Revisión con agujas y uso de bevacizumab en bulas de filtración encapsuladas / Needle revision and the use of bevacizumab in encapsulated filtration blebs

Objetivo: determinar la efectividad a mediano plazo de la revisión con aguja asociada a bevacizumab (avastin) en ampollas de filtración encapsuladas postrabeculectomía. Métodos: se realizó un estudio observacional descriptivo-prospectivo, de serie de casos (14 ojos, 14 pacientes), con antecedentes de quiste de Tenon a corto plazo postrabeculectomía (2 meses - 1 año). Se realizó revisión con aguja asociada a inyección subconjuntival de avastin (1 mg) hasta completar 3 dosis en días alternos. Se evaluaron la presión intraocular y el uso de colirios hipotensores preoperatorio y posoperatorio a la semana, 1 mes, 3 meses y 1 año. Se definió el éxito total (si en el posoperatorio la PIO era menor o igual a 21 mmHg sin necesidad de colirios hipotensores); parcial (si la PIO era menor o igual a 21 mmHg con el uso de hasta dos fármacos); y sin éxito (si la PIO era menor o igual a 21 mmHg con 3 colirios hipotensores o mayor que 21 mmHg). Se registraron las complicaciones quirúrgicas. Resultados: la edad media fue de 59,3 ± 8,4 (43-75). Predominó el sexo femenino (57 por ciento) y no existieron diferencias en cuanto al color de piel (7/7). El grado de reducción de la PIO fue regular a la semana y al mes, y malo a los 3 meses y al año, lo que requirió una nueva cirugía en 11 casos (78,6 por ciento). Las complicaciones más frecuentes fueron: hemorragia subconjuntival (71,4 por ciento de casos) y Seidel positivo (21,4 por ciento). Conclusiones: la revisión con aguja asociada al uso de avastin subconjuntival como tratamiento de la ampolla encapsulada no logra una reducción significativa de la presión intraocular(AU)

Objective: determine the medium-term effectiveness of needle revision with bevacizumab (avastin) in encapsulated filtration blebs after trabeculectomy. Methods: an observational descriptive prospective case-series study was conducted of 14 eyes of 14 patients with a history of Tenon cyst shortly (2 months - 1 year) after trabeculectomy. Needle revision was performed by avastin subconjunctival injection (1 mg) until completing 3 doses on alternate days. Evaluation of intraocular pressure and the use of hypotensive collyriums before and after surgery was conducted at 1 week, 1 month, 3 months and 1 year. Definitions were made of total success (IOP minor or equal 21 mmHg in the postoperative period without hypotensive collyriums), partial success (IOP minor or equal 21 mmHg with up to two drugs), and no success (IOP minor or equal 21 mmHg with 3 hypotensive collyriums or greater than 21 mmHg). Surgical complications were recorded. Results: mean age was 59.3 ± 8.4 (43-75) years. Female sex prevailed (57 percent) and no differences were found based on skin color (7/7). The degree of IOP reduction was fair at one week and one month, and bad at 3 months and one year, 11 cases (78.6 percent) requiring new surgery. The most common complications were subconjunctival hemorrhage (71.4 percent of the cases) and positive Seidel (21.4 percent). Conclusions: needle revision with subconjunctival avastin to treat encapsulated blebs does not achieve a significant reduction in intraocular pressure(AU)

Contractile profile of esophageal and gastric fundus strips in experimental doxorubicin-induced esophageal atresia

Esophageal atresia (EA) is characterized by esophageal and gastric motility changes secondary to developmental and postsurgical damage. This study evaluated the in vitro contractile profile of the distal esophagus and gastric fundus in an experimental model of EA induced by doxorubicin (DOXO). Wistar pregnant rats received DOXO 2.2 mg/kg on the 8th and 9th gestational days. On day 21.5, fetuses were collected, sacrificed, and divided into groups: control, DOXO without EA (DOXO-EA), and DOXO with EA (DOXO+EA). Strips from the distal esophagus and gastric fundus were mounted on a wire myograph and isolated organ-bath system, respectively, and subjected to increasing concentrations of carbamylcholine chloride (carbachol, CCh). The isolated esophagus was also stimulated with increasing concentrations of KCl. In esophagus, the concentration-effect curves were reduced in response to CCh in the DOXO+EA and DOXO-EA groups compared to the control group (P<0.05). The maximum effect values (Emax) for DOXO+EA and DOXO-EA were significantly lower than control (P<0.05), but the half-maximal effective concentration (EC50) values were not significantly different when the three groups were compared (P>0.05). In response to KCl, the distal esophagus samples in the three groups were not statistically different with regard to Emax or EC50 values (P>0.05). No significant difference was noted for EC50 or Emax values in fundic strips stimulated with CCh (P>0.05). In conclusion, exposure of dams to DOXO during gestation inhibited the contractile behavior of esophageal strips from offspring in response to CCh but not KCl, regardless of EA induction. The gastric fundus of DOXO-exposed offspring did not have altered contractile responsiveness to cholinergic stimulation.

