Time to pregnancy and perinatal outcomes in a cohort of spontaneous pregnancies.

BACKGROUND: Obstetric and perinatal outcomes depend not only on care during pregnancy, as there is an increasing evidence of their relationship with preexisting conditions. Woman's age and time to pregnancy (TTP) have been related to the prognosis in reproductive success, but TTP could influence fetal well-being and newborn. According to the World Health Organization, 48 million couples have subfertility globally. METHODS: We analyzed the relationship between TTP and obstetric (premature labor, preeclampsia…), labor (type of delivery, postpartum hemorrhage…), and neonatal outcomes (low birth weight…) in a cohort of 190 spontaneous gestations. Subfertility is a disease defined by the failure to achieve a pregnancy after 12 months of regular unprotected sexual intercourse. RESULTS: TTP was >12 months in 23.1 % (95 % CI = 17.57-29.55), however, no correlation was found with the perinatal outcomes (p = 0.24). We observed that 45.2 % of subfertile women had obstetric complications, 13.2 % labor complications, and 34.2 % neonatal complications, whereas non-subfertile women had 29.4 %, 21.0 %, and 21.0 %, respectively. Half of pregnancies have at least one adverse outcome, and obstetric complications were the most frequent. CONCLUSION: Subfertility condition may appear in up to a fifth of our couples. Subfertility may behave as a mild risk factor for adverse perinatal outcomes. Obstetric or perinatal complication may be expected in up to half of the cases. Subfertile women ≥ 35 years of age have a 3-fold increase in their risk of having an obstetric complication when compared to non-subfertile women of the same age.

Eculizumab, a successful treatment for atypical postpartum hemolytic-uremic syndrome: a case report / Eculizumab, un tratamiento exitoso en el síndrome hemolítico-urémico atípico puerperal: un caso clínico

Atypical hemolytic-uremic syndrome (aHUS) is a rare entity characterized by the association of acute kidney failure, thrombocytopenia and microangiopathic hemolytic anemia due to the dysregulation of the alternative pathway of the complement system. It is included within the thrombotic microangiopathies. The following aHUS was developed in the immediate puerperium in the context of severe preeclampsia. The patient was a primiparous woman of 30+1 weeks who required hospitalization for anticonvulsant and hypotensive treatment, and who underwent an emergency cesarean section due to a pathological cardiotocographic pattern. 36 hours after delivery, the patient presented with sudden dyspnea and cognitive deterioration, progressing in a few hours to renal and multiorgan failure. Blood test showed severe anemia, thrombopenia and hypertransaminemia. In view of the fast evolution and severity, it was decided to treat with Eculizumab, although the scientific evidence was very poor. Aside from the supportive treatment performed in the Intensive Care Unit, the patient was successfully treated with Eculizumab, with favorable evolution over the following months and restoration of kidney function, although need for chronic hypotensive treatment remained.

El síndrome hemolítico-urémico atípico (SHUa) es una entidad rara caracterizada por la asociación de insuficiencia renal aguda, trombocitopenia y anemia hemolítica microangiopática debido a la desregulación de la vía alternativa del sistema del complemento. Se incluye dentro de las microangiopatías trombóticas. Se presenta un SHUa que se desarrolló en el puerperio inmediato en el contexto de una preeclampsia grave. La paciente era una primípara de 30+1 semanas que requirió hospitalización para tratamiento anticonvulsivo e hipotensor, y a la que se le practicó una cesárea de urgencia por un patrón cardiotocográfico patológico. A las 36 horas del parto, la paciente presentó una disnea súbita y un deterioro cognitivo progresivo, que evolucionó en pocas horas a un fallo renal agudo y multiorgánico. La analítica mostró anemia severa, trombopenia e hipertransaminemia. Ante la rápida evolución y gravedad, se decidió tratar con Eculizumab, aunque la evidencia científica era escasa. Aparte del tratamiento de soporte realizado en la Unidad de Cuidados Intensivos, la paciente fue tratada con éxito con Eculizumab, con evolución favorable en los meses siguientes y restablecimiento de la función renal, aunque se mantuvo la necesidad de tratamiento hipotensor crónico.

