The Diethylcarbamazine Delays and Decreases the NETosis of Polymorphonuclear Cells of Humans with DM Type 2.

Type 2 diabetes mellitus (DM2) is a disease that reports high morbidity and mortality rates worldwide. Between its complications, one of the most important is the development of plantar ulcers. The role of the polymorphonuclear cells (PMNs) is affected by metabolic diseases like DM2. Fifteen years ago, reports about a new mechanism of innate immune response where PMNs generate some kind of webs with their chromatin were published. This mechanism was called NETosis. Also, some researchers have demonstrated that NETosis is responsible for the delay of the ulcer healing both in patients with DM2 and in animal models of DM2. Purified PMNs from healthy and DM2 human volunteers were incubated with diethylcarbamazine (DEC) and then induced to NETosis using phorbol 12-myristate 13-acetate (PMA). In a randomized blind study model, the NETosis was documented by confocal microscopy. On microphotographs, the area of each extracellular neutrophil trap (NET) formed at different times after stimuli with PMA was bounded, and the intensity of fluorescence (IF) from the chromatin dyed with 4',6-diamidino-2-phenylindole dihydrochloride (DAPI) was quantified. PMNs from healthy volunteers showed the development of NETs at expected times according to the literature. The same phenomenon was seen in cultures of PMNs from metabolically controlled DM2 volunteers. The use of DEC one hour before of the challenge with PMA delayed the NETosis in both groups. The semiquantitative morphometric analysis of the IF from DAPI, as a measure of PMN's capacity to forming NETs, is consistent with these results. The ANOVA test demonstrated that NETosis was lower and appeared later than expected time, both in PMNs from healthy (p ≤ 0.000001) and from DM2 (p ≤ 0.000477) volunteers. In conclusion, the DEC delays and decreases the NETosis by PMNs from healthy as well as DM2 people.

Randomized double-blind placebo-controlled trial of buccal misoprostol to reduce the need for additional uterotonic drugs during cesarean delivery.

OBJECTIVE: To determine whether buccal misoprostol during cesarean delivery in conjunction with active management of the third stage of labor reduces the need for additional uterotonic drugs. METHOD: A double-blind, randomized, placebo-controlled trial was performed in Monterrey, Mexico, between February 2008 and December 2013. Eligible women had risk factors for uterine atony and were to undergo cesarean delivery under epidural block. Using a computer-generated sequence and blocks of six, patients were randomly assigned to receive 400µg misoprostol or 800µg placebo buccally after cord clamping. Both groups received an intravenous oxytocin infusion. The primary outcome was the need for additional uterotonic drugs. Analyses were performed per protocol. Patients, investigators, and data analysts were masked to group assignment. RESULTS: A total of 120 women were included in analyses (60 in each group). At least one additional uterotonic drug was required in 24 (40%) women in the placebo group versus 6 (10%) women in the misoprostol group (relative risk 0.16; 95% confidence interval 0.06-0.44). No adverse effects due to misoprostol were recorded. CONCLUSION: Buccal misoprostol during cesarean delivery reduced the need for additional uterotonic drugs to treat uterine atony. ClinicalTrials.gov:NCT01733329.

Antimicrobial Effect of Lactobacillus reuteri on Cariogenic Bacteria Streptococcus gordonii, Streptococcus mutans, and Periodontal Diseases Actinomyces naeslundii and Tannerella forsythia.

Lactic acid bacteria (LAB) are well known for their beneficial effects on human health in the intestine and immune system; however, there are few studies on the impact they can generate in oral health. The aim of this study was to test and compare in vitro antimicrobial activity of L. reuteri on pathogenic bacteria involved in the formation of dental caries: S. mutans, S. gordonii, and periodontal disease: A. naeslundii and T. forsythia. Also, we determined the growth kinetics of each bacterium involved in this study. Before determining the antimicrobial action of L. reuteri on cariogenic bacteria and periodontal disease, the behavior and cell development time of each pathogenic bacterium were studied. Once the conditions for good cell growth of each of selected pathogens were established according to their metabolic requirements, maximum exponential growth was determined, this being the reference point for analyzing the development or inhibition by LAB using the Kirby Bauer method. Chlorhexidine 0.12% was positive control. L. reuteri was shown to have an inhibitory effect against S. mutans, followed by T. forsythia and S. gordonii, and a less significant effect against A. naeslundii. Regarding the effect shown by L. reuteri on the two major pathogens, we consider its potential use as a possible functional food in the prevention or treatment of oral diseases.

A comparison of botulinum toxin a and intralesional steroids for the treatment of plantar fasciitis: a randomized, double-blinded study.

BACKGROUND: The objective of this study was to compare intramuscularly applied botulinum toxin A (BTX-A) in the gastroc-soleus complex with intralesional steroids for the treatment of plantar fasciitis. METHODS: The patients were randomly divided into 2 groups according to the treatment received. The patients were evaluated over 6 months. The evaluation scores included the Visual Analog Scale (VAS), Maryland Foot and Ankle, Foot and Ankle Disability Index (FADI), and American Orthopaedic Foot and Ankle Society (AOFAS) score. Moreover, patients were instructed to perform plantar fascia stretching exercises over the course of the study. The final number of patients was 36, of whom 19 received BTX-A (10 men and 9 women) and 17 (6 men and 11 women) received steroids. RESULTS: When compared to patients who received steroids, the patients who received BTX-A exhibited more rapid and sustained improvement over the duration of the study. CONCLUSION: A combination of BTX-A and plantar fascia stretching exercises yielded better results for the treatment of plantar fasciitis than intralesional steroids. LEVEL OF EVIDENCE: Level I, therapeutic studies.

