An on-lattice agent-based Monte Carlo model simulating the growth kinetics of multicellular tumor spheroids.

PURPOSE: To develop an on-lattice agent-based model describing the growth of multicellular tumor spheroids using simple Monte Carlo tools. METHODS: Cells are situated on the vertices of a cubic grid. Different cell states (proliferative, hypoxic or dead) and cell evolution rules, driven by 10 parameters, and the effects of the culture medium are included. About twenty spheroids of MCF-7 human breast cancer were cultivated and the experimental data were used for tuning the model parameters. RESULTS: Simulated spheroids showed adequate sizes of the necrotic nuclei and of the hypoxic and proliferative cell phases as a function of the growth time, mimicking the overall characteristics of the experimental spheroids. The relation between the radii of the necrotic nucleus and the whole spheroid obtained in the simulations was similar to the experimental one and the number of cells, as a function of the spheroid volume, was well reproduced. The statistical variability of the Monte Carlo model described the whole volume range observed for the experimental spheroids. Assuming that the model parameters vary within Gaussian distributions it was obtained a sample of spheroids that reproduced much better the experimental findings. CONCLUSIONS: The model developed allows describing the growth of in vitro multicellular spheroids and the experimental variability can be well reproduced. Its flexibility permits to vary both the agents involved and the rules that govern the spheroid growth. More general situations, such as, e. g., tumor vascularization, radiotherapy effects on solid tumors, or the validity of the tumor growth mathematical models can be studied.

Results of R-ESHAP as salvage therapy in refractory/relapsed follicular lymphoma: a real-world experience on behalf of GELCAB group.

There is no standard treatment for relapsed follicular lymphoma (FL). Although platinum-based combinations are one of the most used treatments, few data have been reported in this setting. Our aim was to analyse R-ESHAP efficacy in relapsed FL patients. We retrospectively analysed 80 FL patients treated with R-ESHAP in the first or successive relapses. Responding patients received a stem cell transplantation following R-ESHAP. Seventeen histologically transformed patients were included. Median age was 50 years. At R-ESHAP initiation, 85% of the patients were in an advanced stage, 28% had a bulky disease and 40% had increased LDH. There were no statistically significant differences between POD24 and non-POD24 patients in terms of response to R-ESHAP (ORR 72% vs. 93%, p = 0.109). When analyzing R-ESHAP efficacy according to the response to the immediately previous line, patients achieving CR or PR had better CR rates to R-ESHAP than those who did not respond (CR of 57% vs. 15%, respectively, p = 0.009), as well as differences in OS (7.2 vs. 1.4 years, p < 0.0001) and in PFS (2.1 vs. 0.3 years, p < 0.0001). R-ESHAP is an effective treatment in relapsed FL patients who respond to the previous line and has to be considered as an adequate alternative for some patients.

A longitudinal communication approach in advanced lung cancer: A qualitative study of patients', relatives' and staff's perspectives.

Communication and the care of patients with advanced cancer are a dynamic, interactive and challenging process, often characterised in every day practice by discontinuity and lack of coordination. The objective of this study was to explore the patients' and family-caregivers' needs and preferences regarding communication, quality of life and care over the trajectory of disease. The second aim was to assess health professionals' views on a longitudinally structured, forward-thinking communication approach based on defined milestones. A qualitative approach was chosen incorporating semi-structured interviews with nine patients with metastatic lung cancer and nine relatives, and focus groups with 15 healthcare providers from different professions involved in the care of these patients. Patients and relatives described a situation of shock and coping deficits with moments of insufficient communication and lack of continuity in care. Healthcare providers reported the strong need for improvement in communication within the team and between patients and professionals and welcomed the implementation of a longitudinal communication approach. Requirements for the implementation of a longitudinal communication approach include specific communication training with focus on the process that patients and relatives are involved in. Team-building measures and the necessary flexibility to respect individuality in life should be incorporated.

A comparative study in patients with fractures of the lower limbs between rivaroxaban versus enoxaparin and its impact on bone healing time.

