad de infectar diferentes tejidos celulares, por portar genes que le confieren resistencia a antibióticos, factores de virulencia y su plasticidad genética, que podrían contribuir a una progresión rápida y complicada de la enfermedad. El Paraguay no cuenta con datos epidemiológicos que indiquen los factores de virulencia que presentan las cepas de S. aureus, por lo que el objetivo del trabajo fue determinar un perfil de virulencia detectando los genes codificantes de: hemolisinas α y β,enterotoxinas A, B, C, D, H y toxinas exfoliativas A y B. Este estudio observacional descriptivo de corte transverso, con muestreo no probabilístico de casos consecutivos, incluyó 50 aislados de S. aureus obtenidos a partir de muestras clínicas de secreciones de piel, partes blandas o líquidos corporales de pacientes menores de 17 años que concurrieron al Hospital General Pediátrico Niños de Acosta Ñú durante el año 2.010. Las reacciones de PCR incluyeron la detección de los genes: sea+seb+sec+ADNr16S, hlA+hlB, eta+etb, sed y seh. El 82% de los aislados provenía de niños que presentaron cuadros clínicos compatibles con infecciones de piel y partes blandas y el 18% de cuadros clínicos graves como sepsis, osteomielitis y neumonías. Los aislados contaban con datos de portación de Leucocidina de Panton-Valentine, el cual fue el factor de virulencia más frecuentemente detectado (58%), seguido de las hemolisinas alfa (16%) y beta (8%). Las enterotoxinas y las toxinas exfoliativas fueron menos frecuentes (0-2%), y no se detectaron genes codificantes de las enterotoxinas C y D.

Staphylococcus aureus is a pathogen that has the ability to successfully infect differenttissues, because it carries genes that confer antibiotic resistance, virulence factors and itshigh genetic plasticity, that could contribute to a quick and complicated diseaseprogression. Paraguay does not have epidemiological data indicating the virulence factorspresented in S. aureus strains. Therefore, the aim of this study was to determine thevirulence profile by molecular methods detecting the codifying genes of: α and β hemolysin, enterotoxins A, B, C, D, H and exfoliative toxins A and B. This descriptiveobservational study with non-probability sampling of consecutives cases, included 50 S.aureus isolates obtained from clinical specimens from skin secretions, soft tissue or bodyfluids of patients younger than 17 years who attended the Niños de Acosta Ñú PediatricGeneral Hospital in 2010. The PCR reactions included the detection of the followinggenes: sea+seb+sec+ADNr16S, hlA+hlB, eta+etb, sed and seh. The 82% of the isolatescame from children skin and soft tissue infections and 18% came from invasive diseasessuch as sepsis, osteomyelitis and pneumonia. The Panton Valentine leukocidin, whichdata was previously obtained, was the most frequently virulence factor detected (58%),followed by alpha (16%) and beta (8%) hemolysins. Enterotoxins and exfoliative toxinswere less frequent (0-2%) and the enterotoxins C and D genes were not detected.

Segregated Delivery of Rifampicin and Isoniazid from Fixed Dose Combination Bilayer Tablets for the Treatment of Tuberculosis.

Aims: Develop an anti-tuberculosis (TB) Fixed Dose Combination (FDC) tablet containing an immediate release layer (IRL) composed of both rifampicin (RIF) and pyrazinamide (PYR) and a retarded release layer (RRL) comprised of isoniazid (INH) which would allow segregated delivery of RIF and INH. Study Design: Trials were conducted on the pre-formulations and formulations to assess the compatibility of excipients and obtain a modified release profile, for an IRL consisting of both RIF and PYR and a RRL containing INH. Place and Duration of Study: This study was performed at the Laboratory of Pharmaceutical Industrial Technology, Drug and Pharmaceutical Department, Faculty of Pharmacy, between March 2008 and April 2010. Methodology: Preformulation studies were performed on RIF and PYR, alone and in combination with excipients. The pharmacopeic attributes of the distinct layers and the FDC tablets were evaluated for hardness, friability and disintegration time. The FDC bilayer tablets were analyzed for their drug content and cumulative dissolution of the drug. Results: Fourier transform infrared, x-ray diffraction and differential scanning calorimetry results revealed the presence of amorphous and crystalline RIF forms and no potentially relevant incompatibilities were identified in the kneaded system containing RIF, PYR and excipients. In vitro drug release from the FDC tablets revealed that the intragranular addition of croscarmellose sodium into the IRL rendered a cumulative dissolution of RIF and PYR within the limits of simulated gastric fluid. And, for RRL, the most effective retardant matrix excipient was found to be hydroxypropyl methylcellulose. Conclusion: Segregated delivery of RIF and INH from bilayer tablets is an option for the development of immediate release FDC tablets and the retarded release of INH, this strategy proved suitable for preventing contact of these two drugs under acidic conditions. This finding suggested that RIF had a high in vivo bioavailability which qualifies this FDC for future bioavailability studies.

