Current use of biologic therapies for musculoskeletal disease: A survey of board-certified equine specialists.

OBJECTIVE: To evaluate the use of mesenchymal stem cells (MSCs), autologous conditioned serum (ACS), platelet-rich plasma (PRP), and autologous protein solution (APS) for the treatment of equine musculoskeletal disease by diplomates of the American College of Veterinary Surgery (ACVS), and American College of Veterinary Sports Medicine and Rehabilitation (ACVSMR). STUDY DESIGN: Cross-sectional study. SAMPLE POPULATION: Diplomates (n = 423). METHODS: An email link was sent to ACVS and ACVMR diplomates. A survey contained 59 questions regarding demographics, as well as indications, frequency, adverse effects, and limitations of use. Responses were analyzed using Fisher's exact test. RESULTS: One hundred and fifty four surveys were analyzed. Years in practice and type of practice were not associated with biologic therapy use. PRP was the most used therapy (120/137; 87.5%). PRP and MSCs were most often administered intralesionally while ACS and APS were most often administered intra-articularly. ACS (50/104; 48.1%) treatment was repeated commonly within 2 weeks of initial injection. MSCs (39/90; 43.3%) and PRP (38/100; 38%) were commonly repeated 1-2 months after initial injection and APS was typically repeated >4 months after initial injection (21/53; 39.6%). Local inflammation and expense were the most common adverse effect and limitation of use. CONCLUSION: Diplomates most commonly utilized PRP and MSC intralesionally for soft-tissue injuries, and ACS and ACP intra-articularly for joint injury. Protocols for repeated administration varied widely. Local inflammation was a clinical concern with the use of biologics. CLINICAL SIGNIFICANCE: Biologic therapies are used commonly by ACVS and ACVSMR diplomates for soft tissue and joint disease.

Effects of grape pomace supplementation on the diet of lactating ewes as compared to vitamin E on the meat shelf life of suckling lambs.

Forty-eight Churra ewes and their suckling lambs were assigned to four dietary treatments: control (CTRL), VIT-E (500 mg kg-1 TMR vitamin E), GP-5 (5% grape pomace) and GP-10 (10% grape pomace). After slaughter (11.5 kg live weight), longissimus muscle of lambs was sliced, packaged under modified atmosphere (80,20%/O 2:CO 2) and stored in retail conditions. At each sampling point (0, 3, 7, 10, 14 days), microbiological, physicochemical and sensory characteristics were analysed. Vitamin E and GP-5 were found to be effective (p < 0.05) at preventing enterobacteria growth as of day 10. After day 10, vitamin E and grape pomace in the ewe's supplementation reduced metmyoglobin (p < 0.05) lipid oxidation (p < 0.05) and sensory spoilage throughout the storage period. An effect of the grape pomace dosage was observed, with the supplementation at 5% being more effective. Therefore, we can conclude that grape pomace was just as effective as vitamin E in preventing spoilage during retail storage.

Interaction among species, time-of-day, and soil water potential on biochemical and physiological characteristics of cladodes of Opuntia.

The physiology and biochemistry of young Opuntia spp. cladodes relate with their Crassulacean acid metabolism, which extends over the day-night cycle in four phases, is species-dependent and is affected by water availability. This study aimed to assess the interaction among species, time-of-day, and the soil water potential (ΨW) on biochemical and physiological characteristics of cladodes of Opuntia species. Three-week-old cladodes were harvested at 7:00 a.m. and 3:00 p.m. from plants with or without irrigation for 30 d (-0.17 and -5.72 MPa soil ΨW), from O. albicarpa, O. ficus-indica, O. hyptiacantha, O. megacantha, and O. streptacantha. The experimental design was a factorial 5 x 2 x 2 (species, sampling time and soil ΨW). The experimental unit was one cladode per plant, and six repetitions were evaluated. Total acids, glucose, fructose, sucrose, starch, total phenolics, free amino acids, and soluble proteins concentrations were evaluated, as well as acid invertase and neutral invertase activities. The interaction among species x soil ΨW and species x time of the day was significant (P ≤ 0.05) in all variables evaluated. An exception was the species x soil ΨW on starch concentration (P = 0.1827). The biochemical and physiological characteristics of Opuntia cladodes were modified by the time of the day and soil ΨW interaction, but most of the characteristics were positively or inversely affected depending on the species, frequently displaying a descending trend following O. streptacantha, O. hyptiacantha, O. megacantha, O. albicarpa and O. ficus-indica. The total acids, glucose, fructose, starch, soluble proteins, and free amino acids concentrations revealed that domestication significantly modifies C and N metabolism in Opuntia.

