Toxicity study about a medicinal plant Casearia sylvestris: A contribution to the Brazilian Unified Health System (SUS).

ETHNOPHARMACOLOGICAL RELEVANCE: Casearia sylvestris S.w (Salicaceae) is catalogued by the Brazilian Unified Health System as a plant of interest for the Brazilian population with the purpose of treating inflammatory disorders, such as pain and gastrointestinal disorders based on the folk use and some literature about efficacy; however, no toxicological studies concerned the safety of extract fluid of this plant have been reported. AIM OF THE STUDY: The present study was carried out to evaluate the acute and subchronic toxicity of the hydroethanolic extract fluid (FE) obtained from leaves of C. sylvestris in Wistar rats. MATERIALS AND METHODS: In the acute toxicity test three female Wistar rats were treated with a single dose of FE (2000 mg/kg) administered by oral gavage and observed for 14 days in order to identify signs of toxicity or death. In subchronic toxicity study animals received, by daily gavage three doses 60, 120 and 240 mg/kg of the FE of the plant for 28 and 90 days. The animals were observed daily for clinical signs and mortality. Body weight and food consumption were measured weekly and at the end of treatment were analysed hematological, biochemical and histopathological parameters. Also was analysed the cellularity of bone marrow and spleen. Moreover, phytochemical analysis by HPLC-PDA-ESI(+)/MS and CG/MS/EI was carried out to qualify the constituents of the extract. RESULTS: The results of acute study indicated that the LD50 is higher than 2000 mg/kg and at 28 and 90 day oral toxicity showed that there were no toxic effects detected in any of the parameters evaluated: body weight and relative organ weight, general behavioral changes, haematological and biochemical parameters and histopathological examination. The analysis by HPLC-PDA-ESI(+)/MS and CG/MS/EI identified the flavonoids rutin, quercetin and luteolin and also chlorogenic on the extract. CONCLUSION: Based on this study the hydroethanolic fluid extract of C. sylvestris could be safe even when used over a long period for therapeutic uses proposed by the Brazilian Unified Health System.

[Bacteriological quality of air in a ward for sterile pharmaceutical preparations]. / Calidad microbiológica del aire de una unidad de preparados farmacéuticos estériles.

BACKGROUND: An extremely clean area is required for preparation of sterile pharmaceutical compounds, in compliance with international standards, to minimize the probability of microbial contamination. AIM: To evaluate the bacteriological quality of the air in the Sterile Pharmaceutical Preparation Unit of the University of Chile's Clinical Hospital and to set up alerts and action levels of bacterial growth. METHODS: We studied eight representative sites of our Unit on a daily basis from January to February 2005 and twice a week from June 2005 to February 2006. We collected 839 samples of air by impact in the Petri dish. RESULTS: 474 (56.5%) samples were positive; 17 (3.5%) of them had an inappropriate bacterial growth (2% of total samples). The samples from sites 1 and 2 (big and small biosafety cabinets) were negative. The countertop and transfer area occasionally exceeded the bacterial growth limits. The most frequently isolated bacteria were coagulase-negative staphylococci, Micrococcus spp and Corynebacterium spp, from skin microbiota, and Bacillus spp, an environmental bacteria. CONCLUSIONS: From a microbiological perspective, the air quality in our sterile preparation unit complied with international standards. Setting institutional alerts and action levels and appropriately identifying bacteria in sensitive areas permits quantification of the microbial load and application of preventive measures.

Calidad microbiológica del aire de una unidad de preparados farmacéuticos estériles / Bacteriological quality of air in a ward for sterile pharmaceutical preparations

