Coexistence of idiopathic intracranial hypertension and optic disc drusen in a latin american patient: case report.

Optic nerve drusen are acellular concretions of calcium located in the parenchyma of the optical nerve head described as the most common cause of pseudo-papilloedema, which makes it difficult to differentiate from a true optical disc oedema. Despite it being rare, the drusen of the optic nerve and the papilloedema secondary to idiopathic intracranial hypertension can coexist in the same patient. The case is presented of a 34 year-old woman referred to the Ophthalmology Department with visual discomfort, headaches, and pulsatile tinnitus of two months onset. In the physical examination there was bilateral blurring of the optic disc margin with absence of spontaneous venous pulsation. The diagnosis of idiopathic intracranial hypertension was made by lumbar puncture with the measurement of the opening pressure, and due to the findings of the magnetic resonance scan of the brain and the eye sockets. The optic nerve drusen was an incidental finding in an optical coherence tomography angiography, which would later be confirmed with an eye ultrasound. To our knowledge, this the first case reported in Latin America of the coexistence of optic nerve drusen and papilloedema secondary to idiopathic intracranial hypertension.

Coexistencia de hipertensión intracraneal idiopática y drusas del nervio óptico en una paciente latinoamericana: reporte de caso / Coexistence of idiopathic intracranial hypertension and optic disc drusen in a latin american patient: case report

Las drusas del nervio óptico son concreciones acelulares de calcio localizadas en el parénquima de la cabeza del nervio óptico, descritas como la causa más frecuente de pseudopapiledema, lo cual las hace difícil de diferenciar de un verdadero edema del disco óptico. A pesar de su poca frecuencia, las drusas del nervio óptico y el papiledema secundario a una hipertensión intracraneal idiopática pueden coexistir en el mismo paciente. Reportamos el caso de una mujer de 34 años de vida remitida al servicio de oftalmología con molestias visuales, cefalea, y tinnitus pulsátil de dos meses de evolución; al examen físico se encontró borramiento del margen del disco óptico de manera bilateral sin pulsación venosa espontánea. El diagnóstico de hipertensión intracraneal idiopática se realizó por una punción lumbar con medición de la presión de apertura, y por los hallazgos de resonancia magnética cerebral y de órbitas. Se observó incidentalmente las drusas del nervio óptico en una tomografía de coherencia óptica con angiografía, que luego se confirmarían con una ecografía ocular. Este es el primer caso reportado en América Latina de la coexistencia de drusas del nervio óptico y papiledema secundario a hipertensión intracraneal idiopática para nuestro conocimiento (AU)

Optic nerve drusen are acellular concretions of calcium located in the parenchyma of the optic nerve head described as the most common cause of pseudo-papilloedema, which makes it difficult to differentiate from a true optical disc oedema. Despite it being rare optic nerve drusen and the papilloedema secondary to idiopathic intracranial hypertension can coexist in the same patient. We present a case of a 34-year-old woman referred to the Ophthalmology Department with visual discomfort, headaches, and pulsatile tinnitus of two months onset. In the physical examination there was bilateral blurring of the optic disc margin with absence of spontaneous venous pulsation. The diagnosis of idiopathic intracranial hypertension was made by lumbar puncture with the measurement of the opening pressure, and due to the findings of the magnetic resonance scan of the brain and orbits. The optic nerve drusen was an incidental finding in an optical coherence tomography angiography, which would later be confirmed with an eye ultrasound. To our knowledge, this the first case reported in Latin America of the coexistence of optic nerve drusen and papilloedema secondary to idiopathic intracranial hypertension (AU)

Síndrome de Susac completo en un hombre de 22 años en Colombia: a propósito de un caso y revisión de la literatura / Complete Susac syndrome in a 22-year old male in Colombia: Case report and a review of the literatura