NATURAL RADIUM ISOTOPES PRESENT IN SOME COSMETIC PRODUCTS: DETERMINATION OF ACTIVITY CONCENTRATION AND DOSE ESTIMATION.

Since the early days, clays, plant extracts and raw materials have been used for therapeutic and beauty purposes. Nowadays, this use is widely spread, as a huge amount of companies have developed new cosmetics based on natural sources. This may lead to an accumulation of radionuclides that can be hazardous for people. Especially dangerous are radium isotopes (226,228Ra), which can be part of the raw materials that cosmetics are made from. In this paper, the concentration of radium isotopes of 18 natural cosmetics was determined. Concentrations resulted in the range 7.9 ± 5.0-37.6 ± 12.5 Bq kg-1 for 226Ra; and 2.5 ± 1.7-35.4 ± 2.6 Bq kg-1 for 228Ra. The effective dose in the skin has been estimated, obtaining a mean value of 13.1 ± 4.9 µSv y-1. This value is far from the reference level of 50 mSv y-1 for the public members. Therefore, no radiological risk derived from the use of these samples, has been found.

Metabolic alkalosis is related to delayed response to treatment of hypokalemia in non-surgical critically ill patients.

Background: Potassium (K+) homeostasis is closely related to acid - base disorders. The aim of this study is to analyze the possible causes of hypokalemia non-surgical critically ill patients including acid - base disorders and its relationship with response to K+ supplementation. Methods: We performed a retrospective cohort study of 122 consecutive non-surgical patients admitted to the Intensive Care Unit during July 2016 Patients were classified according to the presence of hypokalemia or not. Demographic data, morbidities associated with hypokalemia, with emphasis in acid-base disorders and response to treatment were described and analyzed. Results: Hypokalemia was observed in 32,7% (n = 40) of the patients included. Hypokalemic group had a higher value of base excess (median of -0.65 [IQR -3.3-5.2] Vs -3.2 [IQR -5.1--1.4]; p < 0.001). The patients with hypokalemia that achieved normal serum K+ in more than 25 h had a higher value of excess base than those who did so in less than 24 h (median of 4.3 [IQR -2.1-5.5] vs -1.9 [IQR -4.8-3]; p < 0.05). Neither the degree of hypokalemia, the time to development, route of administration or solution concentration, speed of infusion, the amount of K+ administered per day per kg of weight were related with the response of treatment. Conclusions: Hypokalemia is a common disorder in non-surgical critically ill patients. Hypokalemic patients had a higher incidence of metabolic alkalosis. Patients with hypokalemia and metabolic alkalosis needed a higher amount of potassium administration and higher time to achieve correction.

Effects of grape pomace in growing lamb diets compared with vitamin E and grape seed extract on meat shelf life.

The effect of dietary treatment (CTRL, control; VIT-E, 500 mg kg(-1) vitamin E; GSE, 50 mg grape seed extract kg(-1); GP-5, 5% dried red grape pomace kg(-1)) on shelf life of lamb meat was studied. After slaughter (27 kg LBW), m. longissimus thoracis et lumborum was sliced, packaged under modified atmosphere (80:20%/O2:CO2) and stored in retail conditions for 14 days. At each sampling day (0, 4, 7, 11, 14), microbiological, physico-chemical and sensory characteristics were analysed. Meat from VIT-E presented lower microbial counts than CTRL, GSE and GP-5, without differences between polyphenol treatments (GSE and GP-5) and CTRL. Vitamin E reduced meat discoloration and lipid oxidation (TBARS values) from day 7 with respect to the other treatments. Although not significant, an improvement in TBARS values of about 20% was observed for GSE and GP-5, compared with CTRL, from day 7 of storage. VIT-E dietary treatment was more effective in preventing sensory spoilage than the other treatments.

