Pharmacokinetic evaluation of a sustained-release compounded procainamide preparation after 24-h (acute) administration in normal dogs.

INTRODUCTION: The objective of the present study was to evaluate the pharmacokinetics of a compounded sustained-release procainamide formulation in normal dogs. ANIMALS: Six healthy, purpose-bred mixed-breed dogs participated in the study. METHODS: In phase I, two dogs were administered oral procainamide (30 mg/kg), and plasma was obtained to determine plasma concentration ranges and duration. In phase II, six dogs were administered procainamide (30 mg/kg by mouth every 12 hours) to determine the pharmacokinetics of sustained-release procainamide. Serum procainamide concentration was determined using an immunochemistry assay. RESULTS: No adverse clinical effects were noted in any of the dogs studied. The average maximum serum concentration, average serum concentration, and average minimum serum concentration were 10.17, 7.13, and 3.07 µg/mL, respectively. The average time over a 12-h period during which procainamide concentration exceeded 12 µg/mL was 2.35 h, was between 4 and 12 µg/mL was 7.19 h, and was less than 4 µg/mL was 2.46 h. The average times at maximum concentration and minimum concentration were 18.67 and 12.25 h, respectively. CONCLUSIONS: Administration of sustained-release procainamide twice daily achieved targeted plasma concentrations in most dogs. Evaluation of serum trough concentrations should be considered owing to interanimal variability to confirm that serum concentrations are within the reported therapeutic range for an individual patient.

Disposition of levetiracetam in healthy adult horses.

Nine horses received 20 mg/kg of intravenous (LEVIV ); 30 mg/kg of intragastric, crushed immediate release (LEVCIR ); and 30 mg/kg of intragastric, crushed extended release (LEVCER ) levetiracetam, in a three-way randomized crossover design. Crushed tablets were dissolved in water and administered by nasogastric tube. Serum samples were collected over 48 hr, and levetiracetam concentrations were determined by immunoassay. Mean ± SD peak concentrations for LEVCIR and LEVCER were 50.72 ± 10.60 and 53.58 ± 15.94 µg/ml, respectively. The y-intercept for IV administration was 64.54 ± 24.99 µg/ml. The terminal half-life was 6.38 ± 1.97, 7.07 ± 1.93 and 6.22 ± 1.35 hr for LEVCIR , LEVCER, and LEVIV , respectively. Volume of distribution at steady-state was 630 ± 73.4 ml/kg. Total body clearance after IV administration was 74.40 ± 19.20 ml kg-1  hr-1 . Bioavailability was 96 ± 10, and 98 ± 13% for LEVCIR and LEVCER , respectively. A single dose of Levetiracetam (LEV) was well tolerated. Based on this study, a recommended dosing regimen of intravenous or oral LEV of 32 mg/kg every 12 hr is likely to achieve and maintain plasma concentrations within the therapeutic range suggested for humans, with optimal kinetics throughout the dosing interval in healthy adult horses. Repeated dosing and pharmacodynamic studies are warranted.

Pharmacokinetics of Single Oral Dose Extended-Release Levetiracetam in Healthy Cats.

BACKGROUND: Repeated PO dosing of anti-epileptic drugs may contribute to poor compliance in treated cats. Intermediate-release levetiracetam has been used safely in cats, but must be given q8h to maintain serum concentrations in the therapeutic interval for humans (5-45 µg/mL). Approved extended-release levetiracetam (XRL) for human use may require less frequent dosing, but the large dosing unit has limited its use in cats. HYPOTHESES: In healthy cats, serum levetiracetam concentration will remain above 5 µg/mL for at least 24 hours after administration of a single dose of XRL PO and will be well tolerated. ANIMALS: 7 healthy cats. METHODS: Extended-release levetiracetam (500 mg) was administered PO. Blood was collected and neurologic examination findings recorded at scheduled times over 30 hours. Serum levetiracetam concentration was quantitated by an immunoassay validated in cats. Data were subjected to noncompartmental analysis. Descriptive statistics were reported. RESULTS: The median dosage of 86.2 mg/kg, (range, 80-94.3) achieved a mean maximum concentration (Cmax ) of 89.8 ± 25.8 µg/mL at 4.9 ±1.57 hours. Serum levetiracetam was >5 µg/mL in all cats by 90 minutes. Mean concentrations were 43.7 ± 18.4 and 4.9 ± 3.4 µg/mL at 12 and 24 hours, respectively. The half-life was 4.1 ± 1.0 hours. The drug was well tolerated. CONCLUSIONS AND CLINICAL IMPORTANCE: A single 500 mg PO dose of XRL safely maintained serum levetiracetam concentration ≥5 µg/mL in healthy cats for at least 21 hours. Clinical efficacy studies in epileptic cats receiving XRL are indicated; however, monitoring should be implemented for individual cats.

