Ibrutinib-Related Uveitis in Non-Hodgkin Lymphoma Patients: A Case Report and Literature Review.

PURPOSE: To report two cases of ibrutinib-related uveitis and review the literature to date. METHODS: We report two cases of ibrutinib-related uveitis using CARE guidelines and review the cases reported in the literature. RESULTS: Case 1) A 55-year-old female with recurrent primary central nervous system lymphoma presented with bilateral decreased visual acuity, photophobia, and floaters that started one month after initiating oral treatment with ibrutinib. Chronic non-granulomatous bilateral anterior-intermediate uveitis with macular edema was identified. Secondary causes were ruled out, and a presumptive diagnosis of ibrutinib-related uveitis was made. Case 2) A 57-year-old female with Waldenström macroglobulinemia who was treated with ibrutinib for two years presented with bilateral blurred vision, photophobia, red eyes, and floaters. A diagnosis of non-granulomatous, noninfectious panuveitis with bilateral cystoid macular edema was made. Secondary causes were ruled out, and ibrutinib toxicity was the most likely cause. CONCLUSION: Ibrutinib-related uveitis is a novel and under-diagnosed clinical entity. The most frequent clinical presentation in the literature is bilateral, non-granulomatous, anterior, and intermediate uveitis. Macular edema is a frequent complication. Uveitis usually requires topical treatment and the suspension of ibrutinib. Switching to second-generation Bruton tyrosine kinase inhibitors is proposed as a potential therapeutic alternative.

Cleaning of direct compression continuous manufacturing equipment through displacement of API residues by excipients.

This feasibility study evaluates a cleaning process designed to avoid the use of detergents and reduce operator exposure to the active pharmaceutical ingredient (API). The continuous manufacturing equipment was cleaned using excipients to displace ibuprofen residues from the system. The cleaning process was performed using 3.0 kg of Prosolv® and 3.0 kg of Tablettose® 70. The impact of different volumetric feed rates of the cleaning excipient was assessed. The displacement of API and blend residues was evaluated with in-line near infrared (NIR) spectroscopy. Principal component analysis (PCA) was performed to evaluate the cleaning progress as the Prosolv® flowed through the feeder, mixer and stream sampler. In-place Raman spectra were acquired from the material sticking to detect the ibuprofen residues. The study showed that Prosolv® and Tablettose® can remove ibuprofen residues effectively from the hopper, feeder screw, mixer paddles, shaft and stream sampler. The Process Analytical Technology (PAT) system can be utilized to detect API displacement during the cleaning process. However, dismantling and manual cleaning was required to remove material sticking at the surfaces adjacent to the rotating feeder screws and mixer paddles.

Utility of endoscopic ultrasound in idiopathic acute recurrent pancreatitis.

Idiopathic acute recurrent pancreatitis (IARP) is defined as at least two episodes of acute pancreatitis with the complete or near-complete resolution of symptoms and signs of pancreatitis between episodes, without an identified cause. There is a paucity of information about the usefulness of endoscopic ultrasound (EUS) in IARP. OBJECTIVES: To determine the diagnostic yield of EUS in IARP. DESIGN: A retrospective study was performed in patients with IARP evaluated by EUS between January 2009 and December 2016. Follow-up assessments of acute pancreatitis recurrence were carried out. RESULTS: Seventy-three patients with 102 EUS procedures were included. EUS was able to identify the cause of IARP in 55 patients (75.3%). The most common findings were chronic pancreatitis in 27 patients (49.1%), followed by lithiasic pathology in 24 patients (43.6%), and intraductal papillary mucinous neoplasm in four patients (7.3%). A directed treatment against EUS findings had a protective tendency associated with the final resolution of recurrence. There were no complications reported. CONCLUSION: EUS performed in patients with IARP helped to identify a possible cause in 2/3 of the cases. The majority of patients have a treatable disease.

An innovative sampling interface for monitoring flowing pharmaceutical powder mixtures.