Teor e composição do óleo essencial de quatro acessos e duas cultivares de manjericão (Ocimum basilicum L. ) / Essential oil composition and content of different accessions and cultivars of basil (Ocimum basilicum L. )

O objetivo desse estudo foi avaliar o teor e a composição química dos óleos essenciais de quatro acessos silvestres de manjericão (Ocimum basilicum L.), provenientes de diferentes regiões geográficas, e duas cultivares comerciais cultivados sob as mesmas condições edafoclimáticas. As sementes dos acessos foram coletadas nos município de Gurupi-TO (GUR) e de Monte Alegre-GO (MAL, MVE e FPS) e as sementes da cultivar comercial manjericão roxo (MR) foram adquiridas no comércio de Gurupi e da cultivar Maria Bonita (MB) foram fornecidas pelo Horto de Plantas Medicinais da Universidade Federal de Lavras. O plantio foi realizado em vasos com capacidade de dez litros utilizando-se como substrato: solo de barranco e esterco bovino na proporção 2:1. O óleo essencial foi obtido por hidrodestilação em aparelho tipo Clevenger e a identificação e a porcentagem relativa dos compostos do óleo essencial foi realizada por Cromatografia à Gás acoplada a Detector de Espectrometria de Massas. Foram identificados trinta e nove substâncias nos óleos essenciais obtidos, abrangendo monoterpenos, sesquiterpenos e fenilpropanoides. Nas cultivares MB e MR o composto majoritário foi o linalol, enquanto nos acessos silvestres (MAL, GUR, FPS e MVE) o composto em maior quantidade foi o (E)-cinamato de metila. O maior teor de óleo essencial foi obtido na cultivar Maria Bonita (3,77%).

The objective of this study was to evaluate the essential oil chemical composition and content of four wild accessions of basil (Ocimum basilicum L.), from different geographical regions, and two commercial cultivars grown under the same edaphoclimatic conditions. The seeds of the accessions were collected in the municipality of Gurupi, state of Tocantins (GUR), and Monte Alegre, state ofGoiás (MAL, MVE and FPS), and the seeds of the commercial cultivar of purple basil (MR) were acquired in the Gurupi market and the seeds of the commercial cultivar Maria Bonita (MB) were provided by the Garden of Medicinal Plants of the Federal University of Lavras. The seeds were planted in pots with a capacity of ten liters using as substrate soil from earth works and cattle manure in the proportion of 2:1. The essential oil was obtained by hydrodistillation using a Clevenger-type apparatus, and the identification and the relative percentage of the compounds of the essential oil were performed by Gas Chromatography coupled to Mass Spectrometry Detector. Thirty-nine compounds were identified in the essential oils obtained, which were divided into monoterpenes, sesquiterpenes and phenylpropanoids. In the cultivars MB and MR, the major compound was linalool, and in the wild accessions (MAL, GUR, FPS and MVE) it was the (E)-methyl cinnamate. The highest content of essential oil was obtained from the cultivar Maria Bonita (3.77%).

Estudo da divergência genética por características morfológicas entre acessos de mentrasto (Ageratum conyzoides L. ) coletados no estado do Tocantins em diferentes épocas / Genetic divergence study by morphologic traits among mentrasto (Ageratum conyzoides L. ) accessions collected in the state of Tocantins in different period

Este trabalho objetivou avaliar a divergência genética entre nove acessos de mentrasto (Ageratum conyzoides) por métodos multivariados utilizando caracteres morfológicos, em quatro épocas de colheita. Os nove acessos de mentrasto foram obtidos de plantas que ocorrem naturalmente nas cinco regiões climáticas do Estado do Tocantins. Em cada época de colheita foram avaliadas as características como biomassa fresca da parte aérea, biomassa seca, área foliar, número de folhas, floração e altura. Pela análise de agrupamento (método de Tocher) foram formados dois grupos na primeira e quarta épocas de colheita, três grupos na segunda época e quatro grupos na terceira época de colheita. Observou-se variação na constituição dos grupos pelos acessos nas épocas de colheita. A divergência genética entre acessos de mentrasto, avaliada por caracteres morfológicos, foi influenciada pelo estádio de desenvolvimento da espécie. A existência de variabilidade entre os acessos coletados em diferentes localidades fornece subsídio para a coleta sistematizada de germoplasma em A. conyzoides no Estado do Tocantins.

