PHOTOREFRACTIVE SURGERY WITH EXCIMER LASER AND ITS IMPACT ON THE DIAGNOSIS AND FOLLOW-UP OF GLAUCOMA. A REVIEW.

Excimer laser refractive surgery is a procedure performed worldwide to solve refractive errors and reduce dependence on glasses or contact lenses. There has been an increase in the number of procedures performed around the world. Myopia is the most common indication for corneal photorefractive surgery. Myopic patients have a higher risk of developing some type of glaucoma in their lifetime, such as primary open-angle glaucoma and others. Refractive surgery ablates central corneal stromal tissue, altering its thickness and biomechanics, which in turn makes it difficult to accurately measure intraocular pressure (IOP), since it underestimates it. This underestimation of IOP may delay the diagnosis of de novo glaucoma in patients with a history of refractive surgery. Each patient who wishes to undergo corneal refractive surgery should undergo a thorough glaucoma examination in order to monitor and detect the possible development and / or progression of glaucoma. A very useful practical approach is to perform a series of IOP measurements before and after surgery, when the eye is already stable, and the difference between the averages of the two sets of readings can then be used as a personalised correction factor for postoperative IOP monitoring in that eye. Also, if there is any suspicion of a possible glaucoma, paraclinical tests, such as coherent optical tomography of the retinal nerve fibre layer (RNFL), visual fields and photos of the optic nerve should be requested. All this data prior to refractive surgery should be provided to these patients, so that they can save it and give it to their treating ophthalmologists in the future.

Staphylococcus cohnii endocarditis in native valve.

We present a first case of Staphylococcus cohnii endocarditis in an 80-year-old patient with a history of valve regurgitation. Endocarditis by this organism has not been reported previously. The patient declined treatment and died a few days later. When present, S. cohnii endocarditis has a poor prognosis as a result of associated comorbidities and the infection itself.

Hiperostosis esquelética difusa idiopática, una causa infrecuente de disfagia y disfonía

Resumen La hiperostosis esquelética difusa idiopática (DISH) es una enfermedad sistémica caracterizada por la osificación del ligamento longitudinal anterior de la columna. Los pacientes suelen ser asintomáticos o presentar dolor leve o rigidez, sin embargo, cuando afecta la región cervical puede ocasionar disfagia, disfonía o disnea. Presentamos el caso de un paciente de 63 años con disfonía y disfagia en quien los estudios demostraron desplazamiento del aritenoides y colapso del seno piriforme debido a un osteofito a nivel de C4. El paciente presentó mejoría con tratamiento conservador. Realizamos una discusión del caso y una revisión de la literatura sobre diagnóstico y tratamiento de esta patología.

Abstract Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic disease characterized by ossi- fication of the anterior longitudinal ligament of the spine. Patients are usually asympto- matic, or present mild pain or stiffness, however cervical compromise can cause dysphagia, dyspnea and dysphonia. We present the case of a 63-year-old patient with hoarseness and dysphagia. Studies revealed anterior displacement of the arytenoid cartilage and collapse of the pyriform sinus secondary to an osteophyte at C4 level. The patient showed improvement with conservative management. We present a discussion about this case and the available scientific evidence on the diagnosis and treatment of this pathology.

Pronostic factors of good functionality at 12 months of a hip fracture. Maluc Anoia study. / Factores pronósticos de buena funcionalidad a los 12 meses, de una fractura de cadera. Estudio Maluc Anoia.

BACKGROUND: Hip fracture usually occurs in frail elderly patients and is associated with an important morbi-mortality in the first year. The objective of the study is to describe the prognostic factors that would allow maintaining functionality at 12 months. METHOD: From June 1, 2010 to May 31, 2013, all patients older than 69 years with hip fracture due to bone fragility admitted to the Geriatric Acute Unit of our hospital were included. We define as functional maintenance those patients who have lost between 0-15 points in the Barthel Index with respect to the previous to the fracture. Prospective study of bivariate data analysis for related and multivariate prognostic factors for predictive predictors. RESULTS: 271 patients were included, of them, 146 (54.8%), maintained functionality at 12 months and 122 (45.2%) no. Patients who maintain functional status are younger: average age 83.4 vs 85.80 years (P=.002); with better scores in the indexes of: Lawton prior to fracture 4.42 vs 2.40 (P<.001) and Barthel at discharge 34.2 vs. 27.1 (P=.002). There are also differences in the score of the "Geriatric Dementia Scale" 2.59 vs. 3.13 (P=.009), in the score of the "American Society Anesthesiologist"

Losartan attenuates progression of osteoarthritis in the synovial temporomandibular and knee joints of a chondrodysplasia mouse model through inhibition of TGF-ß1 signaling pathway.