Consenso experto sobre los aspectos nutricionales de las leches infantiles de inicio y continuación / Expert consensus on the nutritional aspects of initial and follow-on infant formulas

INTRODUCCIÓN: La alimentación infantil en los primeros meses/años de vida condiciona la salud a corto y largo plazo. La lactancia materna es la alimentación ideal por sus innumerables beneficios. Sin embargo, cuando no es posible la alimentación con leche materna, las fórmulas infantiles constituyen la mejor alternativa. El objetivo del estudio fue definir el papel de las fórmulas de inicio y continuación para lactantes mediante la opinión de un panel de expertos en gastroenterología y nutrición infantil. MATERIAL Y MÉTODOS: Encuesta realizada mediante el método Delphi por 48 especialistas en pediatría y nutrición infantil. El cuestionario constaba de 62 ítems, estratificados en 5 bloques, sobre aspectos nutricionales de las fórmulas infantiles. RESULTADOS: Se consensuó el 64,6% de los ítems, estableciéndose un acuerdo no unificado respecto a aspectos nutricionales y su impacto sobre el desarrollo corporal, cerebral y la maduración inmune. CONCLUSIONES: Según los expertos encuestados, existe consenso sobre la adecuada composición en lípidos, lactosa, calcio, vitamina D y prebióticos, de las fórmulas infantiles, para el correcto desarrollo cerebral, inmunitario y somático. No hubo consenso en aspectos aún no bien definidos, como la calidad nutricional de las proteínas, la utilización de espesantes y la suplementación con taurina, probióticos y simbióticos. Son necesarios más estudios que determinen estos aspectos

INTRODUCTION: Infant feeding in the first months/years of life affects the health in the short and long term. Breastfeeding is the perfect food due to its many benefits. However, when breastfeeding is not possible, infant formulas are the best alternative. The aim of this study is to define the role of the supplemented formulas in infant nutrition using the opinion of a panel of experts in infant gastroenterology and nutrition. MATERIAL AND METHODS: A survey, using 62 items, stratified into 5 blocks, was performed by 48 panelists using the Delphi method to achieve a professional criteria consensus on nutritional aspects of infant formulas. RESULTS: A consensus was reached in 64.6% of the items, with a non-unified agreement being established as regards the nutritional aspects of infant formulas, and their influence in body and brain development and immune maturity. CONCLUSIONS: According to the experts surveyed, there is consensus as regards the suitable composition of lipids, lactose, calcium, vitamin D, and prebiotics in infant formulas, for a correct cerebral, immune and somatic development. There was no consensus on the not yet well-defined subjects, such as nutritional quality of proteins, use of thickeners, taurine supplementation, probiotic, and symbiotic aspects. More studies are necessary to confirm these subjects

[Expert consensus on the nutritional aspects of initial and follow-on infant formulas]. / Consenso experto sobre los aspectos nutricionales de las leches infantiles de inicio y continuación.

INTRODUCTION: Infant feeding in the first months/years of life affects the health in the short and long term. Breastfeeding is the perfect food due to its many benefits. However, when breastfeeding is not possible, infant formulas are the best alternative. The aim of this study is to define the role of the supplemented formulas in infant nutrition using the opinion of a panel of experts in infant gastroenterology and nutrition. MATERIAL AND METHODS: A survey, using 62 items, stratified into 5 blocks, was performed by 48 panelists using the Delphi method to achieve a professional criteria consensus on nutritional aspects of infant formulas. RESULTS: A consensus was reached in 64.6% of the items, with a non-unified agreement being established as regards the nutritional aspects of infant formulas, and their influence in body and brain development and immune maturity. CONCLUSIONS: According to the experts surveyed, there is consensus as regards the suitable composition of lipids, lactose, calcium, vitamin D, and prebiotics in infant formulas, for a correct cerebral, immune and somatic development. There was no consensus on the not yet well-defined subjects, such as nutritional quality of proteins, use of thickeners, taurine supplementation, probiotic, and symbiotic aspects. More studies are necessary to confirm these subjects.

Laboratory metabolic evolution improves acetate tolerance and growth on acetate of ethanologenic Escherichia coli under non-aerated conditions in glucose-mineral medium.