Introducción: La elaboración de preparados farmacéuticos estériles requiere áreas limpias que deben cumplir estándares internacionales para minimizar la contaminación microbiana. Objetivo: Evaluar la calidad bacteriológica del aire de la Unidad de Preparados Farmacéuticos Estériles del Servicio de Farmacia del Hospital Clínico de la Universidad de Chile y establecer niveles de alerta y acción. Material y Métodos: Se monitorearon ocho puntos representativos de la unidad, diariamente entre enero y febrero de 2005 y bisemanal-mente de junio a febrero de 2006. Se estudiaron 839 muestras de aire, recolectadas mediante el método de impacto en placa (equipo MAS-100). Resultados: De las muestras estudiadas, 474 (56,5 por ciento) fueron positivas; de éstas, sólo 17 (3,5 por ciento) estuvieron fuera del rango permitido, porcentaje que representa el 2 por ciento del total. Las muestras de los sitios 1 y 2 (flujo laminar grande y pequeño), que corresponden al área de preparación de preparados estériles fueron negativas. Los sitios 3 (mesón) y 4 (transfer) presentaron ocasionalmente valores superiores a los límites. Los microorganismos más frecuentes fueron Staphylococcus coagulasa negativa, Micrococcus spp y Corynebacterium spp, agentes de la microbiota de la piel y, menor porcentaje, Bacillus spp, agente de la microbiota ambiental. Conclusiones: Desde el punto de vista microbiológico, la calidad del aire de la zona de preparaciones estériles descrita presenta niveles ajustados a estándares internacionales. El establecer niveles de alerta y acción institucionales y la identificación de los microorganismos obtenidos en las áreas más sensibles de la unidad permite cuantificar la carga microbiana y conocer sus componentes para determinar las intervenciones a realizar cuando ellas estén indicadas.

Background: An extremely clean area is required for preparation of sterile pharmaceutical compounds, in compliance with international standards, to minimize the probability of microbial contamination. Aim: To evaluate the bacteriological quality of the air in the Sterile Pharmaceutical Preparation Unit of the University of Chile's Clinical Hospital and to set up alerts and action levels of bacterial growth. Methods: We studied eight representative sites of our Unit on a daily basis from January to February 2005 and twice a week from June 2005 to February 2006. We collected 839 samples of air by impact in the Petri dish. Results: 474 (56.5 percent) samples were positive; 17 (3.5 percent) of them had an inappropriate bacterial growth (2 percent of total samples). The samples from sites 1 and 2 (big and small biosafety cabinets) were negative. The countertop and transfer area occasionally exceeded the bacterial growth limits. The most frequently isolated bacteria were coagulase-negative staphylococci, Micrococcus spp and Corynebacterium spp, from skin microbiota, and Bacillus spp, an environmental bacteria. Conclusions: From a microbiological perspective, the air quality in our sterile preparation unit complied with international standards. Setting institutional alerts and action levels and appropriately identifying bacteria in sensitive areas permits quantification of the microbial load and application of preventive measures.

[Unusual imaging findings of Ewing sarcoma in the childhood]. / Manifestaciones radiológicas infrecuentes del sarcoma de Ewing en la infancia.

OBJECTIVES: To review the cases of Ewing's sarcoma (ES) diagnosed in children at our hospital from 1995 to 2005 and to analyze uncommon imaging signs at diagnosis or during the course of the disease. MATERIAL AND METHODS: We reviewed the cases of 21 patients with ES (12 boys and 9 girls) diagnosed between the ages of 2 and 14 years. We analyzed the types of presentation, the imaging findings (plain-films, CT, and MRI), and the patients' evolution. All cases were confirmed at histological study. RESULTS: The following uncommon manifestations were found in 11 patients: 2 vertebral, one cervical, and one dorsal ES that initially manifested as spinal cord compression and as a mediastinal mass, respectively; 2 sacral ES with ascending epidural masses; 1 mandibular ES; 1 costal ES with hemorrhagic cerebral metastases; 3 extraskeletal (thigh, buttocks, and pelvis minor) ES with bone metastases at diagnosis: the first two had spinal cord and nerve compression due to vertebral metastases; 2 ES had benign-appearing radiological findings (cortical lesion of the radius with osseous remodeling of the ulna and an expanding multilocular lesion of the fibula). CONCLUSIONS: Although ES is the second most common malignant bone tumor in children, its unusual imaging findings are less well known. More than half (52.4 %) of our last 21 patients presented some of these manifestations at diagnosis or during follow-up, so radiologists should be aware of them and include ES in the prebiopsy diagnostic possibilities.