OBJECTIVE: Transforming growth factor beta 1 (TGF-ß1) is implicated in osteoarthritis (OA). The purpose of this study was to explore the ability of Losartan to inhibit the inflammatory signaling pathway of TGF-ß1 observed during osteoarthritic progression in the temporomandibular joint (TMJ) and knee joint using a genetic mouse model. METHODS: A murine OA model displaying the heterozygous chondrodysplasia gene (cho/+), a col11a1 mutation, was used to test this hypothesis. Following a 7-month treatment period with Losartan, the synovial joints were analyzed for histopathological improvement comparing two experimental groups. Tissues were fixed in paraformaldehyde, processed to paraffin section, and stained with Safranin O and Fast Green to visualize proteoglycans and collagen proteins in cartilage. Using the Modified Mankin scoring system, the degree of staining and OA progression were evaluated. RESULTS: Results show heterozygous animals receiving Losartan having diminished degeneration of TMJ condylar and knee joint articular cartilage. This was confirmed in the TMJ and knee by a statistically significant decrease in the Mankin histopathology score. Decreased expression of HtrA1, a key regulator to the TGF-ß1 signaling pathway, was demonstrated in vitro as well as in vivo, via Losartan inhibition. CONCLUSION: Using a genetic mouse model of OA, this study demonstrated the utility of Losartan to improve treatment of human OA in the TMJ and knee joint through inhibition of the TGF-ß1 signaling cascade. We further demonstrated inhibition of HtrA1, the lowering of Mankin scores to wild type control levels, and the limiting of OA progressive damage with treatment of Losartan.

Molecular Identification and Antifungal Susceptibility of Clinical Isolates of Sporothrix schenckii Complex in Medellin, Colombia.

BACKGROUND: Sporotrichosis is a subcutaneous mycosis that affects humans and other animals. Infection prevails in tropical and subtropical countries. Until a few years ago, it was considered that two varieties of Sporothrix schenckii caused this mycosis, but by applying molecular taxonomic markers, it has been demonstrated that there are several cryptic species within S. schenckii complex which varies in susceptibility, virulence, and geographic distribution. OBJECTIVE: This study aimed to identify the clinical isolates of Sporothrix spp. from patients with sporotrichosis in Medellin, Colombia, using two markers and to evaluate the in vitro susceptibility to itraconazole. METHODS: Thirty-four clinical isolates of Sporothrix spp. from Colombia, three from Mexico, and one from Guatemala were identified through sequencing of the noncoding region ITS-1 + 5.8SDNAr + ITS-2 and of the fragment containing exons 3 and 4 of the ß-tubulin gene. Clinical isolate sequences were compared with GenBank reference sequences using the BLASTN tool, and then, phylogenetic analysis was performed. Besides, the in vitro susceptibility to itraconazole was evaluated by determining the minimum inhibitory concentrations according to the CLSI M38-A2 method. RESULTS: Clinical isolates were identified by morphology as Sporothrix spp. Using the molecular markers, ITS and ß-tubulin, isolates were identified as S. schenckii sensu stricto (25) and Sporothrix globosa (13). Susceptibility to itraconazole was variable among clinical isolates. CONCLUSION: This is the first scientific publication that identifies species that cause sporotrichosis in Colombia, along with the antifungal susceptibility to itraconazole.

Multicenter, International Study of MIC/MEC Distributions for Definition of Epidemiological Cutoff Values for Sporothrix Species Identified by Molecular Methods.

Clinical and Laboratory Standards Institute (CLSI) conditions for testing the susceptibilities of pathogenic Sporothrix species to antifungal agents are based on a collaborative study that evaluated five clinically relevant isolates of Sporothrixschenckii sensu lato and some antifungal agents. With the advent of molecular identification, there are two basic needs: to confirm the suitability of these testing conditions for all agents and Sporothrix species and to establish species-specific epidemiologic cutoff values (ECVs) or breakpoints (BPs) for the species. We collected available CLSI MICs/minimal effective concentrations (MECs) of amphotericin B, five triazoles, terbinafine, flucytosine, and caspofungin for 301 Sporothrix schenckii sensu stricto, 486 S. brasiliensis, 75 S. globosa, and 13 S. mexicana molecularly identified isolates. Data were obtained in 17 independent laboratories (Australia, Europe, India, South Africa, and South and North America) using conidial inoculum suspensions and 48 to 72 h of incubation at 35°C. Sufficient and suitable data (modal MICs within 2-fold concentrations) allowed the proposal of the following ECVs for S. schenckii and S. brasiliensis, respectively: amphotericin B, 4 and 4 µg/ml; itraconazole, 2 and 2 µg/ml; posaconazole, 2 and 2 µg/ml; and voriconazole, 64 and 32 µg/ml. Ketoconazole and terbinafine ECVs for S. brasiliensis were 2 and 0.12 µg/ml, respectively. Insufficient or unsuitable data precluded the calculation of ketoconazole and terbinafine (or any other antifungal agent) ECVs for S. schenckii, as well as ECVs for S. globosa and S. mexicana These ECVs could aid the clinician in identifying potentially resistant isolates (non-wild type) less likely to respond to therapy.

