Correlation between some arterial and venous blood gas parameters in healthy newborn Martina Franca donkey foals from birth to 96 hours of age.

In neonatology, blood gas analysis is a useful tool in the evaluation of the health of newborns and plays a key role in early detection of critically ill subjects. Because blood gas analysis parameters have not previously been studied in any depth in donkey foals, this study was performed on 16 healthy Martina Franca donkey foals born after an uncomplicated delivery. Arterial and venous blood samples were collected at 5 minutes and at 12, 24, 72, and 96 hours of age. Blood gas analysis was performed by a portable analyzer, measuring arterial and venous total carbon dioxide, carbon dioxide partial pressure (pCO2), oxygen partial pressure (pO2), oxygen saturation (sO2), bicarbonate, base excess (BE), pH, and lactate (LT). Lower blood pH values, pO2 and sO2, and a higher level of lactate were found at birth in comparison with subsequent sampling times. This moderate acidotic profile disappeared at 12 hours, when all the parameters became constant until the end of the study period. As expected, significant differences between arterial and venous blood gas parameters related to the oxygenation, such as pO2 and sO2, and partially carbon dioxide partial pressure were found, whereas total carbon dioxide, pH, BE, and LT were comparable in arterial and venous blood samples. For these latter parameters, the highly significant correlation between arterial and venous findings suggests that venous samples could be an acceptable alternative to the arterial sample for blood gas analysis in newborn donkey foals, when the oxygenation status of the patient is not the first goal of patient analysis.

Transrectal ultrasonographic evaluation of combined utero-placental thickness during the last half of pregnancy in Martina Franca donkeys.

In the recent years, the donkey population decreased dramatically so that many breeds are presently considered as endangered. In comparison to the horse, the donkey placenta still remains not completely studied. In the horse, one of the diagnostic tools useful to identify pregnant mares at risk of abortion or premature delivery, include the transrectal ultrasound examination of the uterus and its contents; and especially of the combined thickness of the uterus and of the placenta (CUPT). Since the CUPT was never investigated in donkeys, the present study was aimed to define the transrectal CUPT values during the last half of pregnancy in 20 Martina Franca jennies. Foalings times, foals characteristics and placental gross appearance, and measurements were also evaluated and values resulted always within normality. Differently to the mare, a continuous significant CUPT increase between the sixth to the 12 months of pregnancy, and a substantial increase from the ninth to the 12th month of pregnancy, was found. Although statistically not evaluable, the CUPT values recorded from three jennies with pregnancy loss did not show evidence of CUPT increases. In conclusion, normal CUPT values from the sixth to the 12th month of pregnancy in Martina Franca donkeys are provided, but further investigations are needed to define possible breed or body-size CUPT specific differences, as well as the CUPT values during pregnancy disturbances or placental abnormalities.

Primeros casos autóctonos de hepatitis e en Uruaguay / First autochthonous hepatitis E cases in Uruguay

Con el objetivo de describir los primeros casos autóctonosde Hepatitis E se realizó un estudio descriptivo. La población,9 enfermos, se identificó en el periodo noviembre 2009a julio 2010. Se seleccionaron por IgG e IgM específicaspara VHE y se realizó búsqueda de ARN viral en suero porRT-PCR. Presentaron una media de 51 años, 8 del sexo masculino, educación terciaria, nivel socioeconómico medio alto, atención en el sector privado y residencia urbana. La clínica fue similar a Hepatitis A, con transaminasas elevadas por encima de 1500 (mU/ml), la glutamicopiruvica convalores máximos de 5270 (mU/ml). Todos presentaron hiperbilirrubinemia a predominio directa, aumento de lagamaglutamil transferasa y de Fosfatasa Alcalina. Se demostrócirculación en Uruguay del VHE con manifestaciones clínicas, lo que traduce la presencia de una enfermedad emergente. Se plantea introducir el diagnostico del VHE en forma protocolizada en pacientes sin diagnostico etiológico de hepatitis.

