Baseline CD4+ T-cell counts predict HBV viral kinetics to adefovir treatment in lamivudine-resistant HBV-infected patients with or without HIV infection.

BACKGROUND: Coinfection with HIV and hepatitis B virus (HBV) substantially alters the course of HBV. Directly acting anti-HBV agents suppress HBV viral levels; however, the kinetics of HBV decline in mono- and coinfected persons have not been evaluated. We investigated the role of baseline CD4+ T-cell counts as a predictor of HBV response to adefovir (ADV) therapy in chronic HBV with and without HIV coinfection. METHODS: We conducted a double-blind, randomized, placebo-controlled study of HIV-infected (n = 12) and uninfected (n = 5) chronic HBV patients treated with ADV. Five HIV uninfected patients received ADV; the HIV+ patients received ADV or placebo for a total of 48 weeks. At the end of 48 weeks, all patients received open-label ADV for an additional 48 weeks. HBV, HIV viral loads, CD4+ T-cell counts, and safety labs were performed on days 0, 1, 3, 5, 7, 10, 14, and 28 and then every 4 weeks. RESULTS: Lower HBV slopes were observed among coinfected compared to monoinfected patients (P = .027 at 4 weeks, P = .019 at 24 weeks, and P = .045 at 48 weeks). Using a mixed model analysis, we found a significant difference between the slopes of the 2 groups at 48 weeks (P = .045). Baseline CD4+ T-cell count was the only independent predictor of HBV decline in all patients. CONCLUSION: HIV coinfection is associated with slower HBV response to ADV. Baseline CD4+ T-cell count and not IL28B genotype is an independent predictor of HBV decline in all patients, emphasizing the role of immune status on clearance of HBV.

Pharmacokinetic disposition of triclabendazole in cattle and sheep; discrimination of the order and the rate of the absorption process of its active metabolite triclabendazole sulfoxide.

A comparative pharmacokinetic study was conducted to determine the order and the rate of absorption of triclabendazole (TCBZ) in cattle and sheep. A commercial suspension of TCBZ (Biofasiolex, Biogénesis S.A., Argentina) was administered at a dose rate of 10 mg/kg by the oral route to six Holstein female calves and six Corriedale female sheep. The plasma concentration profiles of the metabolites triclabendazole sulfoxide (TCBZ-SO) and triclabendazole sulfone (TCBZ-SO(2)) were analysed by means of the non-compartmental method. The order of the absorption process of the active metabolite, TCBZ-SO, was determined by construction of curves of cumulative absorbed fraction of the drug by means of the Wagner-Nelson method. The appearance of TCBZ-SO in plasma of cattle and sheep resembles the entry of a constant quantity of drug into the organism per unit time. This is explained by the reservoir effect of the rumen, which acts as a biological slow-release system for TCBZ-SO and its precursor TCBZ to the posterior digestive tract where they are absorbed. The plasma concentration profiles of TCBZ-SO in both species were well described by a one-compartment open model with zero-order process of absorption and first-order process of elimination. The values of AUC(0-infinity) and C(max) of TCBZ-SO did not differ between species, while other kinetic parameters except for lambda(z) had higher values in calves than in sheep. In the case of TCBZ-SO(2), t(max) was the only parameter that did not differ between species, while other kinetic parameters except for lambda(z) had higher values in calves than in sheep.

Pharmacokinetics of ricobendazole after its intravenous, intraruminal and subcutaneous administration in sheep.

Ricobendazole (RBZ) was administered in sheep at the dose rate of 5 mg/kg by intravenous (i.v.) route as a 10% experimental solution, by the intraruminal (i.r.) route as a 10% experimental suspension, and by the subcutaneous (s.c.) route as a 10% commercial formulation available in Argentina. Blood samples were drawn during a 60 h period. Plasma concentrations of RBZ and its inactive metabolite albendazole sulphone (ABZSO2) were determined by high-performance liquid chromatography. The pharmacokinetic parameters were determined by compartmental analysis. The fitting of the data was done by weighted least-squares non-linear regression analysis. The pharmacokinetic parameters were estimated for every animal by simultaneous fitting of the plasma concentrations profiles of RBZ obtained after its administration by the three routes. The kinetic analysis of ABZSO2 was performed by a statistical moment approach. Ricobendazole bioavailability was poor after i.r. administration, whereas high and sustained plasma concentrations and higher bioavailability were obtained after s.c. administration. A simple two-compartment open model explains in a mechanical sense the pharmacokinetic behaviour of RBZ in sheep and allows us to estimate the real first-order constant rate of absorption and the loss of drug from the absorption site after its administration by s.c. and i.r. routes.