A chute was designed following the principles of the Theory of Sampling to minimize the variations in powder flow and provide all particles in the flowing blends with the same opportunity of being selected as a sample. The design also reduces the thickness of the chute to allow the analysis of a higher portion of the flowing blends by a near infrared spectrometer. The blends that flowed through the chute had Carr's index values that fluctuated between 23 and 25 percent, indicating passable flowability. A powder fowling evaluation demonstrated that there was no powder accumulation at the inspection window of the chute. The mass flow rate profiles indicated that the system achieves mass steady-state in approximately 30 s and a throughput of 30 kg/h which makes it suitable for continuous manufacturing operations. An in-line NIR calibration model was developed to quantify caffeine concentrations between 1.51 and 4.52 % w/w. The spectra obtained from each experiment had minimal baseline variation. The developed NIR method was robust to throughput changes up to approximately ±7 %. The test blends in the caffeine concentration range between 2.02 % w/w and 4.02 % w/w met the dose uniformity requirements of the Ph.Eur. 9.0, chapter 2.9.47. Variographic analysis was done to estimate the analytical and sampling errors which yielded values below 0.01 (%w/w)2. The obtained results showed that this chute could also be used in a continuous manufacturing line or other applications with flowing powders.

A sampling system for flowing powders based on the theory of sampling.

An innovative chute and stream sampler system for flowing powders has been developed and tested. The system is designed for representative sampling based on the principles of the Theory of Sampling (TOS). The sampling system was used in combination with near infrared (NIR) spectroscopy to determine the drug concentration of flowing powders. The system is comprised of three parts: a chute, a stream sampler and a sample collection port. The NIR spectra were obtained at the chute, before entering the sampler, and as the powder flowed through the stream sampler. Samples were also collected from the sample collection port to be analyzed using an ultraviolet-visible (UV-Vis) reference method to determine drug content. A total of eight pharmaceutical powder blends, ranging in concentration from 10.5(%w/w) to 19.5(%w/w) of caffeine, were used to test the sampling system. Materials were characterized before blends were made to provide information on flow properties. The throughput of the system was between 30 and 35 kg/h based on the flow properties of the blend. Drug concentration was effectively determined at the chute and stream sampler. The NIR calibration models showed low root mean squared errors of prediction, 0.65(%w/w) and 0.51(%w/w), for the chute and stream sampler respectively. The NIR calibration models also showed low bias values -0.36(%w/w) at the chute and 0.057(%w/w) at the stream sampler. Significant agreement was obtained between the results from the nondestructive NIR versus the destructive UV-Vis method. Variographic analysis was performed to estimate the analytical and sampling errors when determining the drug concentration at the chute and stream sampler respectively. The variographic analysis showed low analytical errors, 0.103(%w/w)2 and 0.181(%w/w)2 at the chute and stream sampler respectively. The analysis also showed that the minimum practical error (MPE) was around 0.2(%w/w)2 at both chute and stream sampler.

Características clínicas y microbiológicas de pacientes con neutropenia febril en un hospital Universitario / Clinical and microbiological characteristics of patients with febrile neutropenia in one Colombian Universitary Hospital

