Spatiotemporal hierarchical Bayesian analysis to identify factors associated with COVID-19 in suburban areas in Colombia.

Introduction: The pandemic had a profound impact on the provision of health services in Cúcuta, Colombia where the neighbourhood-level risk of Covid-19 has not been investigated. Identifying the sociodemographic and environmental risk factors of Covid-19 in large cities is key to better estimate its morbidity risk and support health strategies targeting specific suburban areas. This study aims to identify the risk factors associated with the risk of Covid-19 in Cúcuta considering inter -spatial and temporal variations of the disease in the city's neighbourhoods between 2020 and 2022. Methods: Age-adjusted rate of Covid-19 were calculated in each Cúcuta neighbourhood and each quarter between 2020 and 2022. A hierarchical spatial Bayesian model was used to estimate the risk of Covid-19 adjusting for socioenvironmental factors per neighbourhood across the study period. Two spatiotemporal specifications were compared (a nonparametric temporal trend; with and without space-time interaction). The posterior mean of the spatial and spatiotemporal effects was used to map the Covid-19 risk. Results: There were 65,949 Covid-19 cases in the study period with a varying standardized Covid-19 rate that peaked in October-December 2020 and April-June 2021. Both models identified an association of the poverty and stringency indexes, education level and PM10 with Covid-19 although the best fit model with a space-time interaction estimated a strong association with the number of high-traffic roads only. The highest risk of Covid-19 was found in neighbourhoods in west, central, and east Cúcuta. Conclusions: The number of high-traffic roads is the most important risk factor of Covid-19 infection in Cucuta. This indicator of mobility and connectivity overrules other socioenvironmental factors when Bayesian models include a space-time interaction. Bayesian spatial models are important tools to identify significant determinants of Covid-19 and identifying at-risk neighbourhoods in large cities. Further research is needed to establish causal links between these factors and Covid-19.

Butyrate supplementation in the liquid diet of dairy calves leads to a rapid recovery from diarrhea and reduces its occurrence and relapses in the preweaning period.

The present study aimed to evaluate the effect of continuous butyrate administration in dairy calves' liquid diet considering diarrhea, metabolic profile, gastrointestinal development, and corporal growth. Immediately after birth, calves were randomly allocated into 2 groups of 62 calves (50 females and 12 males), with access to water and a solid feed ad libitum. The butyrate group (BG) received 4 g/d of sodium butyrate (Admix Easy, Adisseo) diluted in the whole milk, and the control group (CG) received whole milk with no supplementation. Sodium butyrate was administered from d 1 of life until the weaning at 90 d. Feces consistency was assessed daily for the first 30 d of life and characterized by scores from 0 to 4 (0 and 1 for normal, and 2, 3, and 4 for abnormal feces). Diarrhea was diagnosed when the animals had abnormal feces and fever. Morbidity, recurrence, mortality, and lethality data were recorded and compared between the groups. Average daily gain (ADG) and corporal growth (body weight, thoracic perimeter, height at the withers, and croup width) were evaluated weekly, from the first day to d 30, and later at 45, 60, and 90 d of life. Blood samples were taken weekly for up to 30 d to determine the circulating levels of total calcium, phosphorus, chloride, bicarbonate, glucose, ß-hydroxybutyrate, and nonesterified fatty acids. The males were euthanized at 15 (n = 6 per group) and 30 d (n = 6 per group) for morphometric, histological, and gene expression analysis of the gastrointestinal tract. The results showed that the BG had a lower rate of morbidity (BG = 30% vs. CG = 50%) and recurrence (BG = 26.7% vs. CG = 60%) of diarrhea than the CG. In addition, the BG had abnormal feces for a shorter period (BG = 4.64 ± 0.47 d vs. CG = 8.6 ± 0.65 d). The ADG tended to be higher in BG than CG up to 30 and 60 d. Metabolic evaluations showed the lowest levels of glucose and highest levels of nonesterified fatty acids in BG. On d 30 of life, rumen papillae length, papilla area, duodenum villus length, and crypt depth were higher in BG than in CG. The duodenal gene expression at 30 d showed that animals with diarrhea episodes that did not receive butyrate had the highest levels of transcripts for the LCT and GLP2 genes. In addition, in different ways, both butyrate and neonatal diarrhea affected the gene expression of IGF1, SLC5A1, and AQP3. These results allow us to conclude that continuous supplementation with sodium butyrate improves gastrointestinal development, reduces the occurrence of diarrhea, and makes clinical conditions milder with faster recovery, favoring a higher ADG in the first 30 and 60 d of life. Based on these results, we conclude that sodium butyrate can be indicated for liquid diet supplementation to accelerate gastrointestinal tract development and prevent severe cases of neonatal diarrhea, tending to improve average daily gain until weaning.