BACKGROUND: Each year it is estimated in the United States an approximate of 8 million fractures; 5 to 10% develop delayed union or absence of periosteal new bone. There are several factors that can cause delay in fracture healing, among the well known, is the use of prophylactic antithrombotic therapy for deep vein thrombosis (DVT). DVT appears in 40 to 60% of the patients undergoing orthopedic surgery without prophylactic antithrombotic therapy. The goal of this study was to assess whether there is a difference in time of bone healing in lower limb fractures (femur and tibia) comparing rivaroxaban to enoxaparin as the prophylactic antithrombotic management. MATERIAL AND METHODS: We present a retrospective observational and analytic study in a sample of cases. It is a cross-sectional study with patient data from the database of the American British Cowdray (ABC) Medical Center. We included patients with femur and tibia fractures under antithrombotic prophylactic management with rivaroxaban or enoxaparin during the period of January 2011 to December 2012. Our sample included 32 patients separated into two groups. Students t-test was used for comparing parametric variables and the Mann-Whitney U test for nonparametric variables. Linear regression model was preformed considering the variables related to the time it took the fracture to heal. RESULTS: All fractures consolidated in a time of 13 and 14 weeks for rivaroxaban and enoxaparin respectively (p = 0.67). DISCUSSION: We found no difference in bone healing time for lower limb fractures in patients receiving antithrombotic prophylaxis treatment comparing rivaroxaban with enoxaparin.

ANTECEDENTES: En Estados Unidos se presentan aproximadamente ocho millones de fracturas anuales y de ellas entre cinco y 10% desarrollan retraso o ausencia en la consolidación ósea. Existen diferentes factores bien conocidos que promueven este retraso, entre los cuales se encuentra el uso de los antitrombóticos como terapia profiláctica de la trombosis venosa profunda, la cual aparece de 40 a 60% en pacientes que no los utilizan y son sometidos a cirugías ortopédicas. El objetivo de este estudio fue evaluar si existe diferencia en el tiempo de consolidación de las fracturas de los huesos de las extremidades pélvicas (fémur y tibia) en pacientes sometidos a terapia profiláctica antitrombótica comparando rivaroxabán con enoxaparina. MATERIAL Y MÉTODOS: Presentamos un estudio descriptivo y analítico con muestreo a conveniencia de casos retrospectivos. Es un estudio transversal con datos recolectivos. Se revisó la base de datos del Centro Médico ABC y se incluyeron pacientes con diagnóstico de fracturas de fémur y tibia sometidos a manejo profiláctico antitrombótico con rivaroxabán o enoxaparina durante el periodo de Enero 2011 a Diciembre de 2012. La muestra total se constituyó de 32 pacientes divididos en dos grupos. Se utilizó la prueba T de Student para comparar variables paramétricas y la prueba U de Mann-Whitney para las no-paramétricas. Se realizó un modelo de regresión lineal considerando las variables relacionadas con el tiempo de consolidación ósea. RESULTADOS: Todas las fracturas consolidaron, presentando un tiempo de 13 semanas con rivaroxabán y de 14 semanas (p = 0.67) con enoxaparina. DISCUSIÓN: No encontramos diferencia en el tiempo de consolidación de las fracturas de los huesos de las extremidades pélvicas (fémur y tibia) en pacientes que reciben antitrombóticos como profilaxis comparando rivaroxabán con enoxaparina.

A comparative study in patients with fractures of the lower limbs between rivaroxaban versus enoxaparin and its impact on bone healing time / Estudio comparativo en pacientes con fracturas de extremidades inferiores entre rivaroxaban versus enoxaparina como terapia profiláctica antitrombótica y su impacto en el tiempo de consolidación

Abstract: Background: Each year it is estimated in the United States an approximate of 8 million fractures; 5 to 10% develop delayed union or absence of periosteal new bone. There are several factors that can cause delay in fracture healing, among the well known, is the use of prophylactic antithrombotic therapy for deep vein thrombosis (DVT). DVT appears in 40 to 60% of the patients undergoing orthopedic surgery without prophylactic antithrombotic therapy. The goal of this study was to assess whether there is a difference in time of bone healing in lower limb fractures (femur and tibia) comparing rivaroxaban to enoxaparin as the prophylactic antithrombotic management. Material and methods: We present a retrospective observational and analytic study in a sample of cases. It is a cross-sectional study with patient data from the database of the American British Cowdray (ABC) Medical Center. We included patients with femur and tibia fractures under antithrombotic prophylactic management with rivaroxaban or enoxaparin during the period of January 2011 to December 2012. Our sample included 32 patients separated into two groups. Student's t-test was used for comparing parametric variables and the Mann-Whitney U test for nonparametric variables. Linear regression model was preformed considering the variables related to the time it took the fracture to heal. Results: All fractures consolidated in a time of 13 and 14 weeks for rivaroxaban and enoxaparin respectively (p = 0.67). Discussion: We found no difference in bone healing time for lower limb fractures in patients receiving antithrombotic prophylaxis treatment comparing rivaroxaban with enoxaparin.