In order to describe the first autochthonous Hepatitis E cases, we carried out a descriptive study. The population, 9 patients, was identified from November 2009 to July 2010. They were selected by specificIgG and IgM for HEV and we made viral RNA search in serum by RT-PCR. Patients average age was 51 years old, 8 male, tertiary education, upper middle socioeconomic level, health attention in private sector and urban residence. Clinic results similar to hepatitis A, with elevated transaminases over 1500 (mU/ml) and glutamic pyruvic with maximum values of 5270 (mU/ml). All patients presented hyperbilirubinemia (direct predominance) and increased gamma glutamyl transferase and alkaline phosphatase. Circulation of HEV with clinical manifestations was demonstrated in Uruguay, this showsthe presence of an emergent disease. We suggest introducing a formalized HEV diagnosis in patients without etiologic diagnosis of hepatitis.

Comparative bioavailability of two oral formulations of mycophenolate mofetil in healthy adult Uruguayan subjects: a case of highly variable rate of drug absorption.

OBJECTIVE: To assess the bioequivalence and safety of a new formulation of mycophenolate mofetil (MMF) 500 mg (Suprimun®, Clausen, Montevideo, Uruguay) marketed in Uruguay and other South American countries, and to test Cmax/AUC as a characteristic of its absorption rate. MATERIAL AND METHODS: A randomized, open-label, two-way, two-treatment, two-period crossover study in 24 healthy male volunteers was carried out. One tablet (500 mg) of each formulation was administered after an overnight fast. After dosing, serial blood samples were collected for a period of 36 hours. Plasma concentrations of MPA were determined by high-performance liquid chromatography and pharmacokinetic parameters were calculated. Analysis of variance was carried out using log-transformed AUC0-36, Cmax, and Cmax/AUC0-36. 90% confidence intervals and within-subject between-subject variance were calculated. The bioequivalence of the two formulations was established at the 80% - 125% acceptance limits and untransformed tmax medians were compared using Wilcoxon test. Subjects were monitored for adverse events throughout the study. RESULTS: The means (test and reference) were 21.14 and 20.86 µg × h × ml-1 for AUC0-36, 24.92 and 24.18 µg × h × ml-1 for AUC0-inf, 11.86 and 10.76 µg × ml-1 for Cmax and 0.51 and 0.54 h-1 for Cmax/AUC0-36. The geometric mean ratios (confidence interval 90%) of Test/Reference were 1.00 (0.95 - 1.06) for AUC0-36, 1.09 (0.96 - 1.24) for Cmax and 1.04 (0.99 - 1.09) for Cmax/ AUC0-36. The extra peaks observed are due to enterohepatic recycling of MPA. No serious or unexpected adverse events were observed during the study. CONCLUSIONS: The test formulation containing mycophenolate mofetil 500 mg met regulatory requirements for bioequivalence. Moreover, Cmax/AUC shows interesting features as a putative metric to evaluate the absorption rate of highly variable drugs like mycophenolate mofetil. Generally, both formulations were well tolerated.

Reflex sympathetic dystrophy in children.

Reflex sympathetic dystrophy is becoming increasingly recognized in the pediatric population, yet there is very little about the disease in standard pediatric texts and nothing in the emergency medicine literature. Failure to diagnose Reflex sympathetic dystrophy in a timely fashion greatly decreases the likelihood of recovery. The diagnosis is primarily clinical. This report is intended to increase emergency physicians' awareness of this painful, disabling problem.

A comparison of the efficacy, safety, and patient satisfaction of ondansetron versus droperidol as antiemetics for elective outpatient surgical procedures. S3A-409 and S3A-410 Study Groups.