In vitro evaluation of synergistic activity between ciprofloxacin and broad snouted caiman serum against Escherichia coli.

The in vitro synergistic activity between ciprofloxacin and serum of broad snouted caiman on Escherichia coli was studied. The estimated MIC value of ciprofloxacin was 0.0188 µg/ml, and two assays of kill curve during 5 hours were performed: the first one in a standard culture medium and the second one in the presence of caiman serum. Different concentrations of ciprofloxacin were tested. Ciprofloxacin showed higher values of bacterial elimination rate in the presence of caiman serum in all concentrations tested. The combined activity of sub-inhibitory concentrations of ciprofloxacin and the humoral immune factors present in caiman serum determined an increase in the bacterial elimination observed in this assay. We suggest that the antibacterial activity of complement and natural antibodies present in caiman serum, which can bind to both Gram-negative and Gram-positive bacteria and acting through the classical complement pathway, can inhibit bacterial growth of Escherichia coli by lysis.

Transient hemiballismus and subclavian steal syndrome. Case report.

Transient hemiballismus was observed in a 74-year-old man, displaying subclavian steal syndrome. Such a correlation has not been previously reported in the literature. In this case, transient hemiballismus seemed to depend on hemodynamic factors, but other mechanisms possibly explaining early recovery of the hyperkinesias are discussed. In particular, stress is laid upon the role of preexisting pathological changes of the central nervous system (diffuse cerebral atrophy) associated to the "releasing" lesion.

[Keratodermic genodermatosis with hydrocystomas, miliary cysts, xanthelasmas, nail and dental dystrophies, and basal cell epitheliomas]. / Genodermatosis queratodérmica con hidrocistomas, quistes de milium, xantelasmas, distrofias dentarias y ungulares y epiteliomas basocelulares.

Two cases of a condition including palms and soles keratoderma, ectodermal dysplasias and basal cell epitheliomas are reported by the authors, with clinical, genetical and pathological data. The condition is called Keratodermal Genodermatose with hydrocystomas, milium cysts, xanthelasma, dental and nail dysplasias and basal cell epitheliomata (Borda's syndrome).

[Scleroatrophying and degenerative keratodermic genodermatosis of the extremities]. / Genodermatosis escleroatrofiante y queratodérmica de las extremidades frequentemente degenerativa.

A case of a picture described by Huriez et al. under the title of scleatrophying and keratodermic genodermatosis of the limbs usually degenerative is presented. In the genealogic study it was observed that seven out of the sixteen members that belonged to this primary family group were affected or probably affected and it is stressed that one of them died from metastasis of spinocellular epithelioma.

Propuesta de una dosis de marbofloxacina para el tratamiento de infecciones asociadas a Escherichia coli en cabras de tres semanas de vida

Se estimó una dosis de marbofloxacina (MFX) para tratar infecciones gastrointestinales asociadas a Escherichia coli en cabras de tres semanas de vida. La farmacodinamia de MFX sobre E. coli se evaluó in vitro estimando las concentraciones inhibitoria mínima (CIM), bactericida mínima (CBM) y preventiva de mutantes (CPM). Marbofloxacina se administró en cabras de tres semanas de edad por vía subcutánea a una dosis de 2 mg/kg. Los parámetros farmacocinéticos se estimaron mediante análisis no compartimental. La dosis de MFX capaz de proteger al 95% de una población se calculó considerando la distribución poblacional de los parámetros farmacocinéticos. La eficacia de MFX se evaluó con la relación entre el área bajo la curva y la CPM (ABC/CPM) con un valor de corte de 22 h. Los resultados mostraron que la dosis estimada de MFX para alcanzar la remisión clínica de infecciones gastrointestinales causadas por E. coli y prevenir la emergencia de cepas resistentes en el 95% de una población de cabras de tres semanas de vida fue de 3,179 mg/kg, que a los fines prácticos se fijó en 3,5 mg/kg.

