Massive pleural empyema secondary to amoebic liver abscess in a child / Empiema pleural masivo secundario a absceso hepático amebiano en un niño

Abstract Background: Pleural empyema secondary to a ruptured amoebic liver abscess is a rare complication in the pediatric population. Case report: We report the case of a 13-year-old male with right flank abdominal pain, productive cough with foul-smelling sputum, fever, and respiratory distress. Physical examination revealed breathlessness, decreased vesicular murmur in the right hemithorax, abdominal distension, hepatomegaly, and lower limb edema. Laboratory tests revealed mild anemia, leukocytosis without eosinophilia, elevated alkaline phosphatase, hypoalbuminemia, and positive immunoglobulin G antibodies against Entamoeba histolytica in pleural fluid. He required a chest tube and treatment with metronidazole. After 2 months of follow-up, the abscesses disappeared, and the empyema decreased. Conclusions: Massive pleural empyema secondary to a ruptured liver abscess is a rare complication. The epidemiological link associated with the symptoms and serological tests can help in the diagnosis.

Resumen Introducción: El empiema pleural secundario a ruptura de absceso amebiano hepático es una complicación poco frecuente en la población pediátrica. Caso clínico: Se reporta el caso de un paciente de sexo masculino de 13 años que presentó dolor abdominal en flanco derecho, tos productiva con esputo de mal olor, fiebre y dificultad respiratoria. Al examen físico se encontró amplexación y murmullo vesicular disminuido en hemitórax derecho, distensión abdominal, hepatomegalia y edema de miembros inferiores. Los resultados del laboratorio evidenciaron anemia leve, leucocitosis sin eosinofilia, elevación de fosfatasa alcalina, hipoalbuminemia y anticuerpos IgG contra Entamoeba histolytica positivo en líquido pleural. Requirió tubo de drenaje torácico y tratamiento con metronidazol. A los dos meses de seguimiento los abscesos desaparecieron y el empiema disminuyó. Conclusiones: El empiema pleural masivo secundario a ruptura de absceso hepático es una complicación poco frecuente. El nexo epidemiológico asociado con la sintomatología y pruebas serológicas pueden ser de ayuda en el diagnóstico.

Metronidazole: A culprit to balance and speech

In a country like India, oral metronidazole is the commonly prescribed drug of choice for entities such as amebiasis and visceral abscesses. Oral such cases, it is usually well tolerated and safe but can cause serious neurological adverse events. Peripheral neuropathy commonly encounters in practice but central nervous system toxicity is also well documented as it crosses the blood–brain barrier easily. Neurological toxicity of metronidazole may be due to prolonged administration, high doses, or high cumulative doses. Magnetic resonance imaging (MRI) of brain is the modality of choice to evaluate brain involvement. In the brain, the splenium of the corpus callosum, dentate nucleus of the cerebellum, and posterior pons involvement are commonly seen and diagnostic. Here, we have an interesting case report of a patient who was on oral metronidazole treatment for his large liver abscess, presenting with a complaint of neurological symptoms of unsteady gait, vertigo, dysdiadochokinesia, and difficulty in speech. Moreover, thus suspected as metronidazole drug toxicity and further investigated for the same, and MRI typically shows cerebellar and posterior corpus callosal involvement

Cerebellar ataxia after a single day of metronidazole use: Case report

Cerebellar ataxic syndromes, although uncommon, have been reported previously in patients taking metronidazole. However, almost all cases describe instances where patients were taking prolonged or high doses of the drug. We report a 65-year-old man who consumed 400 mg of metronidazole 3 times over 1 day and presented with slurring of speech, imbalance while walking and diplopia. The symptoms developed the day after consumption of metronidazole. Examination showed slurring of speech, gaze-evoked nystagmus, and dysmetria in all limbs. MRI brain revealed symmetric hyperintense lesions in the dentate nucleus and pons on T2-weighted imaging and FLAIR, which have a well-established association with metronidazole-induced central nervous system (CNS) toxicity. On discontinuation of the drug, symptoms improved, and complete recovery was noted at follow-up 2 weeks later. This case indicates that CNS side effects of metronidazole may not necessarily occur only at high doses or after prolonged courses of metronidazole, but may occur as an idiosyncratic reaction to the drug. Reasons for variable susceptibility require further investigation.