In this work, Escherichia coli MG1655 was engineered to produce ethanol and evolved in a laboratory process to obtain an acetate tolerant strain called MS04 (E. coli MG1655: ΔpflB, ΔadhE, ΔfrdA, ΔxylFGH, ΔldhA, PpflB::pdc ( Zm ) -adhB ( Zm ), evolved). The growth and ethanol production kinetics of strain MS04 were determined in mineral medium, mainly under non-aerated conditions, supplemented with glucose in the presence of different concentrations of sodium acetate at pH 7.0 and at different values of acid pH and a constant concentration of sodium acetate (2 g/l). Results revealed an increase in the specific growth rate, cell mass formation, and ethanol volumetric productivity at moderate concentrations of sodium acetate (2-10 g/l), in addition to a high tolerance to acetate because it was able to grow and produce a high yield of ethanol in the presence of up to 40 g/l of sodium acetate. Genomic analysis of the ΔpflB evolved strain identified that a chromosomal deletion of 27.3 kb generates the improved growth and acetate tolerance in MG1655 ΔpflB derivative strains. This deletion comprises genes related to the respiration of nitrate, repair of alkylated DNA and synthesis of the ompC gene coding for porin C, cytochromes C, thiamine, and colonic acid. Strain MS04 is advantageous for the production of ethanol from hemicellulosic hydrolysates that contain acetate.

Isotopic evidence of natural uranium and spent fuel uranium releases into the environment.

Uranium and plutonium isotopes were measured in soils, sediments and waters in an area subject to the past and present discharges from the uranium conversion plant of Malvési (France). The isotopes (236)U and (239)Pu are well known activation products of uranium and they prove to be powerful tracers of spent fuel releases in soils and sediments. On the other hand (234)U and (238)U activities measured in waters can be used to distinguish between releases and background uranium sources. Such findings contribute to improve the monitoring of the actinides releases by nuclear fuel facilities (mining sites, conversion, enrichment and fuel plants, reprocessing plants).

Predictors of the persistence of childhood asthma

Background. The factors relevant to the prognosis of childhood asthma differ from one population to another. Objectives. To characterize the course of childhood asthma in the catchment area of our hospital, and to identify prognostic factors for this population. Methods. All children given a diagnosis of asthma in the paediatric pulmonology service of a tertiary hospital were followed up for 5 years. Results. Satisfactory control of asthma was achieved in 69 % of cases. The factors identified as associated with poor control were allergy to cats and pollen, a large number of crises in the year prior to diagnosis, and younger age at onset. Conclusions. In our region, childhood asthma has a relatively favourable prognosis. The subsequent course of the disease appears to be determined in childhood. The persistence of symptoms appears to depend to a significant extent on the degree of atopy

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Erupción vesiculosa intermitente en un niño / Intermittent vesiculous eruption in a child

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Calidad de los datos del contenido en ácido fólico en vegetales recogidos en varias tablas de composición de alimentos españolas, y nuevos datos sobre su contenido en folatos / Quality of data on folic acid content in vegetables included in several spanish food composition tables and new data on their folate content