A dose of marbofloxacin (MFX) to treat gastrointestinal infections caused by Escherichia coli in 3-week-old goats was estimated. The pharmacodynamics of MFX against E. coli was evaluated in vitro by estimation of mínimum inhibitory concentration (MIC), mínimum bactericide concentration (MBC) and mutant prevention concentration (MPC). Marbofloxacin was administered to 3-week -old goats by subcutaneous route at the dose of 2 mg/kg. The pharmacokinetic parameters were estimated by non-compartmental analysis. The dose of MFX capable to protect the 95% of population was calculated considering the population distribution of pharmacokinetic parameters. The efficacy of MFX was evaluated by the relationship between the area under curve and MPC (AUC/MPC) with a cut-off value of 22 h. The results showed that the estimated dose of MFX to reach the clinical outcome of gastrointestinal infections caused by E. coli and to prevent the bacterial resistance at the 95% of the population of 3-week-old goats was 3.179 mg/kg, which for practical reasons was fixed at 3.5 mg/kg.

Actividad bactericida in vitro de miel sobre Escherichia coli y Staphylococcus aureus: Comparación con la actividad de cefalosporinas

Se realizó un estudio comparativo entre la actividad antibacteriana de miel y cefalexina sobre una cepa de Escherichia coli y de miel y cefquinoma sobre una cepa de Staphylococcus aureus mediante ensayos de curva de muerte modificada. En todos los ensayos, la máxima actividad antibacteriana de la miel se observó a una dilución del 50% v/v. Respecto de la eficacia comparativa entre la miel y los antibióticos, se observó que sobre E. coli, cefalexina logró una reducción del conteo de bacterias viables compatible con un efecto bactericida (< 500 ufc/mL), mientras que la miel no logró superar este punto de corte. Lo opuesto se observó para S. aureus, donde la miel logró una reducción del conteo de bacterias viables compatible con un efecto de erradicación bacteriana (< 50 ufc/mL) respecto del efecto bactericida obtenido con cefquinoma (< 500 ufc/mL). Estos resultados preliminares, corroboran la necesidad de revalorar la actividad antibacteriana de productos naturales, cuya eficacia -aunque de manera empírica- ya era conocida desde la antigüedad y que fuera olvidada a partir de la aparición de los antibióticos.

A comparative study was conducted between the antibacterial activity of honey and cephalexin against a strain of Escherichia coli and honey and cefquinome against a strain of Staphylococcus aureus by modified time-kill-curves essays. In all trials, the maximum antibacterial activity of honey was observed at a dilution of 50% v/v. Regarding the comparative efficacy between honey and antibiotics, it was observed that against E. coli, cephalexin achieved a reduction in viable bacteria count compatible with a bactericidal effect (<500 cfu/mL), while honey did not overcome this breakpoint. The opposite was observed for S. aureus, where honey achieved a reduction in the viable bacteria count compatible with a bacterial eradication effect (<50 cfu/mL) with respect to the bactericidal effect obtained with cefquinome (<500 cfu/mL). These preliminary results corroborate the need to revalue the antibacterial activity of natural products, whose efficacy - although empirically - was already known since antiquity and was forgotten after the appearance of antibiotics.