Resumen: Antecedentes: En Estados Unidos se presentan aproximadamente ocho millones de fracturas anuales y de ellas entre cinco y 10% desarrollan retraso o ausencia en la consolidación ósea. Existen diferentes factores bien conocidos que promueven este retraso, entre los cuales se encuentra el uso de los antitrombóticos como terapia profiláctica de la trombosis venosa profunda, la cual aparece de 40 a 60% en pacientes que no los utilizan y son sometidos a cirugías ortopédicas. El objetivo de este estudio fue evaluar si existe diferencia en el tiempo de consolidación de las fracturas de los huesos de las extremidades pélvicas (fémur y tibia) en pacientes sometidos a terapia profiláctica antitrombótica comparando rivaroxabán con enoxaparina. Material y métodos: Presentamos un estudio descriptivo y analítico con muestreo a conveniencia de casos retrospectivos. Es un estudio transversal con datos recolectivos. Se revisó la base de datos del Centro Médico ABC y se incluyeron pacientes con diagnóstico de fracturas de fémur y tibia sometidos a manejo profiláctico antitrombótico con rivaroxabán o enoxaparina durante el periodo de Enero 2011 a Diciembre de 2012. La muestra total se constituyó de 32 pacientes divididos en dos grupos. Se utilizó la prueba T de Student para comparar variables paramétricas y la prueba U de Mann-Whitney para las no-paramétricas. Se realizó un modelo de regresión lineal considerando las variables relacionadas con el tiempo de consolidación ósea. Resultados: Todas las fracturas consolidaron, presentando un tiempo de 13 semanas con rivaroxabán y de 14 semanas (p = 0.67) con enoxaparina. Discusión: No encontramos diferencia en el tiempo de consolidación de las fracturas de los huesos de las extremidades pélvicas (fémur y tibia) en pacientes que reciben antitrombóticos como profilaxis comparando rivaroxabán con enoxaparina.

Análisis bibliométrico de los artículos originales publicados en la revista Ciencia & Trabajo: 1999-2015 / Bibliometric analysis of the original articles published in the journal Ciencia & Trabajo: 1999-2015

INTRODUCCIÓN: La Revista Ciencia y Trabajo (C&T) es editada por la Fundación Científica y Tecnológica de la Asociación Chilena de Seguridad desde 1999, publica trabajos científicos en temas relaciona dos con la seguridad e higiene industrial, salud ocupacional, calidad de vida laboral y otras disciplinas asociadas al trabajo y medio ambiente. OBJETIVO: Analizar la producción científica de los artículos originales publicados en C&T durante el periodo 1999-2015. MATERIAL Y MÉTODOS: Estudio bibliométrico descriptivo, longitudinal y retrospectivo. Se analizaron las características metodológicas y técnicas específicas en pre vención de riesgos laborales para cada uno de los artículos analizados, asimismo, la visibilidad en SciELO Analytics para los últimos años. RESULTADOS: Se publicaron un total de 430 artículos originales en 52 números con una media de 27 ± 8,8 artículos por año y 8 ± 2,6 artícu los por número. Los años con más artículos fueron 2009, 2010 y 2011. El número de autores por artículo oscila entre 1 a 4 (82%), en su mayo ría de universidades de Latinoamérica, destacando Chile, México y Brasil como los países de mayor contribución. La Psicosociología y Medicina del Trabajo son las temáticas más investigadas respecto a otras técnicas específicas en prevención de riesgos laborales como la Seguridad en el Trabajo y Ergonomía, predominando los estudios trans versales de carácter descriptivo-observacional en el idioma español. CONCLUSIONES: Se evidencia la consolidación de la revista a lo largo del tiempo. Por la antigüedad, publicación regular y demás atributos, la Revista C&T puede plantearse la posibilidad de ser indexada en la base de datos Scopus.

