Síntesis y uso de histidinato de cobre en niños con enfermedad de Menkes en México / Synthesis and use of copper histidinate in children with Menkes disease in Mexico

Resumen La enfermedad de Menkes es una patología neurodegenerativa y letal debida a mutaciones génicas de la enzima ATP-7A trasportadora de cobre; se manifiesta por síntomas neurológicos y alteraciones del tejido conectivo de severidad variable. El uso subcutáneo oportuno de histidinato de cobre (Cu-His) es determinante en la calidad de vida. Se reportan las primeras experiencias en México en la síntesis y uso seguro de Cu-His en tres casos en los que corroboramos hipocupremia e hipoceruloplasminemia. Bajo asesoramiento del Hospital for Sick Children, Toronto, Canadá, elaboramos una solución de 500 µg/mL. En los tres casos aplicamos 250 µg de Cu-His, sin efectos indeseables relevantes durante 30 días y observamos las siguientes determinaciones séricas de cobre (Cu en µg/L) y ceruloplasmina (Cp en mg/dL): caso 1, Cu días 0 y 30, 8 y 504 µg/L; Cp días 0 y 30, 4 y 10.75 mg/dL; caso 2, Cu días 0 y 30, < 50 y 502, µg/L; Cp días 0 y 30, 2 y 15 mg/dL; caso 3, Cu días 0 y 30, 3 y 84.2 µg/L; Cp días 0 y 30, 4 y 10.7 mg/dL. En México es posible la síntesis segura de Cu-His y tratar la enfermedad de Menkes, la cual debe ser intencionalmente buscada.

Abstract Menkes disease is a neurodegenerative and lethal pathology caused by gene mutations of the copper-transporting ATP-7A enzyme; it manifests itself by neurological symptoms and connective tissue changes of varying severity. Timely subcutaneous use of copper histidinate (Cu-His) is determinant for quality of life. We report the first experiences in Mexico on Cu-His synthesis and its safe use in 3 cases where hypocupremia and hypoceruloplasminemia were corroborated. With advice of the Hospital for Sick Children of Toronto Canada, we prepared a 500 µg/mL solution. In all three cases were 250 µg of Cu-His applied without relevant undesirable effects for 30 days. Serum copper (Cu, expressed in µg/L) and ceruloplasmin (Cp, in mg/dL) were determined: case 1, Cu days 0 and 30, 8 and 504 µg/L; Cp days 0 and 30, 4 and 10.75 mg/dL; case 2, Cu days 0 and 30, <50 and 502 µg/L; Cp days 0 and 30, 2 and 15 mg/dL; case 3, Cu days 0 and 30, 3 and 84.2 µg/L; Cp days 0 and 30, 4 and 10.7 mg/dL. In Mexico, it is possible to safely synthesize Cu-His and treat MD, which must be intentionally sought.

Uso de solução lipídica em intoxicação por beta-bloqueador: relato de caso / Use of lipid solution in beta-blocking severe intoxication: case report

Intoxicações por medicações de uso habitual ou drogas ilícitas tornaram-se um grave problema de saúde pública, com um impacto não apenas na mortalidade, mas com sequelas psicossociais relevantes. As manifestações clínicas dependem das propriedades farmacológicas da droga. Uso de solução lipídica no tratamento de intoxicações graves tem se tornado uma realidade cada vez mais consistente. O objetivo deste trabalho é relatar o caso de uma paciente atendida no HPS João XXIII a partir de coleta de dados em prontuário. C.R.F ,39 anos sexo feminino, encaminhada da Unidade de pronto-atendimento de Ribeirão das Neves devido a ingestão proposital de três cartelas de atenolol, fluoxetina e losartana, onde foi realizado lavagem gástrica, administração de carvão ativado, e reposição volêmica, sem resposta. À admissão, evoluiu com parada cardiorrespiratória durante 10 minutos, sendo iniciadas medidas de ressuscitação, seguida de administração de solução lipídica. Foi encaminhada para unidade de terapia intensiva onde permaneceu por seis dias, seguido de alta para enfermaria e após dez dias de internação alta hospitalar sem qualquer sequela. Os beta-bloqueadores são substâncias bem absorvidas pelo trato gastrointestinal. Os primeiros efeitos tóxicos aparecem 20 a 30 minutos após a ingestão e o efeito máximo ocorre após 4 a 6 horas, podendo chegar a 10 horas em alguns compostos. De 2014 a 2016 foram realizados 92 atendimentos devido a intoxicação por beta-bloqueador (19 presenciais e 73 por telefone) no Serviço de Toxicologia do Hospital João XXIII, sendo metade destes por tentativa de auto-extermínio. Nenhum óbito foi registrado nesse período. (AU)

