[Incidence of intrahospitalary major cardiac events with the use of mechanic thromboaspiration versus only use of IIB/IIIA glucoprotein inhibitors on patients with acute ST elevation myocardial infarction]. / Incidencia de eventos cardiovasculares mayores intrahospitalarios en pacientes sometidos a tromboaspiración mecánica más IIb/IIIa contra solo inhibidores de la glucoproteína IIb/IIIa en infarto agudo al miocardio con elevación del segmento ST.

Objective: To identify the incidence of in-hospital major adverse cardiac events (MACE) with the use of mechanic thromboaspiration plus IIb/IIIa glycoprotein inhibitors versus only use of IIb/IIIa glycoprotein inhibitors on patients with acute ST elevation myocardial infarction. Method: Retrospective, observational, cohort analytic study, on patients with acute ST elevation myocardial infarction that had angiography thrombus TIMI 5 grade, treated between October 2021 and December 2022. Results: A total of 237 patients were included. In 113 patients thromboaspiration were used, 124 patients didn't used. 81.6% were men. In-hospital MACE occurred on 31.9% of patients with thromboaspiration use vs. 30.6% on patients with no use (RR: 1.05; IC95%: 0.61-1.93; p = 0.840). Incidence of malignant arrhythmias were of 8% with thromboaspiration use vs. 1.6% on patients with no use (RR: 5.27; IC95%: 1.11-24.97; p = 0.020). Conclusions: The use of thromboaspiration on concomitant treatment with IIb/IIIa glycoprotein inhibitors was similar with only IIb/IIIa glycoprotein inhibitors in reducing incidence of in-hospital MACE on patients with ST elevation acute myocardial infarction and high thrombus burden. The study has several limitations, so results should be taken with caution.

Objetivo: Identificar la incidencia de eventos cardiovasculares adversos mayores (ECAM) intrahospitalarios con el uso de tromboaspiración mecánica más inhibidores de la glucoproteína IIb/IIIa contra solo inhibidores de la glucoproteína IIb/IIIa en pacientes con infarto agudo al miocardio con elevación del segmento ST (IAMCEST). Método: Estudio retrospectivo, observacional, analítico, de cohorte, en pacientes con IAMCEST con trombo angiográfico de grado TIMI 5, tratados entre octubre de 2021 y diciembre de 2022. Resultados: Cumplieron los criterios de inclusión 237 pacientes. En 113 se usó tromboaspirador más inhibidores IIb/IIIa y en 124 solo inhibidores IIb/IIIa. El 81.6% fueron hombres. La incidencia de ECAM intrahospitalarios fue del 31.9% en los pacientes con tromboaspiración y del 30.6% en los pacientes con solo inhibidores IIb/IIIa (RR: 1.05; IC95%: 0.61-1.93; p = 0.840). La incidencia de arritmias graves fue del 8% en los pacientes con tromboaspiración y del 1.6% en los pacientes con solo inhibidores IIb/IIIa (RR: 5.27; IC95%: 1.11-24.97; p = 0.020). Conclusiones: La frecuencia de ECAM asociados al uso de tromboaspiración mecánica como coadyuvante a los inhibidores de la glucoproteína IIb/IIIa en pacientes con IAMCEST y trombo angiográfico de grado TIMI 5 no es diferente de la de aquellos pacientes en las que solo se utilizan inhibidores de la glucoproteína IIb/IIa. El estudio tiene varias limitaciones, por lo que los resultados deben tomarse con cautela.

A Phase I/II Clinical Trial to evaluate the efficacy of baricitinib to prevent respiratory insufficiency progression in onco-hematological patients affected with COVID19: A structured summary of a study protocol for a randomised controlled trial.

