Linezolid Toxicity: A Clinical Case Report.

Linezolid plays a clinically important role; however, it is responsible for severe pharmacological interactions and side effects, such as myelosuppression, serotonin syndrome, and lactic acidosis. We report a case of an 80-year-old man treated with venlafaxine for depression. He was admitted with a right femur fracture and submitted to surgical intervention, complicated by local infection. In collected pus was identified multiple microorganisms including Enterococcus faecium resistant to vancomycin. The therapeutic was adjusted to linezolid. On the 36th day of treatment, he developed hypertension, poor peripheral perfusion, and generalized tremor. He was disoriented, with marbled skin, myoclonus, and sinus tachycardia; and apyretic, with no signs of respiratory distress or joint/surgical wound inflammatory signs. Blood tests showed hyperlacticemia and discrete elevation of C-reactive protein but in a decrescent trend, with no other relevant alterations. The diagnosis of lactic acidosis and probable serotonin syndrome secondary to linezolid was made, supported by improvement after the drug suspension.

Uncovering a New Family Cluster of Gaucher Disease: A Case Report.

Gaucher disease (GD) is a recessive autosomal lysosomal storage disorder caused by a deficiency in glucocerebrosidase, leading to the accumulation of undigested glycolipids in the lysosomes of monocytes and macrophages. Patients with GD exhibit a spectrum of phenotypic heterogeneity and are broadly classified into three subtypes. Type 1 is the most common and is not associated with neurological damage, while types 2 and 3 are more severe, presenting with acute neuropathic and subacute neuropathic symptoms, respectively. A thorough accurate initial multisystemic assessment is crucial for evaluating the damage to all potentially affected organs and determining the disease burden. This case report highlights the intricacies of GD type 1 by providing a thorough exploration of the clinical presentation and showcasing valuable insights into the unique manifestations of the disease. The key feature was his individual and family medical history, which allowed the identification and treatment of another case within the community.

Hip Pain and Fever During a Nadir Period: Who Came First?

Pyomyositis is a rare bacterial infection of the skeletal muscle that often presents with insidious symptoms, thus making the diagnosis challenging. It is categorized into primary and secondary (usually traumatic) variants, mainly occurring in tropical regions and occasionally in temperate climates, with predisposing factors including immunosuppression. Staphylococcus aureus is the most common pathogen. A 39-year-old woman with a history of breast cancer underwent a mastectomy followed by chemotherapy. After her second chemotherapy cycle, she developed fever, odynophagia, vomiting, and right hip pain (considered to be related to muscle tension due to functional exercises). Fever and hip pain progressively worsened and the other symptoms resolved. On the 12th day after chemotherapy, she received intramuscular diclofenac injections due to severe hip pain. Physical examination revealed tenderness in her right hip and signs of inflammation on her thigh and buttock. Laboratory tests showed elevation of inflammatory markers and mild kidney and liver dysfunction. A CT scan revealed an intramuscular collection in her right gluteal region (~45 x 70 mm), with adjacent fat densification. Attempts to drain the collection initially failed, but a later ultrasound-guided procedure was successful and pus was collected for bacterial culture, which identified methicillin-susceptible Staphylococcus aureus (MSSA). Antibiotic treatment was adjusted to target SA with flucloxacillin and the patient's condition improved. Subsequent imaging showed a resolving collection (<10 mm). The patient continued antibiotic treatment for six weeks, maintaining clinical improvement, normal inflammatory parameters, and apyrexia. Adjuvant chemotherapy was discontinued due to the risk of infection recurrence associated with the multiloculated collection caused by SA. The patient remained asymptomatic four months after hospitalization. An MRI then showed only a residual T2 hyperintensity in the deeper region of the right buttock, with no visible collections. The nadir period refers to the time after each chemotherapy cycle when the risk of neutropenia and subsequent infection is the highest, typically occurring between 7 and 14 days after each cycle. In this case, the intramuscular injection occurred 12 days after the second cycle of chemotherapy. It is most likely that this served as the entry point for the pyomyositis agent (MSSA) during a period of transient neutropenia.

Recovery of Lung Function After 149 Days on Extracorporeal Membrane Oxygenation for COVID-19.