Quemadura genital por producto químico: reporte de caso / Genital burn by chemical product: case report

Resumen ANTECEDENTES: Las quemaduras son la forma más severa de estrés que el cuerpo puede sufrir; pueden generarse por diferentes agentes térmicos y químicos. CASO CLÍNICO: Paciente de 25 años, con dolor intenso en la región genital de 12 horas de evolución, secundario a la introducción en la vagina de una piedra de alumbre. Se le hicieron múltiples irrigaciones con solución salina al 0.9% sin obtener el resto de la piedra de alumbre. Se le aplicó sulfadiazina de plata en la cavidad vaginal cada 12 horas, óvulos vaginales de ketanserina, miconazol y metronidazol cada 8 horas, ketorolaco por vía oral 10 mg cada 8 horas. Durante su estancia hospitalaria tuvo buena evolución, con disminución de la inflamación en la zona genital, epitelización adecuada. Al tercer día se dio de alta del hospital con cita para valoración a los siete días. CONCLUSIÓN: El tratamiento de las quemaduras en el área genital, por agentes químicos, tiene como piedra angular la identificación del agente causante de la lesión que permita actuar de forma inmediata y evitar las secuelas físicas, sexuales y psicológicas mediante el lavado exhaustivo con solución o agua estéril para remover el agente causal y disminuir que continúe actuando en el sitio afectado.

Abstract BACKGROUND: Burns are the most severe form of stress that the body can suffer; they can be caused by various thermal and chemical agents. CLINICAL CASE: A 25-year-old female patient presented with severe genital pain of 12 hours' duration, secondary to the introduction of an alum stone into the vagina. She underwent several irrigations with 0.9% saline without obtaining the rest of the alum stone. She was given vaginal silver sulfadiazine every 12 hours, vaginal ketanserin, miconazole and metronidazole every 8 hours and oral ketorolac 10 mg every 8 hours. During her stay in hospital, she progressed well, with a decrease in genital inflammation and adequate epithelialisation. She was discharged on the third day with an appointment for a seven-day follow-up. CONCLUSION: The management of genital burns caused by chemical agents is based on the identification of the agent causing the lesion, which allows immediate action and prevents physical, sexual and psychological sequelae by thorough washing with sterile solution or water to remove the causative agent and reduce its continued action in the affected area.

Investigation of the Safety and Effectiveness of Metronidazole Gel (Rozex® gel 0.75%) on Sterilization and Reduction of Odor at Cancerous Skin Ulcer (Drug Use-results Survey)

Objective: The drug use-results survey of Metronidazole gel (Rozex® gel 0.75%: hereinafter, this is called “this medicine”) was conducted for the purpose of assessing the safety and effectiveness of this medicine in clinical practice including long-term use. Methods: Patients who initiated treatment with this medicine for sterilization and reduction of odor at cancerous skin ulcer for the first time were registered by the central registration method. The longest period of observation was 1 year. Results: The safety analysis set included 301 patients. The incidence proportion of adverse drug reaction was 3.32% (in 10 of 301 patients), with no serious events. The overall improvement rate was 73.7% (in 205 of 278 patients). At the final observation, the improvement rate of odor by physician's assessment was 80.2% (in 203 of 253 patients) and the improvement rate of patient's satisfaction was 70.1% (in 82 of 117 patients), respectively. Conclusion: The present study demonstrated that this medicine is safe and effective for sterilization and reduction of odor at cancerous skin ulcer, and leads to high treatment satisfaction of patients.

Effect of levofloxacin combined with metronidazole intrauterine infusion on infertility patients with chronic endometritis / 中国综合临床

Objective:To investigate the clinical outcomes of using the levofloxacin combined with intrauterine infusion of metronidazole for the treatment of the infertility patients with chronic endometritis (CE).Methods:Using a case-control study method. 82 infertility patients with CE admitted to Xuzhou Central Hospital from March 2018 to March 2021 were selected and randomly divided into an observation group and a control group using a random number table method, with 41 cases in each group. The control group was treated with oral levofloxacin hydrochloride, while the observation group was treated with metronidazole sodium chloride injection intrauterine infusion on the basis of the control group. Both groups were treated for 14 days. Compare the serum C-reactive protein (CRP) and tumor necrosis factor between two groups before and after treatment α(tumor necrosis factor-α, TNF-α) The levels of monocyte chemotactic protein 1 (MCP-1), natural pregnancy rate within six months, total effective rate, and incidence of adverse reactions during treatment were measured. The measurement data with normal distribution is expressed as: independent sample t-test is used for comparison between the two groups, and paired t-test is used for comparison before and after treatment within the group; The measurement data of non normal distribution is represented by M( Q1, Q3), and the comparison between groups is made by Wilcoxon Rank sum test. The counting data is represented by examples (%), and the comparison between groups is conducted using the χ 2 test. Results:Before treatment, two groups of serum CRP and TNF-α There was no statistically significant difference compared to the levels of MCP-1 (all P>0.05); After 14 days of treatment, both groups had serum CRP and TNF-α、MCP-1 were all lower than before treatment, and the observation group was lower than the control group [(4.12±1.9) ng/L vs (6.36±1.63) ng/L, (47.28±9.10) ng/L vs (62.79±9.34) ng/L, (212.04±24.82) ng/L vs (326.15±27.38) ng/L], with statistically significant differences ( t-values of 5.61, 7.62, and 19.77, all P<0.001). After 14 days of treatment, the total effective rate of the observation group was higher than that of the control group [95.12% (39/41) vs 78.05% (32/41)], with a statistically significant difference (χ 2=5.14, P=0.023). After 6 months of treatment, the natural pregnancy rate in the observation group was higher than that in the control group [53.66% (22/41) vs 31.71% (13/41)], with a statistically significant difference (χ 2=5.96, P=0.044). There was no statistically significant difference in the incidence of adverse reactions between the two groups during the treatment period (χ 2=0.55, P=0.457). Conclusions:The combination of levofloxacin and intrauterine infusion of metronidazole has a good clinical effect in treating infertility patients with CE. It can significantly improve the inflammatory state of the body, reduce serum inflammatory factor levels, increase the natural pregnancy rate within 6 months, and do not increase the incidence of adverse reactions.

