[Extensor pollicis longus rupture in a pediatric patient: case report and a literature review]. / Rotura del extensor pollicis longus en paciente pediátrico: reporte de caso y revisión de la literatura.

INTRODUCTION: the rupture of the extensor pollicis longus (EPL) tendon is a rare pathology and usually occurs in adult women in relation to distal radius fractures. MATERIAL AND METHODS: we present the case of an adolescent female patient who, after conservative treatment with splinting of a Peterson type I physeal fracture of the radius, suffered an acute extension deficit of the thumb at six weeks, diagnosed with clinical radiological examination as spontaneous rupture of the extensor pollicis longus (EPL). She was treated with extensor pollicis indicis propius (EIP) transfer with satisfactory results and recovering her usual activity one month after surgery. CONCLUSION: this kind of injuries are infrequent in pediatric ages and rarely described in a pediatric patient with immature skeleton, what makes this case something exceptional. It is necessary considering these complications in patients of low ages even with no other risk factors. The most frequent treatment applied in adults as in children is the EIP transference with good results in the long term.

INTRODUCCIÓN: la rotura del tendón extensor pollicis longus (EPL) constituye una patología infrecuente y se presenta normalmente en mujeres adultas en relación con fracturas de radio distal. MATERIAL Y MÉTODOS: se presenta el caso de una paciente adolescente femenino que, tras tratamiento conservador con férula de una fractura fisaria Peterson tipo I en radio, sufre a las seis semanas déficit agudo de extensión del pulgar, diagnosticada mediante examen clínico radiológico de rotura espontánea del extensor pollicis longus. Es tratada por medio de transferencia del extensor propio del índice (EPI) con resultados satisfactorios y recuperación de su actividad habitual al mes postoperatorio. CONCLUSIÓN: este tipo de lesiones son poco frecuentes en edad pediátrica y casi nunca descritas en un paciente pediátrico con inmadurez esquelética, lo cual hace de este caso algo excepcional. Es necesario tener en cuenta este tipo de complicaciones en pacientes de baja edad aún sin otros factores de riesgo asociados. El tratamiento aplicado más frecuentemente, tanto en adultos como en niños, es la transferencia del extensor propio del índice con buenos resultados a largo plazo.

Point mutations in the glycosyltransferase domain of the pbp1a gene in amoxicillin-resistant Helicobacter pylori isolates.

INTRODUCTION: Helicobacter pylori (H. pylori) eradication treatment includes a proton pump inhibitor and two antibiotics: amoxicillin and clarithromycin. The goal of that treatment is to eradicate the infection in at least 90% of the patients. Failure to eradicate the infection can have multiple causes, among which is the presence of point mutations in the antimicrobial target genes. OBJECTIVE: To characterize the mutations present in the pbp1a gene and their possible association with resistance to amoxicillin in vitro. METHODOLOGY: Susceptibility to amoxicillin was evaluated in 147 isolates of H. pylori from the Colombian municipality of Túquerres. PCR amplification and sequencing of the glycosyltransferase domain of the pbp1a gene were carried out on Túquerres isolates, and the association between mutations and resistance was evaluated. RESULTS: A total of 5.4% (8/147) Túquerres isolates were resistant to amoxicillin in vitro. PCR amplification of the glycosyltransferase domain of the pbp1A gene was performed on 87.5% of the amoxicillin-resistant isolates in vitro, and in the DNA sequencing analysis, a total of 2 changes of amino acids from 3 DNA mutations that encoded the PBP1A-1 protein were observed. CONCLUSION: The present study is the first report on pbp1a gene mutations in H. pylori isolates coming from a population in Túquerres. Mutations that have not been reported in previous studies were found.

Quasistatic and quantum-adiabatic Otto engine for a two-dimensional material: The case of a graphene quantum dot.

In this work, we study the performance of a quasistatic and quantum-adiabatic magnetic Otto cycles with a working substance composed of a single graphene quantum dot modeled by the continuum approach with the use of the zigzag boundary condition. Modulating an external or perpendicular magnetic field, in the quasistatic approach, we found a constant behavior in the total work extracted that is not present in the quantum-adiabatic formulation. We find that, in the quasistatic approach, the engine yielded a greater performance in terms of total work extracted and efficiency as compared with its quantum-adiabatic counterpart. In the quasistatic case, this is due to the working substance being in thermal equilibrium at each point of the cycle, maximizing the energy extracted in the adiabatic strokes.