Influence of social determinants on fertility: a critical review.

PURPOSE OF REVIEW: Intrinsic factors, such as age, weight and lifestyle habits, together with extrinsic factors, such as socioeconomic level, must be considered when it comes to reproductive healthcare. Over the last few years, studies that attempt to respond to the participation and interaction of these factors in subfertility have been published; however, some questions remain unanswered. RECENT FINDINGS: Although there are little modifiable factors for women, it is possible to influence other factors, such as behavioural or cultural factors in order to minimize fertility problems; however, they are often highly influenced by each other. SUMMARY: Advanced age, obesity, sedentary lifestyle, alcohol, tobacco and other compounds, have a clearly negative effect and may extend time-to-pregnancy, although the responsible mechanisms and the magnitude of the detriment that they produce in the reproductive health are yet to be studied. Economic context and new environmental factors are a current challenge for reproductive health too.

Laryngeal Thermal Injury Model.

A lack of reliable laryngeal thermal injury models precludes laryngeal burn wound healing studies and investigation of novel therapeutics. We hypothesize that a swine laryngeal burn model can allow for laryngeal burn evaluation over time. Twelve Yorkshire crossbreed swine underwent tracheostomy and endoscopically directed laryngeal burns using heated air (150-160°C). Swine larynges were evaluated and sectioned/stained at 12 hours, 1, 3, 7, 14, and 21 days. A board-certified veterinary pathologist assessed anatomic regions (left and right: epiglottis, true/false vocal folds, and subglottis) using a nine criteria histological injury scoring scale. Six swine were euthanized at scheduled endpoints, three prematurely (airway concerns), and three succumbed to airway complications after 16 to 36 hours. Endoscopic and gross examination from scheduled endpoints revealed massive supraglottic edema and tissue damage, particularly around the arytenoids, extending transglottically. Swine from premature endpoints had comparatively increased edema throughout. Microscopic evaluation documented an inverse relationship between injury severity score and time from injury. Inflammation severity decreased over time, nearly resolving by 14 days. Neutrophils predominated early with histiocytes appearing at 3 days. Granulation tissue appeared at 3 days, and early epiglottic and/or subglottic fibrosis appeared by 7 days and matured by 14 days. Edema, abundant initially, decreased by day 3 and resolved by day 7. This approach is the first to provide longitudinal analysis of laryngeal thermal injuries, reflecting some of the first temporal wound healing characteristic data in laryngeal thermal injuries and providing a platform for future therapeutic studies.

Observational Study of the Social Determinants of Health in Subfertile versus Nonsubfertile Women.

CONTEXT: Subfertility affects about 15% of couples worldwide. There are several factors that affect subfertility called social determinants of health (SDH): biological factors as age, ethnic origin, and body mass index; behavioral factors as alcohol intake, smoking, coffee, dietary restriction, physical activity, and psychological state; and contextual factors as education, work activity, and income level. AIMS: The aim of the study is to evaluate the distribution's relevance of the SDH in subfertile women versus nonsubfertile women. SETTINGS AND DESIGN: A prospective comparative study with two groups of women recruited over 1 year at hospital consultation: one group with subfertile women excluding women without a male partner or with a previous child and another one formed by primigravidae, excluding those receiving assisted reproduction techniques to become pregnant. SUBJECTS AND METHODS: We compare the different factors between subfertile and nonsubfertile women one by one. Second, a multivariate analysis was conducted with logistic regression. In all cases, informed consent was obtained. RESULTS: Regular physical exercise 3-4 times/week (odds ratio [OR]: 0.33, 95% confidence interval [CI]: 0.15-0.71) or healthy food products such as fish 1-2 times/week (OR: 0.40, 95% CI: 0.17-0.95) were associated with nonsubfertile women. CONCLUSIONS: The distribution of SDH in natural fertility is not altogether homogeneous. Weight control by means of restricting calorie intake, greater consumption of healthy foods such as fish, regular physical exercise, and lower age are positively associated with fertility. Population-level intervention is possible to improve women's health, as these are modifiable factors. Ethnic origin can be considered as a relevant factor, as it may condition the distribution of other determinants.