This study aimed to analyze the genetic divergence among nine mentrasto (Ageratum conyzoides) accessions by multivariate methods using morphologic traits for four harvesting periods. The nine accessions of mentrasto were obtained from plants that occur naturally in five climatic regions of the state of Tocantins. At each harvesting period, the following traits were evaluated: fresh biomass of the aerial part, dry biomass, leaf area, number of leaves, flowering and height. The grouping analysis (Tocher's method) identified two groups, in the first and fourth harvest periods, three groups in the second harvest period and four groups in the third harvest period. Variation was observed for the group constitutions among the different harvesting periods. The genetic divergence among mentrasto accessions, evaluated by morphologic traits, was influenced by developmental stage of specie. The existence of genetic variability among accessions from different regions supports the systematic collection of A. conyzoides germplasm in the state of Tocantins.

Factores de riesgo prenatales en la muerte fetal tardía, Hospital Civil de Guadalajara, México / Prenatal risk factors in the late fetal death, Hospital Civil de Guadalajara, Mexico

Objetivo: Identificar los factores de riesgo sociodemográficos, obstétricos y perinatales que con más frecuencia se asocian a muerte fetal en embarazos mayores de 27 semanas. Método: De enero de 2004 a junio de 2009 en el Hospital Civil de Guadalajara, se realizó un estudio de casos y controles con 528 casos de muerte fetal de más de 27 semanas de gestación y 528 neonatos vivos cuyo nacimiento ocurrió inmediatamente después. Se comparó la frecuencia de diferentes variables maternas y fetales que en forma previa se han reportado asociadas a muerte fetal, por medio de Chi2 y prueba exacta de Fisher; se estimó la fuerza de asociación entre estas variables y muerte fetal con la razón de momios, con un intervalo de confianza del 95 por ciento. Resultados: De los factores de riesgo estudiados se asociaron con muerte fetal: edad materna mayor de 35 años, escolaridad baja, multiparidad, antecedente de aborto y de muerte fetal, atención prenatal deficiente, complicaciones en el embarazo, líquido amniótico anormal, doble circular de cordón umbilical al cuello del producto y malformaciones congénitas mayores del recién nacido. No se asoció con muerte fetal, el estado civil soltero, ser primigesta, tabaquismo, sexo masculino del feto, circular simple al cuello y macrosomía fetal. Conclusiones: De los factores de riesgo asociados con muerte fetal, resalta la atención prenatal deficiente que de ser mejorada, podría disminuir la fuerza de asociación de algunas de las otras variables que se asociaron a muerte fetal.

Objective: To identify sociodemographic, obstetric and perinatal factors most frequently associated with fetal death in pregnancies over 27 weeks. Methods: From January 2004 to June 2009 at the Civil Hospital of Guadalajara, we performed a case-control study of 528 stillbirths over 27 weeks gestation and 528 living infants whose birth occurred immediately afterwards. We compared the frequency of maternal and fetal variables that previously have been reported associated with fetal death by means of Chi2 and Fisher exact test, we estimated the strength of association between these variables and fetal death with odds ratios with a confidence level of 95 percent. Results: The studied risk factors associated with fetal death was: maternal age older than 35 years, low schooling, multiparity, history of abortion and stillbirth, poor prenatal care, pregnancy complications, abnormal amniotic fluid, circular double umbilical cord around the neck of product and major congenital malformations of the newborn. Single marital status, primiparity, smoking, male fetus, simple circular neck and fetal macrosomia, was not associated with fetal death. Conclusions: Risk factors associated with fetal death, like poor prenatal care emphasizes that, if improved, could decrease the strength of association of some of the other variables associated with fetal death.