Two cases of Lophomonas blattarum infection combined with paragonimiasis and literature review / 中国基层医药

Objective:To investigate the clinical manifestations, diagnosis, and treatment methods of Lophomonas blattarum infection combined with paragonimiasis in children, and improve pediatricians' understanding of the disease. Methods:The clinical data of two children with Lophomonas blattarum infection combined with paragonimiasis who received treatment in the Department of Pediatrics of The First People's Hospital of Yunnan Province were retrospectively analyzed. Children's clinical manifestation and diagnosis and treatment were analyzed. Relative literature was reviewed. Results:Case 1 had the onset of gastrointestinal symptoms. Case 2 had the onset of headache and liver dysfunction. Routine blood tests showed elevated eosinophils two cases and sputum examination results revealed the presence of live eggs of Lophomonas blattarum and paragonimiasis in two cases. Fecal roundworm eggs were also detected in case 1. Follow-up results showed that both cases were cured after treatment with metronidazole injection and praziquantel tablets. Conclusion:Lophomonas blattarum infection is a relatively rare opportunistic infection. Paragonimiasis is a natural parasitic disease that affects both humans and animals. Mixed infection of the two pathogens is rare. We hope that the findings from this paper will broaden clinical physicians' thoughts and guide clinical practice.

Comparative evaluation of efficacy of 10% povidone iodine gel with 2% metronidazole and 1% ornidazole with 0.25% chlorhexidine gel as local drug delivery system in adjunt to nonsurgical periodontal therapy in chronic periodontitis: A randomized, single blind, split-mouth study

Background: Periodontitis is a multi-factorial chronic inflammatory disease of attachment apparatus of teeth with microorganisms playing a major role. To address periodontal disease various strategies have been adopted to target these periodonto-pathogens. Various antimicrobial drugs (systemic as well as local) are effectively used to control the disease. However due to various side effects ofsystemic administration of the drugs like gastro intestinal disturbances, development of resistant organisms, high dosage of the drug required, local delivery of the drug is a better option as the drug is directly delivered at the site of infection with minimum dosage and maximum response achieved thus eliminating all the undesired effects of the drug. Aim: To evaluate the efficacy of 10% povidone iodine with 2% metronidazole and 1% ornidazole with 0.25% chlorhexidine gel as local delivery systems for the reduction in the pocket depth, changes in CAL, gingival inflammation. Materials and methods: A total of 20 patients diagnosed with mild- moderate chronic periodontitis were divided into two groups in a split-mouth study design - Group I and Group II with each group containing 20 sites with probing depth of >5 mm, CAL ?3 mm. In Group I, 10% povidine-iodine gel with 2% metronidazole was delivered inside the pocket and Group II, 1% ornidazole with 0.25% chlorhexidine was used as a local delivery system in adjunct to scaling and root planning. In both groups, medications were delivered at weekly interval for a period of 4 weeks. Baseline and 4 weeks measurements were done and compared for probing pocket depth (PPD), clinical attachment levels (CAL) and gingival inflammation. Results: The results obtained were statistically analyzed. Both groups showed statistically significant improvements in terms of clinical parameters. However, there was statistically insignificant difference when compared between the two groups. The results clearly demonstrate that both povidone iodine with metronidazole and ornidazole with chlorhexidine are also useful in controlling the acute phase of the periodontal disease in adjunct to scaling and root planning (SRP). Conclusion: Both drugs when used as an adjunct to scaling and root planning enhances probing pocket depth reduction, change in clinical attachment levels and gingival inflammation in mild- moderate chronic periodontitis cases.