Objetivo: Describir las características clínicas, demográficas, frecuencia, tipo de aislamientos microbiológicos y resistencia a los antimicrobianos de pacientes con neoplasias hematológicas que presentaron como complicación neutropenia febril en el Hospital Universitario de San Ignacio Métodos: Estudio descriptivo observacional, se tomaron datos de historias clínicas de los pacientes adultos hospitalizados en la Unidad de Hematología y Trasplante de Médula Ósea, que cumplieron criterios de neutropenia febril entre enero de 2013 y diciembre de 2014 Resultados: se recolectaron 345 episodios de neutropenia febril, correspondientes a 193 pacientes. Se documentó foco infeccioso en el 68,1% de los episodios, con aislamiento microbiológico en el 62.9% de los episodios, con predominio de bacilos gram negativos, en 63,7% de los casos, seguido por los cocos gram positivos en 27,9% y hongos en 4,9%. En cuanto a los mecanismos de resistencia, en los aislamientos Escherichia coli y Klebsiella peumoniae se encontró producción de Beta Lactamasas de Espectro Extendido (BLEEs) en 17,5 y 13,8%; Carbapenemasas tipo KPC en 1,25 y 2,8% respectivamente. En cuanto a Staphylococcus aureus, se encontró resistencia a meticilina en 6,8% de los aislamientos. Mortalidad asociada a infección en 16,5% de los casos. Conclusión: En pacientes con Neoplasias Hematológicas con neutropenia febril post quimioterapia en el Hospital Universitario de San Ignacio encontramos alta probabilidad de documentación de foco infeccioso, con predominio de microorganismos gram negativos, especialmente enterobacterias; con comportamiento similar en pacientes post trasplante de precursores hematopoyéticos.

Objective: To describe the demographic and clinical characteristics, as well as frequency and type of bacterial isolate and resistance patterns in patients with hematological neoplasms complicated by febrile neutropenia at San Ignacio University Hospital Methods: This is a retrospective observational study. Data were collected from medical records of adult patients admitted in the Hemato-oncology and Bone Marrow Transplant Unit. Inclusion criteria was presence of febrile neutropenia in the setting of a hematological neoplasm from January 2013 to December 2014. Results: 345 episodes of febrile neutropenia from 193 patients were studied. An infectious focus was identified in 68.1% of episodes, and a bacterial isolate was obtained in 62.9% of episodes. The predominant microorganisms were gram-negative rods, gram-positive cocci, and fungi with a frequency of 63.7%, 27.9%, and 4.9% respectively. In term of resistance patterns, Escherichia coli and Klebsiella peumoniae isolates had a frequency of ESBL susceptibility pattern of 17.5% and 13.8% respectively; and a frequency of KPC susceptibility pattern of 1.25% and 2.8% respectively. The frequency of methicillin resistant Staphylococcus aureus was 6.8%. Death associated to infection ocurred in 16.5% of episodes. Conclusions: In patients with hematological neoplasms complicated by febrile neutropenia at San Ignacio University Hospital, we found a high rate of documentation of infectious focus, with a predominance of gram-negative rods, specially Enterobacteriacea; with a similar pattern in receptors of hematopoietic stem cell transplantation.

Cambios gasométricos en pacientes sometidos a resección prostática robótica / Gasometric changes in patients undergoing robotic prostatic resection

Resumen: Introducción: Las características propias de la cirugía robótica pueden tener efectos fisiológicos a nivel pulmonar que pueden producir complicaciones. Objetivo: Conocer los cambios gasométricos en pacientes sometidos a resección prostática robótica. Material y métodos: Treinta pacientes candidatos a resección prostática robótica fueron incluidos. Se midieron los tiempos quirúrgicos y parámetros de la gasometría arterial en cuatro tiempos: al momento de la inducción de la anestesia (T basal), 120 minutos posteriores a la insuflación de CO2 (T2h), a los 240 minutos (T4h) en la suspensión del capnoperitoneo (T final). Se realizó prueba de t de Student pareada para las variables con distribución normal, y la prueba U de Mann-Whitney en variables continuas no paramétricas, se consideró una significancia estadística de un valor de p ≤ 0.05. Resultados: La edad fue de 65.53 ± 5.92 años, la posición de Trendelenburg con inclinación < 30o se realizó en el 73.3%. El capnoperitoneo osciló de 10-25 mmHg, el tiempo quirúrgico fue de 326.7 ± 77.4 min. El aumento en promedio de la PaCO2 fue 8.57 mmHg: basal (31.33 ± 3.7 mmHg)- PaCO2 fin (39.9 ± 5 mmHg) p < 0.001. El pH disminuyó a partir de la segunda hora, en la medición final el 97% tenía valores < 7.35. Los valores del HCO3 tuvieron un descenso de -2.65 mEq/L: HCO3 basal (21.74 + 0.65 mEq/L)- HCO3 fin (19.09 + 0.78 mEq/L) p < 0.001. La presencia de acidemia se presentó en el 73.3%.