Efecto de la persistencia bacteriana sobre la eficacia de la enrofloxacina y ciprofloxacina frente a una cepa de Escherichia coli

En este trabajo se evaluó el efecto de las bacterias persistentes presentes en un inóculo de alta densidad de una cepa autóctona de Escherichia coli sobre la eficacia de enrofloxacina y ciprofloxacina mediante ensayos in vitro de curvas de muerte bacteriana y de determinación de la concentración preventiva de mutantes. En las curvas de muerte realizadas sobre inóculos de alta densidad, ningún antibiótico presentó actividad bactericida y solo permitieron la sobrevida de bacterias persistentes. En el ensayo para determinar la concentración preventiva de mutantes, sobre la superficie del agar de las placas con elevadas concentraciones de enrofloxacina y ciprofloxacina, las bacterias persistentes permanecieron viables sin desarrollar colonias y adoptando morfología filamentosa como una forma de adaptación y supervivencia. Se discute la utilidad clínica de las concentraciones preventivas de mutantes de enrofloxacina y ciprofloxacina sobre E. coli ya que, estas elevadas concentraciones permitirían la sobrevida de una sub-población de bacterias persistentes originando un reservorio biológico que podría dar origen a infecciones crónicas y a favorecer la emergencia de mutantes resistentes.

This work evaluated the effect of persister cells present in a high inocula size of a wild strain of Escherichia coli on the efficacy of enrofloxacin and ciprofloxacin by in vitro time-kill curve assays and mutant prevention concentration testing. In time-kill curves performed with high inocula size, no antibiotics showed bactericidal activity, but only allowed the survival of persister cells. In the assay to determine the mutant prevention concentration, on the surface of agar plates containing high enrofloxacin and ciprofloxacin concentrations, persister cells remained viable and without bacterial colonies development and adopting filamentous morphology as a form of adaptation and survival. The clinical usefulness of mutant prevention concentrations of enrofloxacin and ciproflocxacin against Escherichia coli is discussed, as these high concentrations would allow the survival of a sub-population of persister cells originating a biological reservoir that could give rise to chronic infections and favor the emergence of resistant mutants.

Caracterización y comparación de la actividad antibacteriana intrínseca del suero de búfalo y del suero de bovino

La actividad antibacteriana de los sueros de bovino y de búfalo fue evaluada in vitro de manera indirecta con dos reacciones de inmunohemólisis: (i) un ensayo de hemólisis-hemoaglutinación sobre eritrocitos no sensibilizados de conejo y (ii) un ensayo de cinética de eritrocitos no sensibilizados de conejo frente a concentraciones crecientes de suero. La actividad bactericida de los sueros fue evaluada in vitro cuantificando la reducción de desarrollo de un inóculo de Escherichia coli en medio de cultivo enriquecido con suero de ambas especies. En el ensayo de hemólisis-hemoaglutinación, la hemólisis máxima se observó hasta la dilución 1:16 del suero de ambas especies. El mayor porcentaje de hemólisis se obtuvo con el suero de búfalo (84,7 ± 9,71%) respecto del suero bovino (71,0 ± 5,05%). Sin embargo no se hallaron diferencias en las diluciones de suero necesarias para obtener el 50% de la hemólisis total, siendo estas de 10,2 ± 2,48 para el suero de bovinos y de 11,8 ± 2,18 para el suero de búfalo. El suero de búfalo redujo el desarrollo bacteriano en un 69,8% respecto del 47,2% obtenido por el suero de bovino. No obstante estos resultados, se necesitarán estudios adicionales para corroborar estos hallazgos in vivo.

The antibacterial activity of serum of bovine and buffaloes was evaluated in vitro indirectly by two immunohemolysis assays: (i) an unsensitized rabbit blood cells hemolysis-hemagglutination assay and (ii) and a hemolytic-kinetic of unsensitized rabbit blood cells in function of increasing serum concentrations. The serum bactericidal activity was evaluated in vitro by quantifying the reduction of the development of an Escherichia coli inoculum in a culture medium enriched with serum of both species. In the hemolysis-hemagglutination assay, the máximum haemolysis was observed until a 1:16 serum dilution for both species. The highest percentage of hemolysis was obtained with buffalo serum (84.7 ± 9.71%) with respect to bovine serum (71.0 ± 5.05%). However, no differences were found in the serum dilutions necessary to obtain 50% of the total hemolysis, being these 10.2 ± 2.48 for the serum of cattle and 11.8 ± 2.18 for the serum of buffalo. Buffalo serum reduced bacterial growth by 69.8% compared to 47.2% obtained by bovine serum. Despite these results, additional studies will be needed to corroborate these findings in vivo.