OBJECTIVES: Baricitinib is supposed to have a double effect on SARS-CoV2 infection. Firstly, it reduces the inflammatory response through the inhibition of the Januse-Kinase signalling transducer and activator of transcription (JAK-STAT) pathway. Moreover, it reduces the receptor mediated viral endocytosis by AP2-associated protein kinase 1 (AAK1) inhibition. We propose the use of baricinitib to prevent the progression of the respiratory insufficiency in SARS-CoV2 pneumonia in onco-haematological patients. In this phase Ib/II study, the primary objective in the safety cohort is to describe the incidence of severe adverse events associated with baricitinib administration. The primary objective of the randomized phase (baricitinib cohort versus standard of care cohort) is to evaluate the number of patients who did not require mechanical oxygen support since start of therapy until day +14 or discharge (whichever it comes first). The secondary objectives of the study (only randomized phase of the study) are represented by the comparison between the two arms of the study in terms of mortality and toxicity at day+30. Moreover, a description of the immunological related changes between the two arms of the study will be reported. TRIAL DESIGN: The trial is a phase I/II study with a safety run-in cohort (phase 1) followed by an open label phase II randomized controlled trial with an experimental arm compared to a standard of care arm. PARTICIPANTS: The study will be performed at the Institut Català d'Oncologia, a tertiary level oncological referral center in the Catalonia region (Spain). The eligibility criteria are: patients > 18 years affected by oncological diseases; ECOG performance status < 2 (Karnofsky score > 60%); a laboratory confirmed infection with SARS-CoV-2 by means of real -time PCR; radiological signs of low respiratory tract disease; absence of organ dysfunction (a total bilirubin within normal institutional limits, AST/ALT≤2.5 X institutional upper limit of normal, alkaline phosphatase ≤2.5 X institutional upper limit of normal, coagulation within normal institutional limits, creatinine clearance >30 mL/min/1.73 m2 for patients with creatinine levels above institutional normal); absence of HIV infection; no active or latent HBV or HCV infection. The exclusion criteria are: patients with oncological diseases who are not candidates to receive any active oncological treatment; hemodynamic instability at time of study enrollment; impossibility to receive oral medication; medical history of recent or active pulmonary embolism or deep venous thrombosis or patients at high-risk of suffering them (surgical intervention, immobilization); multi organ failure, rapid worsening of respiratory function with requirement of fraction of inspired oxygen (FiO2) > 50% or high-flow nasal cannula before initiation of study treatment; uncontrolled intercurrent illness (ongoing or severe active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements); allergy to one or more of study treatments; pregnant or breastfeeding women; positive pregnancy test in a pre-dose examination. Patients should have the ability to understand, and the willingness to sign, a written informed consent document; the willingness to accept randomization to any assigned treatment arm; and must agree not to enroll in another study of an investigational agent prior to completion of Day +28 of study. An electronic Case Report Form in the Research Electronic Data Capture (REDCap) platform will be used to collect the data of the trial. Removal from the study will apply in case of unacceptable adverse event(s), development of an intercurrent illness, condition or procedural complication, which could interfere with the patient's continued participation and voluntary patient withdrawal from study treatment (all patients are free to withdraw from participation in this study at any time, for any reasons, specified or unspecified, and without prejudice). INTERVENTION AND COMPARATOR: Treatment will be administered on an inpatient basis. We will compare the experimental treatment with baricitinib plus the institutional standard of care compared with the standard of care alone. During the phase I, we will define the dose-limiting toxicity of baricitinib and the dose to be used in the phase 2 part of the study. The starting baricitinib dose will be an oral tablet 4 mg-once daily which can be reduced to 2 mg depending on the observed toxicity. The minimum duration of therapy will be 5 days and it can be extended to 7 days. The standard of care will include the following therapies. Antibiotics will be individualized based on clinical suspicion, including the management of febrile neutropenia. Prophylaxis of thromboembolic disease will be administered to all participants. Remdesivir administration will be considered only in patients with severe pneumonia (SatO2 <94%) with less than 7 days of onset of symptoms and with supplemental oxygen requirements but not using high-flow nasal cannula, non-invasive or invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO). In the randomized phase, tocilizumab or interferon will not be allowed in the experimental arm. Tocilizumab can be used in patients in the standard of care arm at the discretion of the investigator. If it is prescribed it will be used according to the following criteria: patients who, according to his baseline clinical condition, would be an ICU tributary, interstitial pneumonia with severe respiratory failure, patients who are not on mechanical ventilation or ECMO and who are still progressing with corticoid treatment or if they are not candidates for corticosteroids. Mild ARDS (PAFI <300 mmHg) with radiological or blood gases deterioration that meets at least one of the following criteria: CRP >100mg/L D-Dimer >1,000µg/L LDH >400U/L Ferritin >700ng/ml Interleukin 6 ≥40ng/L. The use of tocilizumab is not recommended if there are AST/ALT values greater than 10 times the upper limit of normal, neutrophils <500 cells/mm3, sepsis due to other pathogens other than SARS-CoV-2, presence of comorbidity that can lead to a poor prognosis, complicated diverticulitis or intestinal perforation, ongoing skin infection. The dose will be that recommended by the Spanish Medicine Agency in patients ≥75Kg: 600mg dose whereas in patients <75kg: 400mg dose. Exceptionally, a second infusion can be assessed 12 hours after the first in those patients who experience a worsening of laboratory parameters after a first favourable response. The use of corticosteroids will be recommended in patients who have had symptoms for more than 7 days and who meet all the following criteria: need for oxygen support, non-invasive or invasive mechanical ventilation, acute respiratory failure or rapid deterioration of gas exchange, appearance or worsening of bilateral alveolar-interstitial infiltrates at the radiological level. In case of indication, it is recommended: dexamethasone 6mg/d p.o. or iv for 10 days or methylprednisolone 32mg/d orally or 30mg iv for 10 days or prednisone 40mg day p.o. for 10 days. MAIN OUTCOMES: Phase 1 part: to describe the toxicity profile of baricitinib in COVID19 oncological patients during the 5-7 day treatment period and until day +14 or discharge (whichever it comes first). Phase 2 part: to describe the number of patients in the experimental arm that will not require mechanical oxygen support compared to the standard of care arm until day +14 or discharge (whichever it comes first). RANDOMISATION: For the phase 2 of the study, the allocation ratio will be 1:1. Randomization process will be carried out electronically through the REDcap platform ( https://www.project-redcap.org/ ) BLINDING (MASKING): This is an open label study. No blinding will be performed. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): The first part of the study (safety run-in cohort) will consist in the enrollment of 6 to 12 patients. In this population, we will test the toxicity of the experimental treatment. An incidence of severe adverse events grade 3-4 (graded by Common Terminology Criteria for Adverse Events v.5.0) inferior than 33% will be considered sufficient to follow with the next part of the study. The second part of the study we will perform an interim analysis of efficacy at first 64 assessed patients and a definitive one will analyze 128 assessed patients. Interim and definitive tests will be performed considering in both cases an alpha error of 0.05. We consider for the control arm this rate is expected to be 0.60 and for the experimental arm of 0.80. Considering this data, a superiority test to prove a difference of 0.20 with an overall alpha error of 0.10 and a beta error of 0.2 will be performed. Considering a 5% of dropout rate, it is expected that a total of 136 patients, 68 for each study arm, will be required to complete study accrual. TRIAL STATUS: Version 5.0. 14th October 2020 Recruitment started on the 16th of December 2020. Expected end of recruitment is June 2021. TRIAL REGISTRATION: AEMPs: 20-0356 EudraCT: 2020-001789-12, https://www.clinicaltrialsregister.eu/ctr-search/search (Not publically available as Phase I trial) Clinical trials: BARCOVID19, https://www.clinicaltrials.gov/ (In progress) FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol."