Comparative pathogenicity of Coxsackievirus A16 circulating and noncirculating strains in vitro and in a neonatal mouse model

An enterovirus 71 (EV71) vaccine for the prevention of hand, foot, and mouth disease (HMFD) is available, but it is not known whether the EV71 vaccine cross-protects against Coxsackievirus (CV) infection. Furthermore, although an inactivated circulating CVA16 Changchun 024 (CC024) strain vaccine candidate is effective in newborn mice, the CC024 strain causes severe lesions in muscle and lung tissues. Therefore, an effective CV vaccine with improved pathogenic safety is needed. The aim of this study was to evaluate the in vivo safety and in vitro replication capability of a noncirculating CVA16 SHZH05 strain. The replication capacity of circulating CVA16 strains CC024, CC045, CC090 and CC163 and the noncirculating SHZH05 strain was evaluated by cytopathic effect in different cell lines. The replication capacity and pathogenicity of the CC024 and SHZH05 strains were also evaluated in a neonatal mouse model. Histopathological and viral load analyses demonstrated that the SHZH05 strain had an in vitro replication capacity comparable to the four CC strains. The CC024, but not the SHZH05 strain, became distributed in a variety of tissues and caused severe lesions and mortality in neonatal mice. The differences in replication capacity and in vivo pathogenicity of the CC024 and SHZH05 strains may result from differences in the nucleotide and amino acid sequences of viral functional polyproteins P1, P2 and P3. Our findings suggest that the noncirculating SHZH05 strain may be a safer CV vaccine candidate than the CC024 strain.

Analysis of the use of imipenem at a University Hospital following the restructuring of an antimicrobial audit system

This study analyzed the use pattern of imipenem following the restructuring of the antimicrobial audit system at a University Hospital. It was an observational study before and after the restructuring of the antimicrobial audit system in a University Hospital from May to August and then from September to December 2006. The criteria of the rational use of imipenem were obtained from a non-systematic revision of the literature. The collection of data on the general characteristics and clinical state of the patient, the infection and the established therapy was carried out in a previously tested instrument. Data was recorded, revised and analyzed in a database built with the software SPSS® for Windows® PC, version 10.0. The statistical analysis had a descriptive character: frequencies, mean, median and standard deviation. No differences were encountered in relation to the appropriate indication, consumption and clinical outcomes of patients. However, there was a reduction of 4 to 1 (75.0 percent) in the number of associations with spectrum superposition and an increase of 4 to 8 (50.0 percent) in the change of therapy. The restructuring of the antimicrobial audit system in the studied hospital did not reflect significantly the increase of the appropriate indication of imipenem. It contributed, however, to the reduction of the inappropriate associations of this antibiotic and to changes of therapy, without, however, compromising the quality of services rendered to patients.

¿Eciste alguna relación entre el consumo de psicofármacos en las mujeres y los esterotipos de género?: un estudio epidemiológico en una población femenina año 2004 / Is there any relation between the consumption of psychoactive drugs in the women and the sterotypes of gender?: an epidemiological study in a feminine population year 2004

Esta Tesis es un estudio epidemiológico en una población femenina de la ciudad de Córdoba durante el año 2004. Su desarrollo pone en evidencia la relación existente entre el consumo de psicofármacos en las mujeres y los estereotipos de género. Esta perspectiva tiene como una de sus premisas que la violencia ejercida sobre la mujer tiene una larga historia de gestación, desarrollo, justificación y ocultación. Se incorpora en el análisis del consumo de los psicofármacos, el género, como constructo social que nos permite desarrollar conocimientos concretos sobre las situación de las mujeres. El concepto de malestar (ansiedad, inquietud, frustración) introduce una nueva categoría que desarticula el dualismo salud/ enfermedad, y alude a los sufrimientos emocionales de las mujeres como emergentes de su condición de tales. Se ofrecen criterios de análisis que indican de que manera las condiciones de vida de las mujeres, en especial la vida cotidiana (sobrecarga de trabajo, y/o sobrecarga emocional) repercuten de modo decisivo sobre sus modos de enfermar. Este trabajo es solo el comienzo, algo imperfecto e inacabado, pero que puede señalar una apertura para seguir en el camino de la revisión de las certezas heredadas.