Evaluation of Volume of Intramuscular Injection into the Caudal Thigh Muscles of Female and Male BALB/c Mice (Mus musculus).

This study presents recommendations for intramuscular injection into the caudal thigh muscle of mice according to analysis of in vivo imaging of intramuscularly injected iohexol, a radiocontrast agent commonly used in CT imaging. An experienced laboratory animal technician using a Hamilton syringe intramuscularly injected iohexol into isoflurane-anesthetized female and male BALB/c mice. Injected volumes (25, 50, 100, and 200 µL) underwent CT scanning at 9 time points over a 3-h period. The distribution of the injectate in the muscles of the rear leg was examined over time for each volume group. Results indicated that 25- and 50-µL volumes remain intramuscularly. At 100 µL, mild to moderate leakage into the extramuscular tissues occurred. At 200 µL, leakage into the extramuscular tissues was moderate to severe. Our results suggest volumes of 50 µL or less are recommended for the caudal thigh muscles of mice when intramuscular pharmacokinetics are needed; volumes greater than 50 µL display variable distribution into extramuscular tissues, thus potentially yielding different pharmacokinetic profiles.

Comparison of Saliva Collection Methods for the Determination of Salivary Cortisol Levels in Rhesus Macaques (Macaca mulatta), Cynomolgus Macaques (Macaca fascicularis), and African Green Monkeys (Chlorocebus aethiops).

The ability to quickly and accurately determine cortisol as a biomarker for stress is a valuable tool in assessing the wellbeing of NHP. In this study, 2 methods of collecting saliva (a commercial collection device and passive drool) and the resulting free salivary cortisol levels were compared with total serum cortisol concentration in rhesus macaques (Macaca mulatta), cynomolgus macaques (Macaca fascicularis) and African green monkeys (Chlorocebus aethiops) at 2 collection time points. Serum and salivary cortisol levels were determined using a competitive quantitative ELISA. In addition, both saliva collection methods were evaluated for volume collected and ease of use. Compared with passive drool, the experimental collection device was more reliable in collecting sufficient volumes of saliva, and the resulting salivary cortisol values demonstrated stronger correlation with serum cortisol concentration in all species and collection days except cynomolgus macaques on day 1. This saliva collection device allows quick and reliable sample collection for the determination of salivary cortisol levels. In addition, the results might provide a useful tool for evaluating hypothalamic-pituitary-adrenal axis activity or the physiologic stress reaction in NHP as well as a biomarker of psychologic stress states in a variety of situations.

Pharmacokinetics of 2 Formulations of Transdermal Fentanyl in Cynomolgus Macaques (Macaca fascicularis).

Fentanyl is a µ-opioid agonist that often is used as the analgesic component for balanced anesthesia in both human and veterinary patients. Minimal information has been published regarding appropriate dosing, and the pharmacokinetics of fentanyl are unknown in NHP. The pharmacokinetic properties of 2 transdermal fentanyl delivery methods, a solution (2.6 and 1.95 mg/kg) and a patch (25 µg/h), were determined when applied topically to the dorsal scapular area of cynomolgus macaques (Macaca fascicularis). Serum fentanyl concentrations were analyzed by using liquid chromatography-mass spectrometry. Compared with the patch, the transdermal fentanyl solution generated higher drug concentrations over longer time. Adverse reactions occurred in the macaques that received the transdermal fentanyl solution at 2.6 mg/kg. Both preparations showed significant interanimal variability in the maximal serum drug levels, time to achieve maximal fentanyl levels, elimination half-life, and AUC values. Both the maximal concentration and the time at which this concentration occurred were increased in macaques compared with most other species after application of the transdermal fentanyl patch and compared with dogs after application of the transdermal fentanyl solution. The pharmacokinetic properties of transdermal fentanyl in macaques are markedly different from those in other veterinary species and preclude its use as a long-acting analgesic drug in NHP.

