Severe Cutaneous Adverse Reactions to Drugs in Latin America: The RACGRAD Study.

BACKGROUND AND OBJECTIVE: Severe cutaneous adverse reactions to drugs (SCARs) are associated with high morbidity and mortality and with sequelae. Objective: To characterize patients with SCARs in 8 health care institutions in Latin America. METHODS: We performed a cross-sectional, descriptive, multicenter study of patients diagnosed with SCARs in Latin America between January 2009 and December 2018. The analysis was carried out using a database in BD Clinic. RESULTS: We collected 70 patients, of whom 42 (60%) were women. Mean age was 38.7 years. Forty-two patients (60%) had DRESS-DIHS, 12 (17.1%) TEN, 5 (7.1%) SJS, 6 (8.5%) AGEP, 4 (5.7%) other reactions not classified as SCARs, and 1 (1.4%) overlapping SJS-TEN. The main causative drugs were aromatic anticonvulsants in 31 cases (44.3%), ß-lactam antibiotics in 11 cases (15.7%), and non-ß-lactam antibiotics in 6 cases (8.6%). In all of the cases, the suspected drug was withdrawn at the first sign of a SCAR. Sixty-six patients (94.2%) received anti-inflammatory treatment, mostly systemic corticosteroids. Complications occurred in 53 cases (75.7%), and 3 patients died (4.3%). Thirteen patients (18.6%) had sequelae. CONCLUSIONS: This is the first multicenter report on SCARs in Latin America. DRESS-DIHS was the most frequently reported clinical entity, and anticonvulsants were the main triggers. Most of the patients received systemic corticosteroids. Complications were frequent, and 3 patients died.

Understanding why fat, oil and grease (FOG) bioremediation can be unsuccessful.

Commercial kitchen wastewaters are typically strong organic and fat-rich effluents, often identified as major contributors to fatberg formation and associated blockages in sewers. Experimental trials were done using synthetic kitchen wastewater to understand the complex reactions involved in microbial remediation in grease traps/separators prior discharge in sewers. The principle organic components (FOG, carbohydrate and protein nitrogen), were varied using ranges observed in a previous study on real kitchen wastewater characterisation. A model bacterium, Bacillus licheniformis NCIMB 9375, was used to evaluate microbial utilisation of the different organic fractions in relation to fat, oil and grease (FOG) degradation. Novel results in the treatment of these effluents showed that, the presence and concentration of alternative carbon sources and the ratio of carbon to nitrogen (COD:N) had great influence on FOG-degradation response. For example, FOG removal decreased from 24 to 10 mg/l/h when glucose was substitute for starch at equivalent concentrations (500 mg/l); and from 26 to 5 mg/l/h when initial COD:N increased from 45:1 to 147:1. The dominant influence of COD:N was validated using a commercial bioadditive and real kitchen wastewater adjusted to different COD:N ratios, confirming the strong influence of kitchen wastewater composition on bioremediation outcomes. These results can therefore have major implications for biological management of FOG in kitchens and sewers as they provide a scientific explanation for bioremediation success or failure.

Characterisation of food service establishment wastewater and its implication for treatment.

Essential for the selection of a reliable treatment system is the characterisation of the effluent to treat. Kitchen wastewater (KWW) from food service establishments (FSEs) is a strong organic and fat-rich effluent whose characterisation has not been sufficiently addressed. KWW composition is highly variable and linked to the FSE's size, the type of meals prepared and the amount of water used during the cleaning. COD, TSS and fat content (FOG) are the most common parameters found in literature. However, other physical and chemical parameters (e.g. temperature, pH, oil droplets characteristics and trace elements), correlated to commercial kitchen cleaning practices rather than the specific effluent, but equally influential on the treatment efficiencies of both physical and biological methods, have hardly been investigated. A comprehensive characterisation of wastewaters from three food service establishments was used to generate data to support the selection of appropriate FOG mitigation methods. Two novel analytical methods were used to quantify the proportion of emulsified FOG and associated droplet size from different kitchen washing effluents. The results showed that more than 90% of the FOG from the dishwasher effluent and around 35% of sink one was emulsified, with droplet sizes less than 100 µm, well below the removal capabilities of conventional grease interceptors, but easily removed using biological means. From the WW composition results, a formula for predictive modelling was derived to represent average organic matter composition for kitchen wastewater as C20H38O10N, applicable in remediation processes. These results offer a good starting point for the design, operation, and optimisation of wastewater treatment systems of oil-rich KWW.