Prognostic implications of neutrophil-lymphocyte ratio in COVID-19.

BACKGROUND: The clinical presentation of COVID-19 ranges from a mild, self-limiting disease, to multiple organ failure and death. Most severe COVID-19 cases present low lymphocytes counts and high leukocytes counts, and accumulated evidence suggests that in a subgroup of patients presenting severe COVID-19, there may be a hyperinflammatory response driving a severe hypercytokinaemia which may be, at least in part, signalling the presence of an underlying endothelial dysfunction. In this context, available data suggest a prognostic role of neutrophil-lymphocyte ratio (NLR) in various inflammatory diseases and oncological processes. Following this rationale, we hypothesized that NLR, as a marker of endothelial dysfunction, may be useful in identifying patients with a poor prognosis in hospitalized COVID-19 cases. DESIGN: A retrospective observational study performed at Hospital Universitario HM Puerta del Sur, Madrid, Spain, which included 119 patients with COVID-19 from 1 March to 31 March 2020. Patients were categorized according to WHO R&D Expert Group. RESULTS: Forty-five (12.1%) patients experienced severe acute respiratory failure requiring respiratory support. Forty-seven (12.6%) patients died. Those with worse outcomes were older (P = .002) and presented significantly higher NLR at admission (P = .001), greater increase in Peak NLR (P < .001) and higher increasing speed of NLR (P = .003) compared with follow-up patients. In a multivariable logistic regression, age, cardiovascular disease and C-reactive protein at admission and Peak NLR were significantly associated with death. CONCLUSIONS: NLR is an easily measurable, available, cost-effective and reliable parameter, which continuous monitoring could be useful for the diagnosis and treatment of COVID-19.