Intoxications from commonly used medications or illicit drugs have become a serious public health problem, with an impact not only on mortality, but also on psychosocial and morbidity sequelae. The clinical manifestations depend on the pharmacological properties of the drug. Use of lipid solution in the treatment of severe poisoning has become an increasingly consistent reality. The purpose of this paper is to report the case of a patient attended in the HPS John XXIII from data collection in medical records. C.R.F, a 39-year-old female, referred from the Ribeirão das Neves emergency room due to the intentional ingestion of three tablets of atenolol, fluoxetine and losartan, where gastric lavage, activated carbon administration and volumetric replacement were performed without response. Upon admission, he evolved with cardiorespiratory arrest for 10 minutes, and resuscitation measures were initiated, followed by administration of lipid solution. She was referred to an intensive care unit where she remained for six days, followed by discharge to the ward and ten days after hospital discharge without any sequelae. Beta-blockers are well-absorbed substances in the gastrointestinal tract. The first toxic effects appear 20 to 30 minutes after ingestion and the maximum effect occurs after 4 to 6 hours, and can reach 10 hours in some compounds. From 2014 to 2016, 92 consultations were performed due to beta-blocker poisoning (19 presential and 73 by telephone) at the Toxicology Service of the Hospital João XXIII, half of which were for self-extermination. No deaths were recorded during this period. (AU)

Diseño de formulación de sulfato de cinc 10 mg Zn2+/5 mL solución oral para uso pediátrico / Design of formulation of Zinc sulphate 10 mg Zn2+/5 mL oral solution for pediatric use

INTRODUCCIÓN: el sulfato de cinc en forma de solución se administra por vía oral para uso pediátrico, en la profilaxis y tratamiento de estados carenciales de cinc, por escasos aportes o mala absorción, previa determinación de las concentraciones plasmáticas. En niños se emplea como coadyuvante en el tratamiento de bajo peso y talla. OBJETIVO: diseñar una formulación de sulfato de cinc solución oral 10 mg Zn2+/5 mL para uso pediátrico. MÉTODOS: se presentó el estudio en el tiempo de los parámetros químicos, físicos, microbiológicos y toxicológicos de la formulación seleccionada. Se elaboraron tres lotes pilotos y un lote industrial. La estabilidad química en condiciones aceleradas y de estante fue conducida aplicando un método de valoración complejométrica con EDTA desarrollado en el Centro de Investigación y Desarrollo de Medicamentos (CIDEM). RESULTADOS: se obtuvo una formulación líquida incolora y traslúcida libre de partículas extrañas, con sabor dulce. En el ensayo de tolerancia por vía oral en ratas, no se observó toxicidad significativa atribuible a la administración de la formulación a la dosis estudiada. El resto de los parámetros evaluados en el estudio de estabilidad químico-físico de vida de estante mostraron resultados satisfactorios. CONCLUSIONES: la solución resultó ser estable química, física y microbiológicamente, almacenada a temperatura de 32 ± 2 ºC en frascos de vidrio ámbar durante un período de 24 meses. Al comparar los resultados del lote industrial con los lotes pilotos se observa que son similares, lo que demuestra que la tecnología desarrollada es factible de escalar a nivel industrial(AU)

INTRODUCTION: the zinc sulphate solution is orally administered for pediatric purposes, in prophylaxis and treatment of zinc deficiency resulting from inadequate diet or malabsorption. It is also used in children to manage low weight and height. OBJECTIVE: design of a formulation of oral zinc sulphate solution at 10 mg Zn2+/5 mL for pediatric use. METHODS: results of the physical-chemical stability studies, microbiology evaluation and toxicological test were shown for selected formulation. Three pilot scale-up batches and one industrial batch were prepared. The chemical stability under accelerated conditions and shelf-life studies were conducted on the basis of a compleximetric titration with EDTA method developed in the Center of Research and Development of Drugs (CIDEM). RESULTS: a colorless, translucent and sweet liquid formulation, free of foreign matters, was obtained. In the orally administered tolerance test made in rats, no signs of significant toxicity attributable to the administration of the formulation at the study dose were observed. The other parameters evaluated in the physical-chemical stability of the shelf life study proved to be satisfactory. CONCLUSIONS: the solution was chemically, physically and microbiologically stable at a temperature of 32 ± 2 ºC for a 24 month period. When comparing the results of the pilot scale-up batch and those of the industrial batch, they were similar. This showed that the developed technology is feasible at industrial scale(AU)

Effect of artificial cerebrospinal fluid lavage time on the edema of traumatic brain injury / 中南大学学报(医学版)

OBJECTIVE@#To detect the impact of artificial cerebrospinal fluid lavage time on the edema of traumatic brain injury.@*METHODS@#A total of 240 SD rats were randomly divided into a sham group, a traumatic brain injury model group, 3 artificial cerebrospinal fluid lavage groups (3 h, 6 h and 9 h). Each group was divided into 4 sub-groups by time of sacrifice namely 12 h, 1 d, 3 d and 7 d postoperatively. We detected the content of brain water, sodium, and potassium, and the VEGF expression to confirm whether the duration of lavage could reduce the traumatic brain edema.@*RESULTS@#Compared with the sham group and the traumatic brain injury model group, brain water content and sodium content were decreased, while the potassium content and the VEGF levels were increased in the artificial cerebrospinal fluid lavage groups. Significant difference was found at 12 h, 1 d, and 3 d after the injury (P<0.05). With the increase of artificial cerebrospinal fluid lavage time, the difference was more obvious.@*CONCLUSION@#Artificial cerebrospinal fluid lavage can reduce the brain edema after traumatic brain injury. The longer the lavage, the more obvious the effect.