Bound states in the continuum poisoned by Majorana fermions.

In this work, we study the bound states in the continuum (BICs) in a system formed by a triple quantum dot array embedded between two one-dimensional topological superconductors (TSCs), both hosting Majorana bound states (MBSs) at their ends. The results show the formation of BICs with topological characteristics due to the presence of MBSs. This is a consequence of the interplay between the BIC arising from quantum dots states by means of energy level symmetry breaking through gate voltages, and MBSs leaked into the quantum dots. The BIC is not observed when both TSCs are in long wire limit, i.e. for vanishing inter MBSs coupling, while it projects into the electronic transmission whenever the inter MBSs couplings are away from zero, regardless if they have different strength and/or the phase difference between both TSCs. We study the behavior of BICs poisoned by MBSs as a function of the parameters that are controlling the system. We believe our findings could be useful to implement a protection tool for BICs using MBSs based on tunable gate voltages.

Lyman-α source for laser cooling antihydrogen.

We present a Lyman-α laser developed for cooling trapped antihydrogen. The system is based on a pulsed Ti:sapphire laser operating at 729 nm that is frequency doubled using an LBO crystal and then frequency tripled in a Kr/Ar gas cell. After frequency conversion, this system produces up to 5.7 µW of average power at the Lyman-α wavelength. This laser is part of the ATRAP experiment at the antiproton decelerator in CERN.

Neutrophil CD64 expression, procalcitonin and presepsin are useful to differentiate infections from flares in SLE patients with SIRS.

Background/Objective Differentiating systemic lupus erythematosus (SLE) activity from infections in febrile patients is difficult because of similar initial clinical presentation. The aim of this study is to evaluate the usefulness of a number of biomarkers for differentiating infections from activity in SLE patients admitted with systemic inflammatory response (SIRS). Methods Patients with SLE and SIRS admitted to the emergency room were included in this study. Measurements of different markers including procalcitonin, neutrophil CD64 expression and presepsin, were performed. Infection was considered present when positive cultures and/or polymerase chain reaction were obtained. Sensitivity and specificity were calculated for all biomarkers. Results Twenty-seven patients were admitted, 23 women (82.5%), mean age 33.2 years. An infectious disease was confirmed in 12 cases. Markers for SLE activity including anti-DNA titers by IIF ( p = 0.041) and enzyme-linked immunosorbent assay ( p = 0.009) were used for differentiating SLE flares from infection. On the contrary, increased procalcitonin ( p = 0.047), neutrophil CD64 expression by flow cytometry ( p = 0.037) and presepsin ( p = 0.037) levels were observed in infected SLE patients. Conclusions High neutrophil CD64 expression, presepsin and procalcitonin levels are useful to differentiate infections from activity in SLE patients. In most cases, a positive bioscore that includes these three markers demonstrate the presence of an infectious disease.

Finite-size corrections to scaling of the magnetization distribution in the two-dimensional XY model at zero temperature.

The zero-temperature, classical XY model on an L×L square lattice is studied by exploring the distribution Φ_{L}(y) of its centered and normalized magnetization y in the large-L limit. An integral representation of the cumulant generating function, known from earlier works, is used for the numerical evaluation of Φ_{L}(y), and the limit distribution Φ_{L→∞}(y)=Φ_{0}(y) is obtained with high precision. The two leading finite-size corrections Φ_{L}(y)-Φ_{0}(y)≈a_{1}(L)Φ_{1}(y)+a_{2}(L)Φ_{2}(y) are also extracted both from numerics and from analytic calculations. We find that the amplitude a_{1}(L) scales as ln(L/L_{0})/L^{2} and the shape correction function Φ_{1}(y) can be expressed through the low-order derivatives of the limit distribution, Φ_{1}(y)=[yΦ_{0}(y)+Φ_{0}^{'}(y)]^{'}. Thus, Φ_{1}(y) carries the same universal features as the limit distribution and can be used for consistency checks of universality claims based on finite-size systems. The second finite-size correction has an amplitude a_{2}(L)∝1/L^{2} and one finds that a_{2}Φ_{2}(y)≪a_{1}Φ_{1}(y) already for small system size (L>10). We illustrate the feasibility of observing the calculated finite-size corrections by performing simulations of the XY model at low temperatures, including T=0.