Long-Term Effectiveness of Polymerized-Type I Collagen Intra-Articular Injections in Patients with Symptomatic Knee Osteoarthritis: Clinical and Radiographic Evaluation in a Cohort Study.

OBJECTIVE: Polymerized-type I collagen (polymerized-collagen) is a downregulator of inflammation and a tissue regenerator. The aim was to evaluate the effect of intra-articular injections (IAIs) of polymerized-collagen among patients with symptomatic knee osteoarthritis (OA) in delaying or preventing joint replacement surgery. Patients and Methods. This was a cohort study of 309 patients with knee OA. Patients with mild-to-moderate disease were treated weekly with IAIs of 2 mL of polymerized-collagen for six weeks (n = 309). Follow-up was for 6-60 months. The primary endpoints included the following determinations: (1) therapeutic effect; (2) survival from total knee replacement surgery (TKR); (3) Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and pain (visual analogue scale, VAS). Clinical improvement was defined as a decrease in pain exceeding 20 mm on the VAS and the achievement of at least 20% improvement from baseline with respect to the WOMAC score. Radiographic analysis was performed at baseline and 60 months. The joint space width in the medial, lateral, and patellofemoral compartments was calculated. RESULTS: Patients who received IAIs of polymerized-collagen had a statistically significant improvement in the primary criteria (p < 0.05). Kaplan-Meier survival analysis of the therapeutic effect demonstrated 98.8% survival at 60 months with TKR as the endpoint. There was no significant reduction in joint space in any compartment based on the analyzed radiographs. No serious adverse events were recorded. CONCLUSION: Polymerized-collagen increased the time to TKR by at least 60 months, modifying the disease course, improving functional disability, and decreasing pain.

Structure and function of crocodilian hemoglobins and allosteric regulation by chloride, ATP, and CO2.

Hemoglobins (Hbs) of crocodilians are reportedly characterized by unique mechanisms of allosteric regulatory control, but there are conflicting reports regarding the importance of different effectors, such as chloride ions, organic phosphates, and CO2. Progress in understanding the unusual properties of crocodilian Hbs has also been hindered by a dearth of structural information. Here, we present the first comparative analysis of blood properties and Hb structure and function in a phylogenetically diverse set of crocodilian species. We examine mechanisms of allosteric regulation in the Hbs of 13 crocodilian species belonging to the families Crocodylidae and Alligatoridae. We also report new amino acid sequences for the α- and ß-globins of these taxa, which, in combination with structural analyses, provide insights into molecular mechanisms of allosteric regulation. All crocodilian Hbs exhibited a remarkably strong sensitivity to CO2, which would permit effective O2 unloading to tissues in response to an increase in metabolism during intense activity and diving. Although the Hbs of all crocodilians exhibit similar intrinsic O2-affinities, there is considerable variation in sensitivity to Cl- ions and ATP, which appears to be at least partly attributable to variation in the extent of NH2-terminal acetylation. Whereas chloride appears to be a potent allosteric effector of all crocodile Hbs, ATP has a strong, chloride-independent effect on Hb-O2 affinity only in caimans. Modeling suggests that allosteric ATP binding has a somewhat different structural basis in crocodilian and mammalian Hbs.

[Asociación de la composición corporal total con la fuerza del tronco, el dolor y la discapacidad en pacientes con espondiloartrosis lumbar]. / The association of total body composition with trunk strength, pain and disability in patients with lumbar osteoarthritis.

