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PURPOSE: Acromegaly and neuroendocrine tumors are rare diseases that, under certain conditions, can be treated with somatostatin analogs. The aim was to determine the prescription patterns of somatostatin analogs in a group of patients with acromegaly and neuroendocrine tumors affiliated with the Colombian Health System. METHODS: A retrospective study. A cohort of patients from a drug dispensing database that collected all prescriptions of long-acting somatostatin analogs (octreotide, lanreotide, pasireotide). Sociodemographic variables, clinical variables (diagnosis and comorbidities) and pharmacological therapy variables (dose, changes, persistence of use, comedications) were considered. RESULTS: A total of 213 patients were identified, including 139 (65.3%) with acromegaly and 74 (34.7%) with neuroendocrine tumors. There was a predominance of women (58.7%) and a mean age of 59.7 ± 14.5 years. The most commonly used medications were lanreotide autogel (n = 107; 50.2%), octreotide LAR (n = 102; 47.9%) and pasireotide LAR (n = 4; 1.9%). During follow-up, 11.3% of patients experienced modifications of therapy, with a mean duration from the beginning of treatment to the change in medication of 25 ± 15.9 months. A total of 48.9% of the patients with acromegaly and 87.1% of individuals with neuroendocrine tumors received maximum approved doses of the drug. CONCLUSION: Patients with acromegaly and neuroendocrine tumors in Colombia are mainly women and are most frequently treated with lanreotide autogel for acromegaly and with octreotide LAR for neuroendocrine tumors. In addition, a high proportion are managed with maximum doses of long-acting somatostatin analogs.

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Melioidosis is an endemic disease in Southeast Asia and Oceania caused by the gram-negative bacillus Burkholderia pseudomallei. We studied 15 adult patients from Colombia with microbiologically diagnosed pulmonary melioidosis. We reviewed 15 chest X-rays and 10 chest computed tomography (CT) studies. Of the 15 patients, 87% met the criteria for acute infection and 13% met the criteria for chronic infection. The most common findings on chest X-rays were consolidation (86%), nodules (26%), and cavitation (20%). On CT studies, consolidation and nodules were observed in 90% of cases; the areas of consolidation were predominantly located in the basal and central zones in 60%. Areas of cavitation were observed in 50%, pleural effusion in 60%, and mediastinal lymph nodes in 30%. In patients with acute pulmonary melioidosis (n=8), the findings observed were nodules (100%), mixed pattern with nodules and consolidation (87%), pleural effusion (88%), and mediastinal lymph nodes (25%). The two patients with chronic pulmonary melioidosis both had cavitation. Acute lung infection with B. Pseudomallei has radiologic manifestations similar to those of pneumonia