Caracterización epidemiológica: análisis de tasa de mortalidad e índice de swaroop para peritonitis en el periodo 2017- 2021, en Chile / Epidemiological characterization: peritonitis mortality rate and swaroop Index in the period 2017 - 2021, in Chile

Introducción: La peritonitis alcanza una mortalidad global de hasta un 60%. Dada la falta de estudios epidemiológicos nacionales, se plantea calcular la tasa de mortalidad (TM) por peritonitis entre los años 2017-2021 en Chile. Metodología: Estudio descriptivo, ecológico, sobre defunciones por peritonitis entre los años 2017-2021 en Chile (N=1.741), en población mayor de 15 años según grupo etario, sexo y región con datos obtenidos del departamento de estadística e información en salud. Se utilizó estadística descriptiva, cálculo de TM e índice de Swaroop (IS). No requirió aprobación por comité de ética. Resultados: Se calculó una TM de 2,47/100.000 habitantes entre los años 2017 y 2021, siendo el año 2020 la mayor con 3,07. El sexo femenino presentó una tasa de 2,65. El grupo etario con mayor TM es el de 80 y más con 141,7/100.000 habitantes. Para el IS por región, lideran las regiones XV y XII con 100%, siendo la más baja la XI con 83,3%. Discusión: El pico de TM para el año 2020 coincide con la pandemia por Covid-19, donde se reporta mayor mortalidad postoperatoria en pacientes infectados. El IS se mantiene mayor al 90% en el país, excepto en las Regiones X y XI, probablemente debido a la menor disponibilidad de centros de alta complejidad. Conclusión: Dada la ausencia de datos recientes de mortalidad para peritonitis, se realizó una actualización epidemiológica local, con perspectiva comparativa regional respecto a las TM de la población general y en mayores de 50 años.

Introduction: Peritonitis reaches an overall mortality of up to 60%. Given the lack of national epidemiological studies, it is proposed to calculate the mortality rate (MR) due to peritonitis between the years 2017-2021 in Chile. Methodology: Descriptive, ecological study about deaths by peritonitis between 2017 and 2021 in Chile (N=1,741), in a population older than 15 years old according to age group, sex, and region with data obtained from Departamento de Estadística e Información en Salud. Descriptive statistics were used, MR calculation, and Swaroop Index (SI). It did not require approval by an ethics committee. Results: A MR of 2.47/100,000 was calculated between the years 2017 and 2021, with 2020 being the highest with 3.07. The female sex presented a rate of 2.65. The age group with the highest MR is 80 and over with 141.7/100,000. For the SI by region, the XV and XII regions lead with 100%, the lowest being XI region with 83.3%. Discussion: The peak of MR for the year 2020 coincides with the Covid-19 pandemic and the highest postoperative mortality in infected patients. The SI remains above 90% in the country, except in X and XI regions, probably due to the lower availability of high complexity centers. Conclusion: Given the lack of recent mortality data for peritonitis, a local epidemiological update was carried out, with a regional comparative perspective regarding MR in the general population and in those over 50 years old.

pH del agua potable que consumen estudiantes del segundo año de la Carrera de Medicina, Universidad Mayor de San Andrés Gestión 2017 / pH of drinking water that second year students of medicine of the Universidad Mayor de San Andres consume term 2017

INTRODUCCIÓN: El pH es una propiedad básica del agua potable y cuyos valores extremos pueden originar reacciones secundarias dañinas, entendiéndose por agua potable aquel que puede ser consumido sin restricción para el consumo humano, OBJETIVO: Determinar el valor del pH de agua potable que consumen los estudiantes de segundo año de la carrera de medicina de la Universidad Mayor de San Andrés (UMSA). MATERIAL Y MÉTODOS: Se analizaron 388 muestras de agua potable del domicilio de estudiantes regulares de segundo año cátedra de bioquímica entre los meses de julio y agosto del 2017, realizándose un estudio de tipo descriptivo con un enfoque transeccional. RESULTADOS: Se obtuvieron los siguientes resultados, 1) la media del pH total fue de 7,24; con x=7,22 en la ciudad de la Paz y x=7,28 en la ciudad de el Alto. 2) en cuanto al sistema de potabilización se obtuvo: x=7,34 en la planta el Alto, x=7,21 en la planta de Tilata, x=7,15 en la planta de Achachicala y de x=7,20 en la planta de Pampahasi. CONCLUSIONES: El pH del agua potable consumida se encontró dentro de parámetros establecidos con un valor medio de 7,24.