Efficacy and Mechanisms of Action of Fecal Microbiota Transplantation in Ulcerative Colitis: Pitfalls and Promises From a First Meta-Analysis.

BACKGROUND: Inflammatory bowel disease (IBD) is the results of a chronic inflammatory process deriving from disequilibrium between self-microbiota composition and immune response. METHODS: New evidence, coming from Clostridium difficile infection, clearly showed that active and powerful modulation of microbiota composition by fecal microbiota composition (FMT) is safe, easy to perform, and efficacious, opening new frontiers in gastrointestinal and extra-intestinal diseases. FMT has been proposed also for IBD as well as other non-gastrointestinal conditions related to intestinal microbiota dysfunctions, with good preliminary data. RESULTS: In this setting, ulcerative colitis (UC) represents one of the most robust potential indications for FMT after C difficile colitis. CONCLUSIONS: In the present review, we focus on FMT and its application on ulcerative colitis, clarifying mechanisms of actions and efficacy data, trough completion of a meta-analysis on available randomized, controlled trial data in UC. Because microbiota is so crucially involved in this topic, a short review of microbial alterations in UC will also be performed.

Gut Microbiota: A Key Modulator of Intestinal Healing in Inflammatory Bowel Disease.

Mucosal healing (MH) represents a crucial factor for maintaining gut homeostasis. Indeed, in inflammatory bowel disease, MH has become the standard therapeutical target, because it is associated with more effective disease control, more frequent steroid-free remission, lower rates of hospitalization and surgery, and improved quality of life. In this scenario, gut microbiota is a crucial player in modulating intestinal repair and regeneration process. It can act on the tumor necrosis factor-α production, modulation of reactive oxygen and nitrogen species, activity of matrix metalloproteinases and on many other mechanisms strictly involved in restoring gut health. In this review, we analyze and review the literature on the role of gut microbiota in sustaining mucosal injury and achieving MH.

Genotype 1 of hepatitis C virus increases the risk of major depression: a 12-week prospective study.

OBJECTIVE: Depressive symptoms have been frequently observed in association with immune activation. We prospectively evaluate depressive symptoms and risk factors for major depression in patients with hepatitis C virus treated with antiviral combined therapy. METHODS: Fifty patients were assessed during 1 year; the structured diagnostic interview - Mini International Neuropsychiatric Interview - was used to screen psychiatric disorders at the baseline and during the 4th and 12th week of antiviral therapy. STATISTICAL ANALYSIS: generalized estimating equations and pairwise comparisons with Bonferroni adjustment. RESULTS: In our sample the prevalence of the Genotype 1 was 42%, and the pegylated interferon alpha plus ribavirin was the most prevalent treatment used for hepatitis C (86%). We found increased risk of depression in the 4th week (34%) but not in the 12th week (24%) compared with baseline values (20%) (P=0.040). In addition, we found differences between depression prevalence and hepatitis C genotypes, with higher odds in the 4th week compared to the baseline and 12th week [OR: 2.1(1.15-2.9); P=0.040]. Patients with the Genotype 2/3 had significantly lower odds of presenting depression compared to the Genotype 1 [OR: 0.3 (0.1-0.9); P=0.030]. CONCLUSION: This study provides evidence for an association between hepatitis C genotype and major depression, showing that besides immune activation, the Genotype 1 is associated with increased risk for psychiatric symptoms during the follow-up.

Genetic characterization of Latin-American Creole cattle using microsatellite markers.

Genetic diversity in and relationships among 26 Creole cattle breeds from 10 American countries were assessed using 19 microsatellites. Heterozygosities, F-statistics estimates, genetic distances, multivariate analyses and assignment tests were performed. The levels of within-breed diversity detected in Creole cattle were considerable and higher than those previously reported for European breeds, but similar to those found in other Latin American breeds. Differences among breeds accounted for 8.4% of the total genetic variability. Most breeds clustered separately when the number of pre-defined populations was 21 (the most probable K value), with the exception of some closely related breeds that shared the same cluster and others that were admixed. Despite the high genetic diversity detected, significant inbreeding was also observed within some breeds, and heterozygote excess was detected in others. These results indicate that Creoles represent important reservoirs of cattle genetic diversity and that appropriate conservation measures should be implemented for these native breeds in order to minimize inbreeding and uncontrolled crossbreeding.

