Clinical review of the pharmacological and anaesthetic effects of alfaxalone in dogs.

This clinical review summarises the pharmacological and anaesthetic properties of alfaxalone in the dog. Available pharmacokinetic-pharmacodynamic data and factors affecting the induction dose have been reported. Furthermore, quality of induction and recovery after alfaxalone administration, the use of alfaxalone for total intravenous anaesthesia, and its effects on the cardio-respiratory system, on laryngeal motion, on intraocular pressure and tear production have been evaluated. Finally, the use of alfaxalone in dogs undergoing caesarean section and the effect of intramuscular alfaxalone administration have been considered.

Effector cell signature in peripheral blood following nasal allergen challenge in grass pollen allergic individuals.

BACKGROUND: Several studies have demonstrated the time course of inflammatory mediators in nasal fluids following nasal allergen challenge (NAC), whereas the effects of NAC on cells in the periphery are unknown. We examined the time course of effector cell markers (for basophils, dendritic cells and T cells) in peripheral blood after nasal grass pollen allergen challenge. METHODS: Twelve participants with seasonal allergic rhinitis underwent a control (diluent) challenge followed by NAC after an interval of 14 days. Nasal symptoms and peak nasal inspiratory flow (PNIF) were recorded along with peripheral basophil, T-cell and dendritic cell responses (flow cytometry), T-cell proliferative responses (thymidine incorporation), and cytokine expression (FluoroSpot assay). RESULTS: Robust increases in nasal symptoms and decreases in PNIF were observed during the early (0-1 h) response and modest significant changes during the late (1-24 h) response. Sequential peaks in peripheral blood basophil activation markers were observed (CD107a at 3 h, CD63 at 6 h, and CD203c(bright) at 24 h). T effector/memory cells (CD4(+) CD25(lo) ) were increased at 6 h and accompanied by increases in CD80(+) and CD86(+) plasmacytoid dendritic cells (pDCs). Ex vivo grass antigen-driven T-cell proliferative responses and the frequency of IL-4(+) CD4(+) T cells were significantly increased at 6 h after NAC when compared to the control day. CONCLUSION: Basophil, T-cell, and dendritic cell activation increased the frequency of allergen-driven IL-4(+) CD4(+) T cells, and T-cell proliferative responses are detectable in the periphery after NAC. These data confirm systemic cellular activation following a local nasal provocation.

Neutrophils from allergic asthmatic patients produce and release metalloproteinase-9 upon direct exposure to allergens.

BACKGROUND: Asthma is characterized by airway inflammation and remodelling in which matrix metalloproteinases (MMPs) play an important role. MMP-9 is the major MMP found in the bronchoalveolar lavage fluids and bronchial biopsies from patients with allergic asthma after allergen challenge, where it correlates with the count of neutrophils and macrophages. However, the cellular sources of MMP-9 in this inflammatory condition have not yet been clearly identified. This work was undertaken to analyse whether neutrophils may be a source of MMP-9 in the allergic asthma condition upon allergen challenge. METHODS: Neutrophils from allergic asthmatic patients were in vitro stimulated, and the levels of MMP-9 release were measured in the cell culture supernatants using enzyme-linked immunosorbent assay (ELISA) and zymography. RESULTS: We show that MMP-9 is released by neutrophils, but not by eosinophils from allergic asthmatic patients in response to allergens to which the patients were sensitized. Neutrophils also released MMP-9 in response to anti-IgE Abs, and agonist Abs against FcεRI, FcεRII/CD23 and galectin-3. Inhibitors of transcription and translation, actinomycin D and cycloheximide, partially cancelled this process, suggesting that MMP-9 is also de novo synthesized in response to stimuli. We also show evidence that the MAPKs, p38 and extracellular signal-regulated kinase, as well as the transcription factor NF-κB, are involved, as specific chemical inhibitors of these cell-signalling pathways abolished the anti-IgE/allergen-dependent MMP-9 release. CONCLUSIONS: These data demonstrate that the exposure of neutrophils to allergens leads to generation of MMP-9, which may then lead to remodelling in asthma.