An assessor-blind, randomized controlled trial on the efficacy and safety of apple cider vinegar vs. salicylic-lactic acid solution in the treatment of common warts (verruca vulgaris)

BACKGROUND: Common warts are among the top causes of dermatologic consultations. Apple cider vinegar is an old time home remedy for various ailments including common warts.Objectives: To compare the safety and efficacy of apple cider vinegar with salicylic-lactic acid solution in the treatment of common warts.METHODS: Twenty-seven patients clinically diagnosed with a total of 88 common warts were assigned randomly for topical application of either apple cider vinegar or salicylic-lactic acid solution which were applied and occluded for 3 consecutive days. Clinical evaluation and curettage were conducted on day 3 and every 3 days thereafter until complete resolution of the lesion for a maximum of 4 weeks. The primary outcome measured in this study was complete clinical cure of the treated wart. One week post-treatment evaluation assessment was also graded as clinical cure, clinical improvement, clinical failure and side effect failure. Adverse events were monitored.RESULTS: In the ACV group, 33 out of 44 (75%) common warts were completely cleared while in the salicylic-lactic acid (SA/LA) group, 26 common warts were completely cleared (59%). There was no significant difference in the cure rates between the two groups (p=0.112, chi-square test). There was no significant difference in the mean time to cure between the two groups, 11 days and 12 days in the apple cider vinegar and salicylic-lactic acid groups, respectively (p=0.090; log rank test). There was no significant difference in the incidence of adverse reactions between the two groups (p=0.676; Fisher's exact test).CONCLUSION: Apple cider vinegar is a safe and effective topical treatment that was comparable to salicylic-lactic acid solution in the treatment of common warts.

Simultaneous determination of six ingredients in Huoxiang Zhengqi oral liquid by UPLC / 中国中药杂志

<p><b>OBJECTIVE</b>To develop a UPLC method for the simultaneous determination of liquiritin, narirutin, hesperidin, ammonium glycyrrhetate, honokiol and magnolol in Huoxiang Zhengqi oral liquid.</p><p><b>METHOD</b>A Zorbax Eclipse C18 column was used with the mobile phase of acetonitrile and 0. 05% phosphate acid by gradient elution at the detection wavelength of 220 nm. The flow rate was 0.42 mL x min(-1) and the column temperature was 30 degrees C.</p><p><b>RESULT</b>The calibration curves were linear in the ranges of 0.001 7-0.034, 0.003 4-0.068, 0.006 4-0.128, 0.012 8-0.256, 0.003 2-0.064, 0.006 4-0.128 microg, respectively. The average recoveries were 103.3%, 98.39%, 98.29%, 102.1%, 98.45%, 102.2% with RSDs of 2.1%,1.0%, 0.50%, 2.3%, 0.9%, 2.0%, respectively.</p><p><b>CONCLUSION</b>The UPLC method was simple, rapid and accurate, it could be used for quality control of Huoxiang Zhengqi oral liquid.</p>

Estudio comparativo de estabilidad de tres formulaciones magistrales de Sildenafil bajo la forma de solución, obtenidas a partir de diferentes productos comerciales / Comparative study stability of the three master formulation of Sildenafil solution obtained from differents trademarks

El Sildenafil es un fármaco de comprobada actividad terapéutica en la disfunción eréctil; se encuentra disponible bajo la forma farmacéutica de tabletas de administración oral. En la actualidad se está formulando magistralmente en forma de so lución oral a una concentración de 1mg/ml, para la hipertensión pulmonar (HP), por lo que se ha planteado realizar un estudio de la estabilidad en tres condiciones: ambientales (25±-2 ºC), de refrigeración (5±3 ºC) y exageradas de almacenamiento (40 ºC ± 2 ºC). Los parámetros evaluados fueron apariencia, limpidez, densidad, pH y contenido de sildenafil. El método analítico empleado fue cromatografía líquida de alta resolución (HPLC) de fase reversa. La apariencia, los valores de pH y densidad de las soluciones obtenidas se mostraron sin cambios significativos, en las diferentes muestras y condiciones de estudio. En cuanto a los resultados del contenido inicial de sildenafil se obtuvo aproximadamente el 75% en peso al formular la solución, partiendo del comprimido. Cabe señalar que se observó discrepancia en los valores de concentración del sildenafil obtenidos en los diferentes tiempos y condiciones; resultados éstos de esperarse por tratarse de una formulación magistral que parte de comprimidos de diferentes casas comerciales, por lo que este estudio permitió sugerir que la formulación magistral se reformule a la forma farmacéutica de suspensión, para garantizar el contenido de todo el principio activo en la misma.