Prescription of oral anticoagulation for patients with atrial fibrillation and previous hospitalization in a cardiology department. Experience in actual practice in a tertiary hospital. / Prescripción de anticoagulación oral en pacientes con fibrilación auricular e ingreso previo en un servicio de cardiología. Experiencia en un hospital terciario.

INTRODUCTION: Atrial fibrillation is the main reason for oral anticoagulation in our community. New oral anticoagulants (NOACs) overcome the disadvantages of vitamin K antagonists (VKAs), although there are scarce data on its use in our community. The aim of our study was to assess the use of NOACs and anticoagulation control using VKA as measured by the time within the therapeutic range (TTR) in an actual clinical scenario. METHODS: A retrospective cohort analysis was conducted of 816 patients admitted to cardiology over a period of 3 years, with a diagnosis of atrial fibrillation and anticoagulant treatment at discharge. We assessed the percentage of patients prescribed NOACs and the TTR with VKA. We compared safety and efficacy events during the 15-month follow-up among the patients prescribed NOAC, those prescribed VKA with a good TTR and those with a poor TTR. RESULTS: The percentage of patients prescribed NOAC was 7.6%. Serial INR measurements found that 71.3% of patients had a poor TTR. Although the groups were not comparable, a higher incidence of the combined event was observed in those treated with VKA and a poor TTR compared with those prescribed NOAC (p=.01). CONCLUSIONS: For patients with a previous hospitalization in cardiology in a tertiary hospital and a diagnosis of atrial fibrillation, the rate of NOAC prescription is low, and the TTR with VKA was poor.

Outcomes in weight loss, fasting blood glucose and glycosylated hemoglobin in a sample of 415 obese patients, included in the database of the European accreditation council for excellence centers for bariatric surgery with laparoscopic one anastomosis gastric bypass.

BACKGROUND: Obesity is a risk factor for the development of diseases such as type 2 Diabetes Mellitus. Bariatric surgery with laparoscopic single anastomosis gastric bypass is an effective treatment for morbid obesity and diabetes type 2 complete remission, and it has been proven to generate an improvement in glycemic levels and glycosylated hemoglobin (HbA1c) keeping the weight loss for a long time. MATERIAL AND METHODS: In a period of time between June 2002 until May 2012, 2070 patients underwent surgery with LOAGB technique. Between January 2010 an May 2012, 415 patients were included in the European Accreditation Council for Excellence Centers for Bariatric Surgery (EAC-BS) database, from which 79 patients with a glycemic level disturbance in the preoperative blood sample where chosen. Of this group, 47 patients were pre-diabetic (fast plasma glucose ≥ 110 mg/dl ≤ 125 mg/dl) and glycosylated hemoglobin (HbA1c) levels between 5.7-6.4% and 32 were diabetic (fast plasma glucose ≥ 126 mg/dl) and glycosylated hemoglobin (HbA1c) levels ≥ 6.5%. We described the weight evolution, the excess body mass index lost percentage (%EBMIL) the glycemia and the glycosylated hemoglobin levels; and we reported regular laboratory controls during the first year after surgical intervention. RESULTS: Both patient groups achieved their lowest mean weight loss 12 months after surgery, being average weight in the pre-diabetic group 62,41 ± 10,93 and 68,36 ± 11,16 in the diabetic group. Since 3 months after surgery, pre-diabetic patients achieve a mean BMI < 30, according to the Spanish Society for Obesity Study (SEEDO 2007) this amount is outside of the definition of obesity. Not being the case of the diabetic patients who don´t achieve this result until 6 months after surgery. The weight loss was excellent in both study groups, achieving an excess body mass index loss percentage (% EBMIL) greater than 65%, since the first three-month postoperative control. Glycemia levels descend in both groups, achieving the pre-diabetic group a mean glycemia level of < 110 mg/ dl in the second day after LOAGB surgery. Pre-diabetic patients maintain more stable glycemia with better controls, and very favorable outcomes 12 months after surgery. The diabetic patients achieve the mean glycemia level of < 110 mg/dl at the first month after surgery and maintained it 12 months after surgery which is the time of this study. The glycosylated hemoglobin levels descended in both groups, achieving levels of 4% three months after surgery in the prediabetic group and 4.8% at six months in the diabetic group. CONCLUSION: LOAGB proved to be an efficient bariatric technique for complete remission of pre-diabetes and diabetes mellitus type 2 and also with the excess weight loss resolution. We showed that the excess weight loss, the glycemia and glycosylated hemoglobin levels continue being normal after one year of follow up after surgery. The best results are obtained in pre-diabetic patients who underwent LOAGB, this group is integrated with people who are at high risk of suffering a deterioration of their obesity and a rapid advance of the diabetes and the associated comorbidities, that's why surgery has to be performed as soon as possible when the medical exam continues being favorable.