This report highlights survival and the patient's perspective after prolonged venovenous extracorporeal membrane oxygenation (ECMO) for COVID-19-related respiratory failure. A 36-year-old man with COVID-19 presented with fever, anosmia, and hypoxia. After respiratory deterioration necessitating intubation and lung-protective ventilation, he was referred for ECMO. After 3 days of conventional venovenous ECMO, he required multiple creative cannulation configurations. Adequate sedation and recurrent bradycardia were persistent challenges. After 149 consecutive days of ECMO, he recovered native lung function and was weaned from mechanical ventilation. This represents the longest-duration ECMO support in a survivor of COVID-19 yet reported. Necessary strategies included unconventional cannulation and flexible anticoagulation.

Effect of climate change on the water quality of Mediterranean rivers and alternatives to improve its status.

Surface water (SW) quality is particularly vulnerable to increased concentrations of nutrients, and this issue may be exacerbated by climate change. Knowledge of the effects of temperature and rainfall on SW quality is required to take the necessary measures to achieve good SW status in the future. To address this, the aims of this study were threefold: (1) to assess how a changing climate may alter the nitrate, ammonium, phosphorus and biological oxygen demand status (BOD5) of SW; (2) assess the relationship between water quality and flow; and (3) simulate diffuse and point source pollution reduction scenarios in the Júcar River Basin District in the Mediterranean region. A regionalised long-term climate scenario was used following one Representative Concentration Pathway (RCP8.5) with the data incorporated into the coupling of hydrological and water quality models. According to these climate change scenarios, SW with poor nitrate, ammonium, phosphorus and BOD5 status are expected to increase in the future by factors of 1.3, 1.9, 4 and 4, respectively. Furthermore, median ammonium and phosphorus concentration may be doubled in months with low flows. Additional measures are required to maintain current status in the water bodies, and it is necessary to reduce at least 25% of diffuse nitrate pollution, and 50% of point loads of ammonium, phosphorus, and BOD5.

A sex-specific role for the bed nucleus of the stria terminalis in proactive defensive behavior.

The bed nucleus of the stria terminalis (BNST) is a forebrain region implicated in aversive responses to uncertain threat. Much of the work on the role of BNST in defensive behavior has used Pavlovian paradigms in which the subject reacts to aversive stimuli delivered in a pattern determined entirely by the experimenter. Here, we explore the contribution of BNST to a task in which subjects learn a proactive response that prevents the delivery of an aversive outcome. To this end, male and female rats were trained to shuttle during a tone to avoid shock in a standard two-way signaled active avoidance paradigm. Chemogenetic inhibition (hM4Di) of BNST attenuated the expression of the avoidance response in male but not female rats. Inactivation of the neighboring medial septum in males produced no effect on avoidance, demonstrating that our effect was specific to BNST. A follow up study comparing hM4Di inhibition to hM3Dq activation of BNST in males replicated the effect of inhibition and demonstrated that activation of BNST extended the period of tone-evoked shuttling. These data support the novel conclusion that BNST mediates two-way avoidance behavior in male rats and suggest the intriguing possibility that the systems underlying proactive defensive behavior are sex-specific.

Redução da taxa de filtração glomerular em pacientes críticos em uso de vancomicina: um estudo transversal / Decrease of the glomerular filtration rate in critically ill patients using vancomycin: a cross-sectional study

Objetivo: o presente trabalho teve como objetivo avaliar os fatores clínicos e medicamentosos relacionados com a redução da Taxa de Filtração Glomerular (TFG) em pacientes críticos em uso de vancomicina. Métodos: trata-se de um estudo transversal em que pacientes em uso de vancomicina, maiores de 18 anos, hospitalizados em terapia intensiva, foram selecionados no período de agosto a dezembro de 2019. Foram excluídos os pacientes que tiveram permanência inferior a 48h na unidade, aqueles com doença renal crônica e/ou que tiveram antimicrobiano suspenso nas primeiras 48h. Os dados clínicos e laboratoriais foram coletados do prontuário nas mesmas datas das coletas de amostras sanguíneas. As amostras de sangue foram coletadas no vale a partir do terceiro dia de tratamento. Os níveis de vancomicina foram medidos usando VANC VITROS ®. Os dados foram analisados através do software R. Resultados: 54 pacientes foram incluídos, sendo 68,5% do sexo masculino, 98,1% em ventilação mecânica, com foco respiratório (51,2%) e isolado Acinetobacter baumanni (38,0%). As concentrações de vancomicina variaram entre 5,0 e 50,0µg/mL, média 21,6 (DP: 10,6) µg/mL; 50% dos pacientes apresentaram concentração acima de 20µg/mL e 66,7% piora da TFG após o tratamento. A concentração de vancomicina foi a única variável diretamente relacionada com o desenvolvimento da alteração na função renal (p=0.0037). Não foi possível estabelecer a influência da comedicação na redução da taxa de filtração glomerular (TFG). Conclusão: as doses usuais de vancomicina ajustadas por meio da função renal não atingiram os níveis séricos terapêuticos recomendados de vancomicina, sendo relacionados à nefrotoxicidade.

