A non-inferiority study evaluating a new extended-release preparation of tilmicosin injected subcutaneously vs. ceftiofur administered intramammary, as dry-cow therapy in Holstein Friesian cows.

BACKGROUND: A new, extended long-acting tilmicosin (TLAe) preparation was tested against intramammary ceftiofur (CEF) using a non-inferiority trial model during dry-cow therapy (DCT) in a farm with high bovine population density and deficient hygiene application. OBJECTIVES: To evaluate the possibility that TLAe administered parenterally can achieve non-inferiority status compared to CEF administered intramammary for DCT. METHODS: Cows were randomly assigned to TLAe (20 mg/kg subcutaneous; n = 53) or CEF (CEF-HCl, 125 mg/quarter; n = 38 cows) treatment groups. California mastitis testing, colony-forming unit assessment (CFU/mL), and number of cases positive for Staphylococcus aureus were quantified before DCT and 7 d after calving. A complete cure was defined as no bacteria isolated; partial cure when CFU/mL ranged from 150 to 700, and cure-failure when CFU/mL was above 700. RESULTS: TLAe and CEF had overall cure rates of 57% and 53% (p > 0.05) and S. aureus cure rates of 77.7% and 25%, respectively (p < 0.05). The pathogens detected at DCT and 7 days after calving were S. aureus (62.71% and 35.55%), Staphylococcus spp. (22.03% and 35.55%), Streptococcus uberis (10.16% and 13.33%), and Escherichia coli (5.08% and 15.55%). Non-inferiority and binary logistic regression analyses revealed a lack of difference in overall efficacies of TLAe and CEF. Apart from S. aureus, S. uberis was the predominant pathogen found in both groups. CONCLUSIONS: This study is the first successful report of parenteral DCT showing comparable efficacy as CEF, the gold-standard. The extended long-term pharmacokinetic activity of TLAe explains these results.

Definition of Failed Induction of Labor and Its Predictive Factors: Two Unsolved Issues of an Everyday Clinical Situation.

OBJECTIVE: The objectives of this review were to identify the predictive factors of induction of labor (IOL) failure or success as well as to highlight the current heterogeneity regarding the definition and diagnosis of failed IOL. MATERIALS AND METHODS: Only studies in which the main or secondary outcome was failed IOL, defined as not entering the active phase of labor after 24 h of prostaglandin administration ± 12 h of oxytocin infusion, were included in the review. The data collected were: study design, definition of failed IOL, induction method, IOL indications, failed IOL rate, cesarean section because of failed IOL and predictors of failed IOL. RESULTS: The database search detected 507 publications. The main reason for exclusion was that the primary or secondary outcomes were not the predetermined definition of failed IOL (not achieving active phase of labor). Finally, 7 studies were eligible. The main predictive factors identified in the review were cervical status, evaluated by the Bishop score or cervical length. DISCUSSION: Failed IOL should be defined as the inability to achieve the active phase of labor, considering that the definition of IOL is to enter the active phase of labor. A universal definition of failed IOL is an essential requisite to analyze and obtain solid results and conclusions on this issue. An important finding of this review is that only 7 of all the studies reviewed assessed achieving the active phase of labor as a primary or secondary IOL outcome. Another conclusion is that cervical status remains the most important predictor of IOL outcome, although the value of the parameters explored up to now is limited. To find or develop predictive tools to identify those women exposed to IOL who may not reach the active phase of labor is crucial to minimize the risks and costs associated with IOL failure while opening a great opportunity for investigation. Therefore, other predictive tools should be studied in order to improve IOL outcome in terms of health and economic burden.

Lipoatrofia semicircular. Nuestra experiencia dos años después (2007-2009) / Semicircular Lipoatrophy. Our experience two years later (2007-2009)

Fundamento y objetivos: Describir y analizar la presentación clínica y la evolución tras la corrección de determinados factores ambientales, de nuestra serie de casos de lipoatrofia semicircular en el entorno laboral, con especial atención a la resolución de la lesión y valorar la posible asociación con otras patologías desde el punto de vista etiológico o que pudieran formar parte de un síndrome más complejo. Pacientes y método: Trabajadores atendidos entre la primavera de 2007 y el verano de 2009. En la primera consulta se efectúa historia clínica detallada, con medición y localización de la lesión, realización de analítica y de ecografía de la zona supuestamente afecta. Posteriormente tras haberse tomado las medidas recomendadas en las empresas para eliminar la electricidad estática, se incluyen controles cada tres meses con anamnesis, exploración física y ecografía comparativas. Resultados: El 96,7% son mujeres, sin predominio de ninguna edad Todos trabajan en puestos con material informático y abundante cableado eléctrico. Las localizaciones, salvo 3 casos (2 en brazo y uno en región glútea), fueron a nivel de cara anterolateral de muslos y con valores medios de 69x20x73 cm. (altoxanchoxlargo). Evolutivamente a los 6 meses un 93% de casos mostraban remisión clínica (62% completa, 31% parcial); al año solamente 2 casos no han mostrado ninguna variación habiendo un 69% de resoluciones completas. Ningún caso ha presentado otra patología relacionada. En el primer año de control hubo 36 nuevos casos, en el segundo 22 y 4 en los 6 meses trascurridos del tercero. Conclusiones: Las características clínicas son superponibles a las de otras series publicadas en cuanto a manifestaciones, tipo de trabajador afecto y predominio de presentación en mujeres. En cuanto a la evolución una vez modificado el entorno laboral, es evidente la tendencia a la resolución, mucho más rápida que en los casos antiguamente publicados en los que no se modificaba el entorno, en una gran proporción de los casos. Además estas correcciones han demostrado una gran eficacia frenando la aparición de nuevos casos. No se han apreciado otras manifestaciones patológicas que las estrictamente propias de lipoatrofia segmentaria (AU)

Background and objectives: To describe and to analyze the clinical presentation and the evolution after variation of certain environmental factors, of our series of cases of semicircular lipoatrophy in job environment, with special attention to the resolution of the injury and to value the possible association with other patologies from the ethiologic point of view or if it could be part of a more complex syndrome. Patients and method: Workers attended between spring of 2007 and summer of 2009. In the first visit, we made a standardized history performing physical examination with measurement and location of the injury, laboratory parameters tests and ultrasonographic study of the presumptively affected zone. Subsequently, after having been taken the measurements recommended in companies to eliminate the static electricity, quarterly controls are included with anamnesis, physical exploration and ultrasonographic comparatives. Results: 96,7 % are women, without predominance of any age. They all work at desks with informatic material and abundant electric wired up. The locations, except for 3 cases (2 in arm and one in bottom region), were at the level of the anterolateral face of thighs and with average values of 69x20x73 cm. (heightxwidthxlength). Evolvely 6 months later 93 % of cases was showing clinical remiss (62 % complete, 3l % partial); after one year only 2 cases have not showed any variation having a 69 % of complete resolutions. None of the cases has presented any other related pathology. In the first year of control there were 36 new cases, in the second one 22 and in what takes of the third one 4. Conclusions: The clinical characteristics are superimposable on those of other published series as for manifestations, type of affected worker and predominance of presentation in women. As for the evolution once modified the job environment, the trend is evidently to the resolution, much faster than in the published former cases where the environment had not been modified, in a great proportion of the cases. Furthermore these alterations have demonstrated a great efficiency stopping the appearance of new cases. No other pathological manifestations have been assessed than the strictly proper ones of the semicircular lipoatrophy (AU)