A balanced reciprocal translocation t(10;15)(q22.3;q26.1) interrupting ACAN gene in a family with proportionate short stature.

PURPOSE: Few examples of the involvement of a single gene in idiopathic short stature have been described until now. Our aim was to identify the causative gene of proportionate short stature in a large family showing co-segregation of the phenotype with the reciprocal translocation t(10;15)(q22;q24). METHODS: FISH mapping was carried out with BACs and long-range PCR probes to identify the smallest genomic regions harboring the translocation breakpoints. Real-Time RT-PCR was performed in blood after pre-amplification of target genes cDNA. RESULT: The affected family members presented with a final height of between - 2.41 and - 4.18 SDS and very mild skeletal dysmorphisms. Growth rates of the proband and of her cousin, whose childhood and pre-pubertal bone age corresponded to the chronological age, showed a poor growth spurt during treatment with rhGH. However, their adult height was greater than that of their untreated mothers, suggesting efficacy of GH therapy. Breakpoint mapping revealed that the translocation t(10;15)(q22.3;q26.1) disrupts, on 15q, the ACAN gene at intron 1, decreasing its transcriptional expression. CONCLUSIONS: This is the first description of a chromosome rearrangement disrupting ACAN and leading to its haploinsufficiency. ACAN loss of function should be considered a potential underpinning of short patients who display a poor growth spurt and belong to families with autosomal dominant segregation of proportionate short stature. Besides this core phenotype, literature review suggests that advanced bone age, early onset osteochondritis dissecans, osteoarthritis, intervertebral disc disease as well as craniofacial dysmorphisms can be important suggestive phenotypes in affected families.

Quality of life and clinical characterization of patients with vernal keratoconjunctivitis in a pediatric population in Colombia.

Vernal keratoconjunctivitis is one of the most serious ocular allergies that have the potential to induce large ocular morbidity and significant visual changes affecting the quality of life of these individuals. METHODOLOGY: This study was conducted in two phases. The first phase consisted of the clinical characterization of 32 patients from the Clinical Allergology center of the I.P.S. Universitaria from July 2014 to February 2015. A retrospective analysis of medical records was performed. In the second phase, the evaluation of quality of life was conducted using the questionnaire KIDSCREEN 27, which was validated in our population and evaluated as recommended by the creators of this instrument. RESULTS: A total of 24 patients (75%) were men, mean age of 12.1 (SD 2.6) years. 100% of the patients had clinical evaluation and were monitored by Allergology and Ophthalmology, 12 patients (37.5%) were found in mild level, 5 patients (15.6%) were moderate and 14 patients (43.8%) were severe level. The most common symptoms were pruritus (75%), photophobia (50%), lacrimation (37.5%), and secretions (28.1%). 65.6% had a family history of atopy and 84.4% had an allergic comorbidity. Aeroallergen skin tests were found positive in 25 patients (78.1%). All patients had initiated ocular treatment by the time the survey of quality of life was conducted; but, they still had low quality of life scores in the 5 domains assessed. When the scores were evaluated by gender, the only statistically significant difference was found in the domain of family life and free time, which was lower for women. CONCLUSION: The vernal keratoconjunctivitis is a disease more prevalent in men. It apparently has an important atopic base in our environment, which due to its severe ocular involvement causes a marked decrease in the quality of life of the children who present it.

Genome-wide association analysis of body conformation traits in Mexican Holstein cattle using a mix of sampled and imputed SNP genotypes.

In arid and semi-arid zones, animal health and production are closely correlated with body conformation traits. These selected traits, in turn, allow livestock to adapt unfavorable soil and environmental conditions. The primary objective of this study was to perform a genome-wide association analysis for a set of sampled and imputed SNPs with 16 conformation traits in a population of Holstein cows from a desert area of Northwestern Mexico. Imputation from 6K to 50K SNPs was performed as a low-cost optimization strategy. Results show eight SNPs associated with two conformation traits. The Udder Depth trait resulted in seven associated SNPs from chromosome 10, that related to Marbling Score, Milk Yield, Fat Yield, Protein Yield, and Protein Percentage Quantitative Trait Loci (QTLs). The Body Depth trait resulted in one associated SNP from chromosome 2, although no QTL relation was found. The discovery of genes associated with conformation traits may be indicative of the adaptive selection pressures the Holstein breed has undergone in response to the extreme weather conditions found in the northwestern areas of Mexico. Results of this study indicate that traits such as stature and body depth may be used as indicators of cows' potential genetic merits for milk, fat, and protein production.

