Levamisole incorporation in fish feed - Ensuring the medication dose and avoidance of leaching into the water.

Levamisole, an anthelmintic and immunostimulant drug, has been studied as a promising alternative for aquaculture use. While oral administration through feeding is the main route of administration in fish farming, no studies evaluating methods of levamisole incorporation into the feed have been reported so far. Therefore, this study aimed to evaluate potential procedures for levamisole incorporation in extruded fish feed using ethyl cellulose, gelatin, or vegetable oil, to avoid drug leaching to the water during the animal's medication. A suitable LC-MS/MS method was optimized (full factorial design), validated, and applied to evaluate the efficiency of the process, the homogeneity of the drug concentration, and the leaching rate. The method has been demonstrated to be selective, precise (RSD < 4.9%), accurate (recovery > 98.4%), and linear (r > 0.99, 125-750 mg kg-1). The incorporation procedures using the three coating agents showed high incorporation efficiency (70%) and a homogeneous drug concentration among the extruded feed pellets. A low levamisole leaching rate was verified in the feed prepared using the ethyl cellulose coating procedure (4.3% after 15 min of immersion in the water). On the other hand, fish feed coated with gelatin and oil resulted in a high leaching rate (30-35% after 15 min). Thus, this study shows that coating ethyl cellulose may be a promising procedure for levamisole incorporation in fish feed and with the potential to enhance its use in animal production while reducing environmental contamination.

Therapeutic efficacy of enrofloxacin in treatment of Francisella orientalis infections in juvenile Nile tilapia (Oreochromis niloticus L.).

Outbreaks of infections by Francisella orientalis represent one of the main obstacles to Nile tilapia (Oreochromis niloticus L.) farming. It is responsible for acute mortality in fingerlings and juveniles. The main control measure available is oral antibiotic therapy. This study compared the therapeutic efficacy of the antibiotics enrofloxacin and oxytetracycline, the most commonly used antimicrobial, against francisellosis in juvenile Nile tilapia (O. niloticus). Fish were challenged with a virulent isolate of F. orientalis and treated with medicated feed containing one of two doses of oxytetracycline (100 or 300 mg/kg of live weight (LW)) or 10 mg/kg of LW of enrofloxacin. The positive and negative control groups received feed without antibiotics; the negative control group was unchallenged. The results showed that enrofloxacin at a dose of 10 mg/kg of LW is effective against francisellosis in juvenile Nile tilapia (O. niloticus). Treatment with oxytetracycline did not eliminate the pathogen from the infected host, and the surviving fish became carriers. Enrofloxacin was able to cure the fish of infection with F. orientalis. This study suggests that enrofloxacin is a better option for treating francisellosis in Nile tilapia (O. niloticus L.). It controls mortality and avoids the carrier state in the fish, thus reducing the possibility of recurrence in the affected batches.

Contracepção pós-parto e pós-abortamento: um compilado das evidências atuais / Postpartum and post-abortion contraception: a compilation of current evidences

Idealmente, a contracepção deve ser iniciada o mais precocemente possível após o parto ou após o abortamento, permitindo que as mulheres sejam protegidas contra uma gravidez não programada subsequente. O objetivo desta revisão é discutir a contracepção no pós-parto e pós-aborto, por meio da análise de ensaios clínicos e metanálises, além das principais diretrizes internacionais, com ênfase nas indicações e contraindicações, tempo de início do uso dos métodos contraceptivos e possíveis complicações. Nesta revisão não sistemática, são discutidos os principais métodos contraceptivos: dispositivos intrauterinos, métodos somente de progestagênios, métodos hormonais combinados, métodos de barreira, método de amenorreia lactacional e esterilização. O aconselhamento contraceptivo pós-parto deve começar durante o pré-natal e, em pacientes após abortamento, durante a internação hospitalar. Todas as mulheres devem ter acesso a informações claras sobre cada método contraceptivo, e o processo de tomada de decisão deve ser compartilhado com o médico assistente. Idealmente, métodos de contracepção reversíveis de longa duração devem ser priorizados em relação aos outros. Em conjunto, todas as evidências demonstram que o melhor método para cada paciente é aquele que combine altas taxas de segurança com o desejo da paciente de iniciá-lo e mantê-lo pelo tempo que desejar.