Evaluación de la efectividad del renikan: extracto del pelargonium sidoides estandarizado EPs7630 en el tratmiento de las infecciones de las vías respiratorias superiores de etiología viral / Evaluation of the effectiveness of renikan: standardized extract of Pelargonium sidoides tratmiento EPs7630 in infections of the upper respiratory tract viral etiology

Las infecciones respiratorias, uno de los síndromes más frecuentes a nivel comunitario pueden ser de dos tipos: infecciones del tracto respiratorio superior o inferior. En su gran mayoría son inicadas por una infección viral transformando el terreno vulnerable a la sobre infección bacteriana. Hasta 2/3 de los pacientes son tratados desde el inicio de los síntomas con antibióticos, aunque este tratamiento no influye positivamente sobre el curso de la enfermedad. Renikan, fitofármaco extraído de la raíz del Pelargonium Sidoides, posee un triple mecanismo de acción: antiviral, antibacteriano y mucolítico, antiviral, porque activa los mecanismos de defensa antivirales orgánicos, antibacetriano, por su actividad bacteriostática directa e indirecta, y mucolítico, por sus propiedades secretomotoras y expectorantes. El objetivo fue comprobar la efectividad y tolerabilidad de Renikan en el tratamiento de las infecciones respiratorias. Diseño abierto y multicéntrico. Se seleccionaron niños de 6 a12 años y adultos de cualquier sexo o raza, con infecciones del tracto respiratorio superior. A los cuales se le suministró Renikan durante 7 días continuos, se evaluó: evolución de los síntomas, necesidad de uso de antibióticos y la escala de resultados integraticos IMOs. Ingreason un total 305 pacientes, 156 adultos y 149 niños distribuidos en tres grupos de estudio: Rinosinusitis, 97 pacientes, los cuales presentaron mejoría de sus síntomas en un 86% en los adultos y no utilizaron antibióticos en un 86%; los niños mejoraron en un 80%, y no usaron antibióticos en 91%. En el caso de las Amigdalitis hubo 108 pacientes con una mejoría sintomatológica en adultos del 92% y en los niños el 89%, no antibióticoterapia en el 86% de los adultos y 93% de los niños. El uso de Renikan en pacientes con infecciones del tracto respiratorio superior, demuestra ser seguro y efecivo tanto en adultos como en niños mayores de 6 años

Respiratory tract infections are the most common syndromes at community, there are two types: upper and lower respiratory tract infections. The vast majoritary are stared by a viral infection transforming the land vulnerable into a bacterial infection. The 2/3 o patients is treated from the onset of symptoms with antibiotics, although it is known that this treatment not positively influences the course of the disease. Renikan, herbal extrated fron the root of pelargonium sidoides has a threefold mechanism of action: antibiotic and mucolytic, antiviral, because it activates the natural antiviral mechanism of defense; antibacterial, due to its direct and indirect bacterostatic action and mucolytic, owing to its secretomotory and expectorant properties. To test the effectiveness and tolerability of renikan in the treatment of respiratory infections. Open desing, multicenter study. We selected children 6-12 years'age and adults of any sex orrance with upper respiratory tract infecctions. Theyreceived renikan for 7 consecutive days, changes in symptoms; necessity of antibiotic use and the integrative medicine outcome scale (IMOS) were evaluated. Of total of 305 patients, 156 adults and 149 children were divided into three groups: 97 rhinosinusitis patients, who showed symptoms improvement in 86% of adults and 91% of children, in 108 tonsillitis patients, an improvement of symptoms was found in 92% of adults and 89% of children, no antibiotic use were in 86% of adults and 93% of children, and, in a third group consistng of 100 patients with bronchitis, improvement was report in 98% od adults and in 73% of children, no antibiotics were used in 88% of adults and 96% of children. The use of concomitant therapy decreasedin 50% of cases and only 0.02% of patients had adverse events. The use of renikan use in patients with upper respiratory tract infections was shown to be safe and effective in both adults and children over 6 years of age

Controle fitopatológico do Fusarium subglutinans pelo óleo essencial do capim-citronela (Cymbopogon nardus L. ) e do composto citronelal / Fungitoxic activity of essential oil of citronella grass (Cymbopogon nardus L. ) and compound citronellal