Cluster-algorithm renormalization-group study of universal fluctuations in the two-dimensional Ising model.

In this paper we propose a method to study critical systems numerically, which combines collective-mode algorithms and renormalization group on the lattice. This method is an improved version of the Monte Carlo renormalization group in the sense that it has all the advantages of cluster algorithms. As an application we considered the 2D Ising model and studied whether scale invariance or universality are possible underlying mechanisms responsible for the approximate "universal fluctuations" close to a so-called bulk temperature T(L) . "Universal fluctuations" were first proposed in the work of Bramwell, Holdsworth, and Pinton [Nature (London) 396, 552 (1998)] and stated that the probability density function of a global quantity for very dissimilar systems, such as a confined turbulent flow and a two-dimensional (2D) magnetic system, properly normalized to the first two moments, becomes similar to the "universal distribution," originally obtained for magnetization in the 2D XY model in the low-temperature region. The results for the critical exponents and the renormalization-group flow of the probability density function are very accurate and show no evidence to support that the approximate common shape of the PDF should be related to both scale invariance or universal behavior.

Autoinmunidad y función tiroidea en escolares de 2 regiones del Estado Mérida con deficiencia de yodo corregida

Objetivos: El presente estudio transversal fue planificado para evaluar la presencia de anticuerpo antitiroideo antiperoxidasa (ac.anti-TPO) y la función tiroidea, en dos áreas endémicas de bocio, con deficiencia de yodo corregida. Métodos: Se estudiaron 109 escolares, de ambos sexos, entre 6-12 años de edad, procedentes de Bailadores (BA=54) y Mucuchíes (MU=55). El diagnóstico de bocio se obtuvo por palpación clínica. La yoduria se determinó en 34 niños de BA y en 37 de MU, mientras que la concentración sérica de T4 libre (T4L), T3 libre (T3L), T3 total (T3T), TSH y ac.anti-TPO fueron determinadas en todos los escolares estudiados. Adicionalmente se realizó la cuantificación de T3T y ac.anti-TPO en uno de los progenitores de cada niño. Resultados: En BA, el 53,5% de los escolares presentaron bocio y en MU el 42,5%. La mediana de la excreción urinaria de yodo no fue estadísticamente diferente entre ambos grupos (BA=181 µg/L, MU=200 µg/L). La frecuencia global de detectabilidad de ac.anti-TPO en escolares fue del 45,5%, pero solo el 5% presentó seropositivad. Una concentración de ac. anti-TPO, entre 10 y 30 UI/mL, se observó en el 39% de los niños de BA y 40% en MU; 87% en adultos de BA y 54% en MU. En BA, concentraciones de ac.anti-TPO mayores de 30 UI/mL se observaron en el 10% de los niños y en el 17% de los adultos; en MU, no se observó ningún caso positivo para ac.anti-TPO en niños, mientras que en adultos la frecuencia de positividad fue del 8%. Las pruebas de función tiroidea de los escolares y de los progenitores de ambas regiones fueron similares y compatibles con estado de eufunción No hubo asociación entre la presencia de ac.anti-TPO y bocio. Conclusiones: Estos resultados indican que la corrección de la deficiencia de yodo en las áreas endémicas estudiadas se asocia con una alta frecuencia de detectabilidad de ac.anti-TPO, sin cambios en la función tiroidea.

Objective: This cross-sectional study was designed to evaluate the thyroid peroxidase autoantibody (TPO-Ab) concentrations and thyroid function in schoolchildren from two geographic regions were iodine deficiency was corrected. Methods: One hundred nine schoolchildren 6 to 12 years of age were studied: Bailadores (BA=54) and Mucuchíes (MU=55). Goiter size, urinary iodine, and serum freeT4, freeT3, total T3, TSH and TPO-Ab were measured. Total T3 and TPO-Ab were also determined in some parents. Results: Overall frequency of TPO-Ab detectability and positivity in schoolchildren were 45,5% and 5% respectively. TPO-Ab concentration ranging between 10-30 UI/mL was observed in 39% of children from BA and 40% from MU; 87% of parents from BA and 54% from MU. TPO-Ab concentration >30 UI/mL was observed in 10% of children and 17% of their parents. None of the children from MU had positive TPO-Ab, while 8% of their parents were positive. Median urinary iodine was similar in both regions (BA=181 µg/L, MU=200 µg/L). Thyroid function tests were normal in all cases. Goiter was found in 53,5% of children from BA and 42,5% from MU . No association between goiter and ac.TPO-Ab concentration was observed. Conclusions: These results suggest that in both endemic goiter regions, sufficient iodine prophylaxis by iodized salt is frequently associated with low detectable TPO-Ab levels and no changes in thyroid function.