Effectiveness of Different Concentrations of Chlorhexidine and Metronidazole Gels in the Management of Gingivitis: A Randomized Clinical Trial

Background: Management of gingivitis is commonly done by the removal of etiological agents by Periodontist. However, use of topical applications of antibiotic combinations has been shown to improve the treatment outcome. Various drugs alone or in combination have been used. So this study was conducted to determine the effect of different concentrations of combination drugs on gingivitis.Material & Methods:100 patients of gingivitis were divided into two groups of 50 each – Group-A and Group-B. After scaling and root planing, Group-A patients were made to apply Metronidazole 1% and Chlorhexidine 0.25% for period of 12 weeks while as Group-B patients applied Metronidazole 1.5% and Chlorhexidine 0.50% for 12 weeks. Baseline scores of gingival index and bleeding index were recorded followed by readings at 4 and 12 weeks.Results:Results showed that there was a significant improvement in gingivitis and bleeding on probing at 4 and 12 weeks after local application of Metronidazole and Chlorhexidine gel in both the groups. However there were no statistically significant differences between two groups.Conclusions:Topical application of Metronidazole and Chlorhexidine gel as an adjunct to scaling and root planing is an effective treatment modality for the management of gingivitis and the concentrations of the combination do not have any significant effect on the treatment.

Evaluation of Necessity of Appendectomy After Conservative Treatment of Uncomplicated Acute Appendicitis in Children

Background: Acute appendicitis is one of the most common emergency clinical conditions among children. It has two-way treatment options, one is surgical procedures, and another is a conservative approach. In the modern arena conservative treatment approach for acute appendicitis is one of the most preferred options. The aim of the study was to find out the solution to clinical conditions and reduce the procedure of injudicious appendectomy.Material & Methods:This prospective observational study was carried out at the Department of Paediatric Surgery, Dhaka Medical College Hospital, Dhaka to assess the necessity of appendectomy following conservatively managed uncomplicated acute appendicitis. A total of 62 children with uncomplicated acute appendicitis were included in the study. Then a conservative treatment started with the combination of inj. Ceftriaxone (100 mg/kgper day), inj. Metronidazole (1.5 mg/kg/ tds) and inj. Amikacin (7.5 mg/kg/ bd) therapy for five days with associated supportive management. The patients were assessed after 24 hours of treatment, who responded to the above management were the continued for same treatment at least five days then discharged and were followed up for 6 months.Results:Mean age was 8.95 ± 2.10 years within range from 4 years12 years. The male-female ratio was 1.58:1. The mean duration of hospital stay was 5.26 ± 0.63 days. On day 5, 59 (95.1%) were discharged and 3 (4.9%) underwent surgery during the conservative treatment period. A total of 8(13of .0%) cases have recurred during the first 6 months after treatment. Conclusions:Antibiotic treatment in patients with acute appendicitis is quite effective, the success rate is 95.1% during the period of treatment, and the recurrence rate is 13.0%.

Diarrhea associated with Pentatrichomonas hominis in an infant: A case report

Pentatrichomonas hominis is a flagellated protozoan parasite that resides in the digestive tract of humans and is generally nonpathogenic. Although parasites of diarrheal etiology are widespread, neonatal infection with P. hominis is an uncommon incident. This case report depicts an instance of active P. hominis in an 8-month- old child with complaints of fever, vomiting, and loose stools. Stool examination was done with saline and iodine wet mount that showed motile trophozoites of P. hominis with a jerky movement. Treatment with metronidazole was effective as no parasite was found on repeated stool examinations. Pentatrichomonas hominis should be recognized as a cause of diarrhea in neonates, despite being rare.

Efficacy of minocycline hydrochloride ointment combined with metronidazole film in the treatment of periodontitis and their effects on C-reactive protein and elastase levels in gingival crevicular fluid / 中国基层医药

Objective:To investigate the efficacy of minocycline hydrochloride ointment combined with metronidazole film in the treatment of periodontitis and their effects on C-reactive protein and elastase levels in the gingival crevicular fluid.Methods:76 patients with periodontitis who received treatment in Jiaxing Hospital of Traditional Chinese Medicine from May 2019 to January 2020 were included in this study. They were randomly allocated to undergo treatment with metronidazole film (control group, n = 38) or minocycline hydrochloride ointment plus metronidazole film (observation group, n = 38) for 4 weeks. We compared clinical efficacy, periodontal system examination indexes (gingival index, periodontal probing pocket depth, gingival bleeding index, plaque index, loss of attachment), gingival crevicular fluid biochemical markers (C-reactive protein, elastase in the pellet, elastase in the supernatant) measured before and after treatment, the incidence of adverse reactions, and the recurrence rate within half a year after treatment between the two groups. Results:The total response rate was significantly higher in the observation group than in the control group [97.37% (37/38) vs. 78.95% (30/38), χ2 = 6.17 , P < 0.05]. Gingival index, periodontal probing pocket depth, gingival bleeding index, plaque index, and loss of attachment measured after treatment were significantly lower in the observation group than in the control group (all P < 0.001). C-reactive protein, elastase in the pellet, and elastase in the supernatant measured after treatment were (5.31 ± 1.19) μg/L, (0.70 ± 0.20) Abs/mL, (0.48 ± 0.19) Abs/mL respectively in the observation group, which were significantly lower than those in the control group [(7.92 ± 1.27) μg/L, (1.15 ± 0.52) Abs/mL, (1.12 ± 0.31) Abs/mL, t = 9.24, 4.97, 10.85, all P < 0.001]. The recurrence rate within half a year in the observation group was significantly lower than that in the control group [2.63% (1/38) vs. 20% (6/38), χ2 = 3.93, P < 0.05]. There was no significant difference in the incidence of adverse reactions between the two groups ( P > 0.05). Conclusion:Minocycline hydrochloride ointment combined with metronidazole film is safe and effective in the treatment of periodontitis. The combined therapy help downregulate the levels of C-reactive protein, elastase in the pellet, elastase in the supernatant of the gingival crevicular fluid, alleviate inflammation, improve the periodontal status, and reduce the recurrence rate.