Ensayo clínico aleatorizado de técnicas de aclaramiento mucociliar en niños con bronquiectasias sin fibrosis quística / Randomized clinical trial of mucociliary clearance techniques in non-cystic fibrosis bronchiectasis in children

Objetivo Evaluar la eficacia de las presiones manuales espiratorias lentas y aumentos de flujo espiratorio (AFE) combinadas con insuflación-exuflación mecánica (I-EM) y tos asistida (TA), frente al ciclo activo de técnicas respiratorias (CATR) en bronquiectasia infantil estable sin fibrosis quística (FQ).Material y métodos Ensayo clínico aleatorizado en 2 grupos de 6 niños (edad 8,1±1,3) que reciben 2 sesiones de fisioterapia respiratoria (FR) al mes. Las principales variables de estudio son: peso de esputo recogido tras sesión de FR y medición de la función pulmonar al inicio del estudio y a los 12 meses; capacidad vital forzada (CVF), volumen espiratorio máximo en 1 s (VEMS o FEV1) y el flujo espiratorio forzado entre el 25%-75% de la CVF (FEF25-75%). Asimismo, evaluamos el número de ingresos y exacerbaciones infecciosas y el impacto de la tos en la calidad de vida con el Leicester Cough Questionnaire (LCQ), al inicio y al final del estudio. Resultados El peso del esputo y el FEF25-75%, aumenta significativamente con las presiones manuales espiratorias lentas, AFE combinados con I-E M y TA, frente al CATR, en nuestra muestra. No hay diferencias significativas en cuanto a FEV1 y CVF. El número de exacerbaciones disminuyó en ambos grupos con respecto al año anterior (sin tratamiento de FR), y la puntuación total del LCQ. Conclusión Las presiones manuales espiratorias lentas, AFE combinados con I-E M y TA, para la permeabilización de la vía aérea en niños con bronquiectasias sin FQ, producen beneficios significativos en comparación al CATR (AU)

Objective To evaluate effectiveness of manual expiratory pressure and expiratory flow increase (EFI) combined with mechanical insufflation-exsufflation (MI-E) and assisted coughing (AC) versus active cycle of breathing techniques (ACBT) in stable bronchiectasis children without cystic fibrosis (CF).Material and methods Randomized clinical trial with 2 groups of 6 children (age 8.1±1.3) who received of respiratory physiotherapy (RP) sessions twice a month. The main endpoints studied are: weight of sputum collected after each session of RP and lung function measurements at baseline and 12 months, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow between 25%-75% of FVC (FEF25-75%). We also evaluated the number of visits to emergency department, infective exacerbations and the impact of cough on quality of life with the Leicester Cough Questionnaire (LCQ), at the beginning and the end of study. Results The weight of sputum and FEF25-75% increase significantly with manual expiratory pressure, EFI combined with MI-E and AC versus ACBT in our sample. There are no significant differences in FEV1 and FVC. Number of exacerbations decreased in both groups compared to the previous year (without CP treatment), and total score of the LCQ. Conclusion Slow manual expiratory pressure, EFI combined with MI-E and AC for airway permeabilization in children with non-CF bronchiectasis produce significant benefits compared to ACBT (AU)

Manejo de las secreciones pulmonares en el paciente crítico / Management of the pulmonary secretions in the critical patient

Las complicaciones pulmonares en el paciente crítico, derivadas de la enfermedad de base, inmovilidad e infecciones nosocomiales, representan uno de los mayores problemas a la hora de manejarlo. Los programas de fisioterapia respiratoria ayudan a resolver algunos de estos problemas. Sin embargo, la evidencia disponible es escasa no solo en los pacientes críticos, sino también en los crónicos ambulatorios. En los últimos años las técnicas de fisioterapia aplicadas en los pacientes crónicos están siendo utilizadas en pacientes críticos, mejorando la oxigenación, compliance y limpieza de secreciones, aunque sin efectos sobre la estancia media y la mortalidad. En este artículo se revisan las recomendaciones de las sociedades científicas relacionadas con la fisioterapia en pacientes críticos y se exponen las diferentes técnicas (AU)

Pulmonary complications in critical patient, derived from the baseline disease, immobility and nosocomial infections, are one of the major problems in their management. Respiratory physiotherapy programs help to solve some of these problems. However, the available evidence is scarce both critical patients and chronic out-patients. In recent years, the physiotherapy techniques applied in chronic patients are being used in critical patients, improving oxygenation, compliance and aspiration of secretions, although without effects on mean stay and mortality. This article reviews the recommendations of the scientific societies related with physiotherapy in critical patients and presents the different techniques (AU)

[Management of the pulmonary secretions in the critical patient]. / Manejo de las secreciones pulmonares en el paciente crítico.