BACKGROUND: The journal Science and Work (C&T) has been pub lished by the Scientific and Technological Foundation of the Chilean Security Association since 1999, it publishes scientific papers on issues related to industrial safety and health, occupational health, quality of work life and other disciplines associated with Work and the environment. Objetive: To analyze the scientific production of the original articles published in C&T during the period 1999-2015. MATERIALS-METHODS: Descriptive, longitudinal and retrospective bibliometric study. We analyzed the specific methodological and technical characteristics in occupational risk prevention for each of the analyzed articles, as well as the visibility in SciELO Analytics for the last years. RESULTS: A total of 430 original articles were published in 52 numbers with an average of 27 ± 8.8 articles per year and 8 ± 2.6 articles per number, the years with the most articles were 2009, 2010 and 2011. The number of authors per article ranges from 1 to 4 (82%), mostly from Latin American universities, Chile, Mexico and Brazil being the countries with the highest contribution. Psychosociology and Occupational Medicine are the most researched topics in relation to other specific techniques in the prevention of occupational hazards such as Occupational Safety and Ergonomics, with cross - sectional descriptive - observational studies predominat ing in the spanish language. CONCLUSIONS: It is evident the consolida tion of the journal over time. Due to seniority, regular publication and other attributes, C&T can consider the possibility of being indexed in the Scopus database.

Living scaffolds: surgical repair using scaffolds seeded with human adipose-derived stem cells.

BACKGROUND: Decellularized porcine small intestinal submucosa (SIS) is a biological scaffold used surgically for tissue repair. Here, we demonstrate a model of SIS as a scaffold for human adipose-derived stem cells (ASCs) in vitro and apply it in vivo in a rat ventral hernia repair model. STUDY DESIGN: ASCs adherence was examined by confocal microscopy and proliferation rate was measured by growth curves. Multipotency of ASCs seeded onto SIS was tested using adipogenic, chondrogenic, and osteogenic induction media. For in vivo testing, midline abdominal musculofascial and peritoneal defects were created in Sprague-Dawley rats. Samples were evaluated for tensile strength, histopathology and immunohistochemistry. RESULTS: All test groups showed cell adherence and proliferation on SIS. Fibronectin-treated scaffolds retained more cells than those treated with vehicle alone (p < 0.05). Fresh stromal vascular fraction (SVF) pellets containing ASCs were injected onto the SIS scaffold and showed similar results to cultured ASCs. Maintenance of multipotency on SIS was confirmed by lineage-specific markers and dyes. Histopathology revealed neovascularization and cell influx to ASC-seeded SIS samples following animal implantation. ASC-seeded SIS appeared to offer a stronger repair than plain SIS, but these results were not statistically significant. Immunohistochemistry showed continued presence of cells of human origin in ASC-seeded repairs at 1 month postoperation. CONCLUSION: Pretreatment of the scaffold with fibronectin offers a method to increase cell adhesion and delivery. ASCs maintain their immunophenotype and ability to differentiate while on SIS. Seeding freshly isolated SVF onto the scaffold demonstrated that minimally manipulated cells may be useful for perioperative surgical applications within the OR suite. We have shown that this model for a "living mesh" can be successfully used in abdominal wall reconstruction.

Low-dose radiation hyper-radiosensitivity in multicellular tumour spheroids.

OBJECTIVE: We propose and study a new model aimed at describing the low-dose hyper-radiosensitivity phenomenon appearing in the survival curves of different cell lines. METHODS: The model uses the induced repair assumption, considering that the critical dose at which this mechanism begins to act varies from cell to cell in a given population. The model proposed is compared with the linear-quadratic model and the modified linear-quadratic model, which is commonly used in literature and in which the induced repair is taken into account in a heuristic way. The survival curve for the MCF-7 line of human breast cancer is measured at low absorbed doses and the uncertainties in these doses are estimated using thermoluminiscent dosemeters. RESULTS: It is shown that these multicellular spheroids present low-dose hyper-radiosensitivity. The new model permits an accurate description of the data of two human cell lines (previously published) and of the multicellular spheroids of the MCF-7 line here measured. CONCLUSION: The model shows enough flexibility to account for data with very different characteristics and considers in a faithful way the hypothesis of the repair induction.