UNLABELLED: Two identical, randomized, double-blind, placebo-controlled studies enrolled 2061 adult surgical outpatients at high risk of postoperative nausea and vomiting (PONV) to compare i.v. ondansetron 4 mg with droperidol 0.625 mg and droperidol 1.25 mg for the prevention of PONV. The antiemetic drugs or placebo were administered i.v. 20 min before the induction of anesthesia with a barbiturate compound, followed by maintenance with N2O/isoflurane/enflurane. Nausea, emetic episodes, adverse events, and patient satisfaction were analyzed for the 0 to 2 h and 0 to 24 h postoperative periods. In the 0 to 2 h postoperative period, there was a complete response (no emesis or rescue antiemetic) in 46% of subjects given placebo (P < 0.05 versus antiemetic groups), in 62% given ondansetron, in 63% given droperidol 0.625 mg, and in 69% given droperidol 1.25 mg (P < 0.05 versus ondansetron). In the 0 to 24-h postoperative period, there were no significant differences in complete response between the ondansetron and droperidol 0.625 or 1.25 mg groups; all groups remained superior to placebo. The proportion of patients without nausea during the 0 to 24 h postoperative period was greater in the antiemetic groups compared with the placebo group; however, droperidol 1.25 mg was more effective than ondansetron 4 mg or droperidol 0.625 mg (43% vs 29% or 29%, respectively). Headache incidence was higher in the ondansetron group compared with either droperidol group. Patient satisfaction scores did not differ significantly among antiemetic treatment groups, although all were superior to placebo. In conclusion, all antiemetic treatment regimens were superior to placebo for the prevention of PONV in the immediate postoperative period; however, droperidol 1.25 mg was more efficacious than ondansetron during the early recovery period (0-2 h). There were no significant differences between ondansetron and either droperidol dose for emesis prevention during the 0 to 24 h postoperative period. IMPLICATIONS: More than 2000 patients at high risk of postoperative nausea and vomiting were given either placebo, ondansetron 4 mg, or droperidol 0.625 mg or 1.25 mg i.v. before the administration of general anesthesia. After surgery, the incidence of nausea, vomiting, medication side effects, and patient satisfaction were evaluated for 24 h. Droperidol 0.625 or 1.25 mg i.v. compared favorably with ondansetron 4 mg i.v. for the prevention of postoperative nausea and vomiting after ambulatory surgery.

A comparison of mivacurium dosage requirements during isoflurane and desflurane anesthesia.

STUDY OBJECTIVE: To evaluate the dose requirement and recovery characteristics of mivacurium infusions during anesthesia with equipotent concentrations of either desflurane or isoflurane. DESIGN: Randomized, open-study comparing the effects of desflurane and isoflurane on mivacurium-induced neuromuscular blockade. SETTING: Operating suite of a university-affiliated medical center. PATIENTS: 41 ASA status I, II, and III adult patients, requiring more than 45 minutes of neuromuscular blockade for surgery. INTERVENTIONS: Following a standardized induction sequence and established steady desflurane-nitrous oxide (DES group) or isoflurane-nitrous oxide (ISO group) anesthesia at 1 minimum alveolar concentration (MAC), an intubating dose of 0.2 mg/kg of mivacurium chloride was administered. Ventilation was maintained with a face mask until the first twitch (T1) of the evoked train-of-four (TOF) reached 10% or less of control when tracheal intubation was performed. T1 was allowed to return to 10% of its control value. An infusion of mivacurium at the initial rate of 5 micrograms/kg/min was then started and adjusted to maintain T1 at 10% +/- 2% of control. Within 20 minutes of completion of surgery, the mivacurium infusion was stopped, and the time for the evoked electromyograph (EMG) to return to 25% and 75% of the original baseline was noted. MEASUREMENTS AND MAIN RESULTS: Neuromuscular function was monitored continuously by an evoked EMG. The average infusion rate was 5.7 +/- 2.4 micrograms/kg/min (mean +/- SD) for DES group (n = 20) and 6.6 +/- 2.7 micrograms/kg/min for ISO group (n = 21) (p = NS). There was no change in the infusion rate of mivacurium over time for both groups. However, there was an inverse relationship in both groups between the time to recovery following a bolus dose and the subsequent mean infusion rate of mivacurium (correlation coefficient = -5.0; p < 0.005). The spontaneous recovery index (T25-75) for the two groups was identical, 11.5 +/- 4.9 min (mean +/- SD) for DES group and 11.5 +/- 7.9 min for ISO group (p = NS). CONCLUSION: There were no differences in the dose requirement and recovery indices of mivacurium during either desflurane or isoflurane-based anesthesia. Patients who took longer to recover from the bolus dose in both groups showed a subsequent reduction in dose requirements of mivacurium.