INTRODUCCIÓN: Las alteraciones en la composición corporal total podrían influir sobre la fuerza, el dolor y la discapacidad en pacientes con espondiloartrosis lumbar. OBJETIVO: Analizar la asociación de la composición corporal total con la fuerza muscular del tronco, el dolor y la discapacidad en pacientes con espondiloartrosis lumbar. MÉTODO: Estudio piloto en mayores de 50 años con dolor crónico de espalda baja y espondiloartrosis lumbar. Se excluyeron pacientes con diabetes mellitus, depresión, ansiedad, artropatías inflamatorias, fracturas vertebrales, escoliosis, cirugías de columna, cardiopatías, hipertensión arterial, radiculopatía o claudicación neurogénica. Se recolectaron datos sobre tiempo de evolución, composición corporal (masa grasa y muscular total), fuerza del tronco (isocinesia), dolor (escala numérica verbal) y discapacidad (Roland Morris). Análisis estadístico con U de Mann-Whitney y correlaciones de Spearman. RESULTADOS: 27 pacientes (18 mujeres y 9 hombres) con edad de 58.59 ± 6.98 años. La masa muscular total se asoció con el dolor (rho: -0.63, p = 0.001) y con la fuerza del tronco (flexores rho: -0.42, p = 0.02; extensores rho: -0.50, p = 0.007), sin correlación con la discapacidad. No se encontró correlación de la masa grasa con ninguna de las variables. CONCLUSIÓN: La disminución de la masa muscular se asocia con el dolor, pero no con la discapacidad, en pacientes con espondiloartrosis lumbar. BACKGROUND: Variations in body composition among patients with lumbar osteoarthritis may influence pain and disability and muscle strength. OBJECTIVE: To analyze the relationship between body composition with pain, disability and muscle strength, in patients with lumbar osteoarthritis. METHODS: Pilot study in patients older than 50 years of age, with chronic low back pain and lumbar osteoarthritis, who agreed to participate through informed consent. We excluded patients with diabetes mellitus, depression, anxiety, inflammatory arthropathies, vertebral fractures, idiopathic scoliosis, spinal surgery, heart disease or hypertension, radiculopathy or neurogenic claudication. Data on evolution time, body composition (total body fat and muscle mass), trunk strength, pain (numerical rating scale), and disability (Roland Morris questionnaire) were collected. Mann-Whitney U-test and Spearman correlations were performed. RESULTS: 27 patients (18 women and 9 men) aged 58.59 ± 6.98 years. Negative correlations between muscle mass with pain (rho: −0.63, p = 0.001) and strength (flexors rho: −0.42, p = 0.02; extensors rho: −0.50, p = 0.007) were found, without correlation with disability. No correlations of fat mass with pain or disability were found. CONCLUSION: Decreased of muscle mass were associated with higher pain scores without influencing the disability in patients with lumbar osteoarthritis..

Role of estrogen on skeletal muscle mitochondrial function in ovariectomized rats: a time course study in different fiber types.

Postmenopausal women are prone to develop obesity and insulin resistance, which might be related to skeletal muscle mitochondrial dysfunction. In a rat model of ovariectomy (OVX), skeletal muscle mitochondrial function was examined at short- and long-term periods after castration. Mitochondrial parameters in the soleus and white gastrocnemius muscle fibers were analyzed. Three weeks after surgery, there were no differences in coupled mitochondrial respiration (ATP synthesis) with pyruvate, malate, and succinate; proton leak respiration; or mitochondrial reactive oxygen species production. However, after 3 wk of OVX, the soleus and white gastrocnemius muscles of the OVX animals showed a lower use of palmitoyl-carnitine and glycerol-phosphate substrates, respectively, and decreased peroxisome proliferator-activated receptor-γ coactivator-1α expression. Estrogen replacement reverted all of these phenotypes. Eight weeks after OVX, ATP synthesis was lower in the soleus and white gastrocnemius muscles of the OVX animals than in the sham-operated and estrogen-treated animals; however, when normalized by citrate synthase activity, these differences disappeared, indicating a lower muscle mitochondria content. No differences were observed in the proton leak parameter. Mitochondrial alterations did not impair the treadmill exercise capacity of the OVX animals. However, blood lactate levels in the OVX animals were higher after the physical test, indicating a compensatory extramitochondrial ATP synthesis system, but this phenotype was reverted by estrogen replacement. These results suggest early mitochondrial dysfunction related to lipid substrate use, which could be associated with the development of the overweight phenotype of ovariectomized animals.