Factores pronósticos de fracaso terapéutico al radioyodo en enfermedad de Graves / Frequency and prognostic factors of radioiodine treatment failure in basedow Graves disease

Background: Radioiodine treatment fails in 17 percent of patients with Basedow Graves disease (BGD). Aim: To assess the frequency and possible associated factors of treatment failure of the first radioiodine dose in patients with BGD. Material and Methods: Review of medical records of patients with BGD treated with radioiodine at a general hospital between 2004 and 2008. Normal thyroid function or hypothyroidism ensuing after treatment were considered as treatment success criteria. Results: According to the databases of the hospital, 298 patients received radioiodine in the study period. Of these, 254 medical records were recovered and 86 were analyzed. Treatment success and failure was recorded in 67 (78 percent) and 19 (22 percent) patients, respectively. The mean dose used was 12 +/- 2 mCi. Clinically determined goiter size and a high free thyroxin level were significantly associated to treatment failure. The area under the receiver operating characteristic curve (ROC) for a thyroid weight over 60 g, estimated clinically was 0.73, rendering a sensitivity and specificity of 63 and 89 percent respectively, for this parameter as predictor or treatment failure. Conclusions: Thyroid gland size may be a predictor of radioiodine treatment failure. However the variability of the clinical estimation of this parameter casts doubts about its usefulness.

Phyllodes tumor of the prostate.

A 67-year-old man presented with gross hematuria. Magnetic resonance imaging showed a 900-mL cystic mass, in continuity to the basal left side of the prostate, that laterally compressed the bladder. The patient underwent tumor resection, and the histologic diagnosis was benign cystic Phyllodes tumor of the prostate. Phyllodes tumor of the prostate is a rare tumor composed of hyperplastic and neoplastic glandular-stromal proliferation. The tumor grade has an effect on the prognosis, although if not completely resected, even low-grade tumors can recur, metastasize, or differentiate into sarcoma.

Further evaluation of the synthetic peptide vaccine S3Pvac against Taenia solium cysticercosis in pigs in an endemic town of Mexico.

Taenia solium cysticercosis is a parasitic disease frequently affecting human health and the pig industry in many developing countries. A synthetic peptide vaccine (designated S3Pvac) against porcine cysticercosis has been developed previously as an aid to interrupt transmission and has been shown to be effective. The results of the present study support the effectiveness of the vaccine under endemic field conditions. However, given the time-frame of the vaccination trial, no changes in the local levels of transmission were detectable before and after vaccination using sentinel pigs. Thus, this investigation shows the limited usefulness of single vaccination as the sole means of interrupting Taenia solium transmission in an endemic region.

Chile potencia alimentaria: compromiso con la nutrición y la salud de la población / Chile as an agricultural and food power: commitment to nutrition and population health

Hacer de Chile una potencia alimentaria mundial se constituye en el nuevo paradigma de desarrollo del sector agropecuario chileno. En este contexto, la presente contribución tiene como objetivo resaltar la importancia de la Política Alimentaria Chilena en su compromiso con la nutrición y la salud de la población. El artículo profundiza en la manera como el diseño y la implementación de las políticas y programas del Ministerio de Agricultura pueden incidir, creciente y positivamente, en la nutrición y salud de los consumidores. Se enfatiza en la importancia que tiene la coordinación de los distintos agentes de las cadenas alimentarias en la estrategia de promoción del consumo de frutas y verduras, así como en la inocuidad de los productos. Finalmente, se describe el rol del Ministerio de Agricultura en la realización de campañas promocionales como el ®Programa 5 al Día¼.

[Gastrointestinal cancer in four medical centers in Mexico City. A 25-year study]. / Estudio de 25 años de cáncer del aparato digestivo en cuatro instituciones de la Ciudad de México.