Enzyme polymorphism on the metabolic O-demethylation of dextromethorphan in a South American population.

The polymorphic oxidative metabolism of debrisoquine and sparteine were discovered in the seventies by Mahgoub and Eichelbaum. Since then, many other therapeutic substances were added and one of these drugs is dextromethorphan. The object of this investigation was to ascertain the distribution of the oxidative phenotype of dextromethorphan in the Uruguayan population. The drug and its metabolite, dextrorphan, were quantified in the urine of 165 healthy volunteers by modification of an HPLC method by Chen et al. The metabolic ration was calculated and frequency distribution histograms were drawn. By inspection of the histogram two antimodes can be assigned which determine three sub-populations: on one side the fast extensive metabolizers (n = 30, 18.2%), in the middle the extensive metabolizers (n = 123, 74.5%) and on the other extreme of the histogram the slow metabolizers (n = 12, 7.3%). No other studies have confirmed thus far this trimodal distribution. This research will be continued by genotyping the populations studied in order to confirm these findings and to elucidate the underlying genetic mechanisms of the polymorphism.

Single-dose ritanserin and alcohol in healthy volunteers: a placebo-controlled trial.

A double blind cross-over design trial was carried out to investigate the effect of simultaneous administration of alcohol (0.5 g/kg) and ritanserin (10 mg) on biological and behavioral functioning. Twenty healthy volunteers were selected to participate in the study. To assess the effect of treatments the following evaluations were performed: psychomotor tests, vital signs, intoxication, euphoria, and mood. In addition, ritanserin and alcohol plasma concentration were measured. Psychomotor performance and vital signs during the ritanserin session did not differ significantly from the placebo session. Similar results were obtained in regard to alcohol intoxication, euphoria, and mood, except for tiredness and alertness, which were significantly different compared to placebo. Differences in blood alcohol concentration between the ritanserin and the placebo sessions did not attain significance. Plasma ritanserin concentration was 143 ng/ml 1 h after alcohol administration and decayed to 53 ng/ml 6 h after alcohol consumption in the active treatment session. Our findings tend to indicate that ritanserin neither enhances the central nervous system depressant effect of alcohol nor produces a pharmacokinetic interaction during acute alcohol ingestion.

Medical care at mass gatherings: considerations for physician involvement.

Although many authorities define a "mass gathering" as a group exceeding 1,000 persons, several times that number likely are to be present. The event for which the group will gather may be anything from a rock concert to an Olympic competition. Preparations for the event can be minor or major. This article reviews the issues that a physician should consider if he or she chooses to become involved in the delivery of medical care to such populations, as well as the evidence suggesting that a physician should be involved in most such gatherings. Emergency medical care at public gatherings is haphazard at best and dangerous at worst. There are surprisingly few data from which to plan the emergency medical needs for public events and no recognized standards or guidelines for providing emergency medical services at mass public gatherings.

Cough variant asthma.

In recent years it has become increasingly apparent that cough is frequently the sign of airway hyperreactivity. While the association between cough and wheezing is well recognized in asthmatics, cough may be the only clinical manifestation of this problem. Emergency physicians frequently have occasion to evaluate the coughing patient. Awareness of this clinical entity should facilitate appropriate evaluation, management, and referral of these patients.

Idiopathic priapism treated with inhalation of amyl nitrite.

Presented is a case of idiopathic priapism that was successfully treated with inhalation of amyl nitrite. Routine treatment measures had failed. The same patient presented on several other occasions in a similar fashion. Each time amyl nitrite was successful. An investigation for diseases known to be associated with priapism proved negative. Due to the frequency of recurrences, definitive surgical management was offered. The patient refused and has been lost to follow up.