Marijuana, Ondansetron, and Promethazine Are Perceived as Most Effective Treatments for Gastrointestinal Nausea.

BACKGROUND: Many anti-nausea treatments are available for chronic gastrointestinal syndromes, but data on efficacy and comparative effectiveness are sparse. AIMS: To conduct a sectional survey study of patients with chronic nausea to assess comparative effectiveness of commonly used anti-nausea treatments. METHODS: Outpatients at a single center presenting for gastroenterology evaluation were asked to rate anti-nausea efficacy on a scale of 0 (no efficacy) to 5 (very effective) of 29 commonly used anti-nausea treatments and provide other information about their symptoms. Additional information was collected from the patients' chart. The primary outcome was to determine which treatments were better or worse than average using a t test. The secondary outcome was to assess differential response by individual patient characteristics using multiple linear regression. RESULTS: One hundred and fifty-three patients completed the survey. The mean efficacy score of all anti-nausea treatments evaluated was 1.73. After adjustment, three treatments had scores statically higher than the mean, including marijuana (2.75, p < 0.0001), ondansetron (2.64, p < 0.0001), and promethazine (2.46, p < 0.0001). Several treatments, including many neuromodulators, complementary and alternative treatments, erythromycin, and diphenhydramine had scores statistically below average. Patients with more severe nausea responded better to marijuana (p = 0.036) and diphenhydramine (p < 0.001) and less so to metoclopramide (p = 0.020). There was otherwise no significant differential response by age, gender, nausea localization, underlying gastrointestinal cause of nausea, and GCSI. CONCLUSIONS: When treating nausea in patients with chronic gastrointestinal syndromes, clinicians may consider trying higher performing treatments first, and forgoing lower performing treatments. Further prospective research is needed, particularly with respect to highly effective treatments.

Presence of congenital anomalies in three dog litters.

This report describes multiple congenital malformations found in three dog litters delivered by emergency caesarean section. In all of the litters, some puppies were born alive but were euthanized because of the seriousness of their malformations and low probability of survival. In two litters, gastroschisis was associated with amelia of the right anterior limb. Other malformations such as anencephaly were also found in three puppies among the different litters. This report describes the morphological findings of the affected puppies, discusses the most appropriate terminologies for each case and highlights the importance of an epidemiological survey to identify potential factors associated with the cases.

Atención a la función docente educativa en la formación del médico general / Work with the Teaching-Learning Function in the Formation of the General Practitioner

Introducción: la función docente educativa integra el perfil profesional del médico general, e incluye la responsabilidad con la educación en salud y la participación en la formación de estudiantes. Objetivos: evaluar el tratamiento a la función docente educativa en el plan de estudio y la preparación para asumirla según la percepción de los egresados y elaborar acciones para su atención desde el pregrado. Método: se utilizaron métodos teóricos y empíricos, se revisó el plan de estudio y se aplicó cuestionario a 132 recién graduados en la Facultad de Ciencias Médicas Mariana Grajales Coello, en el período de marzo 2014 a enero 2015. Resultados: el plan de estudio tiene posibilidades desde su diseño para la atención a esta función. Solo 34 (25,75%) dominaban sus seis componentes, participar en actividades docentes con estudiantes (67,6%), desarrollar promoción y educación para la salud (65,8%) y la autoeducación (61,8%); 100% reconocen a la disciplina principal integradora y 66,6% al sexto año como las que más aportaron; 83,95% señalaron a la ayudantía y menos de 50% a la investigación y extensión universitaria; el 43,18% se autoevaluaron de regular y solo el 13,63% se consideraron excelentemente preparados. Se diseñaron acciones en los diferentes colectivos pedagógicos y en otras áreas implicadas. Conclusiones: existen insuficiencias en el tratamiento a la función docente educativa en el pregrado y los egresados reconocen carencias en su preparación para asumirla desde su vida laboral. Se hace una propuesta de acciones a partir de las posibilidades que brinda el currículo, y el trabajo metodológico a sus diferentes niveles.