Objective: we aimed to evaluate clinical and drug factors related to the Glomerular Filtration Rate (GFR) reduction in critically ill patients using vancomycin. Methods: This is a cross-sectional study where critically ill patients using vancomycin, aged over 18 years, were selected from August to December 2019. Patients were excluded when hospitalized for less than 48 hours in the unit, those with chronic kidney disease, and/or who had their antimicrobial suspended in the first 48 hours. Clinical and laboratory data were collected from the medical record on the same days as the blood sample collection. All blood samples were collected at the trough during the third day of vancomycin treatment. Vancomycin levels were measured using VANC VITROS ®. Data analysis was analyzed by R software. Results: 54 patients were included, 68.5% male, 98.1% mechanical ventilation, respiratory focus (51.2%), and isolation of Acinetobacter baumanni (38.0%). Vancomycin concentrations ranged between 5.0 and 50.0µg/mL, mean of 21.6 (SD: 10.6) µg/mL; 50% of patients with concentrations above 20µg/mL and 66.7% worsened GFR after vancomycin treatment. Vancomycin concentration was the only variable directly related to the development of renal malfunction (p=0.0037). It was not possible to establish the influence of co-medication in the reduction of the glomerular filtration rate (GFR). Conclusion: the usual doses of vancomycin adjusted by renal function did not reach the recommended therapeutic serum levels of vancomycin, being related to nephrotoxicity.

Effects of human milk on body composition and growth in very low birthweight infants.

OBJECTIVE: To compare body composition and growth in very low birthweight infants according to their source of human milk: maternal expressed breast milk (MEBM) versus donor breast milk (DBM). We hypothesized that infants fed predominately MEBM would exhibit reduced body fat percentage compared to those fed predominately DBM. METHODS: Premature infants weighing ≤1500 g on an exclusive human milk diet were enrolled in a single-center study between 2017 and 2021. Demographic data and anthropometric measurements were collected. All infants underwent body composition analysis via dual energy x-ray absorptiometry at 36 weeks corrected post menstrual age. RESULTS: A total of 60 infants were enrolled and 48 were included in the primary analysis. No differences were detected in percent body fat (14 vs. 12%, p = 0.7) or fat-free mass (2050 vs. 2130 g, p = 0.7). Both groups displayed similar growth and anthropometric measurements. Caloric and macronutrient intake between groups was similar. CONCLUSION: In the cohort of patients studied, no differences were observed in percent body fat based on primary human milk type intake in the first 28 postnatal days. Further investigation is required in a larger population of exclusive human milk fed preterm infants to determine if body composition differences exist based on an infant's primary human milk source. IMPACT: Premature infants are at risk for altered body composition at term corrected age, specifically increased body fat percentage, which may have implications for the future. To our knowledge this is the first study exploring body composition outcomes based on an infant's primary human milk source. Infants fed exclusive human milk (e.g., donor vs. maternal) displayed similar percent body fat and growth outcomes.

Diabetes mellitus, COVID-19, modelos educativos en salud. Importancia del autocuidado

Introducción : El primer trimestre de 2020 se ha visto influenciado por la propagación de una pandemia ocasionada por el virus SARS-CoV-2, el cual origina una afección (COVID-19), la diabetes mellitus es una de las enfermedades que cuando este se padece causa complicaciones y mortalidad. Objetivo : Identificar la relación existente entre la importancia de la educación para la diabetes mellitus y la COVID-19. Métodos : Se realizó una revisión con el método de análisis bibliográfico a través de una búsqueda realizada entre los años 2006 al 2021, donde se consultaron bases de datos especializadas y se seleccionaron 27 publicaciones científicas sobre el tema. Resultados : La educación, el autocuidado y los modelos educativos son importantes. En la diabetes, los cambios en los estilos de vida son esenciales: realizar actividad física, buenos hábitos alimentarios y evitar comportamientos poco saludables, pues son algunos de los factores que propician la enfermedad. Las recomendaciones estándar dictadas por la OMS para prevenir la propagación de la infección COVID-19 incluyen: lavarse las manos de manera regular, especialmente después del contacto con personas enfermas o su entorno, cubrirse la boca y la nariz al toser y estornudar, cocinar bien la carne y los huevos, evitar el contacto cercano con cualquier persona que presente síntomas de enfermedades respiratorias, evitar viajar a las ciudades y áreas afectadas. En el caso de los viajeros con síntomas de infección respiratoria aguda, deben practicar la etiqueta de la tos, ambas enfermedades se pueden prevenir. Conclusiones : Tanto en la diabetes como en la COVID-19 la educación es esencial para prevenirla, de ahí la importancia de velar por la salud y fomentar una cultura educativa basada en el autocuidado.