Pharmacokinetics and dynamics of mycophenolate mofetil after single-dose oral administration in juvenile dachshunds.

Mycophenolate mofetil (MMF) is recommended as an alternative/complementary immunosuppressant. Pharmacokinetic and dynamic effects of MMF are unknown in young-aged dogs. We investigated the pharmacokinetics and pharmacodynamics of single oral dose MMF metabolite, mycophenolic acid (MPA), in healthy juvenile dogs purpose-bred for the tripeptidyl peptidase 1 gene (TPP1) mutation. The dogs were heterozygous for the mutation (nonaffected carriers). Six dogs received 13 mg/kg oral MMF and two placebo. Pharmacokinetic parameters derived from plasma MPA were evaluated. Whole-blood mitogen-stimulated T-cell proliferation was determined using a flow cytometric assay. Plasma MPA Cmax (mean ± SD, 9.33 ± 7.04 µg/ml) occurred at <1 hr. The AUC0-∞ (mean ± SD, 12.84±6.62 hr*µg/ml), MRTinf (mean ± SD, 11.09 ± 9.63 min), T1/2 (harmonic mean ± PseudoSD 5.50 ± 3.80 min), and k/d (mean ± SD, 0.002 ± 0.001 1/min). Significant differences could not be detected between % inhibition of proliferating CD5+ T lymphocytes at any time point (p = .380). No relationship was observed between MPA concentration and % inhibition of proliferating CD5+ T lymphocytes (R = .148, p = .324). Pharmacodynamics do not support the use of MMF in juvenile dogs at the administered dose based on existing therapeutic targets.

Antimicrobial use Guidelines for Treatment of Respiratory Tract Disease in Dogs and Cats: Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases.

Respiratory tract disease can be associated with primary or secondary bacterial infections in dogs and cats and is a common reason for use and potential misuse, improper use, and overuse of antimicrobials. There is a lack of comprehensive treatment guidelines such as those that are available for human medicine. Accordingly, the International Society for Companion Animal Infectious Diseases convened a Working Group of clinical microbiologists, pharmacologists, and internists to share experiences, examine scientific data, review clinical trials, and develop these guidelines to assist veterinarians in making antimicrobial treatment choices for use in the management of bacterial respiratory diseases in dogs and cats.

Profile of a Malignant Brain Tumour in Jamaica: An Eight-year Review, 2005 to 2012.

OBJECTIVE: Glioblastoma multiforme (GBM) is the most malignant and most common primary brain tumour worldwide. This study was undertaken to investigate the demographics of this tumour in Jamaica as there is to date no such published data. Data from the recently started Intracranial Tumour Registry (ITR) at the University Hospital of the West Indies was used. METHODS: All cases of GBM entered into the ITR between 2005 and 2012 were gathered. Of these, only patients with pathologically proven diagnoses were entered into the study. Demographic data, including age and gender, were recorded. The distribution of the tumours by anatomic location was also documented. RESULTS: Of the 602 patients entered into the ITR up to that time, 42 were found to have histologically proven GBM with a male to female ratio of 2.2:1. There was an age range of 8-92 years with a mean age of diagnosis of 48 years. The majority of the tumours (66.7%) occurred in the left cerebral hemisphere with the most common lobe being the temporal lobe. Two patients (4.8%) had lesions spanning both hemispheres. CONCLUSIONS: This preliminary study reveals that there is a similar gender distribution of GBM within our population compared with the rest of the world. It, however, revealed that the mean age of diagnosis in our population (48 years) is lower than that quoted in the worldwide literature (53 to 64 years). One possible explanation for this is the possibility that many of our GBMs are actually secondary tumours which are thought to arise from less malignant, undiagnosed precursors. The percentage of GBMs occurring in the paediatric population was similar to the rest of the world.