Abstract: Introduction: The characteristics of robotic surgery can have physiological effects at the pulmonary level that can produce complications. Objective: To know the gasometric changes in patients undergoing robotic prostatic resection. Material and methods: Thirty patients candidates for robotic prostatic resection were included. Surgical times and arterial blood gas parameters were measured at four times: at the time of induction of anesthesia (basal T), 120 minutes after CO2 insufflation (T2h), at 240 minutes (T.4h) in the capnoperitoneum suspension (final T). A paired Student's t-test was performed for the variables with normal distribution, and the Mann-Whitney U-test in nonparametric continuous variables was considered a statistical significance of a value of p ≤ 0.05. Results: The age was 65.53 ± 5.92 years, the position of Trendelenburg with inclination < 30o was made in 73.3%. The capnoperitoneum ranged from 10-25 mmHg, the surgical time was 326.7 ± 77.4 min. The average increase in PaCO2 was 8.57 mmHg: baseline (31.33 ± 3.7 mmHg) - PaCO2 end (39.9 ± 5 mmHg) p < 0.001. The pH decreased from the second hour on the final measurement 97% had values < 7.35. The values of HCO3 had a decrease of -2.65 mEq/L: basal HCO3 (21.74 + 0.65 mEq/L) - HCO3 end (19.09 + 0.78 mEq/L) p < 0.001. The presence of acidemia was presented in the 73.3%.

In line monitoring of the powder flow behavior and drug content in a Fette 3090 feed frame at different operating conditions using Near Infrared spectroscopy.

Near infrared (NIR) spectroscopy was used to determine the drug concentration in 3% (w/w) acetaminophen blends within the complex flow regime of the tablet press feed frame just before tablet compaction. NIR spectra also provided valuable information on the powder flow behavior within the feed frame and were used to track when a process enters or leaves the steady state. A partial least squares regression calibration model was developed with powder mixtures that varied from 1.5 to 4.5% (w/w) by obtaining 135 spectra after steady state for each concentration while the feed frame and die disc operated at 30.5 revolutions per minute (rpm). The calibration model determined drug concentration in validation blends with a root mean square error of prediction and bias below 0.1% (w/w). The robustness of the NIR calibration model was evaluated by determining the effect of variation on the operating conditions (paddle wheel speed and die disc speed) on NIR predictions. This work found that the paddle wheel speed can be increased up to 30% and the die disc speed decrease 10% without affecting NIR predictions. The results demonstrated that paddle wheel speed has a significant effect on the wave powder behavior (frequency and amplitude) but does not have significant effect on the mass hold-up within feed frame. The die disc speed does not affect wave powder behavior but affects significantly the mass hold-up inside the feed frame. This information can be used to reduce the tablet weight variability and ensure that this critical attribute is met.

Candidiasis sistémica en pacientes críticos, factores predictores de riesgo / Systemic candidiasis in critical patients: risk predictors