Introduction: educational teaching function integrates the professional profile of the general practitioner, highlighting the responsibility for health education and participation in training students. Objectives: to evaluate the graduates’ perception on the treatment during their career and their preparation as professionals. Methods: theoretical and empiricist methods were used with a questionare to 132 recently graduated in Faculty of Medical Sciences Holguin. Results: the curriculum is likely from design to care for this function but only 34 (25.75%) dominated the six components, participate in educational activities with students (67.6%), develop promotion and education health (65.8%) and self-education (61.8%); 100% recognize the integrative core discipline and 66.6% in the sixth year as the largest contributors; the 83.95% drew assistantship and less than 50% to research and extension; 43.18% evaluated themselves regularly and only 13.63% were considered excellently prepared. Several actions were designed in the different pedagogical teams as well as in other implied areas. Conclusions: there are inadequacies in treatment educational role in teaching undergraduate and graduates recognize gaps in their preparation to assume from their working lives. A proposal for action from the possibilities offered by the curriculum and methodological work at different levels.

Effect of preservatives on IgG aggregation, complement-activating effect and hypotensive activity of horse polyvalent antivenom used in snakebite envenomation.

Intravenous administration of antivenoms is associated with early adverse reactions in a number of cases, but the causes of this phenomenon are still unclear. The effect of preservatives (phenol and thimerosal) on IgG aggregate and dimer formation, in vitro complement-activating effect and hypotensive activity of a whole IgG horse liquid polyvalent antivenom, produced by caprylic acid fractionation, was assessed. These parameters were studied since they have been associated with the development of early adverse reactions to the administration of antivenoms and human immunoglobulins. After a three-year storage period at 4 degrees C, antivenoms with preservatives had an increased content of IgG aggregates and dimers when compared with antivenom devoid of phenol and thimerosal. These observations correlate with a slight increment in the turbidity of preservative-containing antivenoms. The three antivenoms studied (formulation: no preservatives; with phenol and thimerosal; with thimerosal alone) activated human complement in vitro, with only minor quantitative differences among them. When antivenoms were administered as a bolus intravenous injection in rats, a rapid and prominent hypotension of short duration was observed after injection of phenol-containing antivenom, whereas such an effect was absent in antivenom free of preservative and in the one containing only thimerosal. Bolus injection of saline solution with phenol resulted in a similar hypotension, indicating that the effect is due to phenol. However, when phenol-containing antivenom was diluted 1:5 with saline solution before infusion, as occurs in the clinical use of this product, no hypotension was observed. Our results stress the need to evaluate the effects of preservatives on the physicochemical and pharmacological characteristics of antivenoms.

Extracto y fracción alcaloidal de annona muricata con actividad de tipo ansiolítica en ratones / Anxiolytic-like effect of the extract and alkaloid fraction from Annona muricata in mice

Se evaluó el efecto neurológico ejercido por el extracto hidroalcohólico (40 por ciento) obtenido de las hojas de Annona muricata (0,5 g/kg, vo) en ratones albinos icr mediante pruebas tendientes a detectar posible actividad de tipo anticonvulsivante (electrochoquepentilentetrazol), antidepresiva (nado forzado), hipnótica (potenciación de sueño barbitúrico) y ansiolítica (laberinto en cruz). Además se examinó la unión con radioligando del extracto a receptores de benzodiazepina, se efectuó el análisis fitoquímico y a la fracción alcaloidal obtenida se le aplicó la prueba del laberinto en cruz (0,5 g/kg, vo), según los resultados previos obtenidos con el extracto. Finalmente se evaluó la toxicidad del extracto (0,1-10 mg/mL) sobre las líneas celulares ecv-304 y k562. Los hallazgos sugieren que compuestos de tipo alcaloidal presentes en Annona muricata tendrían efectos de tipo ansiolítico (53 por ciento y 58 por ciento de tiempo y frecuencia de acceso a las zonas abiertas en la prueba de laberinto en cruz elevado), no vinculados a la activación de receptores de benzodiacepinas y carentes de efectos citotóxicos in vitro. Estos datos ayudan a dar soporte al uso etnobotánico de esta especie.

The present study evaluated the neuropharmacological effect exerted by the hydroalcoholic extract (40 percent) obtained from leaves of Annona muricata (0.5 g/kg, po) in icr albino mice using tests to detect anticonvulsant (electroshock-pentylenetetrazol), antidepressant (forced swimming test), hypnotic (barbiturate sleeping time) and anxiolytic activities (elevated plus maze). The putative binding of the extract to the benzodiazepine receptor by radioligand techniques was also studied. The phytochemical analysis of the extract led to the isolation of an alkaloid fraction that was evaluated in the elevated maze test (0.5 g/kg, po), in agreement with previous results obtained with the extract. Finally, it was assessed the toxicity of the extract (0.1-10 mg/ml) in cell lines k562 and ecv-304. The results suggest that alkaloid metabolites present in Annona muricata exert anxiolytic effects (53 percent and 58 percent of the time and frequency of access to open areas in the elevated plus maze), unrelatedto the activation of benzodiazepine receptors and without cytotoxic effects in vitro. These data help support the ethnobotanical use of this plant specie.