Contraception should ideally be started as early as possible after childbirth or abortion to allow women to be protected against a subsequent unplanned pregnancy. The aim of this review is to discuss postpartum and postabortion contraception, through the analysis of clinical trials and meta-analyses, in addition to the main international guidelines, with emphasis on indications and contraindications, time to start contraceptive method and possible complications. In this review, the main contraceptive methods are discussed: intrauterine devices, progestin-only methods, combined hormonal methods, barrier methods, lactational amenorrhea method and sterilization. Postpartum contraceptive counseling should start during prenatal care and during hospital stay in post-abortion patients. All women should have access to clear information about each contraceptive method and the decision-making process must be shared. Ideally, long acting reversible contraception methods should be prioritized over others. Taken together, all the evidence shows that the best method for each patient is the one that combines high safety rates with the patient's desire to start and maintain it for as long as she wants.

Hormonal intrauterine device in women with renal transplantation: a prospective observational study

SUMMARY OBJECTIVE: The main objective of this study is to evaluate the rate of continuity and satisfaction with hormonal intrauterine device in renal transplant recipients. METHODS: This was a prospective observational study. The sample consisted of patients treated at a Family Planning Outpatient Clinic, from August 2016 to September 2021. Information on each patient's age, parity, and associated diseases as well as satisfaction with the method were analyzed. Patients were invited to participate through electronic messages, and the questionnaire included questions about acceptance of the contraceptive method. RESULTS: A total of 40 patients were included in the study. The mean age of the renal transplant patients was 32.5 years. The mean duration of hormonal intrauterine device use was 37 months. Acceptance of the method was high, with 97.5% of patients remaining on the method for 1 year and 85% of patients using the hormonal intrauterine device at the time of the study. There were no pregnancies or renal transplant complications in the study. Regarding satisfaction with the method, the majority (77.5%) scored 10. CONCLUSION: Patients were satisfied or very satisfied with the hormonal intrauterine device. Therefore, the continuation rate was high. Furthermore, this contraceptive method proved to be safe and effective in kidney transplant recipients. No complications, graft rejection, or graft failure were observed after intrauterine hormonal device insertion and during follow-up.

Effect of the levonorgestrel-releasing intrauterine system on cardiovascular risk markers among women with thrombophilia or previous venous thromboembolism.

OBJECTIVE: To assess the effects of the levonorgestrel-releasing intrauterine system (LNG-IUS) on standard cardiovascular risk markers among women with thrombophilia and/or previous venous thromboembolism (VTE). METHODS: A prospective cohort study enrolled women aged 18-45 years with thrombophilia and/or a history of VTE who received the 52-mg LNG-IUS (20 µg/d initial release) at the University of Ribeirão Preto Medical School, Brazil, from January 2006 to December 2015. Before and 12 months after LNG-IUS placement, the following cardiovascular risk markers were assessed: lipid profile, body mass index (BMI), blood glucose, systolic blood pressure, diastolic blood pressure, and waist circumference. The primary outcome was changes in cardiovascular risk markers. A subanalysis of anticoagulant users versus non-users was also conducted. RESULTS: In total, 45 women were enrolled. BMI increased by 2.3% after 12 months of LNG-IUS placement (P < 0.01), but the other risk factors did not change. Cardiovascular risk markers were similar between anticoagulant users and non-users after 12 months of LNG-IUS use. CONCLUSION: Among women with thrombophilia and/or previous VTE, cardiovascular risk markers were not found to change significantly after 12 months of LNG-IUS use. The study adds safety information regarding use of the LNG-IUS for women at risk of thromboembolism.