Pharmacokinetics and sedative effects of dexmedetomidine in dairy calves.

AIMS: To evaluate the pharmacokinetics of dexmedetomidine (DEX) administered I/V at a dose of 5 µg/kg bodyweight in dairy calves and to compare the sedative effects of anaesthetic protocols involving DEX and xylazine. METHODS: Nine dairy calves, aged 17-20 days, were treated with 5 µg/kg I/V dexmedetomidine. For pharmacokinetic evaluation, blood samples were collected over 12 hours and serum samples were analysed by high performance liquid chromatography-mass spectrometry. Another nine dairy calves, aged 16-20 days, were treated with 0.2 mg/kg I/V xylazine. After both treatments, heart rate, respiratory rate and rectal temperature were measured for 20 minutes. Sedation quality and recovery times were also assessed. RESULTS: The kinetics of DEX was best described by a two-compartment model. The distribution and elimination half-lives were 8.7 (SD 5.0) and 83.5 (SD 67.5) minutes, respectively. Mean maximum concentration and body clearance were 12.5 (SD 8.6) ng/mL and 27.9 (SD 13.1) mL/minute/kg, respectively; the mean volume of distribution at steady state was 2,170.8 (SD 1,657.5) mL/kg. A decrease in heart rate was observed after treatments with both DEX and xylazine. No differences in heart or respiration rate, or rectal temperature were observed between the two treatment groups. The onset of sedation occurred after 2.7 (SD 0.67) minutes for calves treated with DEX and 2.8 (SD 0.78) minutes for calves treated with xylazine, and was characterised by a similar degree of deep sedation and ease of handling of the calves. All recoveries were eventless, and no adverse reactions were noted. CONCLUSIONS AND CLINICAL RELEVANCE: Dexmedetomidine treatment resulted in a reliable and long lasting sedation in calves, a transient decrease in heart rate and no modification in respiratory rate or rectal temperature. The results were comparable to xylazine, the most popular alpha-2-agonist among bovine practitioners. The use of DEX in dairy calves for rapid procedures such as dehorning or castration could be suggested.

In vivo dosimetry of total body irradiation patients: A 10 year retrospective analysis.

Myeloablative Total Body Irradiation (TBI) used in our Institution, as part of the conditioning scheme for haematopoietic stem cell transplantation, is an extended-distance supine technique that has been implemented using a 15 MV LINAC beam, lead lung compensators, PMMA, and water bolus to improve homogeneity. This study reviews in-vivo dosimetry (IVD) over 10 years of treatments, assessing the technique's robustness, accuracy, and efficiency. A 2-lateral opposite fields plan was calculated from planning CT with validated Oncentra TPS (Elekta AB, Sweden). Monitor units (MUs), lung compensators shape and thickness were calculated to deliver the prescription dose (12 Gy in 6 bi-daily fractions or 9.9 Gy in 3 daily fractions) to the patient's abdomen midline at the umbilical level, maintaining lung dose within ±5 % range of prescription. Data from 103 patients, of which more than 87 % were pediatric, were retrieved and analyzed for a total of 537 treatment fractions. The impact of IVD omission was evaluated, supposing doing it only once or in the first two fractions, if necessary. Median ΔMU from planned was -1.2 %. Median percentage dose deviation from prescription in 6 anatomical regions was below 2 %. IVD omission could have resulted in an increase of 7 patients registering at least one anatomical region outside the ±5 % dose range at the end of treatment. It is possible to confirm the implemented technique's robustness and accuracy in delivering the prescribed dose under IVD monitoring. Nevertheless, this technique and associated IVD are time-consuming and IVD omission could be assessed with limited drawbacks.

Chronic full-band recordings with graphene microtransistors as neural interfaces for discrimination of brain states.