INTRODUCTION: The pH is a basic property of potable water and whose extreme values may cause harmful secondary reactions. It is understood that potable water can be consumed without any restriction by human beings. OBJECTIVE: To determine the pH value of potable water consumed by medicine students of second year at UMSA university. MATERIAL AND METHODS: 388 samples of potable water were analyzed which were taken from the homes of the second year students of the biochemistry department between July and August 2017, developing a descriptive study with a cross-sectional approach. RESULTS: The following results were obtained: 1) the average of the pH was 7.24; with x = 7.22 in La Paz city and x = 7.29 in El Alto city. 2) in relation to the drinking water was obtained: x=7.34 in El Alto plant, x=7.21 in Tilata plant, x=7.16 in Achachicala plant and x=7.21 in Pampahasi plant. CONCLUSION: The pH of the drinking water drunk is established within parameters with an average value of 7.24.

Cuantificación sistematizada de la remodelación vascular in vitro en la morbilidad gestacional asociada al síndrome antifosfolípido / Systematic quantification of in vitro vascular remodeling in the pregnancy morbidity associated with antiphospholipid syndrome

Antecedentes: El síndrome antifosfolípido (SAF) se caracteriza por manifestaciones clínicas de trombosis o morbilidad gestacional y la presencia de anticuerpos antifosfolípidos (aAFL), que se pueden unir al trofoblasto o al endotelio materno, alterando la placentación normal. Objetivo: Evaluar el efecto del suero de mujeres con SAF en un modelo tridimensional de remodelación vascular in vitro. Métodos: Cuantificación sistematizada con el programa Image J y el complemento Angiogenesis Analyzer de la interacción de trofoblasto y endotelio en un modelo tridimensional de remodelación vascular y detección por ELISA del factor de crecimiento del endotelio vascular (VEGF). Se incluyeron 25 mujeres: con morbilidad gestacional y trombosis vascular (MG/TV, n=7) y con morbilidad gestacional únicamente (MG, n=8), ambos grupos con presencia de aAFL; con morbilidad gestacional sin aAFL (MG/aFL-, n=10), y un grupo control de mujeres sanas (SHN, n=7). Resultados: El suero de mujeres con morbilidad gestacional, MG/aAFL-, MG y MG/TV indujo disminución de la angiogénesis endotelial, pero en trofoblasto, únicamente el suero de los dos grupos de mujeres con aAFL tuvo este mismo efecto en concordancia con la reducción del VEGF. El suero de mujeres con MG/aAFL- y MG/TV redujo elementos angiogénicos en el co-cutivo de trofoblasto y endotelio, comparado con el grupo control de SHN. En contraste con el grupo de MG/aAFL-, el suero de mujeres con aAFL, redujo la angiogénesis en células trofoblásticas y endoteliales. Conclusión: El efecto anti-angiogénico de los aAFL se observó focalizado en trofoblasto y el suero del grupo de mujeres con MG/TV indujo mayores efectos deletéreos.

Background: Antiphospholipid syndrome (APS) is characterized by manifestations of thrombosis or pregnancy morbidity and antiphospholipid antibodies (aAPL) which can bind to trophoblast or to maternal endothelium, altering normal placentation. Aims: To evaluate the effect of sera from patients with APS on a three-dimensional in vitro model of vascular remodeling. Methods: Systematic quantification of the interaction between trophoblast and endothelium with the software Image J and the plug-in Angiogenesis Analyzer in a three-dimensional model of vascular remodeling and the detection of vascular endothelial growth factor (VEGF) by ELISA. 25 women divided in three groups were included as follows: with pregnancy morbidity and thrombosis (PM/VT, n=7), pregnancy morbidity (PM, n=8), both groups with aAPL; pregnancy morbidity without aAPL (PM/aAPL-, n=10) and healthy women was used as control (NHS, n=7). Results: Sera from women with gestational morbidity: PM/VT, PM, PM/aAPL-, decreased endothelial angiogenesis, but on trophoblast, only the sera of two groups of women with aAPL had this effect along with reduction of VEGF. Sera from women with PM/aAPL- and PM/VT reduced angiogenesis in the co-culture of trophoblast and endotelial cells compared to NHS. In contrast to PM/aAPL-, sera from women with APS decreased angiogenesis in trophoblastic cells. Conclusions: The anti-angiognic effect of aAPL was focused on trophoblast and sera from PM/VT induced higher deleterious effects.