Carry-over and contamination of veterinary drugs in feed production lines for poultry and pigs.

The current model of pigs and poultry production has increased stocking density and reduced downtime between lots. This scenario may favour a rise of infection and disease risk in animals. To avoid this problem, routine use of drugs has been made, intensifying the possibility of residues in animal products and antimicrobial resistance. The aim of this study was to measure carry-over and contaminants of veterinary drugs included in the feed production lines for poultry and pigs. Samples were taken from 25 production lines. LC-MS/MS was used for simultaneous analysis of 62 active ingredients. In the medicated feed, 80.4% of the samples had a concentration of active ingredients different from the stated doses. In 70% of the feed samples, there was heterogeneity in the mixture of active ingredients. In subsequent feeds, carry-over was greater than 1% of the stated dose in 63% of cases. Of the 25 analysed lines, only one showed no contamination with other active ingredients. No correlations were found between the nutritional composition of the feed and carry-over. The present study demonstrated that the current production model allows the occurrence of unwanted drugs in feed-in doses that can contaminate animal products and can select antimicrobial-resistant bacteria.

Lidocaine medicated plaster, an additional potential treatment option for localized post-surgical neuropathic pain: efficacy and safety results of a randomized, placebo-controlled trial.

OBJECTIVE: To assess the efficacy and safety of lidocaine 700 mg medicated plaster (lidocaine plaster) compared to placebo in patients with moderate to severe chronic post-surgical neuropathic pain (PSNP). METHODS: Patients (n = 363) with a diagnosis of PSNP for a minimum of 3 months to 36 months were randomized (1:1) to lidocaine plaster or placebo for a 12 week double-blind treatment period. Randomization was stratified as "plaster-only" (no concomitant medication for PSNP) or as "add-on" (stable systemic medication for PSNP). The primary efficacy endpoint was the change from baseline in 24 hour average pain intensity at Week 12, assessed by 11 point numerical rating scale (NRS). The trial was registered in ClinicalTrials.gov (NCT01752322) and EudraCT (2012-000347-28). RESULTS: Treatment with lidocaine or placebo plaster led to a clinically relevant reduction in average pain intensity. Pain reduction (least squares mean [LS mean] standard error [SE], [95% confidence interval, CI]) with lidocaine plaster (-1.70 [0.16], [-2.03, -1.38]) was numerically higher than with placebo (-1.47 [0.16], [-1.78, -1.15]) but the difference was not statistically significant (-0.23 [0.23], [-0.69, 0.22]). Pre-specified exploratory subgroup analyses showed the largest differentiation between lidocaine and placebo in patients without concomitant pain medication, and in patients with more than 1 year between surgery and enrollment. Many secondary outcomes showed a numerically larger improvement in favor of lidocaine. The most commonly reported adverse events were administration site reactions linked to topical administration. CONCLUSIONS: A clinically relevant pain reduction was observed with lidocaine plaster in patients with PSNP. The safety and tolerability profile is consistent with current knowledge.

Effects of Oral Oxytetracycline-Therapy on Wound Progression and Healing Following Aeromonas caviae Infection in Nile Tilapia (Oreochromis niloticus L)

Abstract The effects of oral oxytetracycline (OTC)-therapy against Aeromonas caviae infection as well as the wound progression and healing in intramuscular (IM) and abrasion-immersion (AI) challenged Nile tilapia juveniles were evaluated. The IM challenge caused significantly (p < 0.05) high mortalities (90%) compared to AI challenge (40%). The mortalities recorded in 10 days OTC-fed (72% in IM group and 30% in AI group) and untreated Nile tilapia were significantly (p < 0.05) high compared to positive (5-10%) controls. The reduction in mortalities in OTC-fed Nile tilapia was significant (p < 0.05) with no further mortalities during the post-OTC therapy period. In IM group, the black scar disappearance, re-growth of dermal fibrous tissue and skin growth at the ulcerated region were seen on day 10 OTC-therapy. In contrast, the disappearance of wound scar and growth of skin and scales at the abraded area were noted on day 1-4 post-OTC therapy. On day10 post-OTC therapy, complete disappearance of wound scar with a mild spot at the abraded area was noted. The degree of wound healing was faster only initially with OTC- therapy. Nevertheless, the wounds were healed completely even in the surviving untreated tilapia in 30 days with no scars left behind. The extent of mortalities observed in Nile tilapia during the OTC-therapy period is a serious cause for concern, which require prudent planning on its suitability in tropical aquaculture.