Candida sp. constituye el microorganismo más frecuentemente implicado en las infecciones por hongos en pacientes críticamente enfermos. La candidemia es la forma más común de candidiasis invasiva, ingresando al torrente sanguíneo por el tracto gastrointestinal y la piel. A nivel mundial la candidemia se destaca como una de las principales causas de morbilidad con aumentos significativos en la incidencia y prevalencia en los últimos años. Además, eleva los costos de la atención hospitalaria. Aunque diversos estudios demuestran que el inicio temprano del tratamiento antifúngico mejora el pronóstico de los pacientes, se tienen dificultades con las pruebas diagnósticas existentes, debido a que no tienen un nivel adecuado de sensibilidad y un óptimo rendimiento. Por tal razón, en la actualidad se vienen utilizando diversos índices clínicos predictores de candidiasis invasiva como Ostrosky, Candida Score, Escala de Pittet, entre otros, los cuales tienen un alto valor predictivo negativo que permite reconocer los pacientes que no se benefician de un inicio temprano de un tratamiento antifúngico mientras se confirma el diagnóstico por laboratorio. La terapia antifúngica disponible para el tratamiento de las candidemias en UCI está compuesta básicamente por tres grupos de medicamentos, los azoles, los polienos y las equinocandinas. A pesar de la validación de los índices predictores de candidiasis invasiva en otros países, se desconoce cuál de estos sería el más efectivo para predecir esta patología en la región

Candida sp. is the microorganism most frequently involved in fungal infections in critically ill patients. Candidemia is the most common form of invasive candidiasis entering the bloodstream from the gastrointestinal tract and skin. Worldwide candidemia stands out as one of the leading causes of morbidity with significant increases in its incidence and prevalence in recent years. In addition, it raises the costs of hospital care. Although several studies show that early initiation of antifungal treatment improves patients' prognosis, there are difficulties with existing diagnostic tests, because they do not have an adequate level of sensitivity and optimum performance. For this reason, various clinical indices are currently being used as predictors of invasive candidiasis, such as Ostrosky Candida Score, Candida Score, Pittet Candida Colonization Index, among others, which have a high negative predictive value that allows to recognize patients who do not benefit from an early initiation of an antifungal treatment while the diagnosis is confirmed by laboratory. Antifungal therapy available for the treatment of candidemia in the ICU consists basically of three groups of drugs: azoles, polyenes and echinocandins. Despite the validation of predictors of invasive candidiasis in other countries, it is still unknown which of these would be the most effective for predicting this disease in the region

Distribución estacional de miasis mucocutánea. Nuestra experiencia / Seasonal distribution of mucocutaneousmyiasis. Our experience / Distribuição sazonal de miíase mucocutânea. A nossa experiencia

Introducción: la miasis es una lesión producida por larvas de mosca que infestan animales, de cuyos tejidos se alimentan en forma parasitaria. En nuestro servicio de otorrinolaringología tratamos frecuentemente pacientes con miasis mucocutáneas. El comprender la distribución estacional de esta patología podría ser una herramienta útil para la prevención de la misma. Métodos: Se valoraron las historias clínicas informatizadas del servicio de Otorrinolaringología del Hospital Federico Abete de Malvinas Argentinas, entre enero de 2013 y diciembre de 2015, utilizando como filtro la palabra “miasis”; de las cuales se analizaron las variables: mes de infestación, sitio anatómico comprometido, la edad, el género y la temperatura al momento de la consulta. Resultados: Se encontraron 27 pacientes. La edad promedio fue de 42 años. Quince pacientes masculinos y 12 femeninos. Sitio anatómico comprometido: conducto auditivo externo: 11; traqueostoma: 8; Sitio operatorio: 5; oído medio: 3. Todos fueron diagnosticados en las estaciones más cálidas. Conclusiones: Se observó la aparición de miasis en las estaciones más cálidas. Sería aconsejable tomar mayor cantidad de medidas preventivas durante estas épocas del año, para evitar los casos de infestación larvaria, cuando es posible.