Brain states such as sleep, anesthesia, wakefulness, or coma are characterized by specific patterns of cortical activity dynamics, from local circuits to full-brain emergent properties. We previously demonstrated that full-spectrum signals, including the infraslow component (DC, direct current-coupled), can be recorded acutely in multiple sites using flexible arrays of graphene solution-gated field-effect transistors (gSGFETs). Here, we performed chronic implantation of 16-channel gSGFET arrays over the rat cerebral cortex and recorded full-band neuronal activity with two objectives: (1) to test the long-term stability of implanted devices; and (2) to investigate full-band activity during the transition across different levels of anesthesia. First, we demonstrate it is possible to record full-band signals with stability, fidelity, and spatiotemporal resolution for up to 5.5 months using chronic epicortical gSGFET implants. Second, brain states generated by progressive variation of levels of anesthesia could be identified as traditionally using the high-pass filtered (AC, alternating current-coupled) spectrogram: from synchronous slow oscillations in deep anesthesia through to asynchronous activity in the awake state. However, the DC signal introduced a highly significant improvement for brain-state discrimination: the DC band provided an almost linear information prediction of the depth of anesthesia, with about 85% precision, using a trained algorithm. This prediction rose to about 95% precision when the full-band (AC + DC) spectrogram was taken into account. We conclude that recording infraslow activity using gSGFET interfaces is superior for the identification of brain states, and further supports the preclinical and clinical use of graphene neural interfaces for long-term recordings of cortical activity.

Identifying individuals at risk for surgical supravalvar aortic stenosis by polygenic risk score with graded phenotyping.

In a previous pathway-based, extreme phenotype study, we identified 1064 variants associated with supravalvar aortic stenosis (SVAS) severity in people with Williams syndrome (WS) and either no SVAS or surgical SVAS. Here, we use those variants to develop and test polygenic risk scores (PRS). We used the clumping and thresholding (CT) approach on the full 1064 variants and a 427-variant subset that was part of 13 biologically relevant pathways identified in the previous study. We also used a lasso approach on the full set. We were able to achieve an area under the curve (AUC) of >0.99 for the two CT PRS methods, using only 622 and 320 variants respectively when 2/3 of the initial 217 participants data were used for training and 1/3 for testing. The lasso performed less well. We then evaluated the performance of those PRS variant sets on an additional group of 138 patients with WS with intermediate severity SVAS and found a misclassification rate of <10% between the surgical and intermediate groups, suggesting potential for clinical utility of the score.

Typical values of z-resolution for different Digital Breast Tomosynthesis systems evaluated in a multicenter study.

PURPOSE: The aim of the present study, conducted by a working group of the Italian Association of Medical Physics (AIFM), was to define typical z-resolution values for different digital breast tomosynthesis (DBT) models to be used as a reference for quality control (QC). Currently, there are no typical values published in internationally agreed QC protocols. METHODS: To characterize the z-resolution of the DBT models, the full width at half maximum (FWHM) of the artifact spread function (ASF), a technical parameter that quantifies the signal intensity of a detail along reconstructed planes, was analyzed. Five different commercial phantoms, CIRS Model 011, CIRS Model 015, Modular DBT phantom, Pixmam 3-D, and Tomophan, were evaluated on reconstructed DBT images and 82 DBT systems (6 vendors, 9 models) in use at 39 centers in Italy were involved. RESULTS: The ASF was found to be dependent on the detail size, the DBT angular acquisition range, the reconstruction algorithm and applied image processing. In particular, a progressively greater signal spread was observed as the detail size increased and the acquisition angle decreased. However, a clear correlation between signal spread and angular range width was not observed due to the different signal reconstruction and image processing strategies implemented in the algorithms developed by the vendors studied. CONCLUSIONS: The analysis led to the identification of typical z-resolution values for different DBT model-phantom configurations that could be used as a reference during a QC program.

Flexible probe for in vivo quantification of corneal epithelium permeability through non-invasive tetrapolar impedance measurements.