Introduction: The first quarter of 2020 has been influenced by the spread of a pandemic caused by the SARS-CoV-2 virus, which causes a condition (COVID-19), diabetes mellitus is one of the diseases that causes complications and mortality when a patient suffers COVID-19. Objective: To identify the relationship between the importance of education for diabetes mellitus and COVID-19. Methods: A bibliographic review was carried out with the bibliographic analysis method through a search carried out between the years 2006 and 2021, where specialized databases were consulted and 27 scientific publications on the subject were selected. Results: Education, self-care and educational models are important. In diabetes, changes in lifestyles are essential: physical activity, good eating habits and avoiding unhealthy behaviors, as they are some of the factors that promote diabetes. The standard recommendations issued by the WHO to prevent the spread of the COVID-19 infection include: regular hand washing, especially after contact with sick people or their surroundings, covering the mouth and nose when coughing and sneezing, cooking well meat and eggs, avoid close contact with anyone showing symptoms of respiratory illness, avoid traveling to affected cities and areas. In the case of travelers with symptoms of acute respiratory infection, they should practice cough etiquette, both diseases can be prevented. Conclusions: In both diabetes and COVID-19, education is essential to prevent it, hence the importance of ensuring health and promoting an educational culture based on self-care.

Unicentric Castleman Disease and Pheochromocytoma.

Castleman disease is an uncommon and heterogenous lymphoproliferative disorder which is classified as unicentric or multicentric depending on the number of lymph nodes involved. Each type has a different clinical presentation, aetiology, treatment and prognosis. We report the case of a young woman who presented with cervical lymphadenopathy and a retroperitoneal mass, and was diagnosed with unicentric Castleman disease and pheochromocytoma. We describe the diagnostic steps, the complications that developed, and the importance of the differential diagnosis in the evaluation of these patients. LEARNING POINTS: Castleman disease in an uncommon disease and should be considered in all patients with adenomegalies and systemic symptoms.Pheochromocytoma should not be overlooked in the differential diagnosis of a retroperitoneal mass.It is important that doctors consider these two diagnoses in patients with adenomegalies and a retroperitoneal mass due to the potential harmful impact of a missed diagnosis.

Muscular Dystrophy and Heart Failure: An Unusual Association.

Type one muscular dystrophy (DM1) is the most common inherited muscular dystrophy in the adult population. Typically, DM1 presents as myotonia, muscle weakness, cataracts, and cardiac abnormalities, mainly in the conduction system. Although left ventricular dysfunction is not the most common manifestation of DM1, it can be seen with disease progression. The presentation of DM1 as a de novo heart failure is unusual, making its diagnosis a clinical challenge.

Esophageal Gastrointestinal Stromal Tumor with Rare Intracranial Metastasis.

Introduction. Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors and constitute the largest group of nonepithelial digestive neoplasms. However, they do not represent more than 1% of primary digestive tumors. They commonly metastasize to the liver and peritoneum, but brain metastases are extremely rare. Clinical Case. A 76-year-old woman with a diagnosis of esophageal GIST with liver and lung metastases for 13 years, medicated with imatinib, is presented. She was brought to the emergency department after falling and due to changes in behavior and vertigo with 24 hours of evolution. On physical examination, she presented changes in behavior, dysarthria, dysmetria on the right, gait imbalance, and no motor or sensory deficits. On brain computed tomography and posteriorly on magnetic resonance, 2 lesions were observed, left frontal and right cerebellar, compatible with metastatic lesions. After contribution of neurosurgery, histology was obtained that confirmed the lesions were GIST metastases. Imatinib was maintained, and whole brain radiotherapy was performed. After 6 months, she died. Discussion. The rarity of GIST brain metastases is noteworthy, and because of that, there is not enough experience to be certain of the best treatment. Our patient lived for 13 years with excellent disease control with imatinib, but the fact that it does not cross the blood-brain barrier makes it not useful in preventing or treating brain lesions. New tyrosine kinase inhibitors that may cross the blood-brain barrier could be the answer to these cases.