Introduction: Myiasis refers to the damage caused by fly larvaes, which infest animals, including humans, and who feed in form parasitic of their dead or living tissue, causing tissue destruction. In our department of otolaryngology, we often treat patients with mucocutaneous myiasis. Understand the seasonal distribution of this disease could be a useful tool for preventing it. Method: Computerized medical records of Otolaryngology Service of Hospital Municipal Dr. Federico Abete of Malvinas Argentinas were valued, in the period between 2013 and 2015, it was used as a filter the word “myiasis”. Were found a series of 27 cases with diagnosis of mucocutaneous myiasis; of which were analyzed the variables: month of infestation, involved anatomic site, age and temperature at the time of medical consultation. Results: 27 patients were found. The average age was 42 years. 15 male patients and 12 female patients. Involved anatomic site: external auditory canal: 11; tracheostomy: 8; infestation surgical site: 5; middle ear: 3. All were diagnosed in the warmer seasons. Conclusions: The appearance of myiasis was observed in the warmer seasons. It would be advisable to take as many preventative measures during these times of the year to avoid cases of larval infestation, when possible.

Introdução: Miíase é uma lesão causada por larvas de moscas que infestam animais e dos que se alimentam de forma parasitária de seus tecidos. Em nosso departamento de otorrinolaringología tratamos muitas vezes pacientes com miíase mucocutânea. Compreender a distribuiçãos a zonal destado ença poderia ser uma ferramenta útil para evitar isso. Método: Forama valiados registros médicos computadorizados de Serviço de Otorrinolaringologia do Hospital Municipal Dr. Federico Abete de Malvinas Argentinas, no período entre 2013 e 2015, ele foi usado como filtro a palavra “miasis”. Foram encontradas uma série de 27 casos com diagnóstico de miíase mucocutânea; dos quais foram analisados as variáveis: mês de infestação, local anatómico en volvidos, idade e sexo dos pacientes; que foram comparados com os dados de temperatura do Servicio Meteorológico Nacional. Resultados: 27 pacientes foram encontrados. A idade média foi de 42 anos. 15 pacientes do sexo masculino e 12 do sexo feminino. Local anatômico envolvidos: canal auditivo externo: 11; traqueostomia: 8; infestação de sítio cirúrgico: 5; ouvido médio: 3. Todos foram diagnosticados nas estações mais quentes. Conclusões: O aparecimento de miíases foi observada nas estações mais quentes. Seria aconselhável tomar tantas medidas preventivas durante estas épocas do ano para evitar casos de infestação larval, quando possível.

Analysis of powder phenomena inside a Fette 3090 feed frame using in-line NIR spectroscopy.

New analytical methods are needed to understand and optimize the processes by which tablets are produced. Fette 3090 tablet presses are commonly used in the pharmaceutical industry. A near-infrared (NIR) probe was installed into a Fette 3090 feed frame to understand and monitor the die filling process. The second objective was to analyze in detail the different factors that could affect the prediction of the developed NIR calibration models. Two monitoring positions for NIR spectrometers were evaluated; one at each side of the feed frame. A powder wave behavior caused by the paddle motion was observed inside the feed frame. The study also revealed that NIR spectra can help in the understanding of powder flow inside the feed frame. It was demonstrated that NIR spectra baselines can also be used to determine changes in mass inside the feed frame. The new NIR method showed that the paddle wheel speed has a significant impact in the powder dynamics inside the feed frame. The baselines of the NIR spectra depended on the mass hold-up inside the feed frame and paddle wheel speed. Studies using blends were performed to develop a NIR calibration model based on the feed frame system dynamics to determine acetaminophen drug concentration variability during the die filling process. The study found that variation in the distance from the powder to the probe due to paddle wheel speed has a significant effect on the NIR prediction. This study found that with NIR spectroscopy, blend uniformity can be assessed with high accuracy during the die filling process using the corresponding paddle wheel speed in-line calibration model. NIR was demonstrated to be a good development tool for the in-line monitoring of powder during the die filling process.

Burkholderia caballeronis sp. nov., a nitrogen fixing species isolated from tomato (Lycopersicon esculentum) with the ability to effectively nodulate Phaseolus vulgaris.