Introducción: La obesidad es un factor de riesgo para el desarrollo de enfermedades tales como la diabetes mellitus tipo II. La cirugía bariátrica laparoscópica de una anastomosis también conocida como mini-bypass con las modificaciones del doctor Carbajo, es un tratamiento efectivo para el manejo de la obesidad mórbida y para obtener una completa remisión de la diabetes tipo II y se ha demostrado que se genera una mejoría de los niveles de glicemia y de hemoglobina glicosilada (HbA1c) manteniendo la pérdida de peso por un largo período de tiempo. Material y métodos: En un período de tiempo entre junio del 2002 hasta mayo de 2012, 2070 pacientes se intervinieron quirúrgicamente con la técnica bariátrica laparoscópica de una anastomosis gástrica (BAGUA). Entre enero de 2010 y mayo de 2012, 415 pacientes fueron incluidos en la base de datos del Consejo Europeo de acreditación para centros de excelencia de cirugía bariátrica, de los cuales se escogieron 79 pacientes que presentaban trastornos de los niveles de glicemia en sus pruebas sanguíneas preoperatorias. De este grupo 47 pacientes se clasificaron como pre-diabéticos con niveles de glucosa en sangre ≥110 mg/ dl ≤ 125 mg/dl y unos niveles de hemoglobina glicosilada ( HbA1C) entre 5.7-6.4% y 32 como diabéticos con niveles de glucosa en sangre ≥ 126 mg/dl y niveles de hemoglobina glicosilada (HbA1C) ≥ 6.5%. Nosotros describimos la evolución de los cambios en el peso, el porcentaje de pérdida del índice de masa corporal, los niveles de glicemia y de hemoglobina glicosilada de los pacientes estudiados y reportamos los resultados de los controles de laboratorio practicados regularmente durante el primer año postoperatorio. Resultados: ambos grupos de pacientes alcanzaron su máxima pérdida de peso a los 12 meses postoperatorios, siendo el peso promedio en el grupo de pre-diabéticos 62,41 ± 10,93 y 68,36 ± 11,16 en el grupo de diabéticos. Los pacientes pre-diabéticos alcanzaron desde los 3 meses de postoperatorio un índice de masa corporal (IMC) < 30, que de acuerdo con el estudio sobre Obesidad de la Sociedad Española (SEEDO 2007) esta cantidad se encuentra por fuera de la definición de obesidad, no siendo el caso del grupo de pacientes diabéticos que no alcanzaron este resultado hasta los 6 meses de postoperatorio. La pérdida de peso fue excelente en ambos grupos alcanzando un porcentaje de pérdida de índice de masa corporal mayor de 65% desde los primeros 3 meses de control postoperatorio. Los niveles de glicemia bajaron en ambos grupos, alcanzando el grupo de pre-diabéticos un nivel de glicemia < 110 mg/dl desde el segundo día postoperatorio de BAGUA. Los pacientes pre-diabéticos mantuvieron un nivel de glicemia estable con mejor control y una muy favorable evolución a los 12 meses de postoperatorio. Los pacientes diabéticos alcanzaron el nivel de glicemia < 110 mg/dl en el primer mes postoperatorio y lo mantuvieron así a los 12 meses de postoperatorio, tiempo en el que se elaboró este estudio. Los niveles de hemoglobina glicosilada descendieron en ambos grupos, alcanzando niveles de 4% a los 3 meses de postoperatorio en los pacientes prediabéticos y un 4,8% a los 6 meses en el grupo de los pacientes diabéticos. Conclusión: BAGUA mostró ser una técnica quirúrgica bariátrica eficiente para la remisión completa de la pre-diabetes y la diabetes tipo II así como de la pérdida del exceso de peso. Nosotros demostramos que la pérdida del exceso de peso, los niveles de glicemia y de hemoglobina glicosilada continuaron siendo normales al año de seguimiento postoperatorio. Los mejores resultados se obtuvieron en el grupo de pre-diabéticos a quienes se les practicó BAGUA. Este grupo está integrado por personas que se encuentran en riesgo de sufrir un deterioro de su obesidad y un rápido avance hacia diabetes y a las comorbilidades asociadas, está es la razón por la cual esta cirugía debe realizarse lo más pronto posible mientras las pruebas médicas de los pacientes sigan siendo favorables.