Presentamos el caso de un joven de 22 años con 4 meses de cefalea, hipoacusia y disminución de la visión izquierdos. Su madre refirió además cambios del comportamiento y del estado de ánimo. La resonancia magnética cerebral mostró múltiples lesiones hiperintensas en la rodilla del cuerpo calloso. La audiometría documentó una hipoacusia neurosensorial. En la oftalmoscopia se observó un infarto retiniano de la capa de fibras nerviosas en el ojo izquierdo, el cual fue confirmado con una tomografía de coherencia óptica; la angiografía fluoresceínica mostró múltiples focos de hiperfluorescencia de la pared de las arteriolas, defectos del llenado de las arteriolas, y regiones focales de isquemia de la coroides. Estos hallazgos confirman el diagnóstico presuntivo de un síndrome de Susac. Este es uno de los pocos casos publicados en la literatura de un síndrome de Susac en un hombre joven con la tríada diagnóstica completa, y el primero en Colombia

We report the case of a 22 year-old male with a clinical picture of 4 months onset of headaches, deafness, and a decrease of vision in the left eye. His mother mentioned he also had changes in behaviour and mood. The magnetic resonance scan of the brain showed multiple hyper-intense lesions in the knee of the corpus callosum. The hearing test reported a neurosensory deafness. In the ophthalmoscopy, a retinal infarction was observed in the nerve fibre layer in the left eye, which was confirmed using optical coherence tomography. The fluorescein angiography showed multiple foci of hyperfluorescence of the arteriole walls, arteriole filling defects, and regional ischaemia foci of the choroid. These findings confirmed the presumed diagnosis of a Susac syndrome. This is one of the few cases reported in the literature of a Susac syndrome in a young man with the complete diagnostic triad, and the first in Colombia

Complete Susac syndrome in a 22-year old male in Colombia: Case report and a review of the literature. / Síndrome de Susac completo en un hombre de 22 años en Colombia: a propósito de un caso y revisión de la literatura.

We report the case of a 22 year-old male with a clinical picture of 4 months onset of headaches, deafness, and a decrease of vision in the left eye. His mother mentioned he also had changes in behaviour and mood. The magnetic resonance scan of the brain showed multiple hyper-intense lesions in the knee of the corpus callosum. The hearing test reported a neurosensory deafness. In the ophthalmoscopy, a retinal infarction was observed in the nerve fibre layer in the left eye, which was confirmed using optical coherence tomography. The fluorescein angiography showed multiple foci of hyperfluorescence of the arteriole walls, arteriole filling defects, and regional ischaemia foci of the choroid. These findings confirmed the presumed diagnosis of a Susac syndrome. This is one of the few cases reported in the literature of a Susac syndrome in a young man with the complete diagnostic triad, and the first in Colombia.

Novel Classes of Antibacterial Drugs in Clinical Development, a Hope in a Post-antibiotic Era.

Bacterial resistance is a growing problem worldwide and is estimated that deaths by infectious diseases associated with resistant pathogens will generate 10 million deaths per year in 2050. This problem becomes more serious due to the low level of research and development of new drugs, which has fallen drastically in the last 40 years. For example, in the last decade of a total of 293 new drugs approved by the FDA, only 9 corresponded to antimicrobial drugs and none constituted a new structural class. The majority of the molecules in the clinical phase II or III, coming from modifications of drugs in clinical use, this strategy makes easier the bacterial susceptibility to generate resistance through the mechanisms expressed for their drug predecessors. Under this scenario, it is urgent to generate the most novel strategies for the development of antibacterial compounds with new targets or mechanism of action, without a structural relationship with the antibiotic drugs predecessors. Under this look, the present review addresses the development of the latest antibacterial drugs in clinical phases II and III, analyzing the design strategies by which these new molecules were obtained and the structure-activity relationship of these new families of antibiotics, in order to define the state of the vanguard antibacterial drugs in the post-antibiotic era.

Gold nanoparticles stabilized with ßcyclodextrin-2-amino-4-(4-chlorophenyl)thiazole complex: A novel system for drug transport.