Treatment regimens used in the management of Helicobacter pylori in Colombia

Abstract Background Helicobacter pylori infection can cause gastritis, gastric ulcers, duodenal ulcers, and gastric cancer. Its treatment involves different medications, but resistance to these treatments is increasing. It is currently considered a public health problem. Aims to identify regimens used for H. pylori eradication by age group, year of treatment and geographical region of Colombia. Methods A cross-sectional study that identified regimens used H. pylori eradication in outpatient consultations over a 6-year period based on a medication dispensing database of 8.5 million people affiliated to the Colombian Health System. The appropriate regimens were those that included a proton pump inhibitor, associated with two antibiotics recommended by clinical practice guidelines (amoxicillin, clarithromycin, levofloxacin, moxifloxacin, tetracycline, doxycycline, metronidazole, tinidazole, and furazolidone). Results A total of 12,011 patients with a diagnosis of acid-peptic disease and H. pylori infection were identified, who had undergone 12,426 eradication treatment courses. Of these, 98.0% used a proton pump inhibitor (PPI), and 91.1% used amoxicillin. A total of 56.1% of the regimens were considered adequate; of these, 42.0% were a combination of PPI, amoxicillin/clarithromycin. This regimen predominated between 2015 and 2017 for all age groups. Conclusions The management of H. pylori infection in the majority of patients is heterogeneous and inconsistent with current recommendations based on evidence of antimicrobial resistance.

Efetividade do metronidazol tópico e/ou sistêmico no controle do mau odor de tumores malignos fétidos: revisão sistemática / Effectiveness of topical and/or systemic metronidazole in the control of bad odor from fetid malignant tumors: systematic review

Introdução: Tumores fétidos são uma complicação devastadora do câncer e causam muito desconforto e isolamento para o paciente. Eles geralmente se desenvolvem nos últimos seis meses de vida e são muito difíceis de tratar com sucesso. O objetivo desta revisão sistemática foi analisar as evidências da efetividade do metronidazol tópico e/ou sistêmico no tratamento de mau odor em feridas tumorais malignas. Resultados: Foram encontrados inicialmente 62 artigos, e destes, apenas 4 artigos na íntegra contemplaram os critérios de inclusão. Dois deles foram ensaios clínicos, sendo 1 duplo-cego, randomizado e 1, não controlado de fase III. Um artigo foi retrospectivo com coleta de dados de 10 anos e 1 foi de coorte prospectivo. Destes, 3 analisaram a eficácia do tratamento de tumores malignos com mau odor com o uso de metronidazol tópico e apenas 1 comparou o uso de metronidazol tópico com sistêmico. Discussão: Um fator que contribui para o mau odor não ser controlado de forma adequada, diz respeito a falta de protocolos padronizados para tal. Ao longo dos anos, estudiosos no assunto, tentam encontrar intervenções acessíveis e eficazes para reduzir as graves recorrências do mau odor em feridas necróticas. Conclusão: Tanto a via tópica quanto à sistêmica demonstram ser eficazes no controle do mau odor. Os resultados desta revisão destacam a falta de pesquisa nesta área com pouca evidência para direcionar a prática clínica no tratamento dessas lesões. Outros estudos se fazem necessários, para se estabelecer protocolos mais efetivos no controle desta condição angustiante, vivenciada por alguns pacientes oncológicos.