Candida tropicalis antifungal cross-resistance is related to different azole target (Erg11p) modifications.

Candida tropicalis ranks between third and fourth among Candida species most commonly isolated from clinical specimens. Invasive candidiasis and candidemia are treated with amphotericin B or echinocandins as first-line therapy, with extended-spectrum triazoles as acceptable alternatives. Candida tropicalis is usually susceptible to all antifungal agents, although several azole drug-resistant clinical isolates are being reported. However, C. tropicalis resistant to amphotericin B is uncommon, and only a few strains have reliably demonstrated a high level of resistance to this agent. The resistance mechanisms operating in C. tropicalis strains isolated from clinical samples showing resistance to azole drugs alone or with amphotericin B cross-resistance were elucidated. Antifungal drug resistance was related to mutations of the azole target (Erg11p) with or without alterations of the ergosterol biosynthesis pathway. The antifungal drug resistance shown in vitro correlated very well with the results obtained in vivo using the model host Galleria mellonella. Using this panel of strains, the G. mellonella model system was validated as a simple, nonmammalian minihost model that can be used to study in vitro-in vivo correlation of antifungals in C. tropicalis. The development in C. tropicalis of antifungal drug resistance with different mechanisms during antifungal treatment has potential clinical impact and deserves specific prospective studies.

Desempeño de las funciones esenciales de salud pública en tres municipios, Antioquia-Colombia, 2011 / Performance measurement of essential public health functions in three municipalities, Antioquia-Colombia, 2011

OBJETIVO: medir el desempeño de las Funciones Esenciales en Salud Pública (FESP) en tres municipios que corresponden a la zona Penderisco del suroeste antioqueño (Concordia, Betulia y Salgar) en 2011. METODOLOGIA: se realizó un estudio descriptivo transversal en los tres municipios. Se adaptó el instrumento de medición de las FESP en el ámbito nacional, elaborado por la OPS para aplicarlo localmente, se ajustó a las competencias y campos de acción de las autoridades municipales, se suprimieron preguntas no pertinentes para el nivel y se recalcularon las fórmulas que generaban el puntaje y los indicadores. El instrumento se aplicó a un grupo de expertos en cada municipio. RESULTADOS:en la zona Penderisco, se encontraron tres funciones FESP1, FESP2 y FESP4 con desempeño óptimo. Las FESP3, FESP5, FESP6, FESP7, FESP8, FESP9 y FESP11 con desempeño medio superior y la FESP10 un desempeño mínimo. Dos indicadores de desarrollo de capacidades e infraestructura para la salud pública, fueron clasificados como debilidades, coincidente en los tres municipios: conocimientos, habilidades y mecanismos para revisar, perfeccionar y hacer cumplir el marco regulatorio y el desarrollo de la capacidad institucional de investigación. CONCLUSIONES: a pesar de los esfuerzos realizados por los países para mejorar el desempeño de las FESP, el desarrollo es incipiente con algunas excepciones, este mismo esquema se refleja en los municipios estudiados. Pocas funciones están clasificadas en desempeño óptimo y como fortalezas. El desarrollo de capacidades e infraestructura para soportar el desarrollo de las FESP es débil.

OBJETIVE: to measure the performance of the Essential Public Health Functions (EPHF) in three municipalities from the Penderisco area of Southwestern Antioquia (a zone encompassing three municipalities: Betulia, Concordia, and Salgar) in 2011. METHODOLOGY: we conducted a cross-sectional descriptive study in three municipalities. To this end, we adapted the instrument for measuring EPHF for use in Colombia. The instrument was developed by the paho, and we implemented its adapted version locally. The instrument was adjusted to the skills and fields of action of the municipal authorities, the questions that were not relevant for the local context were removed, and the formulas for generating scores and indicators were re-calculated. The instrument was applied to a group of experts in each municipality. RESULTS: in the Penderisco zone, three functions had optimal performance: EPHF1, EPHF4, EPHF2. Additionally, the functions labeled EPHF3, EPHF5, EPHF6, EPHF7, EPHF8, EPHF9, and EPHF11 had above average performance. EPHF10, in turn, showed minimum performance. Two indicators of development of capacity and infrastructure for public health were classified as weaknesses, namely: knowledge, skills, and mechanisms to review, refine and enforce the regulatory framework and development of institutional research capacity. This is consistent in the three municipalities. CONCLUSIONS: In spite of the efforts made by countries to improve the performance of the essential public health functions, development is still budding; the same scenario is seen in the studied municipalities. Few functions had optimal performance and were considered strengths and capacity development and the infrastructure for supporting the development of essential public health functions are weak.