Disposition of Extended Release Levetiracetam in Normal Healthy Dogs After Single Oral Dosing.

BACKGROUND: Levetiracetam is an anticonvulsant used for control of canine epilepsy. An extended release preparation should improve dosing convenience. OBJECTIVES: To determine the disposition of extended release levetiracetam in normal dogs after single dosing. ANIMALS: Pharmacokinetic study: 16 healthy, adult dogs. METHODS: Using a partially randomized crossover study, levetiracetam (30 mg/kg) was administered intravenously (i.v.) and orally (p.o.) as extended release preparation with or without food. Blood was collected for 24 hours (i.v.) or 36 hours (p.o.). Serum levetiracetam was quantitated by immunoassay and data were subjected to noncompartmental analysis. RESULTS: Pharmacokinetic parameters for fasted versus fed animals, respectively, were (mean ± SEM): Cmax = 26.6 ± 2.38 and 30.7 ± 2.88 µ/mL, Tmax = 204.3 ± 18.9 and 393.8 ± 36.6 minutes, t1/2 = 4.95 ± 0.55 and 4.48 ± 0.48 hours, MRT = 9.8 ± 0.72 and 10 ± 0.64 hours, MAT = 4.7 ± 0.38 and 5.6 ± 0.67 hours, and F = 1.04 ± 0.04 and 1.26 ± 0.07%. Significant differences were limited to Tmax (longer) and F (greater) in fed compared to fasted animals. Serum levetiracetam concentration remained above 5 µ/mL for approximately 20 hours in both fasted and fed animals. CONCLUSIONS AND CLINICAL IMPORTANCE: Extended release levetiracetam (30 mg/kg q12h), with or without food, should maintain concentrations above the recommended minimum human therapeutic concentration.

Pharmacokinetics of single-dose rectal zonisamide administration in normal dogs.

BACKGROUND: Few medications are available for parental administration to animals with seizures. Rectal administration of medications is often used if the animal cannot be administered oral medications. HYPOTHESIS/OBJECTIVES: To determine the pharmacokinetic differences in zonisamide when administered rectally in either of 2 vehicles and p.o. to dogs. ANIMALS: Eight healthy research dogs. METHODS: Randomized cross-over design. Zonisamide, 10 mg/kg, was administered rectally in polyethylene glycol (PEG-R), rectally in water (H2O-R), and as an oral capsule. Plasma zonisamide concentrations were measured until 72 hours after administration. Zonisamide was quantitated by HPLC and plasma concentration versus time curve data was analyzed by using noncompartmental modeling. RESULTS: Mean maximum plasma zonisamide concentrations (µg/mL) were significantly higher after oral administration (11.56 ± 4.04) compared to H2O-R (5.00 ± 1.83) (P = .004). Disappearance half-life (hours) and mean time to maximum concentration (hours) were not significantly different between methods of administration. Mean relative bioavailability of PEG-R (85 ± 69%) was significantly higher than that of H2O-R (53 ± 37%) (P = .039). Dogs tolerated all dosing forms with no evidence of adverse effects. CONCLUSIONS AND CLINICAL IMPORTANCE: The vehicle in which zonisamide is dissolved influences rectal bioavailability, with PEG preferred to H2O-R. Because of the prolonged time to maximum concentration, rectal administration of zonisamide should not be used to treat status epilepticus in dogs. A dose higher than what was used in this study might be necessary, if currently recommended minimum therapeutic concentrations (10 µg/mL) are to be achieved with a single-dose administration.

Trauma in the developing world: the jamaican experience.

Trauma remains a challenging burden on the often under-funded healthcare systems of developing countries. Ten-year data from the Jamaica Trauma Registry show that trauma accounts for 20% of surgical admissions, with close to 50% being intentional and with a 5% mortality. There is a good opportunity for various preventive programmes to be instituted to reduce the burden of this disease.

The Impact of Trans-thoracic Ultrasound on Cardiac Injuries.