Pulmonary complications in critical patient, derived from the baseline disease, immobility and nosocomial infections, are one of the major problems in their management. Respiratory physiotherapy programs help to solve some of these problems. However, the available evidence is scarce both critical patients and chronic out-patients. In recent years, the physiotherapy techniques applied in chronic patients are being used in critical patients, improving oxygenation, compliance and aspiration of secretions, although without effects on mean stay and mortality. This article reviews the recommendations of the scientific societies related with physiotherapy in critical patients and presents the different techniques.

Neumonías de repetición y fisioterapia respiratoria: a propósito de un caso clínico / Recurrent pneumonia and respiratory physiotherapy: a case report

Objetivos: valorar el efecto de las técnicas de fisioterapia respiratoria en un paciente de 4 años de edad que sufre neumonías de repetición en diferentes localizaciones, lóbulo inferior izquierdo, lóbulo medio derecho y lóbulo inferior derecho.Paciente y métodos: el paciente es derivado por neumología para recibir tratamiento de fisioterapia respiratoria en clínica privada. El tratamiento se llevó a cabo durante 3 semanas en las que se realizaron técnicas de expansión pulmonar y desobstrucción bronquial.Resultados: en la auscultación disminuye el número de sibilancias, aumenta la ventilación y desaparecen los crujidos; los principales valores espirométricos aumentan (FEF 25-75% del 23 al 89%; FEV1/FVC del 86,38 al 96%), disminuye el uso de fármacos y desaparecen las condensaciones pulmonares en radiología.Conclusiones: el programa de fisioterapia respiratoria expuesto resuelve el caso clínico presentado(AU)

Aims: To evaluate the effect of the respiratory physiotherapy techniques in a 4-year old patient who suffered recurrent pneumonia in different sites, these being the lower left lobe, middle right lobe and lower right lobe.Patient and methodsThe patient was referred by the pneumology department for respiratory physiotherapy treatment in a private clinic. Treatment was given for 3 weeks, performing pulmonary expansion and disobstruction maneuver techniques.Results: The auscultation showed a decrease in number of whistling rales, increase in ventilation and disappearance of crepitations. The main spirometric values increased from FEF 25%-75%: 23% to 89%, FEV1/FVC: 86, 38% to 96%. Uses of drugs decreased and the pulmonary condensations disappeared.Conclusions: The respiratory physiotherapy program presented solved the clinical presented case(AU)

Tratamiento fisioterápico en el asma infantil: a propósito de un caso clínico / Physioterapic treatment

Objetivos. En el presente texto se expone un caso clínico de una paciente de ocho años de edad que sufre asma persistente moderada a consecuencia de cuadros de bronconeumonía de repetición. Paciente y métodos. La paciente es derivada por Neumología para recibir tratamiento de fisioterapia respiratoria en una clínica privada, con el objetivo prioritario de permeabilizar sus vías aéreas obstruidas por tapones mucosos que cursan con bronconeumonía. Se llevó a cabo una valoración fisioterapéutica inicial según la GEMA (Guía Española para el Manejo del Asma), para posteriormente llevar a cabo el programa de fisioterapia respiratoria durante 5 meses, y conseguir con éxito un control de su asma. Resultados. Los resultados muestran un aumento en los valores espirométricos, mejora de la auscultación, radiología, anamnesis fisioterapéutica y autocontrol de su cuadro asmático. Conclusiones. Se puede afirmar que un programa de fisioterapia respiratoria en el asma infantil aumenta la función pulmonar y la calidad de vida del niño