Studies concerning the functional status of the corneal epithelium are of special interest due to its key role in preventing ocular surface disease and corneal infections. In particular, quantitative measurements of the epithelium permeability translayer electrical resistance (TER) have been proven as a sensitive in vitro test for evaluation of the corneal barrier function. In a recent work from the authors (Guimera et al. Biosens. Bioelectron. 31:55-61, 2012), a novel method to non-invasively assess the corneal epithelial permeability by using tetrapolar impedance measurements, based on the same TER theoretical principles, was presented and validated using a rigid sensing device. In this work, the usability of this method has been dramatically improved by using SU-8 photoresist as a substrate material. The flexibility of this novel sensing device makes no need to apply pressure on the cornea to ensure the electrical contact between the electrodes and the corneal surface. The feasibility of this flexible sensor has been evaluated in vivo by increasing the permeability of rabbit corneal epithelium. For that, different concentrations of benzalkonium chloride (BAC) solution were instilled on different rabbit corneas. The obtained results have been compared with measurements of the permeability to sodium fluorescein of different excised corneas, a well-known method used to evaluate the corneal barrier function, to demonstrate the feasibility of this novel flexible sensor for quantifying the corneal epithelium permeability in vivo in a non-invasive way.

Motivation for change and barriers to treatment among young cannabis users.

BACKGROUND/AIMS: Despite cannabis use among adolescents has shown to be related to psychosocial and mental health problems, the demand from adolescents for professional help is very low, and determinants of motivation for change among nonclinical populations remain unknown. The purpose of this study was to assess motivation for change among young cannabis users and to identify determinants of intention to change and self-change, as well as perceived barriers to seeking professional help. METHODS: 261 cannabis users aged 16-21 participated in a computerized survey in Spain. RESULTS: Data from this cross-sectional study indicated that few users intend to stop taking the drug. Determining factors of intention to change were the following: having more drug-related problems, paranoid symptomatology and greater concern about the consequences of use. Self-change was facilitated by lower use of cannabis, and could be hindered by tobacco smoking and cannabis dependence. Lack of awareness of the problems and the desire to solve one's problems alone constitute the main barriers to seeking professional help. CONCLUSIONS: Adolescent cannabis users show low motivation for change though experiencing more problems associated with its use emerges as a determinant of increased motivation. Several barriers impede this motivation from turning into treatment demand.

Evaluation of engineered nanoparticle toxic effect on wastewater microorganisms: current status and challenges.

The use of engineered nanoparticles (ENPs) in a wide range of products is associated with an increased concern for environmental safety due to their potential toxicological and adverse effects. ENPs exert antimicrobial properties through different mechanisms such as the formation of reactive oxygen species, disruption of physiological and metabolic processes. Although there are little empirical evidences on environmental fate and transport of ENPs, biosolids in wastewater most likely would be a sink for ENPs. However, there are still many uncertainties in relation to ENPs impact on the biological processes during wastewater treatment. This review provides an overview of the available data on the plausible effects of ENPs on AS and AD processes, two key biologically relevant environments for understanding ENPs-microbial interactions. It indicates that the impact of ENPs is not fully understood and few evidences suggest that ENPs could augment microbial-mediated processes such as AS and AD. Further to this, wastewater components can enhance or attenuate ENPs effects. Meanwhile it is still difficult to determine effective doses and establish toxicological guidelines, which is in part due to variable wastewater composition and inadequacy of current analytical procedures. Challenges associated with toxicity evaluation and data interpretation highlight areas in need for further research studies.

Pharmacokinetic/pharmacodynamic evaluation of the efficacy of flumequine in treating colibacillosis in turkeys.

Flumequine (FLU) is used in the treatment of systemic bacterial infections in poultry, including colibacillosis, which is a common disease in turkeys. The pharmacokinetic (PK) behavior of FLU administered to 32 healthy turkeys as an oral bolus via gavage or as 10-h pulsed administration in drinking water were compared, using the authorized dose of 15 mg/kg and the double dose of 30 mg/kg. The minimum inhibitory concentrations (MIC) of 235 Escherichia coli field strains isolated from poultry were determined for pharmacodynamics (PD) to develop a PK/PD model. Blood samples were collected at established times over 24 h, and the obtained plasma was analyzed using a liquid chromatography tandem mass spectrometry method that was validated in-house. A monocompartmental model and a noncompartmental model were applied to the data to obtain the PK results. For both types of administration and both dosages, the ratios of the maximum concentration (Cmax)/MIC50 and the area under the plasma concentration-time curve (AUC)/MIC50 achieved were considerably lower than the fluoroquinolone breakpoints usually adopted for efficacy. The Cmax/MIC50 and AUC0-24/MIC50 ratios were, respectively, 0.67 ± 0.09 and 4.76 ± 0.48 and 1.18 ± 0.35 and 7.05 ± 2.40 for the 15 and 30 mg/kg bolus doses, respectively. After 10-h pulsed administration of 15 mg/kg, values of Cmax/MIC50, 0.19 ± 0.02 on d 1 and 0.30 ± 0.08 on d 5 of therapy were obtained, the AUC/MIC50 ratios were 2.09 ± 0.29 and 3.22 ± 0.93 on d 1 and 5, respectively. Higher values were obtained with the doubled dose of 30 mg/kg: the Cmax/MIC50 ratios were 0.49 ± 0.11 on d 1 and 0.69 ± 0.18 on d 5; the AUC/MIC50 ratios were 5.15 ± 1.15 and 6.57 ± 1.92 on d 1 and 5, respectively. Based on these results, FLU administration should be adopted when specific diagnostic findings indicate its efficacy, and revising the dosage scheme to comply with the prudent and responsible use of antimicrobials in veterinary medicine is advisable.