Epigenética: definición, bases moleculares e implicaciones en la salud y en la evolución humana / Epigenetics: definition, molecular bases and implications in human health and evolution / Epigenética: definição, bases moleculares e implicações na saúde e na evolução humana

La Epigenética se refiere a los cambios heredables en el ADN e histonas que no implican altera ciones en la secuencia de nucleótidos y modifican la estructura y condensación de la cromatina por lo que afectan la expresión génica y el fenotipo. Las modificaciones epigenéticas son metilación del ADN y modificaciones de histonas. Objetivo: hacer una revisión de la literatura sobre e concepto de epigenética y su impacto en la salud. Materiales y métodos: se realizó una revisión de la bibliografía sobre el concepto de epigenética, sus bases biológicas, el impacto sobre la salud y la enfermedad y su relación con la evolución. Resultados: los mecanismos epigenéticos ha cobrado cada vez más importancia debido a la creciente asociación con enfermedades compleja y comunes, así como por su impacto en la salud de generaciones futuras y en la evolución humana. Conclusiones: la Epigenética tiene un claro impacto en la salud del individuo, en la de su descendencia y en la evolución de la especie humana.

Epigenetics refers to inheritable changes in DNA and histones that do not involve changes in the sequence of nucleotides and that modifies structure and chromatin condensation, thus affecting gene expression and phenotype. Epigenetic modifications are DNA methylation and histone modifications. Objective: A review of the literature on the concept of Epigenetics and its impact on health. Materials and methods: A review of the literature was performed on the concept of epigenetics, its biological basis, the impact on health and disease and its relation to evolution. Results: Epigenetic mechanisms have become increasingly important because of the growing association with common complex diseases as well as its impact on health of future generations and in human evolution. Conclusions: Epigenetics has a clear impact on the health of individuals in their offspring and with the evolution of the human species.

A Epigenética refere-se às mudanças hereditárias no ADN e histonas que não implicam alterações nas sequencia de nucleotídeos e modificam a estrutura e condensação da cromatina, pelo que afetam a expressão gênica e o fenótipo. As modificações epigenéticas são metilação do ADN e modificações de histonas. Objetivo: fazer uma revisão da literatura sobre o conceito de epigenética e seu impacto na saúde. Materiais e métodos: realizou-se uma revisão da bibliografia sobre o conceito de epigenética, suas bases biológicas, o impacto sobre a saúde e a doença e sua relação com a evolução. Resultados: os mecanismos epigenéticos têm adquirido cada vez mais importância devido à crescente associação com doenças complexas e comunes, assim como por seu impacto na saúde de gerações futuras e na evolução humana. Conclusões: a Epigenética tem um impacto evidente na saúde do individuo, na sua descendência e na evolução da espécie humana.

Score de Alvarado: utilidad diagnóstica en el paciente pediátrico / Alvarado Score: diagnostic use in the pediatric patient

La apendicitis aguda constituye la primera causa de abdomen agudo quirúrgico en la etapa preescolar y escolar, y su diagnóstico temprano es un reto para los cirujanos pediatras. El Score de Alvarado, descrito en 1995, es un método sencillo que toma en cuenta parámetros clínicos y de laboratorio, con la finalidad de realizar un diagnóstico temprano de apendicitis aguda. Se incluyeron en el estudio una muestra al azar de 117 pacientes, 63 varones y 54 hembras, con edades comprendidas entre 1 y 12 años, y con clínica sospechosa o evidente de apendicitis aguda. De los 81 pacientes operados, 78 (96.29 por ciento) presentaron Score de Alavarado mayor o igual a 6 puntos, mientras que en los 36 pacientes que no fueron intervenidos quirúrgicamente, ninguno obtuvo Score Alvarado mayor o igual a 7 puntos. Concluimos que este método demostró tener gran utilidad, ya que un Score de 5 puntos o menos descarta el diagnóstico a apendicitis, mientras que un score de 7 o más tiene el 100 por ciento de efectividad, confirmada con histología. Paciente con 5 ó 6 puntos que no tenga modificación del Score tras 12 horas de observación descarta el diagnóstico

Medicina nuclear en el estudio de patología nefrourológica pediátrica / Nuclear medicine in the study of nephrourologic pediatric pathology

Los procedimientos centigráficos permiten el estudio funcional de patologías renales y urológicas, complementando otros estudios por imágenes, tanto en el diagnóstico como seguimiento postratamiento médico o quirúrgico. En este artículo se revisan las principales indicaciones y ventajas de cada uno de los exámenes cintigráficos susceptibles de ser usados en pacientes pediátricos.

