Diagnostic accuracy of thromboelastometry and its correlation with the HPLC-MS/MS quantification test

The aim of the study was to evaluate the diagnostic accuracy of thromboelastometry for assessing rivaroxaban concentrations. The accuracy of thromboelastometry was compared with the high-performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS) method, which is the gold standard for drug plasma monitoring (the reference standard). Forty-six clinically stable patients were treated with 10, 15, or 20 mg of rivaroxaban once daily (OD group) or 15 mg twice a day (BID group) (no particular indication for treatment). Patient samples were collected 2 h after the use of the medication (peak) and 2 h before the next dose (trough). The rivaroxaban plasma concentrations were determined via HPLC-MS/MS, and thromboelastometry was performed using a ROTEM® delta analyzer. There were significant prolongations in clotting time (CT) for the 10, 15, and 20 mg of rivaroxaban treatments in the OD groups. In the 15 mg BID group, the responses at the peak and trough times were similar. At the peak times, there was a positive correlation between the plasma concentration of rivaroxaban and CT (Spearman correlation rho=0.788, P<0.001) and clot formation time (rho=0.784, P<0.001), and a negative correlation for alpha angle (rho=−0.771, P<0.001), amplitude after 5 min (rho=−0.763, P<0.001), and amplitude after 10 min (rho=−0.680, P<0.001). The CT presented higher specificity and sensitivity using the cut-off determined by the receiver characteristics curve. ROTEM has potential as screening tool to measure possible bleeding risk associated with rivaroxaban plasma levels.

Utilização do yacon ( Smallanthus sonchifolius ) na proteção contra colonização intestinal de frangos de corte infectados por Salmonella Enteritidis / Use of yacon (Smallanthus sonchifolius) protect against intestinal colonization of broilers infectes by Salmonella Enteritidis]

Os frutanos do tipo inulina são oligossacarídeos que favorecem a multiplicação de determinados gêneros bacterianos no intestino, promovendo um efeito prebiótico. Este trabalho avaliou o efeito da inulina extraída de raízes de yacon (Smallanthus sonchifolius) sobre a colonização intestinal de frangos de corte experimentalmente infectados por Salmonella Enteritidis. Sessenta frangos de corte com um dia de idade foram divididos em três grupos de tratamento, com duas repetições, criados até 21 dias. As aves do grupo yacon receberam 100mg de inulina/dia, via oral, por três dias consecutivos. No sétimo dia de vida, as aves tratadas e o controle positivo foram desafiados pela via oral com uma cultura de S. Enteritidis. Não foram observadas diferenças de desempenho zootécnico entre os grupos. O índice de infectividade das aves suplementadas com yacon foi menor até o sexto dia após o desafio, mas, ao término do experimento, foi superior ao controle positivo. Os dados deste trabalho demonstram que o uso da inulina nos três primeiros dias de vida promoveu uma redução da colonização intestinal dos frangos por Salmonella Enteritidis na primeira semana após o desafio. Novos estudos são necessários para determinar a dose e o tempo de tratamento ideal para um efeito protetor de maior duração.(AU)

The fructan inulin-type oligosaccharides favor the multiplication of some bacterial genera in the intestine, promoting a prebiotic effect. This study evaluated the effect of inulin extracted from yacon roots (Smallanthus sonchifolius) on intestinal colonization of broilers experimentally infected with Salmonella Enteritidis. Sixty-one day old chicks were grouped into three treatments, with two replicates, and reared until 21 days. Birds in the yacon group received 100mg of inulin/day orally for three consecutive days. On the seventh day of life the treated birds and the positive control were challenged orally with a culture of S. Enteritidis. There were no differences between groups in live performance. The infectivity index of the chicks supplemented with yacon was lower until the sixth day after the challenge, but at the end of the experiment it was higher than the positive control. Data from this study show that the use of inulin during the first 3 days of life caused a reduction of intestinal colonization of chickens by Salmonella Enteritidis in the first week after challenge. Further studies are needed to determine the dose and the ideal time of treatment necessary for a longer protective effect.(AU)

Chromobacterium violaceum infection in Brazil: a case report

We report the second case of infection with Chromobacterium violaceum that occurred in Brazil. A farm worker living in the State of São Paulo presented fever and severe abdominal pain for four days. At hospitalization the patient was in a toxemic state and had a distended and painful abdomen. Chest X-ray and abdominal ultrasound revealed bilateral pneumonia and hypoechoic areas in the liver. The patient developed failure of multiple organs and died a few hours later. Blood culture led to isolation of C. violaceum resistant to ampicillin and cephalosporins and sensitive to chloramphenicol, tetracyclin, aminoglicosydes, and ciprofloxacin. Autopsy revealed pulmonary microabscesses and multiple abscesses in the liver. The major features of this case are generally observed in infections by C. violaceum: rapid clinical course, multiple visceral abscesses, and high mortality. Because of the antimicrobial resistance profile of this Gram-negative bacillus, for appropriate empirical antibiotic therapy it is important to consider chromobacteriosis in the differential diagnosis of severe community infections in Brazil.

Tratamento da mordida cruzada anterior com plano inclinado de acrílico / Anterior cross-bite treated with acrilic inclined plane

Os autores fazem um levantamento sobre a incidência, etiologia, diagnóstico e tratamento da mordida cruzada anterior e, ilustram com a apresentaçäo de caso clínico de um incisivo central em mordida cruzada, tratada com plano inclinado de acrílico

A flebografia pelvica e a laparoscopia no estudo da congestao pelvica cronica. / Pelvic phlebography and laparoscopy in the study of chronic pelvic congestion

A comparacao dos dados clinicos com os quadros flebograficos e laparoscopicos deixou a impressao de que pode haver alteracao de retorno na pelve, traduzida por um esvaziamento lento do contraste de rede venosa visceral, sem que haja ainda aspecto de varizes pelvicas, enquanto, ao contrario, nao verificamos casos com varizes evidentes a flebografia e/ou laparoscopia com tempos de esvaziamento normais. Ja em relacao a correspondencia entre os dados objetivos fornecidos pelos dois metodos de exame e a clinica de dor pelvica cronica, esta correlacao deixa muito a desejar.Comparando os resultados dos dois metodos, a taxa e de positividade foi de 85% para a laparoscopia e de 70% para a flebografia.E importante salientar que, em cinco casos em que a flebografia foi normal, a laparoscopia mostrou sinais de congestao e/ou varizes nas veias viscerais da pelve. Parece-nos, assim, que a laparoscopia apresenta sobre a flebografia pelvica por via endouterina, em nossa experiencia inicial, claras vantagens como metodo de investigacao para o estudo da circulacao de retorno na pelve