Measurement of fecal corticosterone metabolites as a predictor of the habituation of rhesus macaques (Macaca mulatta) to jacketing.

Jacket use in NHP is a common practice and is often considered a form of refinement during experiments necessitating extended periods of catheterization. An important consideration when using jackets is the physiologic effects that jacketing has on NHP and its potential to confound research. Several studies have evaluated the stress response and habituation of NHP to various forms of restraint, but none have looked directly at the timeframe necessary for the habituation of rhesus macaques (Macaca mulatta) to jackets. We set out to determine whether 3 d was a sufficient timeframe for this species to become habituated to a jacket, with or without an undershirt, by evaluating 2 major physiologic parameters. After jacket placement, we measured food consumption and collected fecal samples to measure fecal corticosterone metabolites (FCM) daily for 2 wk. FCM measurements for NHP without undershirts were significantly increased for days 2 and 3 after jacketing before returning to baseline levels. FCM measurements for NHP with undershirts were significantly increased for only 1 d after jacketing, suggesting that the undershirt has a positive effect on jacket habituation. There were no measurable differences in food consumption during the jacket habituation period. Furthermore, no significant differences were noted between sexes. These findings suggest that FCM levels return to baseline 3 d after jacketing and could be a useful predictor of jacket habituation in rhesus macaques.

Evaluation of the use of primate undershirts as a refinement practice for jacketed rhesus macaques (Macaca mulatta).

Jacketing of nonhuman primates (NHP) is a commonly used practice in the laboratory animal setting to support data collection with reduced direct human-to-animal interaction. NHP often wear jackets for several weeks, potentially leading to the formation of dermal lesions ranging from mild alopecia to severe full-thickness ulceration. We sought to evaluate the addition of a commercially available undershirt for primates as a possible refinement practice for our jacketed rhesus macaques. In this study, we compared the lesion count, location, and severity and differences in rectal body temperature between jacketed NHP with undershirts with those wearing the jackets alone. In both groups, most lesions (75%) were located at either the underarm or shoulder. The percentages of total lesions in the back and neck were lower in jacketed NHP that wore undershirts than in those that did not. In addition, the estimated odds of increased severity scores in jacketed NHP without undershirts was 1.80 times that for NHP that wore both jackets and undershirts. Both groups of NHP showed a significant decrease in dermal scores with time, indicating adaptation to the jackets with or without undershirts. However, there was no statistically significant decrease in lesion count, severity, or location in jacketed NHP that wore undershirts compared with those that did not.

Leiomioma con extensión intracardiaca que condiciona insuficiencia cardiaca aguda: Reporte de caso / Leiomyoma with intracardiac extensión leading to acute heart failure: (case report)

Son raros los casos de leiomiomas intravenosos con extensión intracardiaca. En pacientes con manifestaciones de sobrecarga de cavidades derechas o quienes debutan con síntomas de insuficiencia cardiaca aguda y cuyos síntomas no mejoran con el manejo convencional, se debe considerar esta entidad, y es importante evaluar de forma integral con estudios de gabinete como electrocardiograma, ecocardiograma, tomografía o resonancia magnética. Reportamos el caso de una mujer de 46 años que manifiesta síntomas de insuficiencia cardiaca aguda e inadecuada respuesta a los fármacos convencionales. Con hallazgos ecocardiográficos de tumoración en atrio derecho que protruye a ventrículo derecho y causa insuficiencia tricuspídea. Por estudio tomográfico se confirma la extensión del tumor a vena cava inferior y ventrículo derecho; se resuelve de forma quirúrgica con resección radical y se confirma la extirpación histológica mediante estudio anatomopatológico.