Anterior stromal puncture in the treatment of bullous keratopathy: six-month follow-up.

PURPOSE: This study was designed to evaluate the effect of anterior stromal puncture to treat patients with symptomatic bullous keratopathy. METHODS: Fourteen patients with bullous keratopathy who had decreased vision and were or were not awaiting penetrating keratoplasty were evaluated before and 1, 4, 12, and 24 weeks after anterior stromal punctures with a 25-gauge needle. The patients were questioned about pain intensity, foreign-body sensation, and photophobia. Biomicroscopy, esthesiometry, and pachymetry results were evaluated. The results before and after the punctures were compared using the McNemar test, Friedman test, and multiple comparison tests. RESULTS: The comparisons among before and 1, 4, and 12 weeks after the anterior stromal puncture of pain (p = 0.00000556), photophobia (p = 0.0252), foreign-body sensation (p = 0.0000743), and esthesiometry (p = 0.0243) showed significant statistical differences in terms of decreasing symptoms and corneal sensitivity. The average pachymetry did not show statistical difference among before and 1, 4, 12, and 24 weeks after the procedure (p = 0.956). We did not find important differences in terms of corneal neovascularization. CONCLUSION: Anterior stromal puncture is an effective, simple, and low-cost alternative for treating patients with symptomatic bullous keratopathy.

[The factors associated with noncompliance with antimalarial treatment in Ecuadorian patients]. / Factores asociados con el incumplimiento del tratamiento antipalúdico en pacientes ecuatorianos.

A total of 249 persons living in the northwest part of Ecuador with a clinical diagnosis of malaria confirmed by thick blood films were treated with chloroquine and primaquine according to the therapeutical system in force in the National Service for Eradication of Malaria. New clinical assessment and thick blood film were applied after 4 days in P. falciparum (n = 120) cases and after 8 days in P. vivax (n = 129) cases; patients were questioned about the compliance or non-compliance with the treatment, and the reasons for their acting in either way were studied. EPI-INFO 6.04 and SPSS PC 7.0 packages served to process the information: "kind adjustment test" (bondad de ajuste) abd factorial analysis of correspondences were used. The patient who daily took his/her pills for the number of days indicated, at the established intervals and at the right time was defined as a patient complying with the drug therapy. For every 3 patients complying with treatment, there were 2 who did not; non-compliance was not significantly related to age, sex, educational level, ethnic group, urban or rural setting or level of income, but learning about seriousness of the infection did help to compliance with the therapy. The reasons for non-compliance were mainly associated with drugs (side effects/reluctancy to take drugs), with the fact of forgetting to take them and of "getting cured quickly". The profile of the patient who did not comply with treatment corresponded to male, teenager, mixed race, poor and rural setting.

Manipulacion de antibioticos parentales por el profesional de Enfermeria en un hospital de tercer nivel / Parental antibiotics: the role of nursing professional

Con este trabajo se pretendió identificar la manipulación de los antibióticos parenterales que realizan las enfermeras de los servicios de pediatría y la unidad de recién nacidos (URN) en un hospital de tercer nivel. Se seleccionó una muestra de 15 profesionales que laboran en los servicios ya mencionados en el segundo semestre de 1997. Para la recolección de datos se diseñó y aplicó una guía de observación estructurada y un cuestionario de conocimientos. Entre los hallazgos se encontró que las enfermeras poseen buenas bases teóricas pero no son aplicadas en la práctica, observando que el 84 por ciento poseen buenos conocimientos y que sólo el 62 por ciento manipulan correctamente los medicamentos

Oral clindamycin and ciprofloxacin versus intramuscular ceftriaxone and oral doxycycline in the treatment of mild-to-moderate pelvic inflammatory disease in outpatients.