While 2-amino-4-(4-chlorophenyl)thiazole (AT) drug and thiazole derivatives have several biological applications, these compounds present some drawbacks, such as low aqueous solubility and instability. A new complex of ßCD-AT has been synthesized to increase AT solubility and has been used as a substrate for the deposit of solid-state AuNPs via magnetron sputtering, thus forming the ßCD-AT-AuNPs ternary system, which is stable in solution. Complex formation has been confirmed through powder X-ray diffraction and 1D and 2D nuclear magnetic resonance. Importantly, the amine and sulfide groups of AT remained exposed and can interact with the surfaces of the AuNPs. The complex association constant (970 M-1) has been determined using phase solubility analysis. AuNPs formation (32 nm average diameter) has been studied by UV-Visible spectroscopy, transmission/scanning electron microscopy and energy-dispersive X-ray analysis. The in vitro permeability assays show that effective permeability of AT increased using ßCD. In contrast, the ternary system did not have the capacity to diffuse through the membrane. Nevertheless, the antibacterial assays have demonstrated that AT is transferred from ßCD-AT-AuNPs, being available to exert its antibacterial activity. In conclusion, this novel ßCD-AT-AuNPs ternary system is a promising alternative to improve the delivery of AT drugs in therapy.

Comparison of Transpulmonary Thermodilution and Calibrated Pulse Contour Analysis with Pulmonary Artery Thermodilution Cardiac Output Measurements in Anesthetized Dogs.

BACKGROUND: Transpulmonary thermodilution (TPTDCO ) and calibrated pulse contour analysis (PCACO ) are alternatives to pulmonary artery thermodilution cardiac output (PATDCO ) measurement. HYPOTHESIS: Ten mL of ice-cold thermal indicator (TI10 ) would improve the agreement and trending ability between TPTDCO and PATDCO compared to 5 mL of indicator (TI5 ) (Phase-1). The agreement and TA between PCACO and PATDCO would be poor during changes in systemic vascular resistance (SVR) (Phase-2). ANIMALS: Eight clinically normal dogs (20.8-31.5 kg). METHODS: Prospective, experimental study. Simultaneous TPTDCO and PATDCO (averaged from 3 repetitions) using TI5 and TI10 were obtained during isoflurane anesthesia combined or not with remifentanil or dobutamine (Phase-1). Triplicate PCACO and PATDCO measurements were recorded during phenylephrine-induced vasoconstriction and nitroprusside-induced vasodilation (Phase-2). RESULTS: Mean bias (limits of agreement: LOA) (L/min), percentage bias (PB), and percentage error (PE) were 0.62 (-0.11 to 1.35), 16%, and 19% for TI5 ; and 0.33 (-0.25 to 0.91), 9%, and 16% for TI10 . Mean bias (LOA), PB, and PE were 0.22 (-0.63 to 1.07), 6%, and 23% during phenylephrine; and 2.12 (0.70-3.55), 43%, and 29% during nitroprusside. Mean angular bias (radial LOA) values were 2° (-10° to 14°) and -1° (-9° to 6°) for TI5 and TI10 , respectively (Phase-1), and 38° (5°-71°) (Phase-2). CONCLUSIONS AND CLINICAL IMPORTANCE: Although TI10 slightly improves the agreement and trending ability between TPTDCO and PATDCO in comparison to TI5 , both volumes can be used for TPTDCO in replacement of PATDCO . Vasodilation worsens the agreement between PCACO and PATDCO . Because of PCACO 's poor agreement and trending ability with PATDCO during SVR changes, this method has limited clinical application.

Uso de ketamina en el estatus epiléptico superrefractario en pediatría: reporte de un caso / Ketamine use in the super refractory status epilepticus in pediatrics: a case report