Estudio farmacocinético de la asociación atorvastatina 40 mg + ezetimibe 10 mg tabletas / I study farmacocinetico of the association of atorvastatina 40 mg ezetimibe of 10 mg tablets

Determinar la Biodisponibilidad en una dosis única, de Atorvastatina 40 mg + Ezetimibe 10 mg tabletas, con evaluación de los parámetros farmacocinéticos de concentración máxima en el organismo (C Máx), área bajo la curva de los niveles en el organismo (AUC 0→t y AUC 0 →∞)tiempo en alcanzar la concentración máxima (T Máx), tiempo de vida media (t 1/ 2) y constante de eliminación (Ke). El estudio de Biodisponibilidad se desarrolló mediante la determinación de la magnitud y la velocidad de la absorción “in vivo” de la asociación Atorvastatina 40 mg + Ezetimibe 10 mg tabletas, fabricadopor Laboratorios La Santé S.A, en voluntarios sanos. 12 voluntarios sanos, hombres y mujeres, con edades comprendidas entre los 18 y 55 años, con un peso de ± 15% del apropiado según la edad y la talla, que cumplieron a cabalidad con todos los exámenes clínicos efectuados antes del estudio para su selección y que no presentaron alguna anomalía en su historia médica, recibieron una dosis única de la asociación 40 mg de Atorvastatina + 10 mg de Ezetimibe tabletas, fabricado por Laboratorios La Santé S.A. vía oral con administración de 240 mL de agua. Después de su administración se tomaron muestras de sangre de cada voluntario a los siguientes tiempos: 0.25, 0.5, 0.75, 1.0, 1.5, 2.0, 2.5, 3.0, 4.0, 6.0, 8.0, 10.0, 12.0, 24.0, 36.0, 48.0 y 72.0 horas. El análisis de las muestras se realizó por Cromatografía Líquida de Alta Resolución (HPLC) con detección UV, previa extracción de los analitos (extracción líquido/líquido), en el Laboratorio bioanalítico de Delivery Technologies. La determinación de la magnitud y la velocidad de la absorción “in vivo” de Atorvastatina 40 mg + Ezetimibe 10 mg tabletas, se evaluó comparando con los parámetros farmacocinéticos ya reportados en estudios previos de estos principios activos por separados...

To determine the bioavailability in a single dose of Atorvastatin 40 mg + Ezetimibe 10 mg tablets, with assessment of pharmacokinetic parameters of maximum concentration body (C max), area under the curve of the levels in the organism (AUC 0 → t and AUC 0 → ∞), time to reach maximum concentration (T max), half-life (t 1 / 2) and elimination constant (Ke). The bioavailability study was conducted by  determining the magnitude and rate of absorption in vivo of the association Atorvastatin 40 mg + Ezetimibe 10 mg tablets manufactured by Laboratorios La Sante SA, in healthy volunteers. 12 healthy volunteers, men and women, aged between 18 and 55, with a weight of ± 15%  according to the age and size, which fully met  with all the clinical examinations performed prior to study and not presenting any anomaly in these tests, received a single dose of the association Atorvastatin 40 mg + Ezetimibe 10 mg tablets, manufactured by Laboratorios La Santé SA, with oral administration of 240 mL of water. After administration of the drug. blood samples were taken from each volunteer at the following times: 0.25, 0.5, 0.75, 1.0, 1.5, 2.0, 2.5, 3.0, 4.0, 6.0, 8.0, 10.0, 12.0, 24.0, 36.0, 48.0 and 72.0 hours. The sample analysis was performed by High Resolution liquid chromatography (HPLC) with UV detection after extraction of analytes (liquid-liquid extraction) in the bioanalytical laboratory of Delivery Technologies. The determination of the magnitude and absorption rate in vivo of Atorvastatin 40 mg + Ezetimibe 10 mg tablets, was evaluated by comparing with the Pharmacokinetic parameters reported in previous studies of these drug by separate. Adverse Events Report: In general, there were no serious adverse events during the course of this study. According to the results and considering the pharmacokinetic parameters reflecting the amount of Atorvastatin and Ezetimibe absorbed bythe body and the speed...