Sildenafil is a drug with proven therapeutic activity in erectile dysfunction is available under the pharmaceutical form of tablets for oral administration. It is currently being de veloped skillfully in an oral solution at a concentration of 1mg/ml, for pulmonary hypertension (pH), as has been planned to perform a study of stability in three conditions: environmental (25 ± 2 ºC), refrigeration (5 ± 3 ºC) and exaggerated storage (40 °C ± 2 ºC). The parameters evaluated were appearance, clarity, density, pH and content of sildenafil. The analytical method used was high performance liquid chromatography (HPLC) reverse phase. The appearance, pH and density of the solutions were no significant changes in the different samples and study conditions. As for the results of the initial content of sildenafil was obtained about 75% by weight in for mulating the solution, based on the tablet. It should be noted that there was discrepancy in the values of concentration of sildenafil obtained at different times and conditions, results they expected because it is a masterly formulation of tablets of different business houses, so this study suggest that the wording allowed masterful be reformulated to the pharmaceutical form of suspension, to ensure the contents of the entire active.

Fingerprint research and multi-component quantitative analysis of Kumu injection by HPLC / 中国中药杂志

<p><b>OBJECTIVE</b>To establish the HPLC chromatographic fingerprint of Kumu injection and to simultaneously determine the contents of three beta-carboline alkaloids, comprehensively evaluating the immanent quality of Kumu injection.</p><p><b>METHOD</b>The chromatographic analysis was performed on a Phenomenex Gemini C18 ( 4.6 mm x 250 mm, 5 microm) column with the gradient elution solvent system composed of methanol and 30 mmol x L(-1) aqueous ammonium acetate (adjusted with glacial acetic acid to pH 4.5). Similarity evaluation system for chromatographic fingerprint of traditional Chinese medicine (2004 A) was used in data analysis.</p><p><b>RESULT</b>Sixteen co-possessing peaks were selected as the fingerprints of Kumu injection, and 7 peaks were identified by chemical reference substances. There were good similarities between the standard fingerprint chromatogram and each fingerprint chromatogram from the eleven samples for their similarity coefficients were not less than 0.9. Three kinds of beta-carboline alkaloids were separated well. The correlation coefficients were 0.999 9. The linear ranges of three components were 0.020 0-0.300 0, 0.102 0-1.530 0, 0.015 2-0. 228 0 microg, respectively, and the average recoveries ranged were from 99.5% to 102%.</p><p><b>CONCLUSION</b>The method of fingerprint combined with quantitative analysis is sensitive, selective, and provide scientific basis for quality control of Kumu Injection.</p>

Simultaneous quantification of five impurities in puerarin and its injections by HPLC method with correction factor / 中国中药杂志

<p><b>OBJECTIVE</b>To establish a HPLC method with the relative correction factors (RCFs) for quantification of five critical related substances (A, B, C, D and E) in puerarin and its injection.</p><p><b>METHOD</b>Taking puerarin as the internal standard, corresponding RCFs of the critical related substances were determined respectively. According to their RCFs, simultaneous determination of five related substances in puerarin and its injection was performed. The method was evaluated by comparison the quantitative results of external standard method and the method with RCFs correction.</p><p><b>RESULT</b>There were no significant differences in the results of five critical related substances in 38 batches of puerarin and its injection by external standard method and the method with RCFs correction.</p><p><b>CONCLUSION</b>The HPLC method with RCFs was validated to be accurate and can be successfully applied to determine the critical related substances in puerarin and its injection.</p>

Electrochemical biosensors in pharmaceutical analysis / Biossensores eletroquímicos em análise farmacêutica

Given the increasing demand for practical and low-cost analytical techniques, biosensors have attracted attention for use in the quality analysis of drugs, medicines, and other analytes of interest in the pharmaceutical area. Biosensors allow quantification not only of the active component in pharmaceutical formulations, but also the analysis of degradation products and metabolites in biological fluids. Thus, this article presents a brief review of biosensor use in pharmaceutical analysis, focusing on enzymatic electrochemical sensors.

Em virtude do aumento da demanda por técnicas analíticas simples e de baixo custo, os biossensores têm atraído a atenção para a análise de fármacos, medicamentos e outros analitos de interesse em controle de qualidade de medicamentos. Os biossensores permitem a quantificação não somente de princípio ativo em formulações farmacêuticas, mas também de produtos de degradação e metabólitos em fluídos biológicos, bem como análise de amostras de interesse clínico e industrial, além de possibilitar a determinação de enantiômeros. Desta forma, este artigo objetiva fazer uma breve revisão a respeito do emprego de biossensores em análise farmacêutica, com ênfase em sensores eletroquímicos enzimáticos.