Assessment of a segregated medicated early weaning protocol for elimination of Actinobacillus pleuropneumoniae / Avaliação de um protocolo de desmame precoce segregado medicado para a eliminação de Actinobacillus pleuropneumoniae

To assess the success of a segregated medicated early weaning protocol for elimination of Actinobacillus pleuropneumoniae, ten consecutive batches of 100 pigs per batch weaned at 7-9 days of age were monitored at 21-22 weeks of age looking for presence of productive cough, presence of antibodies against the agent and pleuropneumonia-compatible lung lesions at slaughter. Also, whole tonsils were processed for A. pleuropneumoniae identification by both bacteriological isolation and nested-PCR using a direct method. Positive serological test (1.4%) and PCR (3.5%) results, suggested that A. pleuropneumoniae could not be eradicated in all batches, even using segregated medicated early weaning protocol.(AU)

Para avaliar o sucesso de um protocolo de desmame precoce segregado medicado para a eliminação de Actinobacillus pleuropneumoniae, dez lotes consecutivos de 100 suínos por lote desmamados aos 7-9 dias de idade foram monitorados às 21-22 semanas de idade procurando a presença de tosse produtiva, presença de anticorpos contra o agente e lesões pulmonares compatíveis com pleuropneumonia no abate. Além disso, as tonsilas inteiras foram processadas para a identificação de A. pleuropneumoniae por isolamento bacteriológico e nested PCR usando um método direto. Os resultados serológicos (1,4%) e PCR (3,5%) positivos sugerem que não foi possível erradicar em todos os lotes, mesmo usando um protocolo de desmame precoce segregado medicado.(AU)

Antimicrobial wound dressing films containing essential oils and oleoresins of pepper encapsulated in sodium alginate films / Curativos medicamentosos antimicrobiano contendo óleos essenciais e oleoresinas de algumas pimentas encapsulados em filmes de alginato de sódio

Medicated wound dressings are important barriers to avoid contamination and, when they contain antimicrobial additives, can be used as treatment for infected wounds. There are several types of polysaccharide materials that serve as matrices for medicated wound dressings, among them, sodium alginate. For the preparation of the films studied in this paper, sodium alginate was employed in combination with essential oils/oleoresins (EO/OL) of six peppers that are commonly used in cooking. The EO/OL were incorporated at three different concentrations (low, intermediate and high). Most of the films prepared had better dispersion of the EO/OL at the intermediate concentration. All films studied in this research were dissolved in water at different rates. The antibacterial activity of the prepared films showed significant results against Escherichia coli, Staphylococcus aureus and Bacillus cereus, and demonstrated that the films studied may be a new alternative for medicated wound dressings.(AU)

Os curativos medicamentosos são importantes barreiras para se evitar contaminação e ainda, quando contém aditivos antimicrobianos, servem como tratamento para ferimentos infectados. Existem vários tipos de materiais polissacarídicos que servem como matrizes para curativos medicamentosos, dentre eles, destaca-se o alginato de sódio. Para a preparação dos filmes estudados neste trabalho, utilizou-se alginato de sódio e incorporou-se óleos essenciais/oleoresinas (OE/OL) de seis pimentas utilizadas na culinária, em três diferentes concentrações. A maioria dos filmes preparados apresentou melhor dispersão dos OE/OL na concentração intermediária destes. Todos os filmes estudados neste trabalho apresentam solubilidade em água, em uma certa extensão. A atividade antibacteriana dos filmes preparados mostra resultados significantes contra Escherichia coli, Staphylococcus aureus e Bacillus Cereus, mostrando que os filmes estudados podem ser uma nova alternativa como curativos medicamentos.(AU)