OBJECTIVE: To determine the impact of trans-thoracic ultrasound (TTUS) in patients with chest trauma and potential cardiac injuries and to determine the outcome of patients with cardiac injury detected on TTUS. METHOD: Data were obtained from the Trauma Registry for all patients presenting alive to the University Hospital of the West Indies during the 10-year period commencing January 1, 2001 and who were subjected to a TTUS or emergency thoracotomy for cardiac injuries, or had cardiac injuries at postmortem. In addition to demographics, variables analysed included mechanism and site of injury and outcome. RESULTS: Of 405 patients being subjected to a TTUS during the period, 12 (3%) had cardiac injuries. During the same period, 63 patients in the Trauma Registry had proven cardiac injuries. Trans-thoracic ultrasound was thus conducted on 19% of all patients with cardiac injuries. Three patients had positive TTUS but no cardiac injuries. Of the patients with injuries, the mean age was 30.4 years, 92.1% were male and 65% were as a result of stab wounds, while 22% were as a result of gunshot wounds. The right ventricle was the most common site of injury, accounting for 41% of cases, while the left ventricle, both ventricles and other sites accounted for 27%, 17% and 14%, respectively. Ninety per cent of the group was subjected to emergency thoracotomy; mortality of the entire group was 48%, including one patient who had TTUS. CONCLUSIONS: This review demonstrates that cardiac injuries remain lethal, diagnosis is largely clinical and TTUS may be over-utilized, having little impact on clinical outcome of patients presenting with this injury.

Oral cyclosporine treatment in dogs: a review of the literature.

Cyclosporine is an immunomodulatory drug used to treat an increasing spectrum of diseases in dogs. Cyclosporine is a calcineurin inhibitor, ultimately exerting its inhibitory effects on T-lymphocytes by decreasing production of cytokines, such as interleukin-2. Although, in the United States, oral cyclosporine is approved in dogs only for treatment of atopic dermatitis, there are many other indications for its use. Cyclosporine is available in 2 oral formulations: the original oil-based formulation and the more commonly used ultramicronized emulsion that facilitates oral absorption. Ultramicronized cyclosporine is available as an approved animal product, and human proprietary and generic preparations are also available. Bioavailability of the different formulations in dogs is likely to vary among the preparations. Cyclosporine is associated with a large number of drug interactions that can also influence blood cyclosporine concentrations. Therapeutic drug monitoring (TDM) can be used to assist in attaining consistent plasma cyclosporine concentrations despite the effects of varying bioavailability and drug interactions. TDM can facilitate therapeutic success by guiding dose adjustments on an individualized basis, and is recommended in cases that do not respond to initial oral dosing, or during treatment of severe, life-threatening diseases for which a trial-and-error approach to dose adjustment is too risky. Pharmacodynamic assays that evaluate individual patient immune responses to cyclosporine can be used to augment information provided by TDM.

Paediatric ocular trauma admissions to the University Hospital of the West Indies 2000-2005 / Ingresos por trauma ocular pediátrico en el Hospital Universitario de West Indies 2000-2005

PURPOSE: To assess the epidemiology of paediatric ocular trauma presenting to the University Hospital of the West Indies (UHWI), Jamaica, between January 2000 and December 2005. METHODS: Retrospective review of all paediatric patients (< 16 years old) admitted with ocular trauma in the UHWI trauma database. RESULTS: Three hundred and ninety-seven patients were admitted with ocular trauma during the study period, 36.5% of admissions were < 16 years old. Males comprised 69.6% (101/145) of the paediatric admissions. The mean age was 8.3 years (95% CI 7.2, 9.4) and 8.7 years (95% CI 7.9, 9.4) for the females and males, respectively. The commonest place of injury was in the home: 47.5% and 50% in males and females, respectively. Females were more likely to be involved in domestic disputes (4.8%). Stones (20.3%) were the most common causative agent of eye injury in children, only occurring in the 4-16-year old age group. The highest incidence for hospitalization of paediatric eye injury occurred in March and May, with the least admissions occurring in February. Contusions (48.3%) were the most common type of injury. Open globe injuries occurred in 35.9% of cases. Chemical burns were the least common type of injury. The admission period ranged from 1-58 days. The median hospitalization period was five days (95% CI 4.5, 6.0). CONCLUSION: Paediatric ocular injury can be age specific. Contusion was the most common ocular injury and males were more likely to be hospitalized than females. Epidemiological information is important in determining the burden of ocular disease in the population. It is also essential in planning improvement in health services and patient education for prevention of serious eye injuries.