Aims. We present the case history of an eight-year-old girl with persistent moderate asthma due to repetitive bronchopneumonia episodes. Patient and methods. The patient was referred by the Pneumology Unit for respiratory physiotherapy at a private clinic, with the prioritary aim of rendering permeable her airways, which were obstructed by mucous plugs coursing with bronchopneumonia. An initial physiotherapeutic assessment was carried out according to the Spanish Guideline for the Management of Asthma; this was to be followed by a five-month respiratory physiotherapy programme with the objective of achieving successful control of her asthma. Results. The results show an improvement of her spirometric values, of the pulmonary auscultation, of the roentgenologic findings and of the physiotherapeutic anamnesis, and evident self-control of her asthma episodes. Conclusions. The institution of a respiratory physiotherapy programme in cases of childhood asthma improves lung function and the child’s quality of life

Utilidad de la correcta medida de la presión arterial / Utility of correct measurement of blood pressure arterial

La correcta medición de la presión arterial (PA) es fundamental para el diagnóstico y seguimiento del paciente hipertenso. Sin embargo, los errores en la toma de la PA relacionados con la patología local del paciente son poco frecuentes y pasan desapercibidos. Presentamos los casos de dos pacientes hipertensos con obstrucción de la arteria subclavia, lo que provocó errores en la medida de la PA e incorrecto manejo debido a esta circunstancia

Correct measurement of blood pressure (BP) is essential for diagnosis and follow-up of the hypertensive patient. However, errors in measuring BP related with local condition of the patient are uncommon and are overlooked. We present the cases of two hypertensive patients with obstruction of subclavian artery that caused errors in BP measurement and incorrect management due to this circumstance

[Glucose levels in non-diabetic patients. Is it a prognostic factor in acute coronary syndrome?]. / Niveles de glucemia en pacientes no diabéticos. 'Es un factor pronóstico en el síndrome coronario agudo?

INTRODUCTION: The role of glucose elevation above levels considered normal in non- diabetic patients with acute coronary syndromes (ACS) is not adequately defined. The aim of this study was to determine the association between serum glucose at admission and 1-year mortality in this type of patients. METHODS: We studied 648 non diabetic patients admitted consecutively with ACS. Serum glucose was determined at admission, together with classical risk factors, biochemical and inflammatory markers. The primary endpoint was all cause mortality at one year follow-up. RESULTS: Patients with normal glucose had lower mortality than patients with impaired fasting glucose (14.1% vs 5.7% 1-year mortality) or with glucose levels in diabetic range (24.7% vs 5.7% 1-year mortality). CONCLUSIONS: In non-ST elevation acute coronary syndromes, elevated levels of glucose in non-diabetic patients are strong predictors of all cause death at one year follow-up. This prognostic value is independent of other risk factors biochemical and inflammatory markers.

Niveles de glucemia en pacientes no diabéticos. ¿Es un factor pronóstico en el síndrome coronario agudo? / Glucose levels in non-diabetic patients. Is it a prognostic factor in acute coronary syndrome?

Introducción. No está bien definido el papel de la elevación de glucosa por encima de los valores considerados como normales en los pacientes no diabéticos con síndrome coronario agudo (SCA). El objetivo del presente estudio es analizar los efectos sobre el pronóstico a un año de los niveles de glucemia obtenidos durante el ingreso en este tipo de pacientes. Métodos. Estudiamos a 648 pacientes no diabéticos consecutivos con SCA, en los cuales se midieron los niveles de glucosa durante su estancia hospitalaria junto con los factores de riesgo clásicos, los marcadores bioquímicos e inflamatorios. El criterio de evaluación principal fue la muerte por todas las causas a un año. Resultados. Los pacientes con glucemia normal durante el ingreso presentaban un menor porcentaje de fallecimientos en el seguimiento que los que presentaban una glucosa basal alterada (14,1% frente a 5,7%), así como en rango de diabetes (24,7% frente a 5,7%). Conclusiones. Los niveles de glucosa obtenidos durante el ingreso en los pacientes no diabéticos con SCA sin elevación del ST son predictores de muerte, independientemente de factores bioquímicos, epidemiológicos clásicos e inflamatorios