Actividad antibacteriana in vitro de Ciprofloxacina sobre una cepa autóctona de Escherichia coli: efecto del pH sobre su potencia y efecto de la persistencia bacteriana sobre su modo de acción

En este trabajo se evaluó in vitro: (i) el efecto del pH sobre la actividad bactericida de ciprofloxacina (CFX) frente a una cepa autóctona de Escherichia coli y (ii) el efecto de las bacterias persistentes sobre el modo de acción concentración dependiente de CFX. La actividad antibacteriana de CFX disminuyó a causa del descenso del pH, por lo que los valores de concentración inhibitoria mínima (CIM), concentración bactericida mínima (CBM) y concentración de erradicación bacteriana mínima (CEBM) se incrementaron cuando el pH del medio de cultivo descendió de 7,4 a valores de 6,5 y 5,5. La cinética de eliminación bacteriana de CFX fue bifásica a causa de la selección de una sub-población de bacterias persistentes que presentaron una velocidad de eliminación más lenta. Por lo tanto la actividad bactericida de CFX fue definida por su concentración en relación a la CIM y el tiempo durante el cual se mantuvo la exposición de las bacterias a ésta.

In this in vitro assay was evaluated: (i) the effect of pH on the bactericidal activity of ciprofloxacin (CFX) against a native strain of Escherichia coli, (ii) the effect of persister bacteria on the concentration-dependent mode of action of CFX. The antibacterial activity of CFX decreased with reductions of pH, so the values of minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) and minimum eradication bacterial concentration (MEBC) were increased when the pH of the culture medium decreased from 7.4 to 6.5 and 5.5. The kinetics of bacterial elimination of CFX presented a biphasic pattern because of the selection of a sub-population of persistent bacteria which presented a slower elimination rate. Therefore, the antibacterial activity of CFX was determined by its concentration in reference to MIC values and the time during which the exposure of the bacteria was maintained.

Cytochrome P450 2B6 (CYP2B6) G516T influences nevirapine plasma concentrations in HIV-infected patients in Uganda.

OBJECTIVES: Polymorphisms in the cytochrome P450 (CYP) 2B6 gene have been shown to influence nevirapine plasma concentrations in HIV-infected European Caucasians. Although nevirapine is used extensively in Africa, the influence of CYP2B6 genotype on nevirapine exposure has not been assessed in this population. We aimed to determine the influence of CYP2B6 genotype at position 516 on nevirapine trough concentrations in HIV-infected patients in Kampala, Uganda. Additional polymorphisms in the CYP and multidrug resistance protein-1 (MDR-1) genes were also assessed for their impact on nevirapine concentrations. METHODS: The following genotypes were determined in all subjects using polymerase chain reaction-restriction fragment length polymorphism: CYP2B6 G516T, MDR-1 C3435T and G2677T, CYP3A4(*)1B and CYP3A5(*)3. Nevirapine plasma concentrations were determined using high-performance liquid chromatography in 23 HIV-infected patients who were generally healthy and had been taking nevirapine 200 mg twice daily for at least 14 days. Analysis of variance with post hoc testing was used to compare nevirapine concentrations among CYP2B6 genotype groups. RESULTS: The median nevirapine trough concentration in individuals homozygous for the variant allele (TT) was 7607 ng/mL vs 4181 and 5559 ng/mL for GG and GT individuals, respectively (GG vs TT median ratio=1.82; P=0.011). The mean ratio for TT vs GG individuals (95% confidence interval) was 1.51 (1.18, 1.84). No associations were observed between the other polymorphisms studied and nevirapine concentrations. CONCLUSIONS: CYP2B6 G516T significantly influenced nevirapine trough concentrations in HIV-infected patients in Uganda. Additional studies in larger patient populations are necessary to further define the potential clinical impact of these preliminary findings.

Facial myokymia in the course of a pontine tumor.