OBJETIVO: Evaluar la epidemiología del trauma ocular pediátrico en el Hospital Universitario de los Indias Orientales (UHWI), Jamaica, entre enero de 2000 y diciembre de 2005. MÉTODOS: Revisión retrospectiva de todos los pacientes pediátricos (<16 años de edad) ingresados con trauma ocular, según la base de datos del HUWI. RESULTADOS: Trescientos noventa y siete pacientes con trauma ocular fueron ingresados en el periodo bajo estudio; 36.5% de los ingresos tenían < 16 años de edad. Los varones comprendían el 69.6% (101/145) de los ingresos pediátricos. La edad promedio fue de 8.3 años (95% CI 7.2, 9.4) y 8.7 años (95% CI 7.9, 9.4) para las hembras y los varones, respectivamente. El lugar más común del accidente traumático fue la casa: 47.5% y 50% en los varones y las hembras, respectivamente. Las hembras presentaban una mayor probabilidad de estar involucradas en disputas domésticas (4.8%). Las piedras (20.3%) fueron el agente causante más común de la lesión del ojo en los niños, ocurriendo solamente en el grupo de 4-16 años de edad. La incidencia más alta de hospitalización por lesión ocular pediátrica ocurrió en marzo y mayo, siendo febrero el mes de menores ingresos. Las contusiones (48.3%) fueron el tipo más común de lesión. Las lesiones abiertas del globo ocular tuvieron lugar en 35.9% de los casos. Las quemaduras químicas fueron el tipo menos común de lesión. El periodo de ingreso osciló de 1-58 días. El periodo promedio de hospitalización fue de cinco días (95% CI 4.5, 6.0). CONCLUSIÓN: La lesión ocular pediátrica puede ser específica por edad. La contusión fue la lesión ocular más común, y la probabilidad de hospitalización fue más alta en los varones que en las hembras. La información epidemiológica es importante a la hora de determinar la carga de la enfermedad ocular sobre la población. También resulta fundamental cuando se trata de planificar el mejoramiento de nuestros servicios de salud y la educación de los pacientes para prevenir lesiones oculares serias.

Hospitalization trends in adult ocular trauma at the University Hospital of the West Indies / Tendencias de la hospitalización por trauma ocular adulto en el Hospital Universitario de West Indies

OBJECTIVE: To assess the epidemiology of ocular trauma in adult patients admitted to the University Hospital of the West Indies (UHWI), Jamaica, between January 2000 and December 2005. METHODS: Retrospective review of all adult patients admitted with ocular trauma in the UHWI trauma database. RESULTS: Three hundred and ninety-seven patients were admitted with ocular trauma during the study period; 35.8% of admissions with ocular trauma were < 16 years of age. There were 252 adults (>17 years old); 21.4% (54/252) were females and 78.6% (198/252) were males. The ratio of males to females was 3.7:1. The median age of the females and males was 32 years (95% CI 27, 35.9) and 33 years (95% CI 30, 35.0), respectively. The hospitalization period ranged from 1-283 days, mean 8.8 days in the males; and ranged from 1-39 days, mean six days in the females. March had the highest mean admissions over the six years. Severe chemical burns were the cause of the longest admissions. The most common place of injury was the home (30.2%) followed by in the street (28.2%); only 2% were from recreation. The most common cause of ocular injury was motor vehicle accident in 18.6%. The second most common cause was from nail hammering (14.3%); of this, 97.2% were male. Females (14.8%) were more commonly admitted from chemical injuries than males (11.1%). Of the females, 50% were due to domestic dispute and 50% were accidental bleach spills. CONCLUSION: The most common cause of ocular injury was motor vehicle accidents, nail hammering in males and chemical injuries in females. Epidemiological information is important in determining the burden of ocular disease on the population. It is essential in planning improvement in health services and patient education for prevention ofserious eye injuries.