Propuesta de un plan de comunicación en salud dirigido a adultos mayores diabéticos tipo 2 / Proposal for a health communication plan for older adults with type 2 diabetes

RESUMEN Fundamento: la comunicación en salud ha demostrado ser de vital importancia para conseguir cambios en los comportamientos individuales y sociales de las personas. Objetivo: diseñar un plan de comunicación en salud dirigido a adultos mayores con diabetes mellitus. Métodos: se realizó una investigación de desarrollo tecnológico, se emplearon métodos del nivel teórico y del nivel empírico, en el Policlínico Universitario Hermanos Cruz de Pinar del Río, en el segundo trimestre de 2018. Resultados: se realizó el diagnóstico de la situación, se establecieron los comportamientos adecuados que debía seguir la audiencia, se formularon los objetivos de conocimiento y comportamientos adecuados, e igual se realizó la definición de los mecanismos de monitoreo y evaluación. Conclusiones: se elaboró y propuso un plan de comunicación en salud dirigido a adultos mayores con diabetes mellitus, se tuvieron en cuenta los objetivos de conocimiento y comportamientos adecuados, y se ofrece la importancia del mismo para la educación a adultos mayores con diabetes mellitus. El eslogan de los mensajes permite cumplir con el objetivo comportamental y de conocimiento que posee el mismo a partir de las actividades propuestas.

ABSTRACT Background: health communication has shown to be of vital importance to achieve changes in the individual and social behaviors of people. Objective: to design a health communication plan aimed at older adults with diabetes mellitus. Methods: a technological development investigation was carried out, methods of the theoretical level and empirical level were used, in the Hermanos Cruz University Polyclinic of Pinar del Río, in the second quarter of 2018. Results: the diagnosis of the situation was made, the appropriate behaviors to be followed by the audience were established, the objectives of knowledge and appropriate behaviors were formulated and the definition of monitoring and evaluation mechanisms was also made. Conclusions: a health communication plan was developed and proposed for older adults with diabetes mellitus, taking into account the objectives of knowledge and appropriate behavior, and its importance is offered for the education of older adults with diabetes mellitus. The slogan of the messages allows to fulfill the behavioral and knowledge objective that it has from the proposed activities.

Guía para evaluar protocolo y uso del Heberprot-P® en el nivel primario de atención / Guide to evaluate protocol and use of Heberprot-P ® at the primary level of care

RESUMEN Fundamento: la evaluación de programas aplicados es importante, como medida para comprobar la eficacia, efectividad, utilidad, eficiencia y seguridad, así como el costo-beneficio de una nueva o mejorada tecnología o servicio de salud, además del impacto. Objetivo: brindar una herramienta para la evaluación del protocolo a seguir en pacientes con úlcera del pie diabético y uso del Heberprot-P® en el nivel primario de atención. Métodos: se realizó una investigación en sistemas y servicios de salud de desarrollo tecnológico, que permitió la creación de una guía para expresar juicios de valor a partir de la comparación de los resultados alcanzados con estándares establecidos. Se estudiaron la disponibilidad del protocolo, existencia de materiales educativos sobre el uso del Heberprot-P®. Para el proceso, se propuso evaluar las principales actividades realizadas por los recursos humanos encargados. Para operacionalizar criterios, indicadores y estándares se contó con la colaboración de expertos. Resultados: la guía propuesta constó de 35 criterios e indicadores para evaluar las diferentes dimensiones. Se tuvieron en cuenta las enfermeras(os), podólogas(os) disponibles para ejecutar el programa, la capacitación de estos, la opinión de trabajadores y pacientes por los servicios recibidos y otros indicadores como: diagnóstico correcto, tratamiento oportuno, articulación necesaria para una atención multidisciplinaria, atención inmediata, disminución de estadía y costos hospitalarios, disminución de la tasa y el nivel de las amputaciones. Conclusiones: esta guía contribuirá a evaluar la ejecución del protocolo a seguir y, por tanto, a identificar las brechas entre lo deseado y lo observado.

