Pharmacokinetic assessment of the monepantel plus oxfendazole combined administration in dairy cows.

Monepantel (MNP) is a novel anthelmintic compound launched into the veterinary pharmaceutical market. MNP is not licenced for use in dairy animals due to the prolonged elimination of its metabolite monepantel sulphone (MNPSO2 ) into milk. The goal of this study was to evaluate the presence of potential in vivo drug-drug interactions affecting the pattern of milk excretion after the coadministration of the anthelmintics MNP and oxfendazole (OFZ) to lactating dairy cows. The concentrations of both parent drugs and their metabolites were measured in plasma and milk samples by HPLC. MNPSO2 was the main metabolite recovered from plasma and milk after oral administration of MNP. A high distribution of MNPSO2 into milk was observed. The milk-to-plasma ratio (M/P ratio) for this metabolite was equal to 6.75. Conversely, the M/P ratio of OFZ was 1.26. Plasma concentration profiles of MNP and MNPSO2 were not modified in the presence of OFZ. The pattern of MNPSO2 excretion into milk was also unchanged in animals receiving MNP plus OFZ. The percentage of the total administered dose recovered from milk was 0.09 ± 0.04% (MNP) and 2.79 ± 1.54% (MNPSO2 ) after the administration of MNP alone and 0.06 ± 0.04% (MNP) and 2.34 ± 1.38% (MNPSO2 ) after the combined treatment. The presence of MNP did not alter the plasma and milk disposition kinetics of OFZ. The concentrations of the metabolite fenbendazole sulphone tended to be slightly higher in the coadministered group. Although from a pharmacodynamic point of view the coadministration of MNP and OFZ may be a useful tool, the presence of OFZ did not modify the in vivo pharmacokinetic behaviour of MNP and therefore did not result in reduced milk concentrations of MNPSO2 .

Megacolon tóxico en una paciente con colitis seudomembranosa / Toxic megacolon in a patient with colitis pseudomembranous

La colitis seudomembranosa es una patología relacionada con el uso de antibióticos. En raras ocasiones, evoluciona a megacolon tóxico que podría requerir resolución quirúrgica. Comunicamos el caso de una mujer de 22 años, que recibió amoxicilina/ácido clavulánico unos días antes de la consulta. Presentó diarrea, fiebre y vómitos. Radiografía y tomografía computarizada de abdomen: distensión de colon derecho >6 cm. Toxina para Clostridium: positiva. Comienza con el tratamiento médico y requiere cirugía por megacolon tóxico. El megacolon tóxico es una complicación infrecuente de la colitis seudomembranosa. Es rara en pacientes jóvenes y sin comorbilidades. Se llega al diagnóstico mediante los criterios de Jalan. La tasa de mortalidad se aproxima al 70%. Se debe mantener alto nivel de alerta ante signos de toxicidad sistémica y la dilatación colónica es diagnóstica de la entidad. El uso indiscriminado de antibióticos constituye un serio factor de riesgo.(AU)

Pseudomembranous colitis is a condition associated with the use of antibiotics. On rare occasions, it evolves to toxic megacolon which may require surgical resolution. We report the case of a 22-year-old woman who received amoxicillin/clavulanic acid a few days before the consultation. She referred diarrhea, fever and vomiting. Radiography and computed tomography of abdomen: distension of the right colon >6 cm. Clostridium toxin: positive. Medical treatment is administered and surgery is needed for toxic megacolon. Toxic megacolon is an infrequent complication of pseudomembranous colitis. It is rare in young patients without comorbidities. The diagnosis is reached using the Jalan criteria. The mortality rate approaches 70%. A high level of alertness should be maintained for signs of systemic toxicity and colonic dilation is diagnostic of the entity. Indiscriminate use of antibiotics is a serious risk factor.(AU)

Estudio epidemiológico descriptivo de pacientes hospitalizados en el Servicio de ORL del Hospital Clínico de la Universidad de Chile entre los años 2007 y 2014 / Descriptive epidemiological study of patients hospitalized in the ENT Department of the Hospital Clínico de la Universidad de Chile between the years 2007 and 2014