Antimicrobial wound dressing films containing essential oils and oleoresins of pepper encapsulated in sodium alginate films / Curativos medicamentosos antimicrobiano contendo óleos essenciais e oleoresinas de algumas pimentas encapsulados em filmes de alginato de sódio

Medicated wound dressings are important barriers to avoid contamination and, when they contain antimicrobial additives, can be used as treatment for infected wounds. There are several types of polysaccharide materials that serve as matrices for medicated wound dressings, among them, sodium alginate. For the preparation of the films studied in this paper, sodium alginate was employed in combination with essential oils/oleoresins (EO/OL) of six peppers that are commonly used in cooking. The EO/OL were incorporated at three different concentrations (low, intermediate and high). Most of the films prepared had better dispersion of the EO/OL at the intermediate concentration. All films studied in this research were dissolved in water at different rates. The antibacterial activity of the prepared films showed significant results against Escherichia coli, Staphylococcus aureus and Bacillus cereus, and demonstrated that the films studied may be a new alternative for medicated wound dressings.

Os curativos medicamentosos são importantes barreiras para se evitar contaminação e ainda, quando contém aditivos antimicrobianos, servem como tratamento para ferimentos infectados. Existem vários tipos de materiais polissacarídicos que servem como matrizes para curativos medicamentosos, dentre eles, destaca-se o alginato de sódio. Para a preparação dos filmes estudados neste trabalho, utilizou-se alginato de sódio e incorporou-se óleos essenciais/oleoresinas (OE/OL) de seis pimentas utilizadas na culinária, em três diferentes concentrações. A maioria dos filmes preparados apresentou melhor dispersão dos OE/OL na concentração intermediária destes. Todos os filmes estudados neste trabalho apresentam solubilidade em água, em uma certa extensão. A atividade antibacteriana dos filmes preparados mostra resultados significantes contra Escherichia coli, Staphylococcus aureus e Bacillus Cereus, mostrando que os filmes estudados podem ser uma nova alternativa como curativos medicamentos.

Antimicrobial wound dressing films containing essential oils and oleoresins of pepper encapsulated in sodium alginate films / Curativos medicamentosos antimicrobiano contendo óleos essenciais e oleoresinas de algumas pimentas encapsulados em filmes de alginato de sódio

ABSTRACT: Medicated wound dressings are important barriers to avoid contamination and, when they contain antimicrobial additives, can be used as treatment for infected wounds. There are several types of polysaccharide materials that serve as matrices for medicated wound dressings, among them, sodium alginate. For the preparation of the films studied in this paper, sodium alginate was employed in combination with essential oils/oleoresins (EO/OL) of six peppers that are commonly used in cooking. The EO/OL were incorporated at three different concentrations (low, intermediate and high). Most of the films prepared had better dispersion of the EO/OL at the intermediate concentration. All films studied in this research were dissolved in water at different rates. The antibacterial activity of the prepared films showed significant results against Escherichia coli, Staphylococcus aureus and Bacillus cereus, and demonstrated that the films studied may be a new alternative for medicated wound dressings.