Introduction: Fetid tumors are a devastating complica-tion of cancer and cause much discomfort and patient isolation. They usually develop themselves in the last six months of life and they are very difficult to be success-fully treated. The aim of this systematic review was to analyze the evidence on the effectiveness of topical and/or systemic metronidazole for the treatment of bad odor in malignant tumor wounds. Results: Sixty-two articles were initially found, and of these, only 4 articles met the inclusion criteria. Two of them were clinical trials, being 1 double-blind, randomized and 1 non-controlled phase III studies. One study was retrospective with a 10-years data collection period and 1 was a cohort prospective study. Of these, 3 analyzed the efficacy of treating malignant tumors with a bad odor using topical metronidazole and only 1 compared the use of topical and systemic metronidazole. Discussion: A factor that contributes to the bad odor not being properly controlled is the lack of standardized protocols. Over the years, studies have tried to find affordable and effective interventions to reduce serious recurrences of bad odor in necrotic wounds.Conclusion: Both topical and systemic routes have been shown to be effective in controlling bad odor. The results of this systematic review highlight the lack of research in this area with little evidence to guide clinical practice in the treatment of these injuries. Further studies are needed to establish more effective protocols to control this distressing condition, experienced by some cancer patients.

Comparación de antibióticoterapia en la apendicitis complicada en pediatría / Comparison of antibiotic therapy in complicated appendicitis in pediatrics

INTRODUCCIÓN. La apendicitis aguda es una patología pediátrica quirúrgica que en su fase complicada requiere uso de antibióticos en el postoperatorio; encontrar la mejor opción como experiencia local, fue necesario. OBJETIVO. Comparar un esquema de antibioticoterapia triple vs un doble respecto a variables: demográficas, clínicas y de costos en pacientes pediátricos con apendicitis complicada. MATERIALES y MÉTODOS. Estudio analítico transversal. Población de 133 pacientes y una muestra de 93, operados por apendicitis complicada; 58 recibieron ampicilina + metronidazol + gentamicina y 35 ceftriaxona + metronidazol. Se comparó las variables: estadía hospitalaria, complicaciones y costo monetario de cada esquema. Se realizó en la Unidad de Cirugía Pediátrica del Hospital de Especialidades Carlos Andrade Marín, en el periodo enero de 2017 a octubre de 2018. Los datos fueron analizados con R-Studio 1.8.366 para Windows. RESULTADOS. No hubo diferencia estadística con respecto a: estadía hospitalaria (p=0,261); complicaciones como infección del sitio quirúrgico (p=0,196), re-intervención quirúrgica (p=0,653) y costo (p=0,059). CONCLUSIÓN. Se comparó el esquema de antibioticoterapia triple vs un doble, utilizados en apendicitis complicada en pediatría. No se encontró diferencias estadísticamente significativas en este reporte preliminar, con la diferencia de que con el esquema doble la frecuencia de administración fue menor y se evitó la exposición a los efectos colaterales de los aminoglicósidos.

INTRODUCTION. Acute appendicitis is a pediatric surgical pathology that in its complicated phase requires the use of antibiotics during the postoperative period; finding the best option as local experience was a must. OBJECTIVE. Compare a triple vs a double antibiotic therapy scheme respect demographic, clinical and cost variables in pediatric patients whit complicated apendicitis. MATERIALS AND METHODS. Cross-sectional analytical study. Population of 133 patients and sample of 93, with complicated appendicitis; 58 received ampicillin + metronidazole + gentamicin and 35 ceftriaxone + metronidazole. The following variables were compared; hospital stay, complications and monetary cost of each scheme. It was performed in the Pediatric Surgery Unit of the Hospital of Specialties Carlos Andrade Marin, during january 2017, through october 2018. The data were analyzed with R-Studio 1.8.366 for Windows. RESULTS. There was no statistical difference regarding hospital stay (p=0.261); complications such as surgical site infection (p=0.196), re-surgical intervention (p=0.653); nor cost (p=0.059). CONCLUSION. Triple vs. Double antibiotic therapy scheme used in complicated appendicitis in pediatrics was compared. No statistically significant differences were found in this preliminary report, how ever with the double scheme the frequency of administration was lower and exposure to side effects of aminoglycosides was avoided.

Metabolismo intermediario de Blastocystis spp / Intermediate metabolism of Blastocystis spp

Blastocystis es un stramenopile o cromista, pleomórfico no móvil. Se han identificado diecinue-ve subtipos de este organismo (ST1-ST19). Tiene una presencia a nivel mundial. Este microor-ganismo tiene un metabolismo intermediario anaeróbico. Un aspecto interesante de la bioquími-ca de este stramenopile está dado por la presencia de organelas similares a mitocondrias con un conjunto de rutas: cadena de fosforilación oxidativa incompleta, ciclo de Krebs parcial, metabo-lismo de ácidos grasos (anabolismo y catabolismo), metabolismo de aminoácidos y ensamblaje de proteínas con centros hierro/azufre. El tratamiento se ha basado tradicionalmente en metroni-dazol y otros imidazoles. Sin embargo, hay un número creciente de cepas resistentes a esos medicamentos. La reciente obtención del genoma nuclear y los estudios bioquímicos, proteómi-cos, metabolómicos, interactómicos permitirán el desarrollo racional de nuevos fármacos curati-vos. El objetivo de esta revisión es describir el metabolismo de Blastocystis spp