La relación entre una ingesta adecuada de folatos y por tanto niveles séricos correcto y la disminución del riesgo de aparición de enfermedades cardiovasculares, defectos del cierre del tubo neural, enfermedades neurológicas y algunos tipos de tumores ha sido ampliamente estudiada. De ahí que el consumo de alimentos con un elevado contenido de folatos o de alimentos enriquecidos está aumentando debido a los beneficios de esta vitamina sobre la salud. Es, por tanto, muy importante una ingesta adecuada de folatos para alcanzar unos niveles aceptables de folatos en plasma. De esta manera son necesarios datos fiables de composición de alimentos para evaluar y estimar la ingesta de folatos por la población, formular dietas o desarrollar recomendaciones dietéticas. Para ello han revisado los datos de ácido fólico en las Tablas de Composición de Alimentos (TCA) Españolas, comprobando la calidad de los mismos y comparándolas con otras que especifican métodos validados así como con un método de cromatografía líquida de alta resolución (HPLC) validado en nuestro laboratorio. Los datos bibliográficos manejados provenían de las TCA de mayor renombre, consideradas de preferencia. Se evaluaron todos los datos correspondientes a contenido de folatos, así como la información que sobre los mismos especificaban dichas TCA, desde origen del dato, método de análisis, número de muestras, o base de datos de las que se habían obtenido. En el análisis mediante el método validado para HPLC, los alimentos analizados fueron tratados con conjugasa de riñón de cerdo. La muestra resultante fue purificada y concentrada mediante extracción en fase sólida por intercambio aniónico fuerte (SAX), para posteriormente separarla y cuantificar el contenido de folatos mediante HPLC, con una combinación de detectores de ultravioleta y fluorescencia. La evaluación y comparación de los datos se estableció en función de varios parámetros arbitrarios que definen la calidad de los datos, otorgándose una puntuación dependiendo del grado de cumplimiento de los mismos. El estudio de las diferentes fuentes consultadas muestra que los nutrientes difieren en definición, métodos de análisis, unidades y modo de expresión, lo cual puede influir potencialmente en los diferentes valores de contenido de folatos entre las Tablas. También se observó una amplia variación respecto al número de alimentos, forma de nombrarlos así como presencia de alimentos crudos o cocinados con muy diferente composición. Aplicando los criterios de calidad se observó que aquellas que recibían una menor puntuación total, en cuanto a la información referente a los datos de folatos, eran las TCA Españolas. Esto es debido a que dichas TCA no especifican un método validado para la cuantificación de ácido fólico en alimentos (Método directo de elaboración de TCA), sino que para esta vitamina se basan en datos recopilados de la bibliografía (Método indirecto de elaboración de TCA). De forma que estos resultados muestran la importancia de conseguir un consenso en el método de determinación de folatos, en el muestreado y en el protocolo para desarrollar dicho método con el objetivo de obtener una tabla de composición de alimentos con datos más uniformes, contrastados y fiables en lo que respecta a esta vitamina (AU)

The relationship between adequate folate intake, adequate serum levels, and lowering the risk of suffering from cardiovascular diseases, neural tube defects, neural illness and some kind of cancers have been widely studied. Because of the expected health benefits, the consumption of foods with high folate content or enriched foods is increasing. Therefore, an adequate folate intake is important in order to reach acceptable serum levels. Reliable food composition data are necessary in order to evaluate and estimate the populations folate intake, elaborate diets and formulate recommended dietary intakes. For this reason, we revised folic acid data in Spanish Food Composition Tables (FCT). The quality of the data was evaluated and compared with other well-known international Food Composition Tables as well as with a high-resolution liquid chromatographic method (HPLC) validated in our laboratory. We evaluated all data about folate content, as well as all the information given like data origin, analytical method, sampling or original database. For the HPLC method, the food samples were incubated with hog kidney conjugase. After that, the samples were purified and concentrated by strong anion exchange (SAX), then the folate content was quantified by HPLC with a combination of two ultraviolet and fluorescence detectors. The evaluation and comparison of data was established according to some parameters, which define the quality of data, giving punctuation depending on the compliance with these parameters. The study of different sources showed that nutrients were different in definition, analysis method, units and expression of data, and that this fact could have a potential influence on TCA data values. In addition, it has been possible to show a wide variation in food number, name of these foods as well as the analysis of raw or cooked products with different composition. When the quality conditions were tested, the Spanish FCT had the lowest punctuation in folate content data. That is because the Spanish FCT did not use a validated method to quantify folic acid in foods (Direct method of FCT elaboration), but they used folate content data from others FCT (Indirect method of FCT elaboration). These data manifest the importance of getting a consensus method to determine folate content in foods with the aim to obtain a FCT with reliable folate data (AU)

[Bacterial conjunctivitis: most prevalent pathogens and their antibiotic sensitivity]. / Conjuntivitis bacteriana: patógenos más prevalentes y sensibilidad antibiótica.