Cases of intravenous leiomyoma with intracardiac extension are rare. Patients with signs of right-sided overload who present symptoms of acute heart failure and whose symptoms do not improve with conventional management, we must consider this entity. It is important to comprehensively assess with imaging studies such as electrocardiogram, echocardiogram, Tomography (CT scan) or magnetic resonance. The following is a report of the case of a 46 year old woman with symptoms of acute heart failure and inadequate response to conventional drugs. The echocardiographic show findings of a tumor in the right atrium, protruding to the right ventricle causing tricuspid regurgitation. The CT scan confirmed the extent of the tumor to the inferior vena cava and right ventricle, and was resolved surgically with radical resection and histology lineage confirmed by pathologic examination.

[Risk of venous thromboembolic disease in general surgery]. / Riesgo de la enfermedad tromboembólica venosa en cirugía general.

Despite preventive efforts, venous thromboembolic disease (VTED) is still a major problem for surgeons due to its frequency and the morbidity, mortality and enormous resource consumption caused by this entity. However, the most important feature of VTED is that it is one of the most easily preventable complications and causes of death. To take appropriate prophylactic decisions (indication, method, initiation, duration, etc.), familiarity with the epidemiology of VTED in general surgery and some of its most significant populations (oncologic, laparoscopic, bariatric, ambulatory and short-stay) is essential. These factors must also be known to determine the distinct risk factors in these settings with a view to stratifying preoperative risk.

[Prevention of venous thromboembolic disease in general surgery]. / Prevención de la enfermedad tromboembólica venosa en cirugía general.

Postoperative venous thromboembolic disease (VTED) affects approximately one in four general surgery patients who do not receive preventive measures. In addition to the risk of pulmonary embolism, which is often fatal, patients with VTED may develop long-term complications such as post-thrombotic syndrome or chronic pulmonary hypertension. In addition, postoperative VTED is usually asymptomatic or produces clinical manifestations that are attributed to other processes and consequently this complication is often unnoticed by the surgeon who performed the procedure. Thus, the most effective strategy consists of effective prevention of VTED using the most appropriate prophylactic measures against the patient's thromboembolic risk. There is sufficient evidence that VTED can be prevented by pharmacological methods, especially heparin and its derivatives and with mechanical methods such as support tights or intermittent pneumatic compression of the lower extremities. To reduce the incidence of VTED as far as possible, strategies have been proposed that include a combination of drugs and mechanical methods, new antithrombotic drugs, or prolonging the duration of prophylaxis in patients at very high risk, such as those who have undergone surgery for cancer. Another important aspect is the optimal moment to initiate prophylaxis with anticoagulant drugs with the aim of achieving an adequate equilibrium between antithrombotic efficacy and the risk of hemorrhagic complications. The present article reviews the available evidence to attempt to optimize prevention of VTED in general surgery and in some special groups, such as laparoscopic surgery, short-stay surgery and obesity.

Riesgo de la enfermedad tromboembólica venosa en cirugía general / Risk of venous thromboembolic disease in general surgery

A pesar de los esfuerzos preventivos, la enfermedad tromboembólica venosa (ETV) todavía constituye un importante problema para los cirujanos, debido a su frecuencia, morbilidad, mortalidad y al enorme consumo de recursos que ocasiona. Pero lo verdaderamente importante es que potencialmente estamos ante una de las complicaciones y causas de muerte postoperatoria más fácilmente prevenibles. Para tomar correctas decisiones profilácticas (indicación, método, inicio, duración, etc.), es importante conocer la epidemiología de la ETV en la cirugía general y algunas de sus poblaciones más significativas (oncológica, laparoscópica, bariátrica, ambulatoria y de corta estancia), con el objetivo de conocer los diferentes factores de riesgo existentes en las mismas, con la finalidad última de realiza runa estratificación preoperatoria del riesgo. Este artículo hace una puesta al día de todos estos aspectos (AU)