Blastocystis is a stramenopile or chromist, nonmobile pleomorphic. Nineteen subtypes of this organism (ST1-ST19) have been identified worldwide. This microorganism has an intermediate anaerobic metabolism. An interesting aspect of the biochemistry of this stramenopile is given by the presence of mitochondrial-like organelles with a set of pathways: incomplete oxidative phos-phorylation chain, partial Krebs cycle, fatty acid metabolism (anabolism and catabolism), amino acid metabolism and protein assembly with iron / sulfur centers. Treatment has traditionally been based on metronidazole and other imidazoles. However, there are a growing number of strains resistant to these drugs. The recent obtaining of the nuclear genome and the biochemical, proteomic, metabolomic and interactomic studies will allow the rational development of new curative drugs. The objective of this review is to describe the metabolism of Blastocystis spp.

Diagnóstico y tratamiento de osteomielitis mandibular crónica / Diagnosis and treatment of chronic mandibular osteomyelitis

Introducción: La osteomielitis mandibular crónica es considerada como una infección odontogénica que cursa con tumefacción de la cara, limitación de la abertura bucal y dolor. Pocas veces es tratada a través de gammagrafías con fijación a ciprofloxacino con la consiguiente obtención de resultados efectivos. Objetivo: Describir un caso clínico de osteomielitis mandibular crónica tratada con terapia antibiótica y quirúrgica. Presentación de caso: Paciente femenina de 63 años de edad que acudió al servicio de estomatología del Hospital María Auxiliadora, Lima, Perú; con un historial de tres meses de hinchazón creciente a nivel del borde inferior izquierdo de la mandíbula desde que le realizaron una extracción dentaria. Los exámenes tomográficos, gammagrafía, biopsia y antibiograma confirmaron la osteomielitis y la susceptibilidad bacteriana. La decorticación, debridamiento, exodoncia y la administración de metronidazol más vancomicina por dos meses permitió la remisión del cuadro. Conclusiones: El seguimiento clínico de dos años y las gammagrafías de evaluación permitieron verificar la presencia de regeneración ósea y ausencia de focos de reactivación. La osteomielitis crónica puede ser provocada por restos de exodoncias dentarias. Su diagnóstico y seguimiento clínico requiere de múltiples exámenes y controles a largo plazo(AU)

Introduction: Chronic mandibular osteomyelitis is considered to be an odontogenic infection manifesting as facial tumefaction, limited mouth opening and pain. It is not often enough treated with ciprofloxacin fixation gammagraphies with the consequent achievement of effective results. Objective: Describe a clinical case of chronic mandibular osteomyelitis treated with antibiotic and surgical therapy. Case presentation: A female 63-year-old patient attends the dental service at María Auxiliadora Hospital in Lima, Peru, with a history of three-months' swelling of the lower left edge of her mandible upon performance of a dental extraction. Tomographic examination, gammagraphy, biopsy and antibiograms confirmed the presence of osteomyelitis and bacterial susceptibility. Decortication, debridement, exodontia and administration of metronidazole plus vancomycin for two months led to remission of the patient's status. Conclusions: Two-year clinical follow-up and evaluation gammagraphies made it possible to verify the presence of bone regeneration and the absence of reactivation foci. Chronic osteomyelitis may be caused by remains of dental exodontias. Its diagnosis and clinical follow-up require a large number of long-term tests and controls(AU)

A sensitive electrochemical detection of metronidazole in synthetic serum and urine samples using low-cost screen-printed electrodes modified with reduced graphene oxide and C60 / 药物分析学报

Monitoring the concentration of antibiotics in body fluids is essential to optimizing the therapy and minimizing the risk of bacteria resistance,which can be made with electrochemical sensors tailored with appropriate materials.In this paper,we report on sensors made with screen-printed electrodes(SPE)coated with fullerene(C60),reduced graphene oxide(rGO)and Nafion(NF)(C60-rGO-NF/SPE)to determine the antibiotic metronidazole(MTZ).Under optimized conditions,the C60-rGO-NF/SPE sensor exhibited a linear response in square wave voltammetry for MTZ concentrations from 2.5×10-7 to 34×10-6 mol/L,with a detection limit of 2.1×10-7 mol/L.This sensor was also capable of detecting MTZ in serum and urine,with recovery between 94％and 100％,which are similar to those of the standard chromatographic method(HPLC-UV).Because the C60-rGO-NF/SPE sensor is amenable to mass pro-duction and allows for MTZ determination with simple principles of detection,it fulfills the requirements of therapeutic drug monitoring programs.