Viabilidade in vitro de células espermáticas ovinas submetidas a diferentes diluentes e a refrigeração / In vitro viability of ovine sperm cells submitted to different diluents and refrigeration

Avaliou-se a viabilidade in vitro de células espermáticas após a adição de três diluentes comerciais, que foram comparados com o diluente tradicional Tris-gema, utilizados no processo de refrigeração do sêmen ovino, em até 48h de armazenamento. Foram utilizados nove ejaculados diários, obtidos de três reprodutores Dorper, com vagina artificial, em três repetições com intervalo de três dias. O sêmen foi mantido a 30ºC, e foram avaliadas suas características macro e microscópicas. Após formação do pool, repetiram-se as avaliações acrescidas da concentração espermática e da integridade do DNA e do acrossoma. Dividiu-se o pool em cinco tratamento, cada um constituído de uma parte de sêmen para três partes dos respectivos diluentes: Equimix (DI), Laiciphos Green Ovine (DII), FR 4 (DIII), Equimix-Gema- Equimix com gema de ovo (DIV) e Tris-Gema (DV). O material obtido em cada tratamento foi subdividido em quadruplicata, refrigerado e mantido a 4ºC até as avaliações da motilidade individual progressiva (MIP), do vigor e da integridade do DNA e do acrossoma, correspondendo a zero, 12, 24, 36 e 48h. Nas avaliações do sêmen, com o DI ocorreu a maior queda de MIP às 12h em relação aos demais grupos (P<0,05). Às 24h, os tratamentos DII, DIV e DV apresentaram a melhor MIP (P<0,05), que não divergiram (P>0,05) entre si; às 48h, o DII e o DV foram melhores (P<0,05) que os demais. Com relação ao vigor, os tratamentos DII e DV apresentaram valores mais elevados (P<0,05) em relação ao DI e DIII, a partir das 12h, e ao DIV, a partir das 24h (P<0,05). Concluiu-se que o diluente Laiciphos Green Ovine, da mesma forma que o Tris-gema, pode ser utilizado na conservação do sêmen a 4ºC por 48h, enquanto o Equimix, acrescido de 20 por cento de gema de ovo, pode ser seja utilizado no armazenamento do sêmen (4ºC) por até 24h.

The in vitro viability of sperm cells following the addition of three commercial diluents was evaluated and compared with the traditional Tris-yolk diluent for the refrigeration of ovine sperm up to 48h of storage. Nine daily ejaculates were obtained from three Dorper breeders using an artificial vagina; three repetitions were performed in a three-day interval. The semen was kept at 30ºC and macro and microscopic characteristics were evaluated. The samples were pooled and the evaluations were repeated, along with assessments of sperm concentration, DNA integrity, and acrosome integrity. The pool was distributed into five treatments, each with one part of semen to three parts of the following diluents: Equimix (DI), Laiciphos Green Ovine (DII), FR 4 (DIII), Equimix-Yolk-Equimix with egg yolk (DIV), and Tris-Yolk (DV). The material of each treatment was aliquoted in quadruplicate, refrigerated, and maintained at 4ºC until the evaluations of the individual progressive motility (IPM), vigor, DNA integrity, and acrosome integrity, corresponding to 0, 12, 24, 36, and 48h. The highest decrease of IPM occurred with DI (at 12h) in comparison to the other diluent groups (P<0.05). At 24h, DII, DIV and DV had the best IPM (P<0.05) and did not diverge from one another (P>0.05). At 48h, DII and DV had the highest values (P<0.05). Regarding vigor, DII and DV had higher values (P<0.05) than DI and DIII at 12h and higher values than DIV at 24h (P<0.05). From the results, like Tris-Yolk, and Laiciphos Green Ovine can be used for the conservation of semen at 4ºC for 48h, whereas Equimix plus 20 percent egg yolk may be used for the storage of semen at 4ºC for up to 24h.

Validação de método de doseamento e aplicação em estudo de equivalência farmacêutica de solução injetável de metronidazol / Validation of metronidazole assay methods and application to study of pharmaceutical equivalence of injectable solutions of this drug

O presente trabalho tem por objetivos validar métodos por espectrofotometria de absorção no ultravioleta e cromatografia líquida de alta eficiência para o doseamento de metronidazol em solução injetável e aplicá-los em estudo de equivalência farmacêutica entre medicamento de referência, genérico e similar. Os métodos propostos para doseamento de metronidazol em solução injetável por espectrofotometria de absorção no ultravioleta e por cromatografia líquida de alta eficiência foram validados, mostrando especificidade / seletividade, linearidade e faixa linear, limite de detecção /quantificação, exatidão e precisão adequados para o uso pretendido. Os medicamentos foram avaliados quanto aos testes de determinação de pH, volume médio, identificação por espectrofotometria de absorção no infravermelho, identificação por cromatografia líquida de alta eficiência, esterilidade, endotoxinas bacterianas e doseamento por espectrofotometria de absorção no ultravioleta e por cromatografia líquida de alta eficiência. Os três medicamentos atenderam as especificações para os testes avaliados e, portanto, podem ser considerados apresentando equivalência farmacêutica.