INTRODUCCIÓN: El estatus epiléptico superrefractario se define como convulsiones de 24 horas o más posterior al uso de anestésicos generales. Se presenta el siguiente caso con el fin de discutir el uso de anticonvulsivantes y la importancia del manejo multidisciplinario. PRESENTACIÓN DEL CASO: Escolar masculino de 8 años con antecedentes mórbidos de epilepsiades de los 2 meses en tratamiento con ácido valproico, lamotrigina y clobazam por recurrencia de crisis hipotónicas. Se hospitaliza por crisis atónicas frecuentes y compromiso de conciencia, se inicia levetiracetam y se retira lamotrigina. Electroencefalograma (EEG) muestra actividad epileptiforme muy frecuente sin variación ingresándose a unidad cuidados intensivos para administración de metilprednisolona por 5 días y manejo del estatus epiléptico superrefractario con midazolam en infusión continúa. Nuevo EEG severamente patológico compatible con status epiléptico eléctrico generalizado por lo que se induce coma barbitúrico con diferentes esquemas de tiopental y ketamina con persistencia del patrón de estallido supresión. Tras lo cual se modifica esquema a propofol y topiramato manteniendo antiepilépticos de base. A los 2 días de uso, se suspende propofol por mala respuesta, tras lo cual presenta 2 crisis convulsivas iniciándose fenobarbital. Evoluciona deforma favorable, sin crisis epilépticas clínicas, por lo que se decide alta con ácido valproico, levetiracetam, fenobarbital y topiramato. DISCUSIÓN: La tórpida evolución del caso expuesto y la necesidad de múltiples esquemas farmacológicos dejan en evidencia la necesidad de disponer y conocer el modo de uso de un amplio arsenal de fármacos anticonvulsivantes

INTRODUCTION: Super-refractory status epilepticus is defined as a 24 hours or more lasting seizure after the use of anaesthetics. The following case is shown in order to discuss the use of anticonvulsants and the importance of multidisciplinary management. CASE REPORT: 8 year old male with morbid history of epilepsy since 2 months old treated with valproic acid, lamotrigine and clobazam for recurrent hypotonic crisis. Is hospitalized for frequent atonicseizures and impaired consciousness, levetiracetam is initiated and lamotrigine removed. Electroencephalogram (EEG) shows persistent very frequent epileptiform activity. Patient is admitted to the intensive care unit for administration of methylprednisolone for 5 days and management with continuous infusion of midazolam for the super-refractory status epilepticus. New severely abnormal EEG compatible with generalized electrical status epilepticus deciding to induce a barbiturate coma with different schemes of ketamine and thiopental. Because of persistent suppression burst patter whereupon scheme is changed to propofol and topiramte maintaining chronic antiepileptic. After 2 days of use, propofol is suspended for poor response, after which the patient presents 2 seizures beginning the use of phenobarbital. He evolved favourably, without clinical seizures, so it is decided hospital discharge with valproic acid, levetiracetam, phenobarbital and topiramate. DISCUSSION: The torpid case exposed and the lack for multiple drug regimens are evidence of the need of having a wide arsenal of anticonvulsant drugs and how to use them

The atypical cannabinoid O-1602 stimulates food intake and adiposity in rats.

AIMS: Cannabinoids are known to control energy homeostasis. Atypical cannabinoids produce pharmacological effects via unidentified targets. We sought to investigate whether the atypical cannabinoid O-1602 controls food intake and body weight. METHODS: The rats were injected acutely or subchronically with O-1602, and the expression of several factors involved in adipocyte metabolism was assessed by real-time polymerase chain reaction. In vivo findings were corroborated with in vitro studies incubating 3T3-L1 adipocytes with O-1602, and measuring intracellular calcium and lipid accumulation. Finally, as some reports suggest that O-1602 is an agonist of the putative cannabinoid receptor GPR55, we tested it in mice lacking GPR55. RESULTS: Central and peripheral administration of O-1602 acutely stimulates food intake, and chronically increases adiposity. The hyperphagic action of O-1602 is mediated by the downregulation of mRNA and protein levels of the anorexigenic neuropeptide cocaine- and amphetamine-regulated transcript. The effects on fat mass are independent of food intake, and involve a decrease in the expression of lipolytic enzymes such as hormone sensitive lipase and adipose triglyceride lipase in white adipose tissue. Consistently, in vitro data showed that O-1602 increased the levels of intracellular calcium and lipid accumulation in adipocytes. Finally, we injected O-1602 in GPR55 -/- mice and found that O-1602 was able to induce feeding behaviour in GPR55-deficient mice. CONCLUSIONS: These findings show that O-1602 modulates food intake and adiposity independently of GPR55 receptor. Thus atypical cannabinoids may represent a novel class of molecules involved in energy balance.