A patient with facial myokymia, suffering from an infiltrating grade II astrocytoma originating within the pons with vegetations invading the cerebellopontine angle, was studied clinically and electromyographically from 1973 to 1979. The myokymias started in the muscles of the right side of the face and later spread to the left side. The latter point is worth noting because the myokymias of the left side were detectable by EMG but not by inspection. They preceded clinical and instrumental evidence of a contralateral spread of tumoral damage to the brainstem. From the physiopathogenetic angle they point up the importance of a mechanism of hyperexcitability and release of the facial motoneuronal pool. The results of the EMG study suggest that the persistence of myokymia, its association with an ingravescent neurogenic impairment of the facial musculature and its polymorphism in the course of pontine tumors are more reliable features than their discontinuity and rhythmicity.

Squamous cell carcinoma of the nail bed.

A case is presented of squamous cell carcinoma developed from carcinoma in situ of the nail bed of the first finger in a 79-year-old patient. Stress is laid upon the importance of the differential diagnosis. Surgery is considered the treatment of choice for this uncommon condition.

Multiple disseminated pyogenic granuloma.

A 15-month-old baby girl with extensive skin burns developed within the burned areas multiple lesions with the clinical and histological characteristics of granuloma pyogenicum. These lesions seem to differ from those reported by others as pyogenic granuloma with multiple satellites.

Is the EEG cyclic alternating pattern a true autonomous entity? Analytic study in a case of post-traumatic coma with good prognosis.

The cyclic alternating pattern (CAP) characterizes stage-II coma according to Fischgold and Mathis. Its evolution and prognostic value are still uncertain. An analytic investigation of CAP and its components (phase A of greater arousal and phase B of lesser arousal) was conducted on a patient with post-traumatic coma who completely recovered. The relationships between this type of pattern and the stages of physiologic sleep were investigated during four prolonged night recordings taken at regular intervals. The evolution of CAP in post-traumatic coma is compared with the development of CAP observed in Creutzfeldt-Jakob disease. The hypothesis is suggested that CAP may be related to other cyclic phenomena, especially the Lundberg B-type CSF pressure waves. According to this assumption, in a coma with CAP, mechanisms for the organization of arousal, which are not known but persist up to the threshold of death, could still be acting. In sleep these same mechanisms are supposed to be integrated with others, more sophisticated and less resistant to pathogenic injuries.

Pharmacokinetics of ricobendazole in calves.

The pharmacokinetics of ricobendazole (RBZ) and its major metabolite albendazole sulphone (ABZSO2) were studied in six calves, after administration of RBZ (7.5 mg/kg), using a 10% experimental solution by the intravenous (i.v.) route, a 10% commercial solution by the subcutaneous (s.c.) route, and a 10% experimental suspension by the intraruminal (i.r.) route. Blood samples were drawn during a 60-h period. Plasma drug and metabolite concentrations were determined by HPLC. The pharmacokinetic evaluation in each case was prepared by weighted least-squares nonlinear regression analysis. Ricobendazole i.v. data were best fitted by a two-compartment model. The best pharmacokinetic exponents and coefficients were estimated, and the pharmacokinetic variables for RBZ and ABZSO2 were calculated from them. Similar patterns of plasma disposition were found for RBZ after i.r. and s.c. administration, suggesting delayed release from the s.c. site resembling the slow release of the drug from the rumen.

Pharmacokinetics of miocamycin following intravenous administration to cattle.

The plasma pharmacokinetics for a single intravenous dose (10 mg/kg body weight) of miocamycin (a 16-membered macrolide drug) was investigated in Holando Argentino cattle (n = 5). Blood drug concentrations were determined by a microbiological method and data were best-fitted to a two-compartment open model. The pharmacokinetic profile consisted of a short distribution phase (t1/2 alpha = 7.41 +/- 0.53 min), followed by an extended terminal elimination phase (t1/2 beta = 2.49 +/- 0.23 h). The volume of distribution at steady-state was large (2.13 +/- 0.17 l/kg), suggesting extensive tissue distribution, the clearance value was 0.60 +/- 0.03 l/h.