OBJETIVO: Evaluar la epidemiología del trauma ocular en pacientes adultos ingresados en el Hospital Universitario de West Indies (UHWI), Jamaica, entre enero de 2000 y diciembre de 2005. MÉTODOS: Se llevó a cabo una revisión retrospectiva de todos los pacientes adultos ingresados por trauma ocular en el HUWI, de acuerdo con la base de datos de dicho centro hospitalario. RESULTADOS: Trescientos noventa y siete pacientes fueron ingresados con trauma ocular en el periodo del estudio; 35.8% de los ingresos por trauma ocular tenían <16 años de edad. Se trataba de 252 adultos (>17 años de edad); 21.4% (54/252) eran hembras y 78.6% (198/252) eran varones. La proporción de varones con respecto a las hembras fue 3.7:1. La edad promedio de hembras y varones fue 32 años (95% CI 27, 35.9) y 33 años (95% CI 30, 35.0), respectivamente. El periodo de hospitalización osciló de 1 - 283 días, con una media de 8.8 días para los varones; y fluctuó de 1-39 días, con una media de 6 días, para las hembras. Marzo presentó el mayor promedio de ingresos durante los seis años. Las quemaduras químicas severas constituyeron la causa de los ingresos de mayor estadía. El lugar más común de ocurrencia de las lesiones fue la casa (30.2%), seguido por la calle (28.2%); sólo 2% fueron lugares de recreación. La causa más común de lesión ocular fueron los accidentes motovehiculares en 18.6%. La segunda causa más común provino de martillar clavos (14.3%); de éstos, 97.2% fueron varones. Las hembras (14.8%) fueron más comúnmente ingresadas a causa de lesiones por sustancias químicas, en comparación con los varones (11.1%). De las hembras, 50% de los casos se debieron a disputas domésticas, y 50% a derramamientos accidentales de lejía. CONCLUSIÓN: La causa más común de la lesión ocular fueron los accidentes motovehiculares y el martilleo de clavos en los hombres, y las lesiones por sustancias químicas en las hembras. La información epidemiológica es importante a la hora de determinar la carga de las enfermedades oculares sobre la población. La misma es fundamental para planificar el mejoramiento de los servicios de salud y la educación de los pacientes en la prevención de lesiones oculares.

Colonoscopy in Central Jamaica: results and implications / La colonoscopía en Jamaica Central: resultados e implicaciones

The aim of this report was to determine the outcome of all patients subjected to colonoscopy at an outpatient medical facility in central Jamaica. A copy of the colonoscopy report of each consecutive patient during the period March 2007 to April 2011 was entered into a database and analysed. One thousand two hundred and fifty patients were identified with a mean age of 60 years and 56.5% were female. The most common indication for colonoscopy was bleeding (28%) but constipation (15%) and screening (11%) were also important. Caecal intubation was achieved in 96% of the group. While 30% of the group had normal findings, 32% had diverticulosis and 23% had haemorrhoids; importantly 10% had carcinomas and 11 % had adenomas. Adenomas were detected in 13% of the screened patients. The most important predictor ofan abnormal colonoscopy was a history ofbleeding. The perforation rate was 0.24% with no perforations occurring in the latter 650 cases.

El objetivo de este reporte fue determinar la evolución clínica de todos los pacientes sometidos a colonoscopía en una clínica de consulta externa en Jamaica central. Una copia del reporte de la colonoscopía de cada paciente consecutivo durante el periodo de marzo de 2007 a abril de 2011 fue introducida en la base de datos, y luego analizada. Se identificaron un total de mil doscientos cincuenta pacientes con edad promedio de 60 años, de los cuales 56.5% eran hembras. La indicación más común para la colonoscopía fue el sangramiento (28%) pero el estreñimiento (15%) y el tamizaje (11%) fueron también importantes. La intubación cecal se logró en el 96% del grupo. Mientras que el 30% del grupo tuvo resultados normales, el 32% presentó diverticulosis y el 23% tenia hemorroides. Aún más importante: 10% tenían carcinomas y 11% tenían adenomas. Se detectaron adenomas en 13% de los pacientes tamizados. El predictor más importante de una colonoscopía anormal fue una historia de sangramiento. La tasa de perforación fue 0.24% sin que se presentaran perforaciones en los últimos 650 casos.

Can a Simulation Game Change Cystic Fibrosis Patients' Attitudes Toward Treatment Adherence?

OBJECTIVE: The authors hypothesized that playing a simulation game designed according to Multiple Identification Theory (MIT) would improve attitudes toward treatment adherence among adolescent cystic fibrosis (CF) patients. SUBJECTS AND METHODS: Study participants (n=16) were recruited from a large Midwestern children's hospital. As part of a within-group pilot study, they played "My Life with CF," an MIT simulation game. Their attitudes toward treatment adherence and general decision-making were assessed prior to playing the game. They were measured again immediately post-play and 1 month afterward. RESULTS: Statistically significant differences (P<0.05) were found immediately post-treatment on questionnaires concerning participants' holding present versus future-centered orientations and their attitudes toward adherence. One month post-treatment, significant differences were found regarding participants' attitudes toward adherence and whether luck or effort determines what happens to them in life. Effect sizes for all these differences ranged from large (r(2)=0.31) to very large (r(2)=0.94). CONCLUSION: The MIT-based "My Life with CF" game was effective at changing adolescent CF patients' attitudes toward adherence.