Estudo in vitro da ação antimicrobiana de medicações intracanal experimentais sobre biofilmes de Enterococcus faecalis / In vitro study of the antimicrobial action of experimental intracanal medications on Enterococcus faecalis biofilm

Introdução: A eliminação do Enterococcus faecalis dos canais radiculares é fundamental para o sucesso do tratamento endodôntico, uma vez que esses microrganismos são de difícil eliminação, principalmente quando organizados em forma de biofilmes. A busca por drogas ou suas combinações que possam eliminar esses microrganismos é um dos principais objetivos terapêuticos. Objetivo: O presente estudo avaliou a ação antimicrobiana de medicações intracanal experimentais sobre biofilmes de Enterococcus faecalis. Métodos: Quarenta dentes bovinos unirradiculares foram utilizados; suas coroas foram seccionadas e as raízes foram instrumentadas e esterilizadas. As raízes foram contaminadas com suspensão contendo Enterococcus faecalis, mantidas em estufa a 37°C por 30 dias e divididas em quatro grupos, de acordo com a medicação intracanal: GI) medicação experimental 1 (clorexidina [CHX] 0,2%/metronidazol, doxiciclina); GII) medicação experimental 2 (CHX 0,2%/metronidazol, minociclina); GIII) clorexidina a 2% (CHX 2%); e GIV) solução salina. As raízes foram seladas e mantidas em estufa por 7 dias, em tubos contendo TSB. Dentina foi coletada e semeada por 24 h, para formação de UFCs. Os valores obtidos foram comparados pelos testes ANOVA e Tukey (p<0,05). Quando comparados os resultados, não houve diferenças entre os Grupos I, II e III; no entanto, eles foram significativamente diferentes do Grupo IV. Conclusão: As medicações intracanal experimentais exerceram ação antimicrobiana sobre biofilmes de Enterococcus faecalis (AU).

Background: The elimination of Enterococcus faecalis of the root canals is fundamental for endodontic success, since these microorganisms are difficult to killed, especially when organized in biofilms. The search for drugs or their combinations that can eliminate these microorganisms is one of the main therapeutic aim. This study evaluated the antimicrobial action of experimental intracanal medications on Enterococcus faecalis biofilms. Methods: Forty uniradicular bovine teeth were used; their crowns were removed, and the roots were instrumented and sterilized. The roots were contaminated with suspension containing Enterococcus faecalis and kept in an oven at 37°C for 30 days. The roots were divided into 4 groups according to the intracanal medication: I- experimental medication 1 (0.2% CHX/metronidazole/ doxycycline); II- experimental medication 2 (0.2% CHX/ metronidazole/minocycline), III- 2% chlorhexidine (2% CHX), and IV- saline solution. The roots were sealed and kept in tubes containing TSB in an oven for 7 days. Dentin was collected and seeded for 24 h for perform of CFUs. The values obtained were compared using ANOVA and Tukeys tests (p<0.05). When comparing the results, there were no differences among groups I, II and III; however, they were significantly different from group IV. Conclusion: The experimental intracanal medications exerted an antimicrobial action on Enterococcus faecalis biofilms (AU).

Paresia unilateral do terceiro nervo após uso de Metronidazol oral / Unilateral third nerve palsy after use of oral Metronidazole

Resumo Paciente do sexo feminino, 19 anos, com queixa de diplopia, náusea e vômito de início súbito. Ao exame físico, a paciente apresentava rotação da cabeça para a esquerda e limitação da adução do olho direito, sugerindo paresia do músculo reto medial. Ausência de ptose palpebral ou paresia de outra musculatura ocular extrínseca e sem outras alterações na avaliação oftalmológica. Foi relatado pelo paciente o uso de Metronidazol, duas doses de 500 mg, no mesmo dia em que os sintomas começaram. A ressonância magnética do crânio foi solicitada. O resultado mostrou um cisto da glândula pineal, estando os outros aspectos dentro da normalidade. A paresia do músculo reto medial e diplopia persistiram por 14 dias, mesmo após a suspensão do antibiótico, optando, assim, por iniciar a corticoterapia oral, evoluindo com boa resposta clínica, melhora dos sintomas e regressão da paresia muscular.

Abstract Female patient, 19 years old, with a complaint of diplopia, nausea and vomiting of sudden onset. Upon physical examination, the patient presented herself with the head position rotated to the left and limitation of adduction of the right eye, suggesting paresis of the medial rectus muscle. Absence of palpebral ptosis or paresis of other extrinsic musculature of the eye, and without other alterations in the ophthalmological evaluation. It was reported by the patient the use of Metronidazole, two doses of 500 mg, the same day the symptoms started. The magnetic resonance imaging of the skull was requested. The result showed a cyst of the pineal gland, the other aspects being within normality. The paresis of the medial rectus muscle and diplopia persisted for 14 days, even after the antibiotic was discontinued, thus opting to initiate oral corticosteroid therapy, evolving with good clinical response, improvement of symptoms and regression of muscular paresis.