RESUMO: Os curativos medicamentosos são importantes barreiras para se evitar contaminação e ainda, quando contém aditivos antimicrobianos, servem como tratamento para ferimentos infectados. Existem vários tipos de materiais polissacarídicos que servem como matrizes para curativos medicamentosos, dentre eles, destaca-se o alginato de sódio. Para a preparação dos filmes estudados neste trabalho, utilizou-se alginato de sódio e incorporou-se óleos essenciais/oleoresinas (OE/OL) de seis pimentas utilizadas na culinária, em três diferentes concentrações. A maioria dos filmes preparados apresentou melhor dispersão dos OE/OL na concentração intermediária destes. Todos os filmes estudados neste trabalho apresentam solubilidade em água, em uma certa extensão. A atividade antibacteriana dos filmes preparados mostra resultados significantes contra Escherichia coli, Staphylococcus aureus e Bacillus Cereus, mostrando que os filmes estudados podem ser uma nova alternativa como curativos medicamentos.

Assessment of a segregated medicated early weaning protocol for elimination of Actinobacillus pleuropneumoniae / Avaliação de um protocolo de desmame precoce segregado medicado para a eliminação de Actinobacillus pleuropneumoniae

ABSTRACT: To assess the success of a segregated medicated early weaning protocol for elimination of Actinobacillus pleuropneumoniae, ten consecutive batches of 100 pigs per batch weaned at 7-9 days of age were monitored at 21-22 weeks of age looking for presence of productive cough, presence of antibodies against the agent and pleuropneumonia-compatible lung lesions at slaughter. Also, whole tonsils were processed for A. pleuropneumoniae identification by both bacteriological isolation and nested-PCR using a direct method. Positive serological test (1.4%) and PCR (3.5%) results, suggested that A. pleuropneumoniae could not be eradicated in all batches, even using segregated medicated early weaning protocol.

RESUMO: Para avaliar o sucesso de um protocolo de desmame precoce segregado medicado para a eliminação de Actinobacillus pleuropneumoniae, dez lotes consecutivos de 100 suínos por lote desmamados aos 7-9 dias de idade foram monitorados às 21-22 semanas de idade procurando a presença de tosse produtiva, presença de anticorpos contra o agente e lesões pulmonares compatíveis com pleuropneumonia no abate. Além disso, as tonsilas inteiras foram processadas para a identificação de A. pleuropneumoniae por isolamento bacteriológico e nested PCR usando um método direto. Os resultados serológicos (1,4%) e PCR (3,5%) positivos sugerem que não foi possível erradicar em todos os lotes, mesmo usando um protocolo de desmame precoce segregado medicado.

Three-dimensional versus two-dimensional ultrasound for assessing levonorgestrel intrauterine device location: A pilot study.

PURPOSE: To compare the rates of success of two-dimensional (2D) and three-dimensional (3D) sonographic (US) examinations in locating and adequately visualizing levonorgestrel intrauterine devices (IUDs) and to explore factors associated with the unsuccessful viewing on 2D US. METHODS: Transvaginal 2D and 3D US examinations were performed on all patients 1 month after insertion of levonorgestrel IUDs. The devices were considered adequately visualized on 2D US if both the vertical (shadow, upper and lower extremities) and the horizontal (two echogenic lines) shafts were identified. 3D volumes were also captured to assess the location of levonorgestrel IUDs on 3D US. RESULTS: Thirty women were included. The rates of adequate device visualization were 40% on 2D US (95% confidence interval [CI], 24.6; 57.7) and 100% on 3D US (95% CI, 88.6; 100.0). The device was not adequately visualized in all six women who had a retroflexed uterus, but it was adequately visualized in 12 of the 24 women (50%) who had a nonretroflexed uterus (95% CI, -68.6; -6.8). CONCLUSIONS: We found that 3D US is better than 2D US for locating and adequately visualizing levonorgestrel IUDs. Other well-designed studies with adequate power should be conducted to confirm this finding.

Use of 5% lidocaine medicated plaster to treat localized neuropathic pain secondary to traumatic injury of peripheral nerves.