Pharmacokinetics of tramadol and its major metabolites in alpacas following intravenous and oral administration.

Tramadol, a centrally acting opioid analgesic with monamine reuptake inhibition, was administered to six alpacas (43-71 kg) randomly assigned to two treatment groups, using an open, single-dose, two-period, randomized cross-over design at a dose of 3.4-4.4 mg/kg intravenously (i.v.) and, after a washout period, 11 mg/kg orally. Serum samples were collected and stored at -80°C until assayed by HPLC. Pharmacokinetic parameters were calculated. The mean half-lives (t(1/2)) i.v. were 0.85±0.463 and 0.520±0.256 h orally. The Cp(0) i.v. was 2467±540 ng/mL, and the C(max) was 1202±1319 ng/mL orally. T(max) occurred at 0.111±0.068 h orally. The area under the curve (AUC(0-∞)) i.v. was 895±189 and 373±217 ng*h/mL orally. The volume of distribution (V(d[area])) i.v. was 5.50±2.66 L/kg. Total body clearance (Cl) i.v. was 4.62±1.09 h; Cl/F for oral administration was 39.5±23 L/h/kg. The i.v. mean residence time (MRT) was 0.720±0.264. Oral adsorption (F) was low (5.9-19.1%) at almost three times the i.v. dosage with a large inter-subject variation. This may be due to binding with the rumen contents or enzymatic destruction. Assuming linear nonsaturable pharmacokinetics and absorption processes, a dosage of 6.7 times orally would be needed to achieve the same i.v. serum concentration of tramadol. The t(1/2) of all three metabolites was longer than the parent drug; however, O-DMT, N-DMT, and Di-DMT metabolites were not detectable in all of the alpacas. Because of the poor bioavailability and adverse effects noted in this study, the oral administration of tramadol in alpacas cannot be recommended without further research.

Paediatric ocular trauma admissions to the University Hospital of the West Indies 2000-2005.

PURPOSE: To assess the epidemiology of paediatric ocular trauma presenting to the University Hospital of the West Indies (UHWI), Jamaica, between January 2000 and December 2005. METHODS: Retrospective review of all paediatric patients (< or = 16 years old) admitted with ocular trauma in the UHWI trauma database. RESULTS: Three hundred and ninety-seven patients were admitted with ocular trauma during the study period, 36.5% of admissions were < or = 16 years old. Males comprised 69.6% (101/145) of the paediatric admissions. The mean age was 8.3 years (95% CI 7.2, 9.4) and 8.7 years (95% CI 7.9, 9.4) for the females and males, respectively. The commonest place of injury was in the home: 47.5% and 50% in males and females, respectively Females were more likely to be involved in domestic disputes (4.8%). Stones (20.3%) were the most common causative agent of eye injury in children, only occurring in the 4-16-year old age group. The highest incidence for hospitalization of paediatric eye injury occurred in March and May, with the least admissions occurring in February. Contusions (48.3%) were the most common type of injury. Open globe injuries occurred in 35.9% of cases. Chemical burns were the least common type of injury. The admission period ranged from 1-58 days. The median hospitalization period was five days (95% CI 4.5, 6.0). CONCLUSION: Paediatric ocular injury can be age specific. Contusion was the most common ocular injury and males were more likely to be hospitalized than females. Epidemiological information is important in determining the burden of ocular disease in the population. It is also essential in planning improvement in health services and patient education for prevention of serious eye injuries.

Hospitalization trends in adult ocular trauma at the University Hospital of the West Indies.