[Perinatal factors associated with attention deficit/hyperactivity diagnosis in Colombian Paisa children]. / Factores perinatales asociados con la aparición del trastorno por deficiencia de atención en niños de la comunidad colombiana 'paisa'.

INTRODUCTION: Some perinatal factors have been associated with attention d ficit/hyperactivity disorder (ADHD). OBJECTIVE: To estimate the association between perinatal factor and ADHD diagnosis in school, aged 6 to 11 years, children from Medell n city (Colombia). PATIENTS AND METHODS: A randomized sample of 200 cases, 6 to 11 year old, with standardized ADHD diagnosis was selected. A randomized sample of 200 control children, 6 to 11 year old, was selected from a data base of 70 schools of Medell n city. The same diagnostic protocol was administered to controls. A questionnaire with questions about pregnancy, delivery an neonatal period was given to the mothers. Data were analyzed using cross tabulation and stepwise logistic multiple regression analyses. RESULTS: Miscarriage symptoms, premature delivery symptoms, severe flu attacks (cold with fever, without virus confirmation), tobacco abuse, alcohol abuse (to become drunk), minor congenital malformations, neonatal seizures and hospitalizations during newborn period were factors associated with ADHD diagnosis (p< 0.05). However, stepwise logistic multiple regression analysis selected a block of variables formed by premature delivery symptoms, severe flu attacks and neonatal seizures as significant perinatal risk factors (p< 0.01) for ADHD diagnosis.

Factores perinatales asociados con la aparición del trastorno por deficiencia de atención en niños de la comunidad colombiana 'paisa' / Perinatal factors associated with attention deficit/hyperactivity diagnosis in colombian 'paisa' children

Introducción. Se ha informado de que hay factores perinatales asociados con la aparición del trastorno por deficiencia de atención (TDA) en los niños escolares. Objetivo. Estimar la asociación entre factores perinatales con el diagnóstico de TDA en escolares de 6 a 11 años de la ciudad de Medellín (Colombia). Pacientes y métodos. Se seleccionó una muestra aleatoria de 200 casos, de 6 a 11 años, con diagnóstico comprobado de TDA, con la utilización de un patrón estándar. Se obtuvo una muestra aleatoria de 200 controles, de la misma edad, elegidos de una base de datos de 70 colegios públicos y privados de la ciudad de Medellín, a los que se les aplicó el mismo patrón estándar de diagnóstico. Se realizó a las madres de los niños una encuesta sobre los antecedentes del embarazo, el parto y el período neonatal. Los datos se analizaron mediante tablas de contingencia y análisis de regresión logística. Resultados. Los análisis de las tablas de contingencia mostraron que la amenaza de aborto, la amenaza de parto prematuro, los cuadros respiratorios agudos febriles con incapacidad, el tabaquismo, el consumo de alcohol con embriaguez, la presencia de malformaciones menores, las convulsiones neonatales y las hospitalizaciones durante el primer mes, se asociaron con el diagnóstico de TDA (p< 0,05). Sin embargo, el análisis de regresión logística sólo seleccionó un bloque formado por la amenaza de parto prematuro, los cuadros respiratorios agudos febriles con incapacidad y las convulsiones neonatales como los factores perinatales de riesgo significativos para el diagnóstico de TDAH (p< 0,01), aun después de la corrección por género (AU)

Introduction. Some perinatal factors have been associated with attention déficit/hyperactivity disorder (ADHD). Objective. To estimate the association between perinatal factor and ADHD diagnosis in school, aged 6 to 11 years, children from Medellín city (Colombia). Patients and methods. A randomized sample of 200 cases, 6- to 11-year old, with standardized ADHD diagnosis was selected. A randomized sample of 200 control children, 6- to 11-year old, was selected from a data base of 70 schools of Medellín city. The same diagnostic protocol was administered to controls. A questionnaire with questions about pregnancy, delivery an neonatal period was given to the mothers. Data were analyzed using cross tabulation and stepwise logistic multiple regression analyses. Results. Miscarriage symptoms, premature delivery symptoms, severe flu attacks (cold with fever, without virus confirmation), tobacco abuse, alcohol abuse (to become drunk), minor congenital malformations, neonatal seizures and hospitalizations during newborn period were factors associated with ADHD diagnosis (p< 0.05). However, stepwise logistic multiple regression analysis selected a block of variables formed by premature delivery symptoms, severe flu attacks and neonatal seizures as significant perinatal risk factors (p< 0.01) for ADHD diagnosis (AU)

Sexual harassment: a concern for the athletic trainer.