The aim of this study was to validate analytical methods, based on UV absorption spectrophotometry and high performance liquid chromatography (HPLC), to assay metronidazole supplied in injectable solutions, and to employ these methods in a study of the pharmaceutical equivalence of the original brand name medicine (?reference?), generic and similar (brand) medicines. The methods proposed for the metronidazole assay were validated, showing adequate specificity/selectivity, linearity, linear range, detection and quantitation limits, accuracy and precision for the intended purpose. The injectable solutions were then tested to determine pH, volume and identity (by IR spectrophotometry), to verify sterility, detect bacterial endotoxins and assay the drug by the proposed UV spectrophotometric and HPLC methods. All three medicines met the requirements in all tests performed and, therefore, can be considered pharmaceutically equivalent.

Diarrhea in a family in a barangay community of Catarman, Samar

Treating the health problems of the community will treat those of the family. Juan de la Cruz and his son can be made well after proper treatment of their diarrhea, but adequate, proper and continuing management of the environmental problems of Barangay Jose Abad Santos (JAS), related to the development of disease, would be the more lasting solution to this important and common community health problem.

Anestesia espinal en dosis bajas para litotripsia extracorpórea (LEC): comparación de dos dosis de levobupivacaína hipobárica / Spinal anesthesia for extracorporeal shockwave lithotripsy: comparison between two doses of hypobaric levobupivacaine

Introducción: Se han descrito diversas técnicas anestésicas para la Litotripsia Extracorpórea (LEC), procedimiento frecuentemente realizado en forma ambulatoria. El presente estudio compara la calidad de la analgesia, complicaciones y satisfacción usuaria entre dos modalidades de anestesia espinal con Levobupivacaína hipobárica en bajas dosis. Métodos: Estudio de cohorte prospectivo secuencial, con pacientes electivos sometidos a LEC unilateral bajo anestesia espinal, asignados en forma secuencial a uno de los siguientes grupos: levobupivacaína 4,5 mg + 20 ug de fentanyl, volumen total 2,5 ml con agua destilada, concentración 0,18 por ciento (Grupo 1), y levobupivacaína 2,5 mg + 20 ug de fentanyl, volumen total 2,5ml con agua destilada, concentración 0,1 por ciento (Grupo 2). Se evaluó el nivel sensitivo (tórula bañada en alcohol),bloqueo motor (escala de Bromage), alteraciones hemodinámicas (bradicardia o hipotensión), tiempo hasta la primera micción y necesidad de suplemento analgésico durante el procedimiento. Además, se evaluó el grado de confort y si repetirían la técnica anestésica. Resultados: 159 pacientes fueron sometidos a LEC entre junio de 2005 y agosto de 2007, aleatoriamente asignados: 82 al Grupo 1 y 77 al Grupo 2. El nivel sensitivo fue más alto en el Grupo 1 con un 67 por ciento de los pacientes en el nivel T4 respecto al grupo 2 con un3,9 por ciento (p < 0,001). Además, el Grupo 2 presentó un nivel sensitivo más bajo con un 88,3 por ceinto de los pacientes en el nivel T5, en comparación al Grupo 1 con 37,7 por ciento (p < 0.001). El Grupo 1 tuvo mayor incidencia de bloqueo motor, con una escala de Bromage = 1 en 20,7 por ciento de los pacientes, respecto a 3,9 por ciento en el grupo 2(p = 0,001). El Grupo 2 presenta un menor bloqueo motor con Bromage = 0 en el 96,1 por ciento de los pacientes, comparado al Grupo 1 con 74,4 por ciento (p = 0,001). Respecto a las complicaciones hemodinámicas, 11 de los pacientes del Grupo 1...