OBJECTIVE: To assess the epidemiology of ocular trauma in adult patients admitted to the University Hospital of the West Indies (UHWI), Jamaica, between January 2000 and December 2005. METHODS: Retrospective review of all adult patients admitted with ocular trauma in the UHWI trauma database. RESULTS: Three hundred and ninety-seven patients were admitted with ocular trauma during the study period; 35.8% of admissions with ocular trauma were < or = 16 years of age. There were 252 adults (> 17 years old), 21.4% (54/252) were females and 78.6% (198/252) were males. The ratio of males to females was 3.7:1. The median age of the females and males was 32 years (95% CI 27, 35.9) and 33 years (95% CI 30, 35.0), respectively. The hospitalization period ranged from 1-283 days, mean 8.8 days in the males; and ranged from 1-39 days, mean six days in the females. March had the highest mean admissions over the six years. Severe chemical burns were the cause of the longest admissions. The most commonplace of injury was the home (30.2%) followed by in the street (28.2%); only 2% were from recreation. The most common cause of ocular injury was motor vehicle accident in 18.6%. The second most common cause was from nail hammering (14.3%); of this, 97.2% were male. Females (14.8%) were more commonly admitted from chemical injuries than males (11.1%). Of the females, 50% were due to domestic dispute and 50% were accidental bleach spills. CONCLUSION: The most common cause of ocular injury was motor vehicle accidents, nail hammering in males and chemical injuries in females. Epidemiological information is important in determining the burden of ocular disease on the population. It is essential in planning improvement in health services and patient education for prevention of serious eye injuries.

Colonoscopy in central Jamaica: results and implications.

The aim of this report was to determine the outcome of all patients subjected to colonoscopy at an outpatient medical facility in central Jamaica. A copy of the colonoscopy report of each consecutive patient during the period March 2007 to April 2011 was entered into a database and analysed. One thousand two hundred and fifty patients were identified with a mean age of 60 years and 56.5% were female. The most common indication for colonoscopy was bleeding (28%) but constipation (15%) and screening (11%) were also important. Caecal intubation was achieved in 96% of the group. While 30% of the group had normal findings, 32% had diverticulosis and 23% had haemorrhoids; importantly 10% had carcinomas and 11% had adenomas. Adenomas were detected in 13% of the screened patients. The most important predictor of an abnormal colonoscopy was a history of bleeding. The perforation rate was 0.24% with no perforations occurring in the latter 650 cases.

Pharmacokinetics of amikacin in plasma and selected body fluids of healthy horses after a single intravenous dose.

REASONS FOR PERFORMING STUDY: No studies have determined the pharmacokinetics of low-dose amikacin in the mature horse. OBJECTIVES: To determine if a single i.v. dose of amikacin (10 mg/kg bwt) will reach therapeutic concentrations in plasma, synovial, peritoneal and interstitial fluid of mature horses (n=6). METHODS: Drug concentrations of amikacin were measured across time in mature horses (n=6); plasma, synovial, peritoneal and interstitial fluid were collected after a single i.v. dose of amikacin (10 mg/kg bwt). RESULTS: The mean±s.d. of selected parameters were: extrapolated plasma concentration of amikacin at time zero 144±21.8 µg/ml; extrapolated plasma concentration for the elimination phase 67.8±7.44 µg/ml, area under the curve 139±34.0 µg*h/ml, elimination half-life 1.34±0.408 h, total body clearance 1.25±0.281 ml/min/kg bwt; and mean residence time (MRT) 1.81±0.561 h. At 24 h, the plasma concentration of amikacin for all horses was below the minimum detectable concentration for the assay. Selected parameters in synovial and peritoneal fluid were maximum concentration (Cmax) 19.7±7.14 µg/ml and 21.4±4.39 µg/ml and time to maximum concentration 65±12.2 min and 115±12.2 min, respectively. Amikacin in the interstitial fluid reached a mean peak concentration of 12.7±5.34 µg/ml and after 24 h the mean concentration was 3.31±1.69 µg/ml. Based on a minimal inhibitory concentration (MIC) of 4 µg/ml, the mean Cmax:MIC ratio was 16.9±1.80 in plasma, 4.95±1.78 in synovial fluid, 5.36±1.10 in peritoneal fluid and 3.18±1.33 in interstitial fluid. CONCLUSIONS: Amikacin dosed at 10 mg/kg bwt i.v. once a day in mature horses is anticipated to be effective for treatment of infection caused by most Gram-negative bacteria. POTENTIAL RELEVANCE: Low dose amikacin (10 mg/kg bwt) administered once a day in mature horses may be efficacious against susceptible microorganisms.