Este trabalho teve como objetivo avaliar o efeito fungitóxico do óleo essencial de capim-citronela e do seu constituinte majoritário citronelal sobre a inibição micelial do fitopatógeno Fusarium subglutinans, agente causal da fusariose da cultura do abacaxi (Ananas comosus). Para avaliar o efeito do óleo essencial no crescimento micelial do fungo, foram utilizadas seis alíquotas (0, 5, 10, 15, 20 e 25 ìL) do óleo e do citronelal que foram distribuídas na superfície do meio BDA (batata-dextrose-ágar) antes da repicagem do fungo. O crescimento micelial foi medido após 48 h de instalação do experimento e em cinco épocas de avaliação (2, 4, 6, 8 e 10 dias após repicagem). Os resultados indicaram que o óleo essencial do capim-citronela demonstrou maior efeito inibitório do crescimento micelial do fungo F. subglutinans do que o composto citronelal. Em todas as alíquotas utilizadas o óleo essencial proporcionou menor taxa de crescimento micelial do que o citronelal.

This study aimed to evaluate the fungitoxic effect of the essential oil of citronella grass and its major constituent citronellal on the inhibition of mycelial pathogen Fusarium subglutinans, the causal agent of Fusarium culture of pineapple (Ananas comosus). To evaluate the effect of essential oil in the mycelial growth of the fungus were used six rates (0, 5, 10, 15, 20 and 25 mL) of oil that were distributed on the surface of PDA medium (potato dextrose agar) before subculturing of the fungus. Mycelial growth was measured after 48 h of the experiment and five times of assessment (2, 4, 6, 8 and 10 days after subculturing). The results indicated that the essential oil of citronella grass showed higher inhibitory effect of mycelial growth of the fungus F. subglutinans than compound citronellal. In all rates used of the essential oil gave lower growth rate than the mycelial citronellal.

Cálculo del impacto económico para Chile del uso de losartán en diabéticos tipo 2 con nefropatía diabética, basado en resultados del estudio RENAAL / Economic impact of Losartan use in type 2 diabetic patients with nephropathy

Background: The study RENAAL (Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan) demonstrated that Losartan was more effective lo reduce the progression of kidney disease in diabetic patients with proteinuria and a reduction in glomerular filtration rate. Aim: To perform a cost benefit analysis of Losartan use from provider and payer points of view. Material and methods: Published data of the RENAAL study was analyzed. The costs of the use or not use of Losartan in patients with diabetic nephropathy were compared in terms of total costs of the disease including medications, hospital admissions for myocardial infarction, cerebrovascular accidents and congestive cardiac failure and the costs of chronic hemodialysis. Results: The reduction in antihypertensive medication use, hospital admissions, and the delay in dialysis requirement from a mean of 65 to 79 months induced by Losartan use, results in net savings of $7,576,135 per patient, at 3.5 years of intervention. The figure does not change using different sensitivity scenarios. Conclusions: The eventual use of Losartan in type 2 diabetic patients results in important savings.

Distribución de tipo capsular y sensibilidad antimicrobiana de Streptococcusagalactiae productores de infecciones en Argentina / Distribution of capsular types and antimicrobial susceptibility of Streptococcus agalactiae causing infections in Argentina

Streptococcus agalactiae es una bacteria colonizante que ha emergido en los últimos años como causante de infecciones neonatales, perinatales y en pacientes con compromiso inmunológico. La caracterización del polisacárido capsular, de las proteínas de superficie (c, X, R), así como el análisis de marcadores moleculares, permiten su clasificación en serotipos y genotipos. Esto resulta de utilidad para fines epidemiológicos y para estudios de virulencia de la bacteria. El objetivo de este trabajo fue conocer los serotipos prevalentes y la sensibilidad antimicrobiana de aislamientos provenientes de procesos infecciosos en pacientes de distintas zonas de Argentina. En la muestra analizada se obtuvo predominio de los serotipos Ia y III, seguido de II y IV. Todas las cepas resultaron sensibles a penicilina. Se observó 6% de resistencia a eritromicina y 4,5% a clindamicina. En 3 de las cepas se detectó fenotipo MLS (resistencia a macrólidos, lincosaminas y estreptograminas) constitutiva y en una cepa, resistencia MLS inducible. Los resultados logrados en este estudio destacan la importancia de efectuar un relevamiento de los serotipos más frecuentes en nuestro país en vistas a la prevención de esta infección con una vacuna que realmente sea eficaz, como así también el conocimiento de la sensibilidad antimicrobiana para lograr éxito terapéutico en los tratamientos.