This multicenter, prospective, double-blind study compared the safety and efficacy of clindamycin and ciprofloxacin versus ceftriaxone and doxycycline in the treatment of outpatients with mild to moderate pelvic inflammatory disease (PID) diagnosed by laparoscopy. Samples taken from the endocervix, endometrium, and abdominal cavity before treatment and from the endocervix after treatment were cultured for aerobes, anaerobes, Neisseria gonorrhoeae, and Chlamydia trachomatis. Of the 138 patients enrolled, 131 were evaluable for efficacy. The most prevalent bacteria were streptococci, staphylococci, and Escherichia coli (among aerobes) and Bacteroides species and peptostreptococci (among anaerobes). N. gonorrhoeae was present in 2% (3) of the 131 evaluable patients, and C. trachomatis was in 11% (15). The clinical cure rate was 97% (65 of 67) in the clindamycin and ciprofloxacin group and 95% (61 of 64) in the ceftriaxone and doxycycline group. Side effects were similar in both groups. In conclusion, the two regimens for the outpatient treatment of mild to moderate PID were similarly effective and safe.

Recent advances in antibiotic regimens for the treatment of obstetric-gynecologic infections.

This paper reviews new information on antimicrobial agents for the treatment of obstetric-gynecologic infections. The bacteriology of these infections is complex, reflecting the bacteria that usually colonize the vagina and cervix. In general, these infections are polymicrobial in nature: the most frequently isolated microorganisms are gram-negative facultative aerobes, anaerobes, Chlamydia trachomatis, and Neisseria gonorrhoeae. Antibiotic regimens that do provide coverage of these pathogens showed unacceptably high failure rates. A review of the studies recently published confirmed the recommendations of the US Centers for Disease Control and Prevention for severe (inpatients) and mild-to-moderate (outpatients) pelvic inflammatory disease infections. In the case of severe infections, two regimens are recommended: a second-generation cephalosporin like cefoxitin or cefotetan, plus doxycycline or clindamycin/gentamicin. In the case of mild-to-moderate infection, a second- or third-generation cephalosporin plus doxycycline, or oral clindamycin plus an oral quinolone are recommended. Such studies produce high bacteriologic and clinical success rates. New studies indicate that gentamicin may be replaced with a monobactam such as aztreonam; this regimen leads to slightly better efficacy and less toxicity. The possibility of using clindamycin and a quinolone antibiotic is also discussed.

The role of anaerobic bacteria in human infections.

Anaerobes are generally accepted as clinically important pathogens. Although they are found on most mucocutaneous surfaces, anaerobic bacteria are especially abundant in the upper and lower respiratory tracts, gastrointestinal tract, and female genital tract. They are involved in infections such as chronic sinusitis, aspiration pneumonia, lung abscess, intra-abdominal abscess, bacterial vaginosis, decubitus ulcer, and bite wounds. Depending on the type and location of the infection, treatment may involve surgical drainage and a multiple antibiotic regimen that provides protection against both anaerobes and gram-negative aerobes. Penicillin was the drug of choice for anaerobic infections, but its inactivity against most penicillinase-producing anaerobes has made it less useful for empiric therapy. Clindamycin, with its proven activity against anaerobic infections, is the current drug of choice. Clindamycin is particularly effective against upper and lower respiratory tract infections and infections of the female genital tract.

Clindamycin in the treatment of obstetric and gynecologic infections: a review.

The spectrum of clindamycin's activity includes anaerobes and gram-positive aerobes other than enterococci. No inactivation or incompatibility of clindamycin phosphate has been shown in intravenous solutions usually used clinically. After oral administration, clindamycin is almost completely absorbed, with mean peak serum levels reached in 45 to 60 minutes. Clindamycin is widely distributed in many body fluids and tissues. Its normal half-life is two to three hours, and thus it can be given at six-hour intervals. Because of its excellent coverage against anaerobes, gram-positive cocci, and Chlamydia trachomatis, clindamycin is the preferred antimicrobial agent for serious infections of the female genital tract. Clindamycin plus tobramycin or an aminoglycoside is effective treatment for pelvic inflammatory disease, particularly when a tubo-ovarian abscess is present. In post-cesarean section endometritis, clindamycin plus gentamicin has been shown to be more effective than any other treatment. Clindamycin (alone or with an aminoglycoside) has been used successfully in posthysterectomy vaginal cuff infections and, with an aminoglycoside, in septic abortions. Clindamycin has been well tolerated in studies of animals and human subjects; its most significant side effects develop in the gastrointestinal system.