INTRODUCTION: Bacterial conjunctivitis is a self-limiting process, but topical antibiotic treatment is recommended to eradicate the pathogen and reduce symptom duration. Since this treatment is usually empirical and prior cultures are not normally taken, the etiological agents involved in the process are unknown. PATIENTS AND METHODS: A total of 596 conjunctival exudates from pediatric outpatients with a diagnosis of acute conjunctivitis in Medical Area 6 of Madrid, Spain, were studied over 3 years (from 2000 to 2002 inclusive). The patients were divided into three age groups: group 1 (infants), group 2 (2- to 6-year-olds) and group 3 (7- to 14-year-olds). RESULTS: A total of 428 bacteria were isolated. The most prevalent bacteria were Haemophilus influenzae (44.8 %) and Streptococcus pneumoniae (30.6 %) followed by Staphylococcus aureus (7.5 %), S. viridans (7.2 %), Moraxella catarrhalis (6.8 %) and Enterobacteriaceae (4.2 %). In 56 exudates (15.1 %), two or more bacteria were isolated and S. pneumoniae 1 H. influenzae were found in 8.1 % of the cases. By age group, S. aureus was significantly more prevalent (p < 0.0001) in group 3 than in groups 1 and 2. Isolation of Enterobacteriaceae, S. viridans and non-fermentative Gram negative bacilli was significantly more frequent (p < 0.05) in group 1 and isolation of S. pneumoniae (p < 0.05) was significantly more frequent in group 2. S. pneumoniae showed the greatest level of resistance to antibiotics used in eye drops and ophthalmic ointments. Ciprofloxacin, chloramphenicol and rifampin were active in the most prevalent pathogens. CONCLUSIONS: The most prevalent bacteria were H. influenzae and S. pneumoniae. The most active antibiotics in these pathogens were ciprofloxacin, chloramphenicol and rifampin.

Defective natural killer and phagocytic activities in chronic obstructive pulmonary disease are restored by glycophosphopeptical (inmunoferón).

We have investigated both modifications in natural (innate) immunity caused by chronic obstructive pulmonary disease (COPD) and the effects of a glycophosphopeptical immunomodulator (Inmunoferón) treatment on COPD-associated immunoalterations. In a double-blinded clinical trial, 60 patients with COPD received glycophosphopeptical or placebo during 90 consecutive days at oral doses of 3 g/d. Fifty-six sex- and age-matched healthy control subjects were included as a reference group for immunologic parameters. Peripheral blood natural killer (PBNK) cell cytotoxic activity and phagocytic activity of peripheral monocytes/macrophages (Mo/Ma) and polymorphonuclear (PMN) cells were assessed at baseline and then again at the end of treatments. We found both PBNK activity and phagocytic activity to be significantly decreased in patients with COPD compared with levels in healthy volunteers. The treatment with glycophosphopeptical provoked significant stimulatory effects on PBNK cytotoxic activity. This stimulation was not mediated by an increase in CD3(-)CD56(+) NK cells. Further, glycophosphopeptical significantly increased the percentage of monocytes and PMNs that phagocytize Escherichia coli in vitro, as well as increased phagocytic indices. We conclude that peripheral blood cells of patients with COPD show clear defects in natural immunity that are partially rescued by glycophosphopeptical.

Effects of fluoxetine versus bright light in the treatment of seasonal affective disorder.

BACKGROUND: Disturbances of serotonergic neurotransmission appear to be particularly important for the pathophysiology of winter depression. This study investigated whether fluoxetine has antidepressant effects comparable to bright light in the treatment of seasonal affective disorder (winter type). METHOD: A randomized, parallel design was used with rater and patients blind to treatment conditions. One week of placebo (phase I) was followed by 5 weeks of treatment (phase II) with fluoxetine (20 mg per day) and a placebo light condition versus bright light (3000 lux, 2 h per day) and a placebo drug. There were 40 patients (20 in each treatment condition) suffering from seasonal affective disorder (SAD) according to DSM-III-R who had a total score on the Hamilton Depression Scale of at least 16. RESULTS: Forty patients entered phase II and 35 completed it (one drop-out in the fluoxetine group and four in the bright light group). Fourteen (70%) of the patients treated with bright light and 13 (65%) of those treated with fluoxetine were responders (NS). The remission rate in the bright light group tended to be superior (bright light 50%, fluoxetine 25%; P = 0.10). Light therapy improved HDRS scores significantly faster, while fluoxetine had a faster effect on atypical symptoms. Light treatment in the morning produced a significantly faster onset of improvement, but at the end of treatment the time of light application seemed not to be crucial. CONCLUSION: Both treatments produced a good antidepressant effect and were well tolerated. An apparently better response to bright light requires confirmation in a larger sample.