Streptococcus agalactiae is an endogenous bacterium that has emerged in the last 20 years as an etiological agent in both neonatal and perinatal infections, and in immunocompromised patients. The differentiation of the capsular polysaccharide, the presence of surface proteins c, X, R, and molecular methods allow classification in serotypes and genotypes. This identification is a useful tool for epidemiological purposes and virulence studies in this bacterium. The objective of this work was to study the serotypes and the antimicrobial susceptibility of isolates recovered from invasive diseases in different areas of Argentina. In the analyzed sample a fair predominance of Ia and III serotypes was recovered, followed by II and IV serotypes. All the isolates were found to be sensitive to penicillin. A 6% of resistance to erythromycin and a 4.5% to clindamycin were detected. In three of the isolates, constitutive MLS phenotype (resistance to macrolides, lincosamins and streptogramins) was founded, while in the remaining one, inducible MLS phenotype was detected. These results stress the importance of conducting a surveillance of the prevalent serotypes in our country with the goal of future prevention of this disease with an effective vaccine. The knowledge of the antimicrobial susceptibility profile will be also important to obtain therapeutic success in the treatment.

Evaluación de 1497 adultos mayores institucionalizados, usando el sistema de clasificación de pacientes RUG T-18 / Assessment of 1497 Chilean nursing home residents, using the Resource Utilization Group method, RUG T-18

Background: There is little information about Chilean elderly residents of long term care facilities, regarding their characteristics and need for resources. Aim: To describe main characteristics and resource utilization of residents of one of the largest nursing homes in Chile, Fundación Las Rosas de Ayuda Fraterna. Material and Methods: In a cross sectional and descriptive study, all residents were evaluated using the RUG T-18 method, that assess activities of daily living and the complexity of their clinical situation. Results: We assessed 1497 subjects 60 years old and over (73 percent women), with an age range of 60-106 years. Thirty six percent had urinary incontinence, 19 percent required assistance for feeding, and 38 percent needed help for walking or moving. Fifty seven percent were in the lowest category of complexity, ½Institutionalization¼. Very few residents were in the most demanding categories, no one classified as ½Rehabilitation¼, and only 0.7 percent were in ½Special Care¼. Conclusions: This study is an important start point to learn more about elderly subjects living in nursing homes in Chile (Rev Méd Chile 2004; 132: 701-6).

Síndrome de fiebre pariódica, faringitis, aftas y adenitis cervical / Periodic fever, aphtous stomatitis, pharyngitis and cervical adenitis syndrome (PFAPA)

Fiebre peródica, estomatitis aftosa, faringitis y adenopatía cervical (Síndrome PFAPA) es una entidad crónica y esporádica caracterizada por apisodios peiódicos de fiebre elevada de duración entre 3 a 6 días y recurrencia cada 3 a 8 semanas, acompañada por estomatitis aftosa, faringitis y adenitis cervicales. Los pacientes son sanos entre los episodios. Reportamos dos pacientes con los síntomas habituales del síndrome. La edad de comienzo de su enfermedad fue antes del año de vida y fueron tratados previamente a su diagnóstico con variados esquemas antimicrobianos sin respuesta clínica favorable. Posteriormente al diagnóstico de síndrome PFAPA, un paciente fue tratado con prednisona y evolucionó con rápida resolución de fiebre y el segundo ha recibido paracetamol e ibuprofeno con lenta mejoría de su sintomatología. Ambos niños evolucionaron asintomáticos entre los episodios febriles y con desarrollo normal. El conocimiento de este síndrome podría ayudar a un diagnóstico precoz y a un manejo adecuado de las alternativas terapéuticas.

Efecto de los extractos acuosos de Sesamum indicum L. Pedaliacea (Ajonjolí), en el aparato respiratorio en animales de experimentación / Effect of aquos extracts of Sesamun indicum L. Pedaliacea (Ajonjolí), on the respiratory tract of experimental animals