During a survey of Burkholderia species with potential use in agrobiotechnology, a group of 12 strains was isolated from the rhizosphere and rhizoplane of tomato plants growing in Mexico (Nepantla, Mexico State). A phylogenetic analysis of 16S rRNA gene sequences showed that the strains are related to Burkholderia kururiensis and Burkholderia mimosarum (97.4 and 97.1 %, respectively). However, they induced effective nitrogen-fixing nodules on roots of Phaseolus vulgaris. Based on polyphasic taxonomy, the group of strains represents a novel species for which the name Burkholderia caballeronis sp. nov. is proposed. The type species is TNe-841(T) (= LMG 26416(T) = CIP 110324(T)).

Isolation of the opdE gene that encodes for a new hydrolase of Enterobacter sp. capable of degrading organophosphorus pesticides.

Microbial enzymes that can hydrolyze organophosphorus compounds have been isolated, identified and characterized from different microbial species in order to use them in biodegradation of organophosphorus compounds. We isolated a bacterial strain Cons002 from an agricultural soil bacterial consortium, which can hydrolyze methyl-parathion (MP) and other organophosphate pesticides. HPLC analysis showed that strain Cons002 is capable of degrading pesticides MP, parathion and phorate. Pulsed-field gel electrophoresis and 16S rRNA amplification were performed for strain characterization and identification, respectively, showing that the strain Cons002 is related to the genus Enterobacter sp. which has a single chromosome of 4.6 Mb and has no plasmids. Genomic library was constructed from DNA of Enterobacter sp. Cons002. A gene called opdE (Organophosphate Degradation from Enterobacter) consists of 753 bp and encodes a protein of 25 kDa, which was isolated using activity methods. This gene opdE had no similarity to any genes reported to degrade organophosphates. When kanamycin-resistance cassette was placed in the gene opdE, hydrolase activity was suppressed and Enterobacter sp. Cons002 had no growth with MP as a nutrients source.

Actinomicosis pulmonar Una enfermedad olvidada / Pulmonary actinomycosis A forgotten disease

La actinomicosis es una enfermedad causada por un microorganismo gram positivo anaerobio, Actinomyces israelií, habitualmente con ausencia de actividad patogénica. Su expresión infecciosa más común se localiza en piel de cara y cuello, dado que éste es residente frecuente de nariz y garganta. Su comportamiento infeccioso es raro en otros órganos. Se presenta un paciente adulto con cuadro clínico respiratorio de tres meses de evolución, en quien se diagnostica actinomicosis pulmonar posterior a lobectomía por sospecha clínica inicial de malignidad (Acta Med Colomb 2010; 35: 132-134).

Actinomycosis is a disease caused by Actinomyces israelii, a gram-positive, anaerobic microorganism which usually lacks pathogenic activity. Its most common clinical expression is infection of the skin of the face and neck, since the microorganism is a frequent resident of the nose and throat. Infectious behavior is extremely rare in other organs. We present the case of an adult patient with respiratory manifestations which evolved over a period of three months, who was diagnosed with Pulmonary Actinomycosis after lobectomy performed due to an initial clinical suspicion of malignancy (Acta Med Colomb 2010; 35: 132-134).

Safety, tolerability, and immunogenicity of a two-dose regimen of high-titer varicella vaccine in subjects > or =13 years of age.

A new manufacturing process, known as process upgrade varicella vaccine (PUVV) was developed for a refrigerated formulation of varicella vaccine and for an investigational zoster vaccine. Safety and tolerability of a two-dose regimen of high-titered (approximately 50,000 PFU) PUVV were compared to a lower-titer formulation (approximately 5400 PFU) of VARIVAX; in 1366 healthy subjects > or =13 years old. Only one vaccine-related clinical serious adverse experience (pruritus; no hospitalization) was reported, in the VARIVAX group. Injection-site adverse experiences following any dose were higher in the PUVV group, 70.0%, than in the VARIVAX group, 56.2%, but generally were mild. Immunogenicity were similar in both groups in seronegative subjects. PUVV was generally well tolerated, and elicited an immune response similar to that induced by the marketed formulation of VARIVAX.