Effect of solid storage on caprine semen conservation at 5 degrees C.

In this work, we investigated the effect of storage in solid-phase extender on buck semen conserved at 5 degrees C. Furthermore, we studied the effect of addition of cysteine to the extender and the washing of seminal plasma on sperm survival. In Experiment 1, milk-based extender (M) was used as a control to study the effect of solid media storage (G) and cysteine supplementation (C), and the combination of both (GC), on in vitro sperm survival of washed and non-washed semen, conserved up to 72 h at 5 degrees C. Motility, acrosome integrity (NAR) and hypo-osmotic swelling tests (HOST) were evaluated to assess in vitro sperm survival. In Experiment 2, an artificial insemination (AI) field trial was performed to compare G versus M. Solid media (G) maintained motility of spermatozoa during storage higher than any other extender (67% G versus 62% GC; 61% M and 59% C; P<0.05), but there was no difference in NAR or HOST between extenders (P>0.05). No improvement in sperm viability was obtained by addition of cysteine to the media. Washing of semen improved motility (65% versus 60%; P<0.05), NAR (70% versus 64%; P<0.05) and HOST (37% versus 28%; P<0.05). No significant differences in fertility were obtained between G and M extenders (47% versus 41%; P>0.05). In conclusion, washing of semen and dilution in gelatin-supplemented milk extender (solid storage) appears to be a successful method for goat semen storage at 5 degrees C.

Determination of multiclass pesticides in food commodities by pressurized liquid extraction using GC-MS/MS and LC-MS/MS.

Pressurized liquid extraction (PLE) was applied to the simultaneous extraction of a wide range of pesticides from food commodities. Extractions were performed by mixing 4 g of sample with 4 g of Hydromatrix and (after optimization) a mixture of ethyl acetate:acetone (3:1, v/v) as extraction solvent, a temperature of 100 degrees C, a pressure of 1000 psi and a static extraction time of 5 min. After extraction, the more polar compounds were analyzed by liquid chromatography (LC), and the apolar and semipolar pesticides by gas chromatography (GC); in both cases LC and GC were coupled with mass spectrometry in tandem (MS/MS) mode. The overall method (including the PLE step) was validated in GC and LC according to the criteria of the SANCO Document of the European Commission. The average extraction recoveries (at two concentration levels) for most of the analytes were in the range 70-80%, with precision values usually lower than 15%. Limits of quantification (LOQ) were low enough to determine the pesticide residues at concentrations below or equal to the maximum residue levels (MRL) specified by legislation. In order to assess its applicability to the analysis of real samples, aliquots of 15 vegetable samples were processed using a conventional extraction method with dichloromethane, and the results obtained were compared with the proposed PLE method; differences lower than 0.01 mg kg(-1) were found.

Estudio de la actividad analgésica de extractos metanólicos de Maytenus krukovii (chuchahuasi), Alchornea castaneifolia (hiporuro), Sambucus nigra (saúco) y Aristeguietia discolor (pulmonaria) en ratones frente el Ibuprofeno / Study of the analgesic activity of methanolic extracts of Maytenus krukovii (chuchahuasi) castaneifolia Alchornea (hiporuro), Sambucus nigra (elderberries) and Aristeguietia discolor (pulmonary) in mice versus Ibuprofen

Al evaluar el efecto analgésico se encontró actividad positiva del extracto metanólico de Maytenus krukovii (chuchahuasi), Alchornea castaneifolia (Hiporuro), Sambucus nigra (Saúco) y Aristeguietia discolor (Pulmonaria) a las dosis de 100 mg/kg, 250 mg/kg, 250mg/kg y 750 mg/kg, respectivamente, por vía oral; luego de una hora de administración se encontró que el efecto analgésico de Chuchuhuasi y Pulmonaria eran comparables al Ibuprofeno. Asimismo, apreciamos, en todos los extractos, una prolongación del período de latencia con respecto al control.