Pharmacokinetics and perioperative efficacy of intravenous ketorolac in dogs.

Ketorolac (KET) is a nonsteroidal anti-inflammatory drug approved for the use in humans that possesses a potent analgesic activity, comparable to morphine, and could represent a useful tool to control acute pain also in animals. The clinical efficacy and pharmacokinetic profile of intravenous (IV) ketorolac tromethamine (0.5 mg/kg) were studied in 15 dogs undergoing gonadectomy. Intra-operative cardiorespiratory variables were monitored, and post-operative pain was assessed using a subjective pain score (0-24) in all dogs, whereas the pharmacokinetic profile of the drug was determined in 10 animals. During surgery, mean minimal alveolar concentration of isoflurane was 1.69 ± 0.11%, and normocapnia and spontaneous ventilation were maintained in all animals. During pain assessment, no significant differences between males and females were found, and in no case rescue analgesia was necessary. No adverse effects were reported. Serum samples were purified by solid-phase extraction and analysed by HPLC with UV-Vis detection. A large variability was observed in serum concentrations. The kinetics of ketorolac was described by a noncompartmental analysis. The elimination half-life (t½λz ) and ClB were 10.95 ± 7.06 h and 92.66 ± 84.49 mL/h/kg, respectively, and Vdss and Vz were 1030.09 ± 620.50 mL/kg and 1512.25 ± 799.13 mL/kg, respectively. AUC(0→last) and MRT(0→last) were 6.08 ± 3.28 h × µg/mL and 5.59 ± 2.12 h, respectively. The results indicate that ketorolac possess good post-operative analgesic effects until about 6 h after administration in dogs undergoing moderately painful surgery.

Electrochemical biosensor for aerobic acetate detection.

There is an increasing demand on alternatives methods to animal testing. Numerous health parameters have been already studied using in vitro devices able to mimic the essential functions of the organs, being the real-time monitoring and response to stimuli their main limitations. Regarding the health of the gut, the short chain fatty acids, and particularly acetate, have emerged as key biomarkers to evaluate gut healthiness and disease development, although the number of acetate biosensors is still very low. This article presents a microbial biosensor based on fully biocompatible materials which is able to detect acetate in aerobic conditions in the range between 11 and 50 mM, and without compromising the viability and function of either bacteria (>90% viability) or mammalian cells (>80% viability). The detection mechanism is based on the metabolism of acetate by Escherichia coli bacteria immobilized on the transducer surface. Ferricyanide is used as a redox mediator to transfer electrons from the acetate metabolism in the bacterial cells to the transducer. High bacterial concentrations are immobilized in the transducer surface (109 cfu mL-1) by electrodeposition of conductive alginate hydrogels doped with reduced graphene oxide. The results show successful outcomes to exploit bacteria as a biosensing tool, based on the use of inkjet printed transducers, biocompatible materials and cell entrapment technologies.

Health-related quality of life in children and adults with respiratory allergy in Colombia: prospective study.