[Catheter in the superior vena cava for hemodialysis as a last resort in superior hemithorax]. / Catéter en vena cava superior para hemodiálisis entre los últimos recursos en hemitórax superior.

We report four patients with chronic kidney disease undergoing haemodialysis therapy, which had exhausted conventional venous access (internal jugular, subclavian) and non-conventional access (axillary, innominate) in the upper hemithorax for haemodialysis. This was primarily due to thrombosis of these veins caused by previous catheterisation. These patients did not qualify for peritoneal dialysis. Using the technique recommended by Archundia et al., 4 indwelling catheters were implanted directly in the superior vena cava in each of the patients with subsequent subcutaneous tunneling. The catheters operated correctly and are currently permeable after being used for an average of 19 months.

Identificación diferenciación de monosacárido y disacáridos diasteroméricos no derivatizados por esi-it-ms/ms / Identification nnd differentiation of underivatzed diasteromeric mono-and disaaccharides by esi-it-ms/ms

Los azúcares son importantes moléculas que desempeñan funciones trascendentales de señalización celular en los organismos superiores. Su complejidad estructural, representada por sus isómeros, anómeros y diasterómeros, amerita la implementación de metodologías modernas, rápidas y sensibles para su identificación y diferenciación. La espectrometría de masas y su analizador de trampa de iones brinda nuevas alternativas de análisis que favorecen el control de las energías de fragmentación de los analitos. A pesar de que la diferenciación de estereoisómeros no ha sido el campo de aplicación principal de la espectrometría de masas, se ha implementado una metodología para diferenciar los monosácaridos β-D-galactosa y β-D-glucosa y los disacαridos β-D-galactopiranosil-(1→4)-β-D-glucopiranσsido (lactosa), α-D-glucopiranosil-(1→4)-β-D-glucopiranσsido (maltosa) y β-D-fructofuranosil-(2↔1)-α-D-glucopiranσsido (sacarosa) a travιs de sus aductos con amonio y litio por ESI-IT-MS/MS en infusión directa. Se emplean diferentes energías de fragmentación para asegurar la existencia de iones marcadores de la estereoquímica de los analitos. Se evidencia que controlar las energías de colisiones en el análisis estructural de moléculas provee una poderosa y moderna herramienta analítica para los laboratorios de análisis.

Sugars are important molecules with remarkable cell signals pathway functions in higher organisms. The structural complexity of sugar represented by its isomeric, anomeric and diasteromeric configurations deserve the implementation of modern, rapid and sensitive methodologies for its identification and differentiation. Mass spectrometry and its analyzer of ion trap provide new alternative techniques that encourage the control of the fragmentation energies supplied to molecules. Since stereoisomer differentiation is consider outside the mass spectrometry domain, a methodology has been applied in order to differentiate β-D-galactose, β-D-glucose and the disaccharides β-D-galactopyranosyl-(1→4)-β-D-glucopyranoside (lactose), α-D-glucopyranosyl-(1→4)-β-D-glucopyranoside (maltose) y β-D-fructofuranosyl-(2↔1)-α-D-glucopyranoside (sacarose) trough its ammonium and lithium adducts by infusion on ESI-IT-MS/MS mass spectrometer. Different fragmentation energies have been used to ensure the ion marker occurrence in the analyte stereochemistry. It is evident that the collision energies control in structural analysis of molecules provides a powerful and modern analytical tool to be applied in control laboratories.

Apoptosis as pathogenic mechanism of infection with vesicular stomatitis virus. Evidence in primary bovine fibroblast cultures.

To determine whether fibroblasts from Blanco Orejinegro cattle, exhibit any level of resistance to infection against vesicular stomatitis virus (VSV) serotypes Indiana (VSV-I) or New Jersey (VSV-NJ), 30 fibroblast cultures were phenotyped to evaluate their resistance/susceptibility. Thirty three % of Blanco Orejinegro fibroblast cultures were classified as very resistant, 50% as resistant, and 17% as susceptible to VSV-I infection, whereas 20% were classified as very resistant, 50% as resistant and 30% as susceptible to VSV-NJ infection. Therefore, there appears to be a large variation in phenotypic polymorphism among the fibroblasts to infection by VSV. To elucidate the mechanisms responsible for this diversity, we searched for a possible relationship between resistance/susceptibility and production of factors with antiviral activity; however fibroblasts did not secrete factors with antiviral activity. We examined also whether apoptosis where induced by infection and its correlation with the polymorphism of resistance/susceptibility to VSV. Using morphological analyses, hypoploidy measurements, and level of phosphatidyl serine expression, high levels of apoptosis were measured in VSV infected fibroblasts. However, no correlation exists between apoptosis and the category of resistance/susceptibility to infection, indicating that apoptosis is a pathogenic mechanism of VSV.