OBJECTIVE: Sexual harassment is a vital social issue that affects the business community, educational institutions, and personnel in the U.S. military. Addressing sexual harassment in the athletic training clinical setting is an important issue for the athletic training professional. Athletic trainers need to understand the complex definitions of sexual harassment and how to identify and handle claims of sexual harassment in order to prevent sexual harassment from occurring and to prevent civil lawsuits of alleged sexual harassment. BACKGROUND: Professional journals, legal textbooks, policy handbooks, unpublished findings from the NATA Women in Athletic Training Committee report, and current news media sources were used to gain a greater understanding of this social problem. DESCRIPTION: To make the athletic trainer aware of this important social issue and to offer suggestions for the athletic training staff to aid in preventing problems of sexual harassment. CLINICAL ADVANTAGES: This article provides definitions and examples of sexual harassment, discussion of policy development, and suggestions for ways to eliminate sexual harassment in the athletic training environment.

Okadaic acid regulation of the retinoblastoma gene product is correlated with the inhibition of growth factor-induced cell proliferation in mouse fibroblasts.

Okadaic acid, a specific inhibitor of protein phosphatases 1 and 2A, was used to study the mechanism of action of transforming growth factor beta (TGF-beta) on cell cycle progression in C3H/10T1/2 mouse embryonic fibroblasts, where TGF-beta exerts a growth-stimulatory effect. Concentrations of okadaic acid as low as 5 nM inhibited TGF-beta (5 ng/ml)- or 10% serum-induced [3H]thymidine incorporation into postconfluent, quiescent cells. Further, these inhibitory effects were observed when okadaic acid was added as late as 10 hr after TGF-beta or serum stimulation. Since C3H/10T1/2 fibroblasts undergo the G1/S transition at 10-14 hr after TGF-beta and 8-12 hr after serum stimulation, these observations indicate that a phosphatase activity may be required for S-phase entry. In a parallel experiment, okadaic acid partially inhibited TGF-beta-induced [14C]leucine incorporation by 20-65%, depending upon the okadaic acid concentration. In conjunction with the effect of okadaic acid on DNA and protein synthesis, Western blot analysis indicated that okadaic acid inhibited phosphorylation of the retinoblastoma gene product and decreased its protein level, even when added 10 hr after TGF-beta or 8 hr after serum stimulation. These findings strongly suggest that protein phosphatases play a pivotal role for S-phase entry in mouse fibroblasts. Moreover, protein phosphatases may be required in the intermediate steps of TGF-beta or serum growth factor signal-transduction pathways for the stimulation of phosphorylation of the retinoblastoma protein, especially in late G1.

Clinical experience with ciprofloxacin.

In a multicenter study of 32 patients treated with ciprofloxacin (mean daily dosage, 1,000 mg per day; mean duration of treatment, 9.5 days) for a variety of infections, eight were microbiologically proved. Of these, bacteriologic cure and/or improvement resulted in all cases. For all 32 infections, clinical cure and/or improvement resulted. Four infections were classified as chronic. There were 3/32 (9.4 per cent) adverse reactions (ADRs), and one case each of nausea, dizziness and increased menstrual flow. Only the dizziness and nausea were considered related definitely to ciprofloxacin therapy. Therapy with ciprofloxacin was discontinued in all three patients because of adverse effects.

Study on the influence of NA-872 (ambroxol) and dexamethasone on the differentiation of Clara cells in albino mice.

The techniques of light and electron microscopy were used to study the sequence of changes in the fine structure of the developing nonciliated bronchiolar cells in the last quarter of gestation in the mouse, and up to the 3rd postnatal day. Control animals were compared with two groups that received either dexamethasone or ambroxol. At the beginning of the study no identifiable Clara cells were seen in any group, and phenotypically differentiated cells were seen until 1 day post partum in every group examined. Dexamethasone appears to increase the glycogen deposition found in the cells, reaching its maximum 1 day prior to delivery. Ambroxol induced an earlier development of the secretory organelles, beginning on day 17 of gestation. In the differentiated cells more secretory dense granules were found in this group; and at the 3rd day post partum a great accumulation of secretory product that filled large areas of cytoplasm was seen only in the ambroxol-treated group. The significance of these finding is discussed.