Introducción: Las enfermedades de origen otorrinolaringológico (ORL) tienen una elevada prevalencia en atención primaria de salud, sin embargo, la información epidemiológica en pacientes hospitalizados es bastante escasa. Objetivo: Obtener características demográficas y prevalencia de enfermedades en los pacientes hospitalizados del Servicio de ORL del Hospital Clínico de la Universidad de Chile (HCUCh). Material y método: Estudio de tipo descriptivo y retrospectivo, llevado a cabo en el Servicio de ORL del HCUCh, donde se revisaron los registros electrónicos, existentes de grupos relacionados a diagnóstico (GRD) de egresos, entre los años 2007 y 2014. Resultados: Se incluyeron 7.353 egresos, con un promedio de edad de los pacientes de 28,24 años. La causa de hospitalización más frecuente fue la patología de faringe. Del total de los egresos 87,88% presentaron una intervención quirúrgica donde la amigdalectomía con adenoidectomía alcanzó el 15,7% de las cirugías realizadas. Conclusión: Este estudio nos entrega información epidemiológica sobre los pacientes hospitalizados en un servicio de ORL de un hospital de referencia a nivel nacional.

Introduction: Diseases ofotolaryngology (ENT) origin have a high prevalence in primary health care, however, the epidemiological information on hospitalized patients is almost null. Aim: To obtain demographic and disease prevalence information in hospitalized patients of the ENT Department at the Hospital Clínico de la Universidad de Chile (HCUCh). Material and method: A descriptive and retrospective study, was carried out at the ENT department of the HCUCh, reviewing existing records of diagnostic related groups (GRD) for discharges between 2007 and 2014. Results: We review a total of 7353 discharges, with an average age of patients of 28.24 years. The most frequent cause of hospitalization was pharynx pathology. An 87.88% of discharges had surgery performed, where tonsillectomy with adenoidectomy reached 15,7% of the total. Conclusion: This study provides us with epidemiological information on patients hospitalized in an ENT department in a nationwide referral hospital.

Educational impact of a clinical anatomy workshop on 1st-year orthopedic and rheumatology fellows in Mexico City.

We aim to study the educational impact of a clinical anatomy workshop in 1st-year orthopedic and rheumatology fellows. First-year rheumatology fellows (N = 17) and a convenience sample of 1st-year orthopedic fellows (N = 14) from Mexico City in the 9th month of training participated in the study. The pre- and the post- workshop tests included the same 20 questions that had to be answered by identification or demonstration of relevant anatomical items. The questions, arranged by anatomical regions, were asked in five dynamic stations. Overall, the 31 participants showed an increase of correct answers, from a median of 6 (range 1 to 12) in the pre-workshop test, to a median of 14 (range 7 to 19) in the post-workshop test. In the pre-workshop test, the correct median answers were 7 (range 2 to 12) in the orthopedic fellows and 5 (range 1 to 10) in the rheumatology fellows (p = 0.297). Corresponding scores in the post-workshop were 15 (range 10 to 19) and 12 (range 7 to 18) (p = 0.026) showing a significant difference favoring the orthopedic group. Our clinical anatomy workshop was efficacious, in the short term, as a teaching instrument for 1st-year orthopedic and rheumatology fellows. The post-workshop scores, although significantly improved in both groups, particularly in the orthopedic fellows, were still suboptimal. Further refinements of our workshop might yield better results.

Cáncer de cabeza y cuello asociado al virus papiloma humano: revisión de la literatura / Head and neck cancer associated with human papilloma virus: literature review

Oral cavity and oropharyngeal squamous cell carcinoma is the sixth most common cancer worldwide and human papillomavirus (VPH) is proposed as an etiologic risk factor. In our country there is no prevalence studies of this virus either in oral or oropharyngeal mucosa. This data would be useful at the moment of evaluating the risk in general population of developing head and neck cancer VPH related and also the impact that it could have the proved effective vaccines against VPH...

Localización del electrodo de marcapasos definitivo en el tracto de salida del ventrículo derecho mediante tomografía axial computarizada / Determinating the location of the permanent pacemaker lead in the right ventricle outflow tract by computed tomography