En algunos países caribeños se usa el Ajonjolí o Worwoli para el tratamiento del llamado pecho apretado o neumopatía y en el tratamiento de la conjuntivitis . Las semillas de Sesamum indicum L. Pedaliacea, contienen globulinas, aniones, cationes, arginina, ácidos grasos, carbohidratos, flavonoides, llignanos y otras sustancias con diferentes acciones farmacológicas: inmunológicas, bactericidas, inhibidoras de prostaglandina sintetasa y lipoxigenasa, corticoesteroidea, antiagregante plaquetaria, antidisminorréicas, antiespasmódicas, hipoglicemiante y otras. La investigación inicial sobre los efectos del extracto acuoso de semillas de Sesamum indicum L. Pediaceae (Ajonjolí) en ratas anestesiadas revelan efectos estimuladores de la frecuencia respiratoria a dosis de 12.5 y 25 mg/kg I.g. (intragástrica) seguidos de inhibición, comienza a invertirse las respuestas a los 50 mg/kg I.g. y deprimen la frecuencia respiratoria a dosis de 100 mg/kg I.g. en forma estadísticamente significativa. La amplitud de los movimientos respiratorios es disminuido en casi todas las dosis ensayadas 12.5, 25, 50 y 100 mg/kg I.g. En las primeras dos dosis ocasionalmente se observan respuestas estimuladoras. En el ensayo Hipócratico de Malone realizado en ratas, dosis de 100,500 y 750 mg/kg I.g. redujeron significativamente la frecuencia respiratoria en delta porcentaje de -39.2, -45.6 y -40.9 respectivamente. La administración del extractoo de semillas de Sesamum indicum L. Pedaliaceae en conejos anestesiados, incrementó: el flujo respiratorio y el volumen ventilatorio, la frecuencia respiratoria y el volumen ventilatorio, la frecuencia respiratoria y el volumen respiratorio minuto a dosis menores de 200 mg/kg I.g. del extracto de Sesamum indicum L. Pedaliceae, la frecuencia cardíaca prácticamente no se modificó. Este hallazgo se había observado en las ratas. Podemos concluír que los efectos del ajonjoli se pueden clasificar en el grupo "D" de Cámbar P. que son los extractos que disminuyen la resistencia pulmonar y aumentan la adaptabilidad pulmonar. Se puede asumir que esta planta es broncodilatodora y aumenta la "elasticidad" pulmonar. Los mecanismos precisos de estos cambios permanecerían por dilucidar

Resultados al aplicar el sistema de clasificación de pacientes RUG-T18 en ancianos ingresados a un hospital universitario / Application of RUG-T18 classification to elderly patients admitted to an university hospital

Background: Among case mix classifications, the best for hospitalized elders is the Resource Utilization Groups (RUG) system, which allows a better location of patients, resource administration and the design of health care strategies for elderly people. Aim: To report the results of RUG-T18 classification of elderly patients admitted to an university hospital. Patients and methods: RUG-T18 classification was applied to 210 patients aged 75.2 ñ 7.2 years old, 108 male, admitted to the Clinical Hospital of the Catholic University of Chile. Results: The clinical classification of assessed patients was rehabilitation in 50.9 per cent of cases, special care in 10.5 per cent, clinically complex in 37.1 per cent and reduced physical functions in 0.5 per cent. None had behavioral alterations. There were no differences between subjects older or younger than 75 years old. Daily life activities showed that help was required for sphincter control in 46 per cent of patients, for feeding in 44 per cent and for mobilization in 64 per cent (28 per cent of patients required help from two or more people). Geriatric assessment showed that, since 1993, the proportion of elders with greater functional derangement increased from 18 to 28 per cent, and the proportion of those with mental disturbances from 4 to 12 per cent, specially among those over 75 years old. Conclusions: Most elders admitted to the hospital are classified in the superior categories of the RUG-T18 system and have severe mental and functional limitations. These patients require a multidisciplinary approach with a great emphasis in rehabilitation

Valoración geriátrica ambulatoria de 2116 adultos mayores pobres / Geriatric assessment of 2116 free living elders

Background: Geriatric assessment quantifies medical, functional, mental and social capabilities and alterations of elders and is the first step to initiate specific intervention programs. Aim: To report the initial geriatric assessment of a program aimed to help poor elders living in Metropolitan Santiago. Subjects and methods: Two thousand one hundred sixteen free living subjects aged 65 to 99 years old (711 males) were subjected to an assessment using a simple geriatric score validated abroad and used previously in Chile. The resulting score ranges from 0 (better) to 5 (worst). Results: Eighty eight percent of elders did not have problems in the functional evaluation. Subjects over 75 years old needed occasional support for the daily activities with higher frequency than younger subjects (12 and 5.4 per cent respectively, p< 0.001) and had a higher frequency of major functional limitations (7.8 and 3.2 per cent respectively, p< 0.001). Mental assessment was considered normal in 89.4 per cent of subjects. Those over 75 years old had a higher frequency of memory disturbances (11.4 and 6.5 per cent respectively) and cognitive alterations (4.6 and 1.8 per cent respectively). Indefinite social support could be received by 84 per cent of subjects, but 7.4 per cent did not have access to this resource. Conclusions: Geriatric assessment of poor elders gives useful information to identify those subjects that require community help

