Synergistic action of fatty acids, sulphides and stilbene against acaricide-resistant Rhipicephalus microplus ticks.

Six compounds in a methanolic extract of Petiveria alliacea stem (cis-stilbene; benzyl disulphide; benzyl trisulphide; and methyl esters of hexadecanoic acid, octadecadienoic acid and octadecenoic acid) are known to exercise acaricide activity against cattle tick Rhipicephalus microplus larvae and adults. The synergistic effect of 57 combinations of these six compounds on acaricide activity against R. microplus was evaluated. Larvae immersion tests produced the lethal concentrations needed to kill 50% (LC50) and 99% (LC99) of the population. Adult immersion tests produced rates (%) for mortality, oviposition inhibition and eclosion inhibition. Individually, none of the compounds (1% concentration) exhibited acaricide activity (mortality ≤2.3%). When combined, however, nine mixtures exhibited a synergistic increase in activity, with high mortality rates (≥92%) in larvae. Values for LC50 ranged from 0.07 to 0.51% and those for LC99 from 0.66 to 5.16%. Thirty six compound mixtures had no significant activity (mortality ≤30%) against larvae. Two mixtures exhibited synergism against adults, with high rates (≥92%) of oviposition inhibition. The mixtures based on the benzyl disulphide+benzyl trisulphide pairing produced a synergistic effect against acaricide-resistant R. microplus larva and adults, and are therefore the most promising combination for controlling this ubiquitous ectoparasite.

Estrategias efectivas para incrementar el consumo de la bebida láctea "Purita Mamá" en gestantes y nodrizas de la provincia de Ñuble, año 2012 / Effective strategies to increasing the consumption of the dairy drink "Purita Mamá" for pregnant and lacting women from the Ñuble province, year 2012

Objective: To identify effective strategies to increase the consumption of the product "Purita Mama" in pregnant and lactating women from Ñuble. Subjects and methods: Observational cross sectional study; two instruments were applied, the first one observing of consumption and acceptability of the product in pregnant and lactating women from a non-probabilistic sample; the second one applied to the health team showing major variations in the consumption from a non-probabilistic "intentional" sample. Results: The product was consumed by 38% of pregnant and 34.6% of lactating women; acceptability was regular in 54.6% and 48.2% of pregnant and lactating women, respectively. On the other hand, 34% of the professionals and technicians who work directly with pregnant and lactating women "did not know" the product. The main effective educational strategy implemented (60.2%), is product tasting. Conclusion: The largest consumption of the product is seen in those establishments who implement effective instructional strategies.

Objetivo: identificar estrategias efectivas para que los equipos de salud de la provincia de Ñuble - Chile incrementen el consumo del producto lácteo "Purita Mama" para gestantes y nodrizas. Sujetos y métodos: estudio observacional, pasivo de caso y control donde se aplicaron dos instrumentos, el primero de consumo y aceptabilidad del producto en gestantes y nodrizas a una muestra no probabilística "por cuota"; y el segundo, aplicado a los equipo de salud que presentó mayores variaciones en el consumo a una muestra no probabilística "intencional". Resultados: Consumen el producto 38% de las gestantes y 34,6% de las nodrizas; de las que lo consumen su aceptabilidad es regular en 54,6% de las gestantes y en 48,2% de las nodrizas. Por otra parte "no conocen el producto" 34% de los profesionales y técnicos que trabajan directamente con gestantes y nodrizas. La principal estrategia educativa efectiva implementada (60.2%), es la "degustación del producto". Conclusión: El mayor consumo del producto, se presenta en aquellos establecimientos donde se implementan estrategias educativas efectivas.

Human adjuvant disease induced by foreign substances: a new model of ASIA (Shoenfeld's syndrome).

OBJECTIVE: To investigate the clinical, laboratory and histological manifestations of patients who received illegal injections of foreign substances for cosmetic purposes. PATIENTS AND METHODS: We studied patients who met the following inclusion criteria: 1) history of application of foreign substances for cosmetic purposes, 2) clinical data of autoimmune disease or non-specific autoimmune manifestation (i.e. arthralgias, myalgia, malaise, fever, and weight loss), 3) detection of autoantibodies in patients' sera, 4) histological evidence of chronic inflammation and/or granulomatous reaction to foreign body. RESULTS: Fifty female patients aged 44.4 ± 10 years were studied. The mean time between application of foreign substances and onset of symptoms was 4.5 ± 4.3 years. Patients were followed for 12 ± 7.5 years. Forty-one patients were injected with mineral oil, nine patients received other substances: three iodine gadital, one guayacol, one guayacol plus silicone fluid, two collagen, two silicone fluid. The sites of application were: buttocks (36), legs and/or thighs (11), breasts (eight) hands and face (one), face (two) (seven patients received an injection to more than one site). Thirty patients presented with non-specific autoimmune manifestations, whereas 20 patients fulfilled the criteria for a defined autoimmune disease such as systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, overlap syndrome, autoimmune hemolytic anemia, autoimmune thyroiditis, autoimmune hepatitis, and ulcerative colitis. CONCLUSIONS: Cases of human adjuvant disease following illegal injections of oil substances for cosmetic purposes are reported. Patients presented with defined autoimmune diseases as well as with non-specific autoimmune manifestations. Illegal injection of these substances could lead to serious local and systemic complications, even to death. These cases represent another model of Autoimmune/inflammatory Syndrome Induced by Adjuvants (ASIA). The use of these substances should be prohibited.