Apoptosis as pathogenic mechanism of infection with vesicular stomatitis virus: evidence in primary bovine fibroblast cultures

To determine whether fibroblasts from Blanco Orejinegro cattle, exhibit any level of resistance to infection against vesicular stomatitis virus (VSV) serotypes Indiana (VSV-I) or New Jersey (VSV-NJ), 30 fibroblast cultures were phenotyped to evaluate their resistance/susceptibility. Thirty three % of Blanco Orejinegro fibroblast cultures were classified as very resistant, 50% as resistant, and 17% as susceptible to VSV-I infection, whereas 20% were classified as very resistant, 50% as resistant and 30% as susceptible to VSV-NJ infection. Therefore, there appears to be a large variation in phenotypic polymorphism among the fibroblasts to infection by VSV. To elucidate the mechanisms responsible for this diversity, we searched for a possible relationship between resistance/ susceptibility and production of factors wi th antiviral activity; however fibroblasts did not secrete factors with antiviral activity. We examined also whether apoptosis where induced by infection and its correlation with the polymorphism of resistance/susceptibility to VSV. Using morphological analyses, hypoploidy measurements, and level of phosphatidyl serine expression, high levels of apoptosis were measured in VSV infected fibroblasts. However, no correlation exists between apoptosis and the category of resistance/susceptibility to infection, indicating that apoptosis is a pathogenic mechanism of VSV.

Prevalence and incidence of multiple sclerosis in Panama (2000-2005).

BACKGROUND: The first cases of multiple sclerosis (MS) in Panama were notified in the 1980s and it was considered a low-risk region for this disease. Between 2000 and 2005, a prevalence study was conducted to characterize MS in Panama. METHODS: An instrument was developed to gather information from clinical files and interviews with previous informed consent. The diagnosis was confirmed by neurologists applying the Poser and McDonald criteria as per the inclusion period. RESULTS: 178 patients from the public and private health sectors were captured between 1970 and 2005. The prevalence rate was 5.24/100,000 inhabitants, and the incidence was between 0.28 and 0.61/100,000 inhabitants. The disease was predominant among women, the mean age +/- SD being 34.76 +/- 10.909 years (1st crisis), and the average number of crises was 2.88. The most common clinical findings were motor, optic neuritis, sensitive and cerebellous. 52.4% presented monosymptomatic manifestations, 71.6% were clinically defined according to Poser's criteria and 55.6% had MS according to McDonald's criteria. 77.8% had their debut with the relapsing-remitting type and presented an Expanded Disability Status Scale score of 2.7 after the first crisis. CONCLUSION: MS is in Panama a neurological pathology with a low prevalence and the results of this investigation improved early treatment and diagnosis of this disease.

Adverse pregnancy outcomes in women with systemic lupus erythematosus from a multiethnic US cohort: LUMINA (LVI) [corrected].

OBJECTIVE: To study the factors associated with an adverse pregnancy outcome in women with systemic lupus erythematosus (SLE). METHODS: SLE women from LUMINA of Hispanic, African American and Caucasian ethnicity were studied. Adverse pregnancy outcome was a miscarriage or abortion (<20 weeks), a stillbirth (> or = 20) and/or a moderate to severe preterm-baby (<34 weeks); good outcome was either a mild preterm-baby (> or = 34 weeks) or a full-term baby [C-section or vaginal delivery (38-42 weeks)]. Pregnancies occurring after SLE diagnosis (TD) were included; pregnancy outcome was the unit of analyses. The relationship between selected variables and pregnancy outcomes was examined by univariable and multivariable analyses. RESULTS: Adverse outcomes occurred in 63.7% of 102 pregnancies. In the univariable analyses, Texan Hispanic and African American ethnicities, fewer years of education, higher number of ACR criteria, renal involvement, glucocorticoid exposure and the maximum dose of glucocorticoids used prior to the pregnancy outcome were associated with an adverse pregnancy outcome. Renal involvement was independently associated with an adverse pregnancy outcome [Odds ratio (OR)=5.219 (95% Confidence Interval (CI) 1.416-19.239, p=0.0131] as were the maximum dose of glucocorticoids used prior to the pregnancy outcome (OR=1.028; CI:1.002-1.054; p=0.0315) and fewer years of education (OR=1.204; CI:1.006-1.472; p=0.0437). Ethnicity was not retained in the multivariable model. CONCLUSION: Renal involvement, the maximum dose of glucocorticoids used prior to pregnancy and fewer years of education were associated with adverse pregnancy outcomes. These data have implications for the management of women with lupus planning to become pregnant.