Intento de suicidio vía ingesta de fármacos en niños / Suicide attempts secondary to self-inflicted drug poisoning

Suicide attempts in children are an important worldwide cause of morbidity and mortality and an emerging reason for admission in Pediatric Critical Care. Objective: Identify the epidemiologic and clinical characteristics of patients with drug poisoning with a suicide purpose as an admission cause in a Chilean Pediatric Intensive Care Unit (PICU). Design: Retrospective observational study. Setting: 14 beds PICU of a tertiary care public teaching hospital in Santiago de Chile. Material and Method: All patients admitted to the PICU between January 2005 and December 2008 for self-inflicted drug poisoning with an expressed intention of suicide were included. Analysis of the PICU clinical chart was performed with sampling on an excel data base. For seasonal distribution we used statistical analysis Xil. Results: 178 of 3045 PICU admissions were diagnosed as drug poisoning (5,8 percent), 108 of them for suicide attempts (60,6 percent).The number of annual patients increased, with highest incidence in spring and autumn and lowest in winter. Mean and median age was 13 years, 8,4 percent less than 12 years. 88,9 percent were females. They used polipharmacy in 57 percent. Drugs were taken from home. Antidepressants and sedatives were the most often used. An underlying psychiatric condition was present in 100 cases (92,6 percent). Associated factors were family disfunction, school problems, abuse and violation and bullying. Mean PICU stay was 1,46 days with 16,7 percent requiring transient mechanical ventilation No death was reported in this serie. Conclusions: The number of cases of suicide attempt via drug ingestion as a motive for admission in PICU is increasing, causing a raising number of short and transient admissions, more in spring less in winter. Risk factors were mostly an underlying psychiatric disorder and family disfunction.

Introducción: El intento de suicidio en pediatría, via ingestión de fármacos, es una importante causa de mor-bimortalidad en el mundo y un creciente motivo de ingreso a cuidados intensivos. Objetivo: Identificar las características clínicas y epidemiológicas de los pacientes con intoxicación por fármacos con un intento de suicidio, como causa de ingreso a una Unidad de Cuidados Intensivos Pediátricos en Chile (UC1P). Diseño: Estudio retrospectivo observacional. Pacientes y Método: UClP de 14 camas críticas en un hospital pediátrico de Santiago. Se incluyeron todos los pacientes ingresados a la UClP debido a intento de suicidio por ingestión de fármacos, entre enero 2005 a diciembre 2008. Resultados: 178 de 3 045 egresos se debieron a intoxicación por fármacos (5,8 por ciento) ,108 de ellos por intento de suicidio (60,6 por ciento). La tendencia observada es a un incremento anual, con mayor incidencia en primavera y otoño, y menor en invierno. La media y mediana de edad fue de 13 años, 8,4 por ciento menor de 12 años. 88,9 por ciento fueron mujeres, Se utilizó polifarmacia en un 57 por ciento con fármacos disponibles en el hogar. Antidepresivos y sedantes fueron los más usados. Patología psiquiátrica de base se diagnosticó en un 92,6 por ciento de los casos. Factores asociados fueron disfunción familiar, problemas en el colegio, abuso y violación, bullying. La estadía promedio en UClP fue de 1,5 días, requiriendo un 16,7 por ciento ventilación mecánica transitoria. No hubo fallecidos en esta serie. Conclusiones: El intento de suicidio por ingestión de fármacos como motivo de ingreso a UClP ha aumentado, requiriendo estadías cortas y transitorias, mayormente en primavera y menos en invierno. Factores asociados fueron patología psiquiátrica de base y disfunción familiar.