Cumplimiento sobre las recomendaciones de uso y evaluación del impacto económico de un programa de uso restringido de imipenem-cilastatina / Imipenem-cilastatin use in a university hospital in Chile

Imipenem is an expensive broad-spectrum antimicrobial, reserved for infections caused by multi-resistant nosocomial pathogens. Since 2001 our university hospital applies a restriction policy that allows rejecting or authorizing its use after a supervising evaluation whith pre-specified criteria for appropriate or inappropriate use. An audit was performed for all the supervisions made during the periods of March-April and September-October, 2004, totalizing 136 treatments. In global terms, 58.1 percent of treatments were considered appropriate and 11.8 percent inappropriate; other 20.6 percent had been discontinued by physicians in charge prior to evaluation. Susceptibility to other antimicrobials compounds was the main reason for inappropriate use. The remaining fraction involved deceased or discharged patients. Discontinuation of treatments by supervising physicians allowed to save 75 days and 362 vials of imipenem equivalent to US $ 6,777 during this period after discounting administrative and human resources costs.

Imipenem-cilastatina es un compuesto de amplio espectro y de alto costo, reservado para el manejo de infecciones nosocomiales y que requiere ser restringido para evitar la emergencia de agentes resistentes a esta alternativa y para contener costos. Desde el año 2001 existe un programa de uso restringido y supervisión de este compuesto en nuestro hospital que permite aprobar o rechazar su uso. Se efectuó una auditoria de todas las supervisiones efectuadas durante marzo-abril y septiembre-octubre del año 2004, totalizando 136 tratamientos. En términos globales, 58,1 por ciento de los tratamientos fue considerado apropiado, 11,8 por ciento inapropiado y 20,6 por ciento ya había sido suspendido por médicos tratantes al momento de la visita de supervisión. La fracción restante incluye pacientes de alta, fallecidos o trasladados. Las interrupciones de tratamiento implicaron un ahorro de imipenem-cilastatina de 75 días, 362 frascos y 3.524.133 de pesos (US 6,777) en los 4 meses de supervisión al incluir gastos en recursos humanos y costos administrativos.

A rapid method to assess the coverage of the mass drug administration of diethylcarbamazine in the program to eliminate lymphatic filariasis in India.

A rapid method to assess the coverage of mass drug administration (MDA) in the program to eliminate lymphatic filariasis needs to be developed for monitoring and evaluation of the program. This study attempted to develop and test a method of rapid assessment of coverage by using the existing resources of the program. This is based on the data obtained from the randomly selected health workers and drug distributors involved in the drug distribution process and the data of a household coverage survey of the program. The MDA coverage rate obtained through the evaluation survey was highly correlated with the rates obtained from health workers and drug distributors as a rapid assessment. Thus, MDA coverages assessed through health workers and drug distributors can give a good coverage estimate. The involvement of the existing human resources of the program in this rapid method of assessing MDA coverage was cost-effective.

Drug utilization study in dermatology in a tertiary hospital in Delhi.

The present study was undertaken to describe patterns of dermatological drug utilization in a tertiary hospital in Delhi by measuring WHO delineated drug use indicators. Six hundred and six prescriptions of dermatology out-patients were analyzed and the data collected were used to evaluate the following drug use indicators: average number of drug per prescription, average consultation time, percentage of drugs prescribed by generic name, percentage of encounters with an antibiotic prescribed, percentage of encounters with an injection prescribed and percentage of drug prescribed from the essential drugs list or formulary. The average number of drugs per prescription +/- SD was found to be 2.6 +/- 1.2, average consultation time +/- SD was 4.4 +/- 2.6 minutes, percentage of drug prescribed by generic name was 6.98, percentage of encounters with an antibiotic and injection prescribed were 46.86 and 6.76 respectively and 23% of the total drugs prescribed were from Delhi State Essential Drugs Formulary.