La microdosis en Cuba / Microdoses in Cuba

Es un método terapéutico que emplea cantidades muy pequeñas de medicamento diluidas en un vehículo (alcohol etílico al 33 por ciento) depositadas en la boca en forma de dos gotas, o en otras superficies corporales -oído, piel, etc. El empleo de estas microdosis no deben ni pueden ser consideradas experimento en humanos pues utilizamos plantas medicinales, medicinas de Patente, tejidos glandulares; todos ellos productos autorizados. Su administración más frecuente es por vía bucal.Lo novedoso del tratamiento obliga a que todos los usuarios de esta terapia, médicos, promotores, etc., tengan presente esta circunstancia y observen atentamente los efectos, de tal manera que puedan ir haciendo los ajustes necesarios y, oportunamente intercambiar las experiencias con los demás interesados(AU)

Tratamiento endoscópico de urgencia de la patología biliar litiásica durante el embarazo / Emergency endoscopic treatment of the cholelithiasis during pregnancy

Se presenta nuestra experiencia en el tratamiento de la patología biliar litiásica aguda en 3 pacientes embarazadas de 27 + 3 sem., 32 sem. y 32 sem. Empleamos procedimientos mínimamente invasivos, tales como la colangiopancreatografía endoscópica retrógrada (CPER) y la esfinterotomía endoscópica (EE). Los resultados obtenidos fueron satisfactorios tanto desde el punto de vista materno como fetal

Hypericum in the treatment of seasonal affective disorders.

Seasonal affective disorder (SAD) represents a subgroup of major depression with a regular occurrence of symptoms in autumn/winter and full remission in spring/summer. Light therapy (LT) has become the standard treatment of this type of depression. Apart from this, pharmacotherapy with antidepressants also seems to provide an improvement of SAD symptoms. The aim of this controlled, single-blind study was to evaluate if hypericum, a plant extract, could be beneficial in treating SAD patients and whether the combination with LT would be additionally advantageous. Patients who fulfilled DSM-III-R criteria for major depression with seasonal pattern were randomized in a 4-week treatment study with 900 mg of hypericum per day combined with either bright (3000 lux, n = 10) or dim (< 300 lux, n = 10) light condition. Light therapy was applied for 2 hours daily. We found a significant (MANOVA, P < .001) reduction of the Hamilton Depression Scale score in both groups but no significant difference between the two groups. Our data suggest that pharmacologic treatment with hypericum may be an efficient therapy in patients with seasonal affective disorder.

[Therapeutic efficacy of ursodeoxycholic acid in persistent gallbladder lithiasis and persistent biliary sludge: preliminary results of a multicenter experience]. / Eficacia terapéutica del ácido ursodesoxicólico (AUDC) en litiasis vesicular persistente (LV) y barro biliar persistente (BBP): Resultados preliminares de una experiencia multicentrica.

A prospective and multicenter study was performed to determine the efficacy and tolerance of ursodeoxycholic acid (UDCA) in the treatment of gallstones and biliary sludge. Criteria for entry into the trial were radiolucent gallbladder stones; until 20 mm of size and visualization of the gallbladder by oral cholecystography. Too were treatment the patients with persistent biliary sludge (PBS) defined by the persistence of the biliary sludge in two consecutive echography along three months. Without severe gallbladder disease. Then daily UDCA doses of 600 mg were suminstred divided in two postprandial times for a six months period. The control to the treatment were: basal ultrasonography (US) of the gallbladder and by follow-up gallbladder US for six months; clinical examination every month and cholecystography before and after the treatment. Of 110 admitted patients, 19 (17%) stopped the treatment for no-medical reasons and 91 (83%) arrived to the and point. After six months of treatment, complete dissolution was observed in 50% of the patients (46/91), partial in the 43% (39/91) and failed the treatment in 6.5% (6/91) who presented high density stones for computed tomography, CT (greater than 60 UH). According to pattern of lithiasis dissolution was complete in 100% (22/22) of the patients with PBS; 71.4% (10/14) in microlithiasis and 25% (14/55) in macrolithiasis. Minor adverse effects were acidism in the 7.7% (7/91) and diarrhea in the 1.1% (1/91). In the other hand, one patient presented acute pancreatitis (1/91; 1.1%), it must be discussed if was a complication of the lithiasis or an therapeutic effect. The UDCA was a safe and effective treatment without lethality in PBS and in microlithiasis while in case of macrolithiasis must be standardized response criterion, for example density stones for CT.