We evaluated the analgesic effect of four different plants, and this effect was positive for thr metanolic extracts of Maytenus krukovii (Chuchuhuasi), Alchornea castaneifolia (Hiporuro), Sambucus nigra (Saúco) y Aristeguietia discolor (Pulmonaria) in the doses of 1000 mg/g, 250 mg/kg, and 750 mg/kg, respectively administered orally to mice. After one hour of administration the analgesic effect of Chuchuhuasi and Pulmonaria were comparable to that Ibuprofene. It was also noted that all extracts delayed the latency time regarding to the control sample.

Vaginal misoprostol 800 microg every 12 h for second-trimester abortion.

The objective of the study was to evaluate the efficacy and safety of 800 microg misoprostol every 12 h, up to three doses, for pharmacological second-trimester abortion. The misoprostol doses were always administered by doctors into the vagina. Two-hundred and sixty-nine women with gestations within 12 and 20 weeks were recruited into the study. The main outcomes measured were successful abortion (passage of fetus and placenta without surgery), side effects and mean drop in hemoglobin, vaginal bleeding and mean time of return of menstruation. Complete abortion occurred in 245/269 (91.1%, 95% confidence interval 87-94%) patients. Vaginal bleeding lasted 15.7 +/- 4.1 days. The mean drop in hemoglobin, calculated 24 h after abortion, were statistically significant (p = 0.0001), as also was the mean hemoglobin measured 14 days after abortion, but without clinical relevance. According to the results obtained, 800 microg of misoprostol administered every 12 h, up to a maximum of three doses, could be a valid method for abortion within 12 and 20 weeks of gestation.

[Demographic study of tobacco addiction in Health District 5, Valencia, Spain]. / Estudio demográfico del tabaquismo en el Area de Salud 5 de Valencia.

OBJECTIVES: To determine the number of smokers, their demographic characteristics, and the stages of change among patients visiting health care centers. PATIENTS AND METHODS: Descriptive cross-sectional study carried out at 7 primary health care centers in Health District 5 of the Autonomous Community of Valencia. RESULTS: An interview was given to 3633 people with a mean (SD) age of 55 (19) years, (range: 14-96 years). Women made up 61.7%, and 65% were seeking medical attention. Twenty-three per cent were current smokers (mean age 41.8 [15.2] years), 17.2% ex-smokers (60.6 [16.2] years), and 59.8% never smokers (58.4 [18.8] years). The stages of change were pre-contemplation for 32.1%, contemplation for 4.9%, chronic contemplation for 12.2%, preparation to quit for 6.8%, action for 2.3%, maintenance for 15.1%, and termination for 26.7%. According to current recommendations, it seems that between 23.6% and 44.7%, depending on category definitions, needed specific attention concerning tobacco dependence. CONCLUSIONS: Twenty-three per cent of the patients attended by the primary care physician were smokers. More than half did not want to quit smoking and 1 in 10 were prepared to do so. Between 23.6% and 44.7% of the people who came to the primary care center needed specific attention concerning tobacco dependence.

Oral and vaginal misoprostol 800 microg every 8 h for early abortion.

The objective of the study was to evaluate the efficacy and safety of 800 microg misoprostol (Cytotec) every 8 h for 24 h for pharmacological abortion; the treatment was repeated if abortion did not occur in the first 24-h interval. The first misoprostol doses were always self-administered into the vagina; the second and third doses could be administered orally or vaginally depending on the amount of bleeding. Four-hundred and fifty-two women with gestations between 36 and 63 days were recruited into the study. The main outcomes assessed were: successful abortion (complete abortion without surgery), side effects, mean drop in hemoglobin, vaginal bleeding and mean time of return of menstruation. Complete abortion occurred in 409/452 (90.5%; 95% confidence interval [CI] 87%, 93%) patients. Medication to relieve symptoms was administered to all women before the first misoprostol dose. Vaginal bleeding lasted 15.9 +/- 4.4 days. The mean drop in hemoglobin, measured 14 days after abortion, was statistically significant (p = 0.0001) but without clinical relevance. According to the results obtained, 800 microg of misoprostol administered every 8 h for 24 h could be a valid method for abortion for up to 9 weeks of gestation.

[Collagenous colitis: presentation of 12 cases]. / Colitis colágena: presentación de 12 casos.