ABSTRACT Background: the evaluation of applied programs is important, as a measure to check the effectiveness, utility, efficiency and safety, as well as the cost-benefit of a new or improved technology or health service, in addition to the impact. Objective: to provide a tool for the evaluation of the protocol to be followed in patients with diabetic foot ulcer and the use of Heberprot-P® at the primary care level. Methods: a research on systems and health services of technological development was carried out, which allowed the creation of a guide to express value judgments based on the comparison of the results achieved with established standards. It was studied the availability of the protocol existence of educational materials on the use of Heberprot-P®. For the process, it was proposed to evaluate the main activities carried out by the human resources in charge. In order to operationalize criteria, indicators and standards, experts collaborated. Results: the proposed guide consisted of 35 criteria and indicators to evaluate the different dimensions. The nurses, podiatrists available to execute the program, the training of these, the opinion of workers and patients for the services received and other indicators such as, correct diagnosis, timely treatment, articulation necessary for a multidisciplinary care, immediate attention, decreased stay and hospital costs, decrease in the rate and level of amputations. Conclusions: this guide will help to evaluate the execution of the protocol to be followed and, therefore, to identify the gaps between the desired and the observed.

Caracterización clínica de pacientes fallecidos por enfermedad cerebrovascular / Clinical Characterization of Patients who Died due to Cerebrovascular Disease

RESUMEN Fundamento: las enfermedades cerebrovasculares constituyen la tercera causa de muerte en el mundo y una de las principales responsables de discapacidad y minusvalía en el adulto. Objetivo: describir las principales características clínicas en fallecidos por enfermedad cerebrovascular en el Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos. Métodos: se realizó un estudio descriptivo, transversal. El universo estuvo conformado por 517 pacientes fallecidos con diagnóstico de enfermedad cerebrovascular en el período comprendido entre el 1 de enero 2014 y el 31 de diciembre 2016 en Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos. Se consideraron como variables: edad, sexo, tipo y forma de presentación de la enfermedad cerebrovascular focal, estadía hospitalaria, patologías asociadas y año de defunción. Se obtuvieron los resultados en frecuencias absolutas y porcientos. Resultados: el 31,1 % de los fallecidos se halló entre los 80-89 años. Predominó el sexo masculino en un 55,3 %. El ictus de tipo isquémico representó el 62,5 %, fue la forma aterotrombótica la más frecuente con un 31,9 %. El 2015 fue el año con mayor número de defunciones con 186. El 75,2 % de las muertes se registró en los primeros 7 días de estadía hospitalaria. La principal patología asociada fue la hipertensión arterial (34,6 %). Conclusiones: la mortalidad por enfermedad cerebrovascular se presentó principalmente en pacientes de edades avanzadas, varones e hipertensos. Predominó la etiología isquémica. La mayoría de los pacientes que fallecieron lo hicieron en la primera semana de estadía hospitalaria.

ABSTRACT Foundation: cerebrovascular diseases are the third cause of death in the world and one of the main causes of disability in the adult. Objective: to describe the main clinical characteristics of deceased patients due to cerebrovascular disease at the Dr. Gustavo Aldereguía Lima General Hospital in Cienfuegos. Methods: a descriptive, cross-sectional study was conducted between January 1, 2014 and December 31, 2016 in the General University Hospital Gustavo Aldereguía Lima de Cienfuegos. The universe consisted of 517 deceased patients with a diagnosis of cerebrovascular disease in the period and the variables considered were: age, sex, type and form of presentation of focal cerebrovascular disease, hospital stay, associated pathologies and year of death. The results were obtained in absolute and percent frequencies. Results: from the deceased 31.1 % of were between 80-89 years old. Male sex predominated in 55.3 %. Stroke of the ischemic type represented 62.5 %, the athero-thrombotic form was the most frequent with 31.9 %. The year 2015 had the highest number of deaths with 186. The first 7 days of hospital stay recorded 75.2 % of deaths. The main associated pathology was hypertension (34.6 %). Conclusions: mortality from cerebrovascular disease. Most patients who died did so in the first week of hospital stay.

Binary and ternary complexes of norfloxacin to improve the solubility of the active pharmaceutical ingredient.

AIM: Binary and ternary complexes with hydroxypropyl-ß-cyclodextrin (HPßCD), using glutamic acid (GA), proline or lysine as the third component, were developed to increase the solubility and the dissolution rate of norfloxacin (NOR). METHODS/RESULTS: Complexation was evaluated by phase solubility studies, obtaining the highest NOR solubility with GA and HPßCD. Thermal analysis suggested that different kinds of interactions occur among NOR, HPßCD and each amino acid, and when the systems were prepared by kneading or by means of freeze-drying technique. Dissolution studies, performed on simulated gastric fluid and subsequent simulated intestinal fluid, showed the highest rate of NOR from NOR-HPßCD-GA. CONCLUSION: NOR:HPßCD:GA was the best approach for improving the bioavailability of NOR.