Still's disease, lupus-like syndrome, and silicone breast implants. A case of 'ASIA' (Shoenfeld's syndrome).

In recent years, four conditions, siliconosis, Gulf War syndrome (GWS), macrophagic myofasciitis syndrome (MMF) and post-vaccination phenomena, were linked to a previous exposure to an adjuvant, suggesting a common denominator, and it has been proposed to incorporate comparable conditions under a common syndrome entitled Autoimmune/inflammatory Syndrome Induced by Adjuvants (ASIA). We report a case of a female who at the age of 11 years was diagnosed with Still's disease. At the age of 22 she underwent silicone breast implants and presented with a transient lupus-like syndrome. Then, at 25 years old she had a severe activation of Still's disease in association with rupture of silicone breast implants. When the prostheses were removed, the clinical picture improved. This case fulfills the criteria for ASIA and complements seven previous reports of Still's disease in association with silicone breast implants.

Comparación de los costos reales anuales asociados al manejo ambulatorio de pacientes hipertensos del programa cardiovascular en el Hospital Comunitario de Bulnes con el pago de prestaciones de Fonasa / Cost of ambulatory care of hypertensive subjects in a community hospital (bulnes): comparison of activity associated costs to the national health fund (fonasa) estimated payments in the setting of a national cardiovascular care program

Antecedentes: El financiamiento de las prestaciones entregadas a los usuarios de atención primaria portadores de Hipertensión Arterial, esta determinado por un arancel definido por el Fondo Nacional de Salud (FONASA), el cual ha estimado montos a pagar a la institución prestadora, basados en estudios realizados a nivel nacional, los cuales difieren de las estimaciones de gasto real de cada prestación, para lo cual se hace necesario objetivar dicha diferencia de estimación a nivel local. Objetivo: Determinar los costos directos e indirectos reales de las prestaciones entregadas a los usuarios hipertensos de control ambulatorio en atención primaria de salud mediante la metodología de costos asociados a actividades (ABC), para compararlos con los valores asignados por FONASA. Diseño: Estudio Analítico no experimental de enfoque cuantitativo de corte transversal, en que se revisaron 290 tarjetas de control de usuarios hipertensos bajo control en el Hospital Comunitario de Salud Familiar de Bul-nes. Se analizaron específicamente los valores del control Médico, control Enfermera, control Nutricionista, y valores de exámenes: hematocrito, perfil lipídico, glicemia, creatinina plasmática, orina completa, potasio plasmático, electrocardiograma, atención farmacéutica. Resultados: Los costos reales de las prestaciones incluidas en la Guía Clínica GES para el manejo ambulatorio de la Hipertensión Arterial, obtenidos mediante el uso de la metodología ABC fueron significativamente mayores a los establecidos por el FONASA (promedio miles de pesos: Fonasa 21.370; Costo real 39.991,7 +/- 11.999,4; p <0,001). Conclusión: Estos resultados sugieren que existe una diferencia entre lo que FONASA cancela por estas prestaciones y el gasto real en que se incurre por su atención. Si estos valores se acercan, podría obtenerse un mejor financiamiento del programa.

Background: Payments for ambulatory care of hypertensive patients in the national cardiovascular program is defined by FONASA based on national studies. Considerable differences are observed upon confrontation with the real costs involved in a given place. Aim: to determine direct and indirect costs of health care actions in the ambulatory care of hypertensive patients through an activity based cost (ABC) methodology and to compare these with the corresponding payments defined by FONASA Method: In a cross sectional design, 290 records of hypertensive subjects under control at the Community Hospital in Bulnes were analyzed. Costs of doctor, nurse and nutritionist controls were determined along with those related to laboratory tests including hematocrit, lipid profile, glycemia, plasma creatinine, urine analysis, plasma K level and electrocardiogram. Cost of pharmacy was also included. Results: a monthly mean of $ 39 992 +/- 12 000 per hypertensive patient cared was determined through ABC based costs. This is considerable greater than de $ 21 370 determined by FONASA (p<0.001). Conclusion: Payments considered by FONASA are insufficient to cover real costs involved in ambulatory care of hypertensive patients. A better financing of the cardiovascular care program requires these costs and payments to converge.