Despite preventive efforts, venous thromboembolic disease (VTED) is still a major problem for surgeons due to its frequency and the morbidity, mortality and enormous resource consumption caused by this entity. However, the most important feature of VTED is that it is one of the most easily preventible complications and causes of death. To take appropriate prophylactic decisions (indication, method, initiation, duration, etc.), familiarity with the epidemiology of VTED in general surgery and some of its most significant populations (oncologic, laparoscopic, bariatric, ambulatory and short-stay) is essential. These factors must also be known to determine the distinct risk factors in these settings with a view to stratifying preoperative risk (AU)

Prevención de la enfermedad tromboembólica venosa en cirugía general / Prevention of venous thromboembolic disease in general surgery

La enfermedad tromboembólica venosa (ETV) postoperatoria constituye una complicación que afecta aproximadamente a 1 de cada 4 pacientes quirúrgicos generales intervenidos y que no reciben medidas para su prevención. Además del riesgo de embolismo pulmonar, fatal en muchos casos, los pacientes que sufren ETV están expuestos a desarrollar complicaciones a largo plazo, tales como síndrome postrombótico o hipertensión pulmonar crónica. Por otra parte, la ETV postoperatoria suele ser asintomática o producir manifestaciones clínicas que se atribuyen a otros procesos, por lo que muchas veces esta complicación pasa desapercibida para el cirujano que intervino al paciente. Así pues, la mejor estrategia consiste en una eficaz prevención de la ETV, utilizando para ello las medidas profilácticas adecuadas al nivel de riesgo tromboembólico del paciente. Existe suficiente evidencia de que la ETV se puede prevenir mediante métodos farmacológicos, entre los que destacan la heparina y sus derivados, y con métodos mecánicos como las medias elásticas o los sistemas de compresión neumática intermitente de los miembros inferiores. Con objeto de reducir en lo posible la incidencia de ETV postoperatoria, se han propuesto estrategias que incluyen la combinación de fármacos y métodos mecánicos, nuevos fármacos antitrombóticos, o prolongar la duración de la profilaxis en los casos de muy alto riesgo, como los operados por cáncer. Otro aspecto importante es el del momento óptimo de inicio de la profilaxis con los fármacos anticoagulantes, con objeto de conseguir un equilibrio adecuado entre la eficacia antitrombótica y el riesgo de presentación de complicaciones hemorrágicas. En este artículo revisamos la evidencia disponible para intentar optimizar en lo posible la prevención de la ETV en cirugía general y en algunos grupos especiales, como la cirugía laparoscópica, de corta estancia y de la obesidad (AU)

Postoperative venous thromboembolic disease (VTED) affects approximately one in four general surgery patients who do not receive preventive measures. In addition to the risk of pulmonary embolism, which is often fatal, patients with VTED may develop long-term complications such as post-thrombotic syndrome or chronic pulmonary hypertension. In addition, postoperative VTED is usually asymptomatic or produces clinical manifestations that are attributed to other processes and consequently this complication is often unnoticed by the surgeon who performed the procedure. Thus, the most effective strategy consists of effective prevention of VTED using the most appropriate prophylactic measures against the patient’s thromboembolic risk. There is sufficient evidence that VTED can be prevented by pharmacological methods, especially heparin and its derivatives and with mechanical methods such as support tights or intermittent pneumatic compression of the lower extremities. To reduce the incidence of VTED as far as possible, strategies have been proposed that include a combination of drugs and mechanical methods, new antithrombotic drugs, or prolonging the duration of prophylaxis in patients at very high risk, such as those who have undergone surgery for cancer. Another important aspect is the optimal moment to initiate prophylaxis with anticoagulant drugs with the aim of achieving an adequate equilibrium between antithrombotic efficacy and the risk of hemorrhagic complications. The present article reviews the available evidence to attempt to optimize prevention of VTED in general surgery and in some special groups, such as laparoscopic surgery, short-stay surgery and obesity (AU)

Hipertiroidismo transitorio secundario a hiperemesis gravídica / Transient hyperthyroidism associated with hyperemesis gravidarum