Colgajo torácico a distancia para la reconstrucción de un segmento de la mano / Flap chest distance for the reconstruction of a segment of the hand

La necesidad de tomar una conducta apropiada en la reconstrucción de la anatomia de la mano y sobre todo preservar su funcionalidad es sumamente importante, ya que esta es parte fundamental en la economía humana. El empleo de un colgajo a distancia torácico es ideal para la reconstrucción de las lesiones traumáticas de miembros superiores, cuando existen lesiones graves e importantes que afectan elementos nobles de la mano ( hueso, músculo, tendón), con el que existe la gran factibilidad de preservar su funcionalidad. Se presenta el caso clínico de un paciente que sufrió ablación de dedos de la mano derecha a consecuencia de quemadura eléctrica y en el que se realizó un colgajo a distancia de la región torácica anterior a primer espacio interdigital, lograndose buenos resultados, con recuperación funcional de la mano.

Reconstruction of the damaged hand and consequently preservationof the capacity of movement, is extremely important since it is avital part of human economy. This at distance skin graft is ideal fortraumatic lesions of the upper extremities when severe and importantlesions are present that affect bones, muscles and tendons, becauseit is feasible and preserves the function of movement. In this sense,we present the case of a patient who suffered ablation of fingers ofthe right hand as a consequence of electric burning. At distance skingraft of the anterior thorax region to the first interdigital space wascarried out obtaining good results with recovery of the function ofthe hand.

Reconstrucción parcial del pabellon auricular con colgajo retroauricular / Partial reconstruction with flap pinna retroauricular

El pabellon auricular por su situación anatómica se encuentra susceptible a una serie de lesiones traumáticas y/o patológicas, por lo que su reconstrucción es un verdadero desafío para el área quirúrgica encargada de mantener la simetría con el pabellon contralateral como su compleja estructura. Presentamos el caso clínico de un paciente con pérdida del borde helical, posterior a mordedura humana, reconstrucción del daño mediante colgajo retroauricular, una técnica versátil, sencilla que requiere siempre cumplir con todos los requisitos de orden técnico-quirúrgicos de tratamiento de movilización de colgajos.

The earlobe, due to its exposed situation, is susceptible to a variety of traumatic and/or pathologic lesions, therefore its reconstruction is a real challenge for surgery in order to maintain symmetry with the earlobe on the opposite side as its complex structure. Therefore we present the case of a patient with loss of the posterior helical border after a human bite. The damage was cured by retroauricular skin graft, a versatile, simple technique which requires always the fulfilment of all surgical technical requirements of treatment by movilization of skin grafts.

Comparacion floristica de doce parcelas en bosque de tierra firme en la amazonia peruana

Floristic composition of twelve plots, 25 m by 25 m, was studied in the Peruvian Amazonia in order to investigate if it were possible to use a part of the flora as an indicator of the changes observed in other components of the flora. Floristic similarities among the plots were calculated using six different taxonomic or physiognomic groups: ferns, the families Melastomataceae and Myristicaceae, trees thicker than 2.5 cm diameter at breast hight (DBH), trees between 2.5 cm and 5 cm DBH, and trees thicker than 5 cm DBH. The similarities were used for agglomerati ve classifications of the plots and for analyzing the correlations among the different groups of plants with Mantel's test. The results indicate that floristic changes were similar in all of the groups and therefore every group can potentially be used as an indicator.

Um estudo da composição florística de doze parcelas de 25 m 25 m foi realizado na Amazônia peruana com o objetivo de observar a possibilidade de utilizar uma parte da flora como indicador para as alterações anotadas em outros elementos da flora. As similaridades florísticas entre as parcelas foram definidas usando seis grupos taxonômicos ou fisionômicos diferentes: fetos, as famílias Melastomataceae e Myristicaceae, árvores com diâmetro á altura do peito (DAP) maior a 2.5 cm, árvores com DAP entre 2.5 cm e 5 cm, e árvores maiores a 5 cm de DAP. As similaridades foram utilizadas para classificar as parcelas e para analisar as correlações entre os grupos diferentes de plantas com a prova de Mantel. Os resultados mostram que as alterações florísticas são similares em todos os grupos, e por isso qualquer destes grupos é capaz de servir de indicador.