Rinoescleroma, una enfermedad rara en Chile: reporte de un caso clínico / Rhinoscleroma, a rare illness in Chile: report of a clinical case

Se presenta el primer caso publicado de rinoescleroma en un paciente chileno, con historia de tres años de evolución de obstrucción nasal izquierda que luego se hace bilateral. Es estudiado en el Policlínico de Otorrinolaringología del Hospital Barros Luco Trudeau, pesquisándose una masa en fosas nasales de aspecto polipoideo atípico. Mediante estudio histopatológico e infectológico se confirma el diagnóstico de rinoescleroma, con cultivo positivo para Klebsiella rhinoscleromatis. El paciente es tratado con moxifloxacino durante seis semanas previo a la cirugía endoscópica, efectuándose resección de la patología en ambas fosas nasales. Se trata con antibiótico durante seis semanas más, quedando, a los tres meses postcirugía, con leve obstrucción nasal a izquierda secundaria a una estenosis fibrosa de coana izquierda, residual a su patología.

Autotransfusion in trauma. A pragmatic analysis.

The precise role of autotransfusion in trauma is ill defined. This review was undertaken to identify pragmatic factors that limit the utility of autotransfusion in trauma. The Cell Saver III autotransfusion devise was prepared for use in 85 trauma victims. Only 22 (26 percent) of these patients actually received autologous blood. The remaining 63 patients (74 percent) did not utilize the autotransfuser because of inadequate blood retrieved (60 percent), extensive contamination from colon injury (21 percent), or operating room death before reinfusion (19 percent). Those receiving autologous blood had an average 8,600 ml blood loss, but only 2,250 ml or 28 percent of the total blood transfused was from the autotransfuser. Age, mechanism of injury, and presence of shock were not predictors of autotransfusion usefulness. An initial hematocrit value of less than 35 percent and more than 2 liters of crystalloid resuscitation in the emergency department indicate a potential role for autotransfusion. Inadequate blood scavenging remains the principal limiting factor in autotransfusion for trauma.

Some hormonal effects on myocardial phosphate efflux.

The effects of 23 agonists on the rates of cellular 32P efflux and lactate dehydrogenase (LDH) release were tested in a perfused rat heart preparation which had been prelabelled in vitro with [32P]Pi. Some 13 compounds produced detectable changes at high doses within 10 min, and in most cases a polyphasic response was observed. Six classes of compound gave rise to substantial effects, as follows. Catecholamines and glucagon produced a transient initial stimulation of Pi efflux, followed by a long-term inhibition of Pi transport and an increased rate of LDH release. These effects were clearly different from the response seen after treatment with dibutyryl cyclic AMP, which had a slower, stimulatory, effect on Pi output in doses which gave rise to a pronounced inotropic effect, and produced a marked increase in both coronary flow and LDH release. Carbachol also gave rise to a large transient stimulation of Pi efflux, which was followed by smaller sustained increase in Pi output without any obvious effect on LDH release. Dibutyryl cyclic GMP had no effect on Pi efflux or LDH release. Insulin decreased the rate of Pi efflux, although the loss rate partially recovered towards the control value after prolonged exposure to the hormone. Insulin had no obvious inotropic effects and produced no change in the rate of LDH release. Corticosteroids increased the rate of Pi efflux, although the loss rate partially declined towards the control value with prolonged exposure to the hormones. Corticosteroids produced a very slight inotropic response, and large doses sometimes increased the rate of LDH release from the tissue. Aldosterone slightly stimulated Pi output. A small, transient and somewhat variable stimulation of Pi efflux was observed with vasopressin and angiotensin, whereas tri-iodothyronine was slightly inhibitory, but adenosine, histamine, spermidine, des-Asp1-angiotensin, prolactin, parathyroid substances, calcitonin and somatostatin had no significant effects under our experimental conditions. Ouabain stimulated Pi efflux in doses that had no detectable inotropic effect. It is suggested that Pi efflux involves the electroneutral transport of NaH2PO4 across the cardiac plasmalemma and that many of the hormonal effects might be explained by changes in the intracellular [Na+] and pH in addition to changes in the intracellular [Pi].