Las alteraciones de la función tiroidea durante la gestación son frecuentes debido a los cambios fisiológicos propios del embarazo. Uno de los trastornos es el llamado hipertiroidismo asociado a la hiperemesis gravídica de las primeras semanas de embarazo y normalmente autolimitado. Presentamos el caso de una gestante ingresada en nuestro servicio por hiperemesis gravídica de larga evolución y resistente a los tratamientos habituales, acompañada de síntomas y signos propios del hipertiroidismo, y en el cual fue muy difícil el diagnóstico diferencial con la enfermedad de Graves

Thyroid disorders during pregnancy are frequent due to significant changes in normal thyroid activity. One of these disorders is transient hyperthyroidism of hyperemesis gravidarum in the first few weeks of pregnancy, which is usually self-limiting. We present a case of longstanding and refractory hyperemesis gravidarum with manifestations of hyperthyroidism, posing a difficult differential diagnosis with Graves' disease (AU)

Effects of housing density on Long Evans and Fischer 344 rats.

At many breeding facilities, rats are housed at relatively high densities until they are 5 weeks old, at which point they are either shipped for research or rehoused at standard cage densities according to weight. The authors carried out a pilot study in Long Evans and in Fischer 344 rats to investigate whether continuing to house rats at high densities (24 in(2) floor space per rat) past the age of 5 weeks, through puberty and into adulthood would alter behavioral or physiological parameters compared with raising rats at standard densities (about 72 in(2) floor space per rat). After rats reached puberty, the authors rehoused them with unfamiliar cagemates. The researchers evaluated clinical and behavioral signs of stress, weight, blood glucose concentration, white blood cell count and serum corticosterone concentration. Overall, cage density had little effect on the parameters measured, though gender seemed to affect stress in Long Evans rats. The results suggest that rats of these strains can be raised at the higher densities tested until any age and regrouped with unfamiliar cagemates without compromising rats' welfare or subsequent experimental data.

Short-course postexposure antibiotic prophylaxis combined with vaccination protects against experimental inhalational anthrax.

Prevention of inhalational anthrax after Bacillus anthracis spore exposure requires a prolonged course of antibiotic prophylaxis. In response to the 2001 anthrax attack in the United States, approximately 10,000 people were offered 60 days of antibiotic prophylaxis to prevent inhalational anthrax, but adherence to this regimen was poor. We sought to determine whether a short course of antibiotic prophylaxis after exposure could protect non-human primates from a high-dose spore challenge if vaccination was combined with antibiotics. Two groups of 10 rhesus macaques were exposed to approximately 1,600 LD50 of spores by aerosol. Both groups were given ciprofloxacin by orogastric tube twice daily for 14 days, beginning 1-2 h after exposure. One group also received three doses of the licensed human anthrax vaccine (anthrax vaccine adsorbed) after exposure. In the ciprofloxacin-only group, four of nine monkeys (44%) survived the challenge. In contrast, all 10 monkeys that received 14 days of antibiotic plus anthrax vaccine adsorbed survived (P = 0.011). Thus postexposure vaccination enhanced the protection afforded by 14 days of antibiotic prophylaxis alone and completely protected animals against inhalational anthrax. These data provide evidence that postexposure vaccination can shorten the duration of antibiotic prophylaxis required to protect against inhalational anthrax and may impact public health management of a bioterrorism event.

Comparative study of lung cytologic features in normal rhesus (Macaca mulatta), cynomolgus (Macaca fasicularis), and African green (Chlorocebus aethiops) nonhuman primates by use of bronchoscopy.

Invasive bronchoscopy and bronchoaveolar lavage (BAL) fluid collection represents an important tool in studies of the respiratory system of nonhuman primates. Bronchoscopy and BAL fluid collection was performed on groups of rhesus (Macaca mulatta) and cynomolgus (Macaca fasicularis) macaques and African green monkeys (Chlorocebus aethiops), and the resulting comparative lavage cytologic features are described. Analysis of the BAL fluid did not reveal significant differences among species with respect to total cells recovered or differential cellular composition. This description of the method used to lavage the nonhuman primates and the resulting lung cytologic findings provide important comparative data for three species commonly used in biomedical research.