Manifestaciones radiológicas infrecuentes del sarcoma de Ewing en la infancia / Unusual imaging findings of Ewing sarcoma in the childhood

Objetivos: revisión de los sarcomas de Ewing (SE) infantiles diagnosticados desde 1995 hasta el 2005 en nuestro hospital, analizando las manifestaciones infrecuentes en el momento del diagnóstico o en su evolución. Material y métodos: estudio retrospectivo de 21 pacientes con SE (12 varones y 9 mujeres) diagnosticados entre los 2 y 14 años. Análisis de sus formas de presentación, hallazgos radiológicos (radiografía, tomografía computarizada y resonancia magnética) y evolución. Todos los casos tienen confirmación anatomopatológica. Resultados: 11 pacientes tuvieron las manifestaciones infrecuentes siguientes: 2 SE vertebrales, 1 cervical y 1 dorsal que se iniciaron con compresión medular y masa mediastínica, respectivamente; 2 SE sacros con masa epidural ascendente; 1 SE de localización mandibular; 1 SE costal con metástasis cerebral hemorrágica; 3 SE extraesqueléticos (muslo, glúteo y pelvis menor) con metástasis óseas al diagnóstico, los 2 primeros con compresión medular y radicular por metástasis vertebrales; 2 SE con manifestaciones radiológicas de benignidad (lesión cortical del radio incurvando al cúbito y aspecto insuflante multiloculado del peroné). Conclusiones: aunque el SE es el segundo tumor óseo maligno más frecuente de la infancia, sus manifestaciones infrecuentes son menos conocidas. Más de la mitad (52,4 %) de nuestros últimos 21 casos han presentado alguna de estas manifestaciones al diagnóstico o en su evolución, que deben conocerse para incluir al SE como posibilidad diagnóstica prebiopsia (AU)

Objectives: to review the cases of Ewing's sarcoma (ES) diagnosed in children at our hospital from 1995 to 2005 and to analyze uncommon imaging signs at diagnosis or during the course of the disease. Material and methods: we reviewed the cases of 21 patients with ES (12 boys and 9 girls) diagnosed between the ages of 2 and 14 years. We analyzed the types of presentation, the imaging findings (plain-films, CT, and MRI), and the patients' evolution. All cases were confirmed at histological study. Results: the following uncommon manifestations were found in 11 patients: 2 vertebral, one cervical, and one dorsal ES that initially manifested as spinal cord compression and as a mediastinal mass, respectively; 2 sacral ES with ascending epidural masses; 1 mandibular ES; 1 costal ES with hemorrhagic cerebral metastases; 3 extraskeletal (thigh, buttocks, and pelvis minor) ES with bone metastases at diagnosis: the first two had spinal cord and nerve compression due to vertebral metastases; 2 ES had benign-appearing radiological findings (cortical lesion of the radius with osseous remodeling of the ulna and an expanding multilocular lesion of the fibula). Conclusions: although ES is the second most common malignant bone tumor in children, its unusual imaging findings are less well known. More than half (52.4 %) of our last 21 patients presented some of these manifestations at diagnosis or during follow-up, so radiologists should be aware of them and include ES in the prebiopsy diagnostic possibilities (AU)

[Pleuropulmonary blastoma in children: imaging findings and clinical patterns]. / Blastoma pleuropulmonar en niños: manifestaciones clínicas y radiológicas.

PURPOSE: To describe the imaging findings, clinical presentation and follow up of pleuropulmonary blastoma (PPB) in children. MATERIALS AND METHODS: Authors present a retrospective review of three young children with pathologically proven PPB seen from 1992 to 2006 in a pediatric hospital. The imaging findings on simple views, CT and MRI are presented. RESULTS: The first patient showed two bilateral well-defined solid lung lesions on chest X-rays, with homogeneous low attenuation on CT. Patient is free of disease following chemotherapy and surgical treatment. The second patient displayed a right tension pneumothorax. After drainage, he presented on chest X-rays and CT an underlying multicystic lesion. Following chemotherapy and surgical treatment, he presented two pulmonary metastases, which were treated with chemotherapy and surgery. The patient is now free of disease. The third patient showed a complete opacification of the left hemithorax due to a massive pleural effusion; a pleuropulmonary solid mass was seen on US, CT and MRI. The disease progressed with mediastinal, orbital and abdominal metastasis. The patient eventually died. CONCLUSION: PPB is a rare chest tumor seen in young children that can present with diverse radiological findings, and sometimes can arise in congenital cystic lung lesions. CT is the gold standard technique both for diagnosis and follow-up of these tumors.