OBJECTIVE: The efficacy of 5% lidocaine medicated plaster (LMP) has previously been demonstrated in post-traumatic localized neuropathic pain. This study evaluated the use of LMP in localized neuropathic pain secondary to traumatic peripheral nerve injury. PATIENTS AND METHODS: This prospective observational study enrolled patients with traumatic injuries to peripheral nerves that were accompanied by localized neuropathic pain of more than 3 months duration. Demographic variables, pain intensity (measured using the numeric rating scale; NRS), answers to the Douleur Neuropathique 4 (DN4) questionnaire, and the size of the painful area were recorded. RESULTS: Nineteen patients were included, aged (mean ± standard deviation) 41.4 ± 15.7 years. Nerve injuries affected the upper (eight patients) or lower (11 patients) limbs. The mean duration of pain before starting treatment with LMP was 22.6 ± 43.5 months (median 8 months). Mean baseline values included: NRS 6.7 ± 1.6, painful area 17.8 ± 10.4 cm(2) (median 18 cm(2)), and DN4 score 6.7 ± 1.4. The mean duration of treatment with LMP was 19.5 ± 10.0 weeks (median 17.4 weeks). Mean values after treatment were: NRS 2.8 ± 1.5 (≥3 point reduction in 79% of patients, ≥50% reduction in 57.9% of patients) and painful area 2.1 ± 2.3 cm(2) (median 1 cm(2), ≥50% reduction in 94.7% of patients). Functional improvement after treatment was observed in 14/19 patients (73.7%). CONCLUSION: LMP effectively treated traumatic injuries of peripheral nerves which presented with chronic localized neuropathic pain, reducing both pain intensity and the size of the painful area.

Resolución laparoscópica de translocación abdominal de dispositivo intrauterino: Reporte de un caso / Laparoscopic removal of an intra-abdominal translocated intrauterine device: Case report

A partir de que Richter R, en 1909, realizó la primera publicación sobre el uso de dispositivos intrauterinos con fines anticonceptivos, la forma, los materiales, las indicaciones, así como las contraindicaciones han evolucionado hasta convertirse en el método de planificación familiar más usado en el mundo. El riesgo de perforación durante la inserción es bajo; sin embargo, ha sido referida. En la literatura se ha descrito el uso de la laparoscopia para la extracción de dispositivos intrauterinos migrados a cavidad abdominal. En la presente publicación se reporta el caso clínico de una mujer de 29 años de edad, con antecedente de colocación de dispositivo intrauterino, dos años previos, por vía vaginal sin complicación aparente; comenta sólo dolor de cólico posterior a la colocación que va cediendo a analgésicos vía oral no especificados, sin sintomatología hasta la fecha. Acude a revisión y realización de citología cervical donde no se encuentran hilos guía del dispositivo intrauterino. Mediante radiografía simple de abdomen y bajo fluoroscopia se determina la localización intraabdominal del testigo radiopaco del dispositivo, es valorada por el Servicio de Cirugía General y se determina a realizar la extracción del mismo por vía laparoscópica sin complicaciones; se encontró el dispositivo con adherencias a omento mayor, sin afección aparente de órganos intraabdominales. La Organización Mundial de la Salud recomienda la extracción inmediata de los dispositivos intrauterinos que han migrado. La migración del dispositivo intrauterino a la cavidad abdominal es una complicación poco frecuente, y la presentación como hallazgo en pacientes asintomáticas es aún menos frecuente; en una revisión sistemática de la literatura, Richdeep S y cols. valoraron 49 artículos en los que encontraron 179 casos de manejo laparoscópico, reportando al omento como el sitio más frecuente de localización (26.7%). La relevancia del presente caso radica en la presentación asintomática dos años posteriores a su inserción, la ruta diagnóstica utilizando radiografías simples y fluoroscopia, así como la extracción sin complicaciones y con excelente resultado, vía laparoscópica.