Collagenous colitis (CC) is a cause of chronic aqueous diarrhea with normal radiologic study and endoscopic appearance of the colonic mucosa. Histologically, it is defined by the presence of a thickened subepithelial collagenous band and inflammatory changes of the mucosa. The cause of CC is currently unknown, although several mechanisms have been proposed, such as an inflammatory, autoimmune, origin, disregulation in collagen synthesis, plasma vasculosis and a possible role of bacterial or drug toxins. The clinicopathological data of 12 patients (9 females and 3 males) with a mean age of 52.4 years diagnosed by histologic criteria are presented. Aqueous diarrhea was observed in all the patients with a mean number of 5.4 stools/day during a time period between 3 weeks and 10 years (mean, 14.7 months). In a 6 patients allergies and/or associated diseases, mainly rheumatologic diseases were found. Laboratory and endoscopic data were normal or unspecific, with colon biopsy being carried out in all the patients. Several treatments were tested with good response with sulphasalazine derivatives, corticoids, antibiotics, and mebeverine, with no solution to the diarrhea in 2 patients. A review of the literature is also provided.

[Tubular duplication of the colon: a case report and review of the literature]. / Duplicação de cólon: relato de caso e revisão da literatura.

Among Gastrointestinal Duplications, colonic duplications are the less common. The case presented here consist of a duplication of the transverse colon, difficult to diagnose, which had abdominal distension as the main symptom. A 4-year-old child was referred to the Unity of Pediatric Surgery, Hospital de Base, Brasilia, DF with a history of progressive abdominal distension. Plain X-Rays of the abdomen demonstrated a large fecaloma, which demanded removal. A Barium Enema was done suggesting Congenital Megacolon. A rectal biopsy was performed under general anesthesia, demonstrating normal ganglion cells. Medical treatment was instituted for chronic constipation in the Pediatric Gastroenterology clinic. The patient returned three months later with the same complaints. A new rectal biopsy was done; normal ganglion cells were described, ruling out Hirschsprung's disease. The parents were told to insist on the medical treatment diets. Four years later the patient was seen in the Emergency Room with signs and symptoms of low intestinal obstruction. Exploratory Laparotomy was undertaken as an emergency and the findings were complete volvulus of the large bowel involving the transverse colon up to the splenic flexure, demonstrating a large duplication of the transverse colon. A resection of the duplication and end-to-end colonic anastomosis was performed with an uneventful postoperative care. Discharged on excellent conditions.

Lymphoepithelial-like carcinoma of the uterine cervix. Study of a case with in situ hybridization of the Epstein-Barr virus genome and the human papillomavirus genome.

Lymphoepithelial-like carcinoma of the uterine cervix is very rare in Caucasian women. We present a new case in a 74 year-old European. Morphologically the undifferentiated carcinoma was accompanied by intense lymphocytic infiltration. Immunohistochemically the tumor expressed epithelial markers such as cytokeratin CAM 5.2, and a large proportion of cells expressed the proliferating cell nuclear antigen. The accompanying lymphocytic reaction was composed predominantly of T-lymphocytes which express the UCHL1 antigen. The in situ hybridization of the Epstein-Barr virus genome and the human papillomavirus proved negative.

Ulcera duodenal, metaplasia gástrica y helicobacter pilory

La relación entre H.P. metaplasia gástrica y gastritis antral fue evaluada entre 50 pacientes con úlcera duodenal activa. Todos ellos se sometieron a evaluación endoscópica y biopsia del antro y del duodeno. La investigación del H.P. y de la metaplasia gástrica en las biopsias se realizaron mediante tinción con hematoxilina-eosina. La prevalencia de H.P. fue del 70 por ciento en la muestra estudiada. La presencia de H.P. más metaplasia gástrica en el bulbo se encontró en el 44 por ciento de los casos estudiados. No hubo ni metaplasia gástrica ni H.P. en el bulbo en el 56 por ciento. Estos datos indican que el H.P. es positivo en el bulbo sólo cuando concomitantemente está presente mucosa gástrica metaplasiada en el bulbo. En este caso se entiende facilmente la patogenia del H.P. en el desarrollo de la U.D. No así cuando la bacteria está presente solamente en el antro.