BACKGROUND: Digestive cancer is an important mortality cause in Mexico. In the past decades a change in the frequency of digestive malignancies has been observed. AIM: To evaluate the frequency of digestive malignancies in four hospitals in México City during a 25 years period. PATIENTS AND METHODS: All digestive cancers were studied at the following hospitals: Hospital General de México (HGM), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirdn (INCMNSZ), Centro Médico Nacional 20 de Noviembre (CMN20Nov) and Hospital Español (HE). The diagnosis was established by histopathology study. Cases frequency is were compared in three-years intervals. RESULTS: 8,879 digestive cancers were documented. Gastric cancer frequency decreased during the study period at HGM (59% in 1978 to 38% in 2003) and at INCMNSZ (32% in 1978 to 24% in 2003), p = 0.013 andp = 0.012 respectively. Colon cancer frequency increased significantly at HGM (15% in 1978 to 36% in 2003, p < 0.001) and at CMN20Nov (20% in 1981 to 51% in 2003, p < 0.01) and at INCMNSZ with tower significancy. A change in squamous esophageal cancer (SC) and esophageal adenocarcinoma (EA) frequencies was observed in at the INCMNSZ, with a SC:EA ratio of 7:1 between 1977 to 1987and 1:2 between 1988 to 2005. Alimentary habits questionnaries showed early during the study diferences in caloric intake between the four hospitals (mean HGM: 2,169 kcal, INCMNSZ: 2,195 kcal, CMN2O0Nov: 3,133 y 2,262 kcal HE) and in animal protein intake, being lower at HGM (9.3 g/day) and IN-CMNSZ (11.8 g/day) compared with CMN2ONov (45.6 g/day) and HE (63.4 g/day), in the next questionnary these differences dissapeared and there was an increase in both, the same was observed for lipid intake. CONCLUSIONS: We observed a reduction in gastric cancer fre quency and an increase in colon cancer in 25 years, probably associated to a change in habits dietary. Also a change in the main histological type of esophageal cancer was observed, initially epidermoid cancer was the most frequent and in the last 10 years adenocarcinoma is the most frequent.

Contribución de enfermería en la prevención y detección temprana de la sepsis / The contribution of nursing in the prevention and early detection of sepsis

El propósito del presente trabajo fue hacer una revisión sobre la campaña de "Sobrevivir a la Sepsis" y contribuir en la difusión de la misma en el medio, con la operatividad necesaria para su adaptación. Para ello se realizó una revisión de las publicaciones médicas y de enfermería, en la cual se destacan que los avances en el manejo de la sepsis severa, la comprensión en su fisiopatología y nuevas estrategias de tratamiento, no han reducido su mortalidad y en tal sentido se han desarrollado algunas iniciativas, una de ellas es la Campaña para sobrevivir a la Sepsis, la cual ha difundido protocolos para el manejo de la Sepsis Severa y el Shock Séptico. Sin embargo, hay que reconocer que la principal acción que se debe emprender es la prevención y para ello el papel que realiza Enfermería es el más indicado, pues este profesional se encuentra en la mejor posición para identificar sus signos tempranos, por el estrecho y continuo cuidado del paciente

Cleavage of the MLL gene by activators of apoptosis is independent of topoisomerase II activity.

Exposure to topoisomerase II inhibitors is linked to the generation of leukemia involving translocations of the MLL gene, normally restricted to an 8.3 kbp tract, the breakpoint cluster region (BCR). Using an in vitro assay, apoptotic activators, including radiation and anti-CD95 antibody, trigger site-specific cleavage adjacent to exon 12 within the MLL BCR and promote translocation of the MLL gene in cells that can survive. To explore the mechanism of cleavage and rearrangement in more detail, the entire MLL BCR was placed into the pREP4 episomal vector and transfected into human lymphoblastoid TK6 cells. Episomes containing either the MLL BCR, or deletion constructs of 367 bp or larger, were cleaved at the same position as genomic MLL after exposure to apoptotic stimuli. Further analysis of sequence motifs surrounding the cleaved region of MLL showed the presence of both a predicted nuclear matrix attachment sequence and a potential strong binding site for topoisomerase II, flanking the site of cleavage. Inactivation of topoisomerase II by the catalytic inhibitor merbarone did not inhibit MLL cleavage, suggesting that the initial cleavage step for MLL rearrangement is not mediated by topoisomerase II.

[Whipple's disease. Two new cases of an underdiagnosed disease]. / Enfermedad de Whipple. Dos nuevos casos de una enfermedad infradiagnosticada.

Whipple's disease is a rare systemic infectious disease caused by the bacterium Tropheryma whippelii. Early diagnosis is essential. Whipple's disease is potentially fatal but responds dramatically to antibiotic treatment. The diagnosis is confirmed by means of polymerase chain reaction (PCR) technology. This analysis may be useful for monitoring the efficacy of therapy. The recommended treatment al present is administration of cotrimoxazole twice daily for one year. When CNS involvement occurs, it is recommended initial treatment with daily parenteral administration of streptomycin 1 g and 1.2 million units of benzyl penicillin (Penicillin G) over a period of 14 days.