Introduction. The role of glucose elevation above levels considered normal in non- diabetic patients with acute coronary syndromes (ACS) is not adequately defined. The aim of this study was to determine the association between serum glucose at admission and 1-year mortality in this type of patients. Methods. We studied 648 non diabetic patients admitted consecutively with ACS. Serum glucose was determined at admission, together with classical risk factors, biochemical and inflammatory markers. The primary endpoint was all cause mortality at one year follow-up. Results. Patients with normal glucose had lower mortality than patients with impaired fasting glucose (14.1% vs 5.7% 1-year mortality) or with glucose levels in diabetic range (24.7% vs 5.7% 1-year mortality). Conclusions. In non-ST elevation acute coronary syndromes, elevated levels of glucose in non-diabetic patients are strong predictors of all cause death at one year follow-up. This prognostic value is independent of other risk factors biochemical and inflammatory markers

Utilidad de los ultrasonidos para la valoración de la mineralización ósea en recién nacidos / Usefulness of ultrasound in the assessment of bone mineralization in newborns

Antecedentes: El estudio de la mineralización ósea en el período neonatal y sus enfermedades tiene un interés creciente. La osteosonografía es un nuevo método que permite valorar la mineralización ósea sin radiación. Objetivo: Conocer la velocidad de conducción de los ultrasonidos en recién nacidos normales, las posibles variaciones en pretérminos y las relaciones con la edad gestacional y antropometría. Métodos: La población fue de 100 recién nacidos, 53 de ellos a término (26 varones, 27 mujeres) y 47 pretérminos (27 varones, 20 mujeres). Se evaluaron la siguientes variables: edad gestacional, longitud, peso, perímetros (craneal y torácico) y la velocidad del sonido dependiente de la amplitud (Ad-SOS). Se realizó estudio previo para elegir el punto de medición con ultrasonidos entre ambos fémures y húmeros. Resultados: No se encontraron diferencias significativas de la Ad-SOS entre las mediciones realizadas en fémures y húmeros derechos frente a los izquierdos; sí existen entre fémures y húmeros (p < 0,001). La Ad-SOS media de la población fue 1.706,6 ± 36,3 m/s. La Ad-SOS en los niños a términos fue de 1.726 ± 26,2 m/s y en los pretérminos de 1.679 ± 36,7 m/s, diferencia estadísticamente significativa. Se encontraron correlaciones de la Ad-SOS con la edad gestacional y los parámetros antropométricos. Conclusiones: La Ad-SOS es un buen método para el cribado de la mineralización ósea en el recién nacido y monitorización de los cambios posnatales (AU)

[In vivo effect of Resistocell on the Phytohemagglutinin Immunocompetence Index (rabbits)]. / Efecto "in vivo" del RSTL sobre el IIC.PHA (conejos).

The RST-SAS effect in normal adult albino New Zealand giant male rabbits was studied. A positive individual response in 89% of the animal and no harmful side-effects were observed, after the i.v. administration of a suitable RSTL-SAS dose. The statistical evaluation of group data showed a significative 42% increased of the IIC.PHA above the normal basal level. Thus, the RSTL-SAS could provide an unique immunomodulator agent due to its significant biological effect and the apparent lack of any side effect.

[Pharmacokinetic study of adriamycin in dogs. The problem of parameter calculations]. / Estudio farmacocinético de la adriamicina en perros. Problemática sobre el cálculo de parámetros.

The authors make a spectrophotometric, chromatographic and spectrofluorimetric analysis of serum adriamycin, and use the resulting data for pharmacokinetic calculation by means of two computer programs, one of them original.

[Pharmacokinetic study of adriamycin in dogs and rabbits, in the absence of a carrier]. / Estudio farmacocinético de la adriamicina en perros y conejos, en ausencia de portador.

The authors make a pharmacodynamic study about the effect of adriamycin administered intravenously without any carrier to dogs and rabbits, in order to compare it with the action of the drug when it is administered bound to specific immunoglobulins.

[Effect of RSTL on IIC-PHA (rabbits)]. / Efecto del RSTL sobre el IIC-PHA (conejos).

The effect of RSTL upon in vitro cultures of peripheral blood lymphocytes is studied in six rabitts. RSTL stimulates the blastogenic response in all of them.