Blastoma pleuropulmonar en niños: manifestaciones clínicas y radiológicas / Pleuropulmonary blastoma in children: imaging findings and clinical patterns

Objetivos. Describir los hallazgos por imagen del blastoma pleuropulmonar (BPP) en niños, así como su presentación clínica y evolución. Material y métodos. Estudio retrospectivo de tres pacientes consecutivos con confirmación anatomopatológica de BPP, recogidos entre 1992 y 2006 en un hospital de referencia pediátrico. Se analizan los hallazgos en la radiografía (Rx) de tórax, la tomografía computarizada (TC) y la resonancia magnética (RM). Resultados. Un paciente presentó en la Rx de tórax dos masas pulmonares sólidas bilaterales bien delimitadas, que en la TC se mostraban hipocaptantes y homogéneas. Tras tratamiento quimioterápico y cirugía, el paciente permanece libre de enfermedad. El segundo paciente comenzó con neumotórax a tensión derecho. Tras el drenaje del mismo se observó en la Rx de tórax y en la TC la presencia de una lesión multiquística subyacente. Posterior a la cirugía y al tratamiento quimioterápico presentó dos metástasis pulmonares que fueron tratadas con quimioterapia (QT) y cirugía. Actualmente está libre de enfermedad. El tercer caso presentó una opacificación completa del hemitórax izquierdo por derrame pleural masivo y masa sólida pleuropulmonar vista en la ecografía, la TC y la RM. La enfermedad progresó con extensión al mediastino, la órbita y el abdomen, y el paciente falleció. Conclusiones. El BPP es un tumor pulmonar infrecuente que se da en niños, con manifestaciones radiológicas diversas, que en ocasiones se asocia a una patología pulmonar quística congénita. La TC es la técnica de elección (patrón oro) tanto para el diagnóstico como para el seguimiento de estos tumores

Purpose. To describe the imaging findings, clinical presentation and follow up of pleuropulmonary blastoma (PPB) in children. Materials and methods. Authors present a retrospective review of three young children with pathologically proven PPB seen from 1992 to 2006 in a pediatric hospital. The imaging findings on simple views, CT and MRI are presented. Results. The first patient showed two bilateral well-defined solid lung lesions on chest X-rays, with homogeneous low attenuation on CT. Patient is free of disease followingchemotherapy and surgical treatment. The second patient displayed a right tension pneumothorax. After drainage, he presented on chest X-rays and CT an underlying multicystic lesion. Following chemotherapy andsurgical treatment, he presented two pulmonay metastases,which were treated with chemotherapy and surgery. The patient is now free of disease. The third patient showed a complete opacification of the left hemithorax due to a massive pleural effusion; a pleuropulmonary solid mass was seen on US, CT and MRI. The disease progressed with mediastinal, orbital and abdominal metastasis. The patient eventually died. Conclusion. PPB is a rare chest tumor seen in young children that can present with diverse radiological findings, and sometimes can arise in congenital cystic lung lesions. CT is the gold standard technique both for diagnosis and follow-up of these tumors (AU)

[Primary pulmonary actinomycosis: the experience in a general hospital]. / Actinomicosis pulmonar primaria: experiencia en un hospital general.

Although all Actinomyces species are capable of producing primary pulmonary pathology, actinomycosis is a rare entity which is infrequently diagnosed. The clinician's lack of knowledge of the disease is frequently blamed for this, and it is estimated that its incidence in our environment is greater than suspected. We present our experience consisting of four cases of primary pulmonary actinomycosis (PPA) diagnosed at La Paz Hospital from 1974 to 1988. Its particular characteristics are emphasized as well as the need to include it in the differential diagnosis of chronic pulmonary infiltrations, cavitated lesions or pulmonary masses.