Introducción: Precisar la ubicación del electrodo de marcapasos en el tracto de salida del ventrículo derecho (TSVD) es difícil mediante las técnicas convencionales (fluoroscopia y electrocardiografía). La tomografía permite determinar de forma tridimensional la relación del electrodo en el TSVD. Objetivo: Determinar la localización del electrodo de marcapasos mediante la tomografía axial computarizada y comparar los resultados con la localización electrocardiográfica y fluoroscópica. Material y métodos: Se incluyeron 36 pacientes portadores de marcapasos definitivo VVI con el electrodo localizado en el TSVD, a quienes se les tomó un electrocardiograma de 12 derivaciones, proyecciones fluoroscópicas convencionales y tomografía multicorte para determinar la posición del electrodo en el TSVD. Resultados: Mediante el electrocardiograma se localizó el electrodo septal en 58.3% y en pared libre en 41.7%. Por fluoroscopia en oblicua anterior izquierda (OAI) a 35° se localizó el electrodo en pared anterior 5.6%, en pared libre en 38.9% y septal en 55.6%; en OAI a 45° en pared anterior en 2.8%, en pared libre 44.4% y septal en 52.8%. Mediante tomografía se documentó la posición anterior del electrodo en 39%, pared libre en 48% y septal en 13%. El coeficiente Kappa de las 3 pruebas mostró una concordancia muy baja. Conclusión: La tomografía es un mejor método para determinar la posición del electrodo en TSVD comparado contra la fluoroscopia y el electrocardiograma.

Introduction: Determination of the location of the lead of the permanent pacemaker in the right ventricle outflow tract (RVOT) it's difficult with the conventional techniques (fluoroscopic images and electrocardiography). The computed tomography (CT) allows to determinate in three dimensions the relation between the lead and the RVOT. Objective: Determine the location of the electrode lead by computed tomography and compare the results with electrocardiographic and fluoroscopy images localization. Material and methods: 36 patients were included with VVI permanent pacemaker with the lead in the RVOT. A 12-lead electrocardiogram, fluoroscopy images and CT were performed to determine the position of the lead in the RVOT. Results: By electrocardiogram, we located the lead in septal wall 58.3% and free wall 41.7%. By fluoroscopy images in left anterior oblique (LAO) 35° the lead was located on the anterior wall 5.6%, free wall 38.9% and septal 55.6%; in LAO 45° anterior wall 2.8%, free wall 44.4% and septal 52.8%. By Tomography the lead was positioned on anterior wall in 39%, free wall 48% and septal 13%. The Kappa coefficient of the 3 tests showed very low concordance. Conclusion: CT is a better method for determining the position of the lead on the RVOT compared to fluoroscopy images an electrocardiogram.

Epidemiologic analysis of the laboratory-confirmed cases of influenza A(H1N1)v in Colombia.

From 2 May to 16 July 2009, a total of 183 laboratory-confirmed cases of influenza A(H1N1)v were reported in Colombia, 117 (63.9%) of these had travelled outside the country. Hospital admission was necessary in 26 (14.21%) cases and seven patients died (fatality-case ratio: 3.8%). The infection affected younger age-groups and the symptoms most frequently reported were cough, fever and sore throat. Our findings are consistent with recent reports from other countries.

Disseminated classic Kaposi's sarcoma.

Kaposi's sarcoma (KS) is characterised by proliferation of vascular endothelial and lymphoreticular cells, frequently with a multicentric expression developed from a single node and evolving to multiple cutaneous lumps or plaque-like appearance. Four types of KS with similar histological patterns have been described in terms of their clinical and epidemiological features: classic KS, endemic (African) KS, iatrogenic KS and epidemic (AIDS-related) KS. The differences in clinical features are quite relevant: classic KS is usually limited to the lower extremities; whereas immunodeficiency-related diseases frequently involve several organs. A case of a 67-year-old woman with metastatic KS and unproven immunodeficiency is presented.

[Devices for saliva collection from the major salivary glands. Results in normal subjects]. / Dispositivos para colección de saliva de las glándulas salivales mayores. Resultados en sujetos normales.

BACKGROUND: Collection of saliva produced by the major salivary glands may be accomplished either by cannulation of the glandular ducts or by the application of specific collecting devices to the emergence area of the glandular ducts. Those procedures are complex, slow, invasive and require skilled personnel. AIM: To report the design and application of a device to collect parotid saliva (snail collector) and another device to collect saliva from the submandibular/sublingual complex. MATERIAL AND METHODS: The saliva collection devices were tested in 40 healthy volunteers (20 male) aged 18 to 22 years old. Saliva was collected using conventional conditions, during 5 to 15 min. RESULTS: An average of 1 to 1.5 ml of saliva was collected in the 10-15 min period from both parotid and submandibular/sublingual glands. Flow rates from parotid glands were 80 microliters/min and 180 microliters/min from submandibular/sublingual glands. Parotid saliva had a protein and organic material concentration twice as high than saliva from submandibular/sublingual glands. The presence of human alpha-amylase duplet (Mr 55 kD and 58 kD) predominated in parotid saliva, whereas saliva from submandibular/sublingual glands had other molecular markers such as the lysozyme duplet (Mr 18.5 kD and 17 kD). CONCLUSIONS: The tested devices were easily applicable, comfortable and allowed the collection of both parotid saliva and submandibular/sublingual saliva from various subjects at once, under the supervision of a single professional.