Modification of the technique for subclavian-vein catheterization.

INTRODUCTION: In invasive monitoring, subclavian-vein puncture is a routine procedure indicated for central vein cathe-terization. It is indicated in patients according to hospital stay, including the administration of drugs and the treatment of chronic and cardiac disease. The techniques described to date include infraclavicular percutaneous puncture; others place catheters using angiographic methods, and the use of magnetic resonance imaging and ultrasound has also been reported. Studies have been done in cadavers to get a better understanding of the procedure since the relationship between vascular elements and surrounding tissues are obtained. The usual technique is with the patient in Trendelenburg position, with the arm in adduction, the placement of an interscapular roll, and the head turned away from the puncture site. OBJECTIVE: The aim of this study was to demonstrate less frequent technical failures and complications using a modification of the usual technique. We propose catheterization of the right subclavian vein with the patient in decubitus, without an interescapular roll, with the arm in abduction and using the distal third of the clavicle and the suprasternal notch as anatomical references. RESULTS: Two technical puncture failures and three complications occurred in a total of 42 patients with a statistically significant difference (p = 0.0410) in frequency (11.9%) from that reported with the traditional technique (21.8%). CONCLUSIONS: Greater efficacy with the technique modified by the authors was confirmed. Anatomical cadaver dissections showed a greater space between the right subclavian vein and the clavicle.

[Effectiveness of 5-fluoruracil and vinorelbine in patients who had received multi-treatments for metastatic breast cancer]. / Efectividad de 5-fluoruracilo y vinorelbina en pacientes multitratadas por cáncer de mama metastásico.

PURPOSE: In this study we evaluated the activity and toxicity of a combination of 5-fluorouracil continuous infusion and vinorelbine as second or third line chemotherapy in metastatic breast cancer (MBC). PATIENTS AN METHODS: A total 24 patients who had received doxorrubicin and/or paclitaxel were included in this study. The regimen consisted in 5-fluorouracil 1 gr/m(2) BSA continuous infusion for 3 days and vinorelbine 30 mg/m(2) intravenous (IV) on day 1. The cycles were repeated every 21 days for 6 cycles. RESULTS: Objective responses were recorded in 37.5% (12.5% complete remission). The median disease-free survival was calculated 6.33 +/- 8.12 months (CI 95% of 3.43 months). Toxicity was observed in 12.5% of the patients and no treatment related deaths were recorded. CONCLUSION: The combination of 5-fluorouracil/vinorelbine at the dose administered is an effective regime in patients with MBC, with low toxicity and cost.

Efectividad de 5-fluoruracilo y vinorelbina en pacientes multitratadas por cáncer de mama metastásico / Efectiveness of 5-fluoruracil and vinorelbine in patients who had received multi-treatments for metastatic breast cancer

Objetivo. Evaluar la actividad y toxicidad de fluoruracilo en infusión continua y vinorelbina en segunda o tercera línea de tratamiento del cáncer de mama metastásico (CMM).Método y pacientes. En este estudio fase II se incluyeron 24 pacientes que habían recibido doxorrubicina y/o paclitaxel. Se administró 5-fluoruracilo a 1g/m²/día en infusión continua por 3 días y vinorelbina a 30 mg/m² D1 cada 21 días por 6 ciclos. Resultados. Las respuestas globales observadas fueron del 37,5% (12,5% respuestas completas). El período libre de enfermedad se calculó una media de 6,33 ± 8,12 meses (IC 95% de 3,43 meses). Se observó toxicidad en el 12,5% de las pacientes y no se registró toxicidad grave ni muertes relacionadas a tratamiento. Conclusión. El 5-fluoruracilo/vinorelbina a las dosis administradas es un esquema efectivo en pacientes con CMM multitratadas, con un bajo perfil de toxicidad y costo

Purpose. In this study we evaluated the activity and toxicity of a combination of 5-fluoruracil continuous infusion and vinorelbine as second or third line chemotherapy in metastatic breast cancer (MBC). Patients an methods. A total 24 patients who had received doxorrubicin and/or paclitaxel were included in this study. The regimen consisted in 5-fluoruracil lgr/m² BSA continous infusion for 3 days and vinorelbine 30 mg/m² intravenous (IV) on day 1. The cycles were repeated every 21 days for 6 cycles. Results. Objective responses were recorded in 37.5% (12.5% complete remission). The median desease-free survival was calculated 6.33 ± 8.12 months (CI 95% of 3.43 months). Toxicity was observed in 12.5% of the patients and no treatment related deaths were recorded. Conclusion. The combination of 5-fluoruracil/vinorelbine at the dose administered is an effective regime in patients with MBC, with low toxicity and cost