Since Richter R. in 1909 performed the first publication on the use of intrauterine devices; materials, forms, indications and contraindications of these have evolved to become the method most widely used family planning in the world. Although the risk of perforation during insertion is low, it exists. The literature has described the use of laparoscopy for removal of intrauterine devices migrated to the abdominal cavity. Case report: 29 years old woman who two years before suffers colic pain posterior to application of an intrauterine device with no complications, and diminishes with the use of unspecified analgesics, and stays asymptomatic to date. She attended a review, and underwent to cervical cytology, during the procedure, was impossible to see the strings of the intrauterine device. Plain abdominal radiography and fluoroscopy were done to determine the location of the radiopaque intraabdominal witness. Assessed by the General Surgery Service we determined extraction of the device by laparoscopy and was done without any complication. Findings: strong omentum adhesions to the device, but no apparent damage to other abdominal organs. The World Health Organization recommends the immediate removal of intrauterine devices that have migrated. The migration of the intrauterine devices into the abdominal cavity is a rare complication, and the presentation as an incidental finding in asymptomatic patients is even less common, a systematic review of literature, Richdeep S. et al, evaluated 49 items found 179 cases of laparoscopic management reporting the omentum as the most common site of localization (26.7%). The relevance of this case lies in the asyntomatic presentation two years after insertion, the diagnostic route using radiographs and fluoroscopy, and extraction without complications and with excellent results laparoscopically.

Um método chamado Pinotti: sal medicamentoso, malária e saúde internacional (1952-1960) / A method called Pinotti: medicated salt, malaria, and international health (1952-1960)

Analisa a criação, a recepção e o abandono do método Pinotti de combate à malária: sal de cozinha misturado com cloroquina. Idealizado no início da década de 1950 pelo malariologista brasileiro Mario Pinotti como ação profilática e terapêutica contra a malária, foi testado durante a primeira metade daquela década e utilizado no Brasil entre 1959 e 1961, como parte da campanha de erradicação da malária coordenada pela Organização Mundial da Saúde. Conquistou reconhecimento no cenário internacional da saúde, sofreu críticas e foi testado em outros países até meados dos anos 1960. Argumentamos que, no Brasil, o abandono foi devido, sobretudo, ao ocaso político de seu criador, a partir de 1960.

Treatment of localized post-traumatic neuropathic pain in scars with 5% lidocaine medicated plaster.

OBJECTIVE: To evaluate the use of 5% lidocaine medicated plaster (LMP) for treating painful scars resulting from burns or skin degloving. PATIENTS AND METHODS: This was a prospective, observational case series study in individuals with painful scars <70 cm(2) in area, caused by burns or skin degloving. The study included a structured questionnaire incorporating demographic variables, pain evaluation using the numeric rating scale (NRS), the DN4 questionnaire, and measurement of the painful surface area. Patients with open wounds in the painful skin or with severe psychiatric disease were excluded. RESULTS: Twenty-one men and eight women were studied, aged (mean + standard deviation) 41.4 ± 11.0 years, with painful scars located in the upper extremity (n = 9), lower extremity (n = 19), or trunk (n = 1). Eleven patients (37.9%) had an associated peripheral nerve lesion. The scars were caused by burns (n = 13), degloving (n = 7), and/or orthopedic surgery (n = 9). The duration of pain before starting treatment with lidocaine plaster was 9.7 ± 10.0 (median 6) months. The initial NRS was 6.66 ± 1.84 points, average painful area 23.0 ± 18.6 (median 15) cm(2), and DN4 score 4.7 ± 2.3 points. The duration of treatment with LMP was 13.9 ± 10.2 (median 11) weeks. After treatment, the NRS was reduced by 58.2% ± 27.8% to 2.72 ± 1.65. The average painful area was reduced by 72.4% ± 24.7% to 6.5 ± 8.6 (median 5) cm(2). Nineteen patients (69%) showed functional improvement following treatment. CONCLUSION: LMP was useful for treating painful scars with a neuropathic component, producing meaningful reductions in the intensity of pain and painful surface area. This is the first time that a decrease in the painful area has been demonstrated in neuropathic pain using topical therapy, and may reflect the disease-modifying potential of LMP.