Allergic contact dermatitis to manganese in a prosthodontist with orthodontics

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Fasciolasis hepática: enfermedad con múltiples presentaciones / Hepatic fascioliasis: a disease with multiple presentations

Human Fascioliasis is a zoonosis produced by the liver fluke fasciola. Its diagnosisrequires a high index of suspicion because of the polymorphism in its presentation. However, treatment with triclabendazole is highly effective. We report three cases that, in spite off presenting with diverse clinical severity, all had good response to treatment. Patient 1 presented with nonspecific recurrent abdominal pain with a normal CT scan of abdomen. Patient 2 presented with an abdominal CT scan showing multiple hepatic nodules. Patient 3 with an asymptomatic liver tumor requiring a comprehensive and expensive evaluation. All had eosinophilia and all responded to triclabendazole therapy without adverse effects.

La fasciolasis humana es una zoonosis producida por el trematodo fasciola hepática. Su diagnóstico requiere un alto índice de sospecha dado el polimorfismo en su presentación. Pese a esto, el tratamiento con triclabendazol es muy efectivo. Se reportan tres casos clínicos que, pese a presentar muy distinta clínica y gravedad, todos tuvieron buena respuesta al tratamiento con Triclabendazol. El paciente 1 se presentó con dolor abdominal inespecífico y recurrente, sin compromiso del estado general con tomografía de abdomen normal. La paciente 2 presentó dolor abdominal intenso, baja de peso y gran compromiso del estado general que requirió hospitalización, con tomografía de abdomen que mostró lesiones nodulares hepáticas. La paciente 3 se presentó como hallazgo de tumor hepático asintomático que requirió amplio estudio y grandes costos. Todos presentaron eosinofilia y todos respondieron a terapia con triclabendazol sin efectos adversos.

The major antennal chemosensory protein of red imported fire ant workers.

Some chemosensory proteins (CSPs) are expressed in insect sensory appendages and are thought to be involved in chemical signalling by ants. We identified 14 unique CSP sequences in expressed sequence tag (EST) libraries of the red imported fire ant, Solenopsis invicta. One member of this group (Si-CSP1) is highly expressed in worker antennae, suggesting an olfactory function. A shotgun proteomic analysis of antennal proteins confirmed the high level of Si-CSP1 expression, and also showed expression of another CSP and two odorant-binding proteins (OBPs). We cloned and expressed the coding sequence for Si-CSP1. We used cyclodextrins as solubilizers to investigate ligand binding. Fire ant cuticular lipids strongly inhibited Si-CSP1 binding to the fluorescent dye N-phenyl-naphthylamine, suggesting cuticular substances are ligands for Si-CSP1. Analysis of the cuticular lipids showed that the endogenous ligands of Si-CSP1 are not cuticular hydrocarbons.

Cambios en la articulación de la palabra en pacientes con oclusión clase III o mordida abierta anterior sometidos a cirugía ortognática / Changes in speech articulation in class III occlusion patients undergoing orthognathic surgery

La presenta investigación analizó los cambios en la articulación de la palabra (AP), los niveles de estridencia y sibilancia en pacientes con maloclusiones clase III o mordida abierta anterior sometidos a cirugía ortognática, con el fin de aportar e integrar conocimientos a la profesión odontológica en el manejo integral y multidisciplinario de dichas alteraciones. La muestra incluyó diciséis pacientes (doce mujeres y cuatro hombres), doce de ellos fueron atendidos en la Unidad de Cirugía Maxilofacial y Estomatología del Hospital Universitario San Vicente de Paul, Medellín (Colombia) y los cuatro restantes fueron seleccionados en la consulta privada durante el período entre marzo y diciembre de 2001. La edad osciló entre los 16 y 37 años de edad, con un promedio de 23,8 años. Se incluyeron pacientes con clase III o mordida abierta anterior que fueron sometidos a procedimientos de cirugía ortognática. Para la evaluación de la AP se utilizó un software Sound Forge 5.0 de propiedad y licencia de la Emisora Cultural de la Universidad de Antioquia, en la búsqueda de cambios en la articulación de diversos fonemas que implican pronunciación dentoalveolar. Los resultados sugieren que luego de la corrección quirúrgica se obtiene un cambio positivo en la articulación de la palabra para la mayoría de los pacientes.