Estudio comparativo de nonagenarios que viven en sus propios hogares versus los institucionalizados / Comparative study of nonagenarians living at their own homes and institutionalized

Subjects and methods: During 24 months, 241 people of 90 years or older were interviewed. One hundred twenty seven (96 female) lived in their own homes and 114 (108 female) lived in institutions. The geriatric evaluation scale, validated in previous studies, was used as the assessment instrument. Results: Mean age of subjetcs was 94 years old (range 90 to 106). Eight percent of subjects were bedridden. No differences in general condition, fecal or urinary continence, nutritional status, blood pressure, cognition, sight and hearing acuity, were observed between free living and institutionalized subjetcs. Free living elders had a significantly higher number of bothers or offspring and 90 percent were happy with the place where they lived. Conclusions: Most nonagenarians in Santiago are in good general medical conditions. Probably, the decision to become institutionalized depends more on lack of family support than on worse medical, functional or mental conditions

Experiencia piloto en el uso de una ficha de evaluación geriátrica ambulatoria / Pilot experience with an ambulatory geriatric assessment questionnaire

Ten percent of the chilean population is over 60 years old and general practitioners need an instrument to assess the degree of disability and multiple ailments of elders. Aim: to develop and use an instrument to assess elders consulting in primary care outpatient clinics. An instrument to be used by general practitioners, aimed to assess bio-psico-social risk of elders was devised by the Geriatrics Program at the Faculty of Medicine of the Catholic University of Chile. The instrument was used in 100 elders (82 female) aged 71ñ8 years old consulting in a primary care outpatient clinic. The instrument took less than 5 minutes to be used. The most frequent risk factors found were living alone in 62 percent of subjects, falls in the last year in 47 percent, memory disturbances in 62 percent, overweight in 76 percent, visual impairment in 76 percent, urinary incontinence in 26 percent and depression in 76 percent. Thirty percent had difficulties to climb stairs and 4 percent had no support in case of severe disability. The applied instrument is fast to apply, easily understood by patients and detects problems associated with old age, that will help to plan primary care health programs

Estudio de la permeabilidad intestinal en enfermos celíacos con EDTA-Cr51 / Study of intestinal permeability in celiac disease with 51 Cr-EDTA

Presentamos un estudio sobre la permeabilidad intestinal en una serie de diez niños diagnosticados de enfermedad celiaca cuando tomaban una dieta con gluten y tenían una atrofia severa de las vellosidades intestinales y posteriormente durante un período con dieta sin gluten y vellosidades intestinales normales. Tomamaos como grupo control a diez niños sanos. Se utilizó como marcador el EDTA-Cr51 (Etiléndiaminotetracetato Cr51) administrado por vía oral. Su excreción urinaria estaba signficativamente elevada en los pacientes con biopsia alterada, manteniéndose una moderada elevación en los pacientes celiacos con dieta exenta de gluten y sin atrofia de las vellosidades

Piometra: estudio de evaluación en 15 años en el hospital Loayza / Piometra: evaluation study in 15 years in hospital Loayza

Se revisa en forma retrospectiva nueve casos de piometra ocurridos durante un período de 15 años en el Hospital Arzobispo Loayza, Lima*Perú. El diagnóstico fue establecido clínicamente luego de la observación de material purulento que escapaba a través del orificio cervical en forma espontánea o luego de dilatación del cervix. El promedio de edad fue de 52.5 años. Siete pacientes se encontraban en edad post*menopáusica. El síntoma de flujo vaginal como descarga purulenta fétida se presentó en siete pacientes, cinco de las cuales acudieron con fiebre y compromiso del estado general. En ningún caso se encontró asociación con enfermedad maligna del cervix o útero. En seis casos se encontró útero aumentado de tamaño y, en todos los casos, este fue doloroso a la palpación. El diagnóstico preoperatorio fue hecho en cuatro casos. Los resultados bacteriológicos son limitados por no haberse hecho cultivos para anaerobios. Todas las pacientes recibieron tratamiento médico y quirúrgico, y su evolución fue favorable. Se discute los resultados basados en una revisión bibliográfica actualizada