Several anesthesia techniques have been described for extracorporeal shockwave lithotripsy (ESWL).It is often performed as an ambulatory procedure. The aim of this study is to compare quality of analgesia, complications and patient’s satisfaction with two regional (spinal) anesthesia techniques with small doses of hypobaric Levobupivacaine. Methods: This is a sequential and prospective study in elective patients undergoing unilateral ESWL under spinal anesthesia. Patients were sequentially allocated to one of two groups: levobupivacaine 4,5 mg + 20 ug of fentanyl, total volume of 2,5 ml with distilled water,concentration 0,18 percent (Group 1), and levobupivacaine 2,5 mg + 20 ug of fentanyl, total volume of 2,5ml, concentration 0,1 percent (Group 2). We evaluated sensitive level (alcohol swab), motor block (Bromagescale), hemodynamic alterations (bradycardia and hypotension) and time until fi rst voiding and the need for further analgesic doses. Patient’s comfort and satisfaction with the technique for a new procedure was also recorded. Results: 159 patients underwent an ESWL between June 2005 and august 2007, and randomized to: Group 1, 82 and Group 2, 77. The sensitive level was higher in Group 1 with 67 percent of patients at T4 respect to Group 2, 3.9 percent (p < 0.001). Group 2 had a lower sensitive level with 88.3 percent of the patients at T5(< 0.001). Group 1 had a higher incidence of motor block: Bromage scale 1 in 20,7 percent of patients respect to3,9 percent in Group 2. Group 2 had lower motor block: Bromage scale 0 in 96,1 percent of patients compared to Group1, 74,4 percent (p = 0,001). With respect to the hemodynamic complications, 11 of the patients in Group 1 (13,4 percent)presented bradycardia, compared to 2 patients in Group 2 (2,5 percent) (p = 0,005). 6 patients in Group 1(7,3 percent)showed hypotension, 2 of those required ephedrine (10 mg). No patients in Group 2 presented hypotension (p = 0,014). There was no difference...

Morphology and function of platelets stored in modified platelet additive solution at low temperature / 中国实验血液学杂志

The aim of study was to evaluate the function of modified platelet additive solution (PAS-IIIM) with trehalose as a substitute of plasma for the storage of platelet concentrates at low temperature (10 degrees C). Apheresis platelets from 6 donors were divided and added with different media (group A: 100% plasma; group B: 70% PAS-IIIM/30% plasma; group C: 100% plasma/trehalose). Groups A, B, C were stored at 10 degrees C, 22 degrees C and -85 degrees C separately. In addition, group D (platelet concentrates stored with 100% plasma at 4 degrees C) was set up as control group for scan electronmicroscopy. The samples of each platelets were collected on day 0, 1, 5, 7 and 9 after storage respectively, while samples of platelets stored at -85 degrees C (group C) were collected on day 20 after storage. CD62p, hypotonic shock response (HSR), platelet aggregation, lactic dehydrogenase (LDH) and morphology of platelets were evaluated. The results showed that the expressions of CD62p in groups A and B increased in a time-dependent manner, but HSR and platelet aggregations decreased. The expression of CD62p, LDH release, and platelet aggregation in group A were significant higher than that in group B (p < 0.05). HSR in group A was significant lower than that in group B (p < 0.05). LDH release was significant high in samples of group C and the expression of CD62p was lower than that in other two groups (p < 0.05). It is concluded that the protective effects of 70% PAS-IIIM/30% plasma (10 degrees C) and plasma platelets (22 degrees C) on morphology of platelets are similar, but better than those of plasma platelets (4 degrees C) and plasma/trehalose (-85 degrees C). In short, PAS-IIIM serves as a good substitute of plasma for platelet storage, and protects the chilled platelets.

Insulina intravenosa: controvérias sobre o processo de adsorção nos dispositivos de infusão / Intravenous insulin: controversy on the adsorption process of infusion kits

A adsorção de insulina é um fenômeno de superfície inespecífico que interfere na demanda de insulina ao paciente.Esta revisão bibliográfica objetivou identificar os agentes causais da adsorção de insulina em soluções intravenosase verificar as estratégias utilizadas para reduzir a adsorção. Utilizaram-se artigos selecionados nas bases dedados Medical Literature and Retrieval System On Line (MEDLINE), Literatura Latino-Americano e do Caribe emCiências da Saúde (LILACS), Cumulative Index to Nursing & Allied Health Literature (CINAHL) e no portal daCoordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) publicados entre 1960-2005. Os frascosde polipropileno e os equipos sem filtro apresentaram menor adsorção; o processo de adsorção foi máximo nainfusão dos primeiros 100 ml da solução. A pré-exposição do equipo com 50-100 ml da solução por um período de30-60 minutos, o uso de frascos de superfície interna menor e equipos curtos foram estratégias utilizadas paraminimizar a adsorção da insulina.

A modified CZ-1 preserving solution for organ transplantation: comparative study with UW preserving solution / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The University of Wisconsin colloid based preserving solution (UW solution) is the most efficient preserving solution for multiorgan transplantation. Unfortunately, unavailability of delayed organ preserving solutions hindered further progression of cardinal organ transplantation in China. In this study, we validated an organ preserving Changzheng Organ Preserving Solution (CZ-1 solution) and compared it with UW solution.</p><p><b>METHODS</b>A series of studies were conducted on how and how long CZ-1 solution could preserve the kidneys, livers, hearts, lungs and pancreas of New Zealand rabbits and SD rats. Morphology of transplanted organs was studied by visible microscopy and electron microscopy; biochemical and physiological functions and the survival rate of the organs during prolonged cold storage were studied.</p><p><b>RESULTS</b>There was no significant difference between CZ-1 and UW solutions in preserving the kidneys, livers, hearts or lungs of rabbits; kidneys, livers, intestinal mucosa or pancreases of SD rats or five deceased donors' testicles. In some aspects, such as preserving rabbits' hearts, rats' intestinal mucosa and pancreases, the effect of CZ-1 solution was superior to UW solution. CZ-1 could safely preserve kidneys for 72 hours, livers for 24 hours, hearts for 18 hours and lungs for 8 hours for SD rats. Twelve kidneys preserved in cold CZ-1 solution for 22 - 31 hours were transplanted successfully and the mean renal function recovery time was (3.83 +/- 1.68) days.</p><p><b>CONCLUSIONS</b>CZ-1 solution is as effective as UW solution for organ preservation. The development of CZ-1 solution not only reduces costs and improves preservation of organs, but also promotes future development of organ transplantation in China.</p>