[Kinetic assessment of salivary secretory response to citric acid. Differences with pilocarpine]. / Caracterización cinética de la respuesta de secreción salival producida por ácido cítrico. Diferencias con pilocarpina.

BACKGROUND: Induction of salivation is becoming increasingly popular in the assessment of salivary gland status. Various mechanical or pharmacological procedures are empirically used to produce salivation. Oral stimulation by citric acid (AC) is by far the most used sialagogue procedure. AIM: To characterize the salivary secretory response to AC solutions applied to the dorsolateral tongue surfaces. SUBJECTS AND METHODS: Young healthy women from the upper levels of a medical career (n = 19) participated as volunteers. Salivary volume and UV-absorbing organic material in saliva from single subjects were measured after various protocols of topical stimulation by AC. RESULTS: After a single stimulation by 1-8% AC the salivary flow rate peaked before 30 seconds and recovered the basal level earlier than 2 minutes. Repetitive stimulations at 30-sec intervals kept the flow rate at a maximum. After suspending these stimulations, basal flow rate was recovered before 2 minutes. Repetitive AC-stimulations at 8-min intervals produced a series of identical and independent secretory responses. The concentration of organic material in saliva remained unaltered after the various modes of stimulation. Thus, the profile of organic material secretion was always a direct expression of changes in salivary flow rate. In contrast to AC, the oral administration of the cholinergic agonist pilocarpine (PIL) produced a two-wave salivary response that as a whole lasted for about 30 minutes. In this case the volume and the amount of organic material were at least 10-fold the ones secreted in response to AC. CONCLUSIONS: AC provoked a rapid and short-lived salivary response that differs markedly from the one produced by other secretagogues, like pilocarpine.

Determinación de la actividad de la renina plasmática en pacientes con cor pulmonale secundario a enfermedad pulmonar obstructiva crónica / Plasmatic renin ativity in patients with cor pumlmonale

Se estudiaron 16 pacientes con diagnóstico de EPOC, 14 hombres y 2 mujeres, con edad promedio del 61 años (DE 5.8), todos con antecedentes de tabaquismo pesado (promedio de paquetes-año 88, DE 42), sin consumo actual de tabaco. La mayoría de los sujetos tenía enfermedad obstructiva moderada a severa (promedio del VEF1 predicho 50 por ciento DE 26 por ciento; relación VEF1 sobre CVF 51 por ciento, DE 15 por ciento) y la limitación funcional se consideró de moderada a severa, pues 13 pacientes tenían clase funcional 2 a 3. El compromiso de la oxigenación fué leve (Pa02 promedio 52, DE 7 mmHg), hipercapnia moderada (34.3 mmHg, DE 4.1) y el estado ácido base estaba en el rango normal (ph 7.40, DE 0.027; HC03 21.63, DE 2.5). Debido al diseño del trabajo, que no incluyó pacientes con hipertensión arterial sistémica, las cifras de presión sistólica (122, DE 12) y diastólica (76, DE 7) se encontraban dentro del rango normal. El estudio ecocardiográfico demostró hipertensión pulmonar moderada a severa en todos los pacientes, la presión sistólica pulmonar fue, en promedio, de 61 (DE 9.6) y la media pulmonar de 41.7 (DE 5,5) y 81 por ciento de los pacientes tenian disfunción diastólica del ventrículo izquierdo de leve a moderada. La función ventricular izquierda presentaba alteración diatólica en 87 por ciento de los sujetos, mientras que la función sistólica era completamente normal con una fracción de eyección de (59.7 por ciento DE 5.1) y el gasto cardiaco promedio fue de 5.76 It/min (DE 1.7). Todos los pacientes tenían actividades de renina plasmática normal, lo que significa que la prevalencia de hiperactividad del sistema renina angiotensina aldosterona sistémico es del 0 por ciento en estos pacientes.