Miocardiopatía hipertrófica asociada a embarazo / Hypertrophic cardiomyopathy associated to pregnancy

La miocardiopatía hipertrófica es una rara condición, a veces familiar, que puede complicarse con síncope, arritmias auriculares o ventriculares y episodios de falla cardiaca. Hay pocas experiencias publicadas con relación a miocardiopatía hipertrófica y embarazo. Si bien los informes sugieren que es una patología bien tolerada, esta puede desarrollar una insuficiencia cardiaca congestiva e incluso la muerte materna. El pronóstico fetal en la mayoría de los casos no es afectado. En aquellas con síntomas de obstrucción del flujo, la segunda etapa del parto debería ser acortada con el uso de fórceps. El parto vaginal ha mostrado ser seguro y la cesárea debe restringirse a las indicaciones obstétricas habituales. Se informa el manejo obstétrico, cardiológico y perinatal de una embarazada portadora de esta patología.

Papel de los calcio-antagonistas en el control de ventos vaso-oculsivos y hemolíticos en drepanocitosis: estudio piloto con nitrendipina / Paper of the calcium-antagonists in the control of events occlusives and hemoliticos in sickle cell disease: study pilot with nitrendipin

Recientemente se inició el estudio de fármacos capaces de inhibir la pérdida de agua y K+ del glóbulo rojo dependiente de Ca++, mediante el bloqueo del canal de gardos, como medida terapéutica para evitar el fenómeno de falciformación. Nuestro estudio intenta establecer el rol de la nitrendipina en el control de las manifestaciones clínicas y paraclínicas en drepanocitosis. Se realizó un estudio clínico controlado con placebo, randomizado, bajo protocolo simple ciego, de grupo en paralelo, con dos niveles de dosis, de 10 semanas de duración. Se incluyeron 26 pacientes (16 mujeres y 10 hombres) aleatoreamente distribuidos en tres grupos para recibir placebo o nitrendipina a 20 mg/día o nitrendipina a 30 mg/día. En ambos grupos de tratamiento con nitrendipina se apreció una tendencia hacia una menor frecuencia de eventos vaso-oclusivos con una menor proporción de pacientes afectados, pero sin lograr una diferencia estadísticamente significativa en las medias de evento por paciente, ni de intensidad medida en cada grupo. La nitrendipina logró una reducción significativa en el porcentaje de reticulocitos y en los niveles de bilirrubina indirecta basales en ambos niveles de dosis con respecto al placebo (comparación intergrupo e intragrupo: p<0.005). El resto de los parámentros no se modificaron. La droga fue bien tolerada. La nitrendipina redujo algunos marcadores de hemólisis (porcentaje de reticulocitos y BI). El verdadero potencial terapéutico de este agente debe ser confirmado en nuevos protocolos clínicos controlados

A new method to evaluate plume characteristics of hydrofluoroalkane and chlorofluorocarbon metered dose inhalers.

Two concerns raised when comparing metered dose inhalers (MDIs) to other inhalation devices are their relatively high throat deposition and the 'cold-Freon' effect seen in a small number of patients. The cold-Freon effect is presumed to be a result of the cold, forceful MDI plume impacting on the back of a patient's throat. This in vitro study uses a new plume characterization method to determine the spray force and plume temperature of various MDIs. Spray force measurements were made for 28 marketed products consisting of bronchodilators, steroids, press-and-breathe, breath-actuated and nasal inhalers. Results show that chlorofluorocarbon (CFC)-containing MDIs produce extremely forceful and cold plumes. Several hydrofluoralkane (HFA)-containing MDIs produced much softer and warmer plumes, but two HFA products had spray forces similar to the CFC products. Although the type of propellant used can affect spray force, actuator orifice diameter is the most important factor. Data obtained from marketed products and experimental inhalers show that MDIs that have a low spray force also have low throat deposition.