Experiencia clínica: análisis cuantitativo del cambio de videotricograma en pacientes chilenas con alopecia androgenética en respuesta a la utilización de una formulación a base de aminexil SP94® / Effect of a formulation using Aminexil SP94® in 48 chilean patients with androgenetic alopecia

Durante un período de 12 semanas se realizó un estudio clínico abierto, de tipo prospectivo, con el fin de evaluar la acción de una formulación a base de Aminexil SP94® en 48 pacientes con alopecia androgenética, diagnosticada clínicamente. Fue posible evaluar los efectos de la formulación sobre la fase anágena y telógena mediante la realización de videotricogramas, y conjuntamente se analizaron los efectos de la formulación sobre densidad capilar, sebumetría y presencia de halo-pericapilar. Se observó una mejoría significativa en cada uno de los parámetros medidos. Los efectos adversos se limitaron a la aparición de ardor en sólo un 4 por ciento de las pacientes, lo cual no derivó en la suspensión del tratamiento ni la eliminación del estudio. Se confirma la eficacia y seguridad de la formulación en el tratamiento de alopecia androgenética.

During twelve weeks, an open and prospective clinical study was performed in order to analyze the effect of a formulation using Aminexil SP94® in 48 patients with clinically diagnosed androgenetic alopecia. We evaluated effects during the telogen and anagen phase with video trichogram, and hair density, sebumetry and pericapillary halo were measured as well. There was a significant improvement in each of the parameters studied. Adverse effects were limited to mild itching in 4 percent of the patients. The efficacy and safety of the formulation in the treatment of androgenetic alopecia was confirmed.

Patterns of prescription and drug dispensing.

OBJECTIVE: To analyze the patterns of prescriptions and drug dispensing using World Health Organization core drug use indicators and some additional indices. METHODS: Data were collected prospectively by scrutinizing the prescriptions written by pediatric resident doctors and by interviewing parents of 500 outpatient children. RESULTS: The average number of drugs per encounter was 2.9 and 73.4% drugs were prescribed by generic name. Majority of drugs prescribed were in the form of syrups (60.8%). Use of antibiotics (39.6% of encounters) was frequent, but injection use (0.2% of encounters) was very low. A high number of drugs prescribed (90.3%) conformed to a model list of essential drugs and were dispensed (76.9%) by the hospital pharmacy. Certain drugs (5.7%) prescribed as syrups were not dispensed, although they were available in tablet form. Most parents (80.8%) knew the correct dosages, but only 18.5% of drugs were adequately labeled. No copy of an essential drugs list was available. The availability of key drugs was 85%. CONCLUSION: Interventions to rectify over prescription of antibiotics and syrup formulations, inadequate labeling of drugs and lack of access to an essential drugs list are necessary to further improve rational drug use in our facility.

Affection of different preparations on the content of toxic constituents in traditional Chinese medicines, examplified with Caulis Aristolochiae Manshuriensis / 中国中药杂志

<p><b>OBJECTIVE</b>Taking Caulis Aristolochiae Manshuriensis (Guanmutong in Chinese, derived from the stem of Aristolochia manshuriensis) as an example, to study the affection of different preparations on the content of toxic constituents in traditional Chinese medicines.</p><p><b>METHOD</b>The separation was performed on a zorbax SB-C18 column with mobile phase of acetonitrile-3.7 mmol x L(-1) phosphoric acid buffer, detected at 260 nm.</p><p><b>RESULT</b>The extraction percentage of aristolochic acids I, II and IV a in water extraction (1 h x 2) of Guanmutong were 53.4%, 75.5% and 61.9%, respectively; the remaining quantity of aristolochic acids I, II and IVa in the dregs of the decoction were 22.3%, 15.7% and 30.3%, respectively; Aristolochic acid I was still main substance among these aristolohic acids in the decoction of Guanmutong.</p><p><b>CONCLUSION</b>The content of toxic constituents of the traditional Chinese medicines varies evidently with different preparations of Guanmutong. So the preparation methods of traditional Chinese medicines should be suitably selected according to characteristics of the toxic constituents so as to lessen the body damages of human.</p>