BACKGROUND: Allergic diseases are very common, with the estimated cumulative prevalence in Colombia for asthma and allergic rhinitis being 22.7% and 31.3% respectively, and with a clear upward trend. A major social as well as economic impact associated with allergic disease has been described. Because in Colombia there are no studies that assess the Health-Related Quality of Life (HRQOL) in allergic respiratory diseases, our aim is to describe the HRQOL in subjects with respiratory allergy and its association with clinical control variables. METHODS: A prospective descriptive study was conducted among 76 Colombian subjects with rhinitis and asthma/allergic rhinitis. In order to evaluate the HRQOL, the instruments Kidscreen-27 and SF-36 were applied. The scores obtained in the HRQOL fields were correlated with the following clinical variables: peak expiratory flow (PEF) and peak nasal inspiratory flow (PNIF). RESULTS: In children, the better HRQL domain is present in the school environment (55.9) and the worst in psychological well-being (39.9). For adults the worst HRQL was found in the emotional function domain (55.6) while the physical function (81.7) had the best. There were no statistical differences between groups of asthma/allergic rhinitis and allergic rhinitis. Subjects with allergic asthma showed a strong correlation between the mental health domain and PEF values (r=-0717, p=0.046). CONCLUSION: Mental health is more affected than physical health in Colombian subjects with respiratory allergy. There was a strong correlation between the mental health domain and the values of PEF in patients with asthma/allergic rhinitis.

Pharmacokinetics of ketamine and propofol combination administered as ketofol via continuous infusion in cats.

The pharmacokinetics of the extemporaneous combination of low doses of ketamine and propofol, known as 'ketofol', frequently used for emergency procedures in humans to achieve safe sedation and analgesia was studied in cats. The study was performed to assess propofol, ketamine and norketamine kinetics in six female cats that received ketamine and propofol (1:1 ratio) as a loading dose (2 mg/kg each, IV) followed by a continuous infusion (10 mg/kg/h each, IV, 25 min of length). Blood samples were collected during the infusion period and up to 24 h afterwards. Drug quantification was achieved by HPLC analysis using UV-visible detection for ketamine and fluorimetric detection for propofol. The pharmacokinetic parameters were deduced by a two-compartment bolus plus infusion model for propofol and ketamine and a monocompartmental model for norketamine. Additional data were derived by a noncompartmental analysis. Propofol and ketamine were quantifiable in most animals until 24 and 8 h after the end of infusion, respectively. Propofol showed a long elimination half-life (t(1/2λ2) 7.55 ± 9.86 h), whereas ketamine was characterized by shorter half-life (t(1/2λ2) 4 ± 3.4 h) owing to its rapid biotransformation into norketamine. The clinical significance of propofol's long elimination half-life and low clearance is negligible when the drug is administered as short-term and low-dosage infusion. The concurrent administration of ketamine and propofol in cats did not produce adverse effects although it was not possible to exclude interference in the metabolism.

Laparoscopic transperitoneal hernia repair (TAPP) in emergency: long-term follow-up in a high volume centre.

PURPOSE: Aim of this study was to analyse feasibility, safety and effectiveness of laparoscopic transperitoneal hernia repair (TAPP) approach to inguinal hernias in the emergency setting, with a longer follow-up than the studies present in literature. METHODS: We retrospectively analysed all patients who underwent emergency TAPP hernia repair in San Marco Hospital (Zingonia, Italy), from September 2010 to June 2020. A prospectively collected database of 685 consecutive TAPP hernia repair was reviewed. Feasibility and safety were evaluated through operative time, conversion rate, perioperative mortality, morbidity and prosthesis infection rate. Effectiveness was assessed by recurrence and complication rate, acute (during admission) and chronic (during follow-up) pain by Visual Analogic Scale (VAS), and recovery to normal activity in a long-term follow-up (mean period 1718 days). RESULTS: The final study group included 47 patients. The mean age was 59.6 years (range 22-89), 29 patients were male and 18 were female. The mean operation time was 64 min. Two cases were converted to open approach (4%). In four cases bowel resection became necessary (8.5%). Appendicectomy and omentectomy occurred once and twice, respectively (2% and 4%), and orchiectomy was required in two patients (4%). Seroma was the only postoperative complication that we registered in four patients. During a mean follow-up period of 1718 days, there was no recurrence of the hernia or other complications. Five patients referred mild occasional groin pain (VAS < 3), with quick relief without taking any pain killers. CONCLUSION: TAPP approach is a safe, feasible and effective therapeutic option for groin hernias in emergency setting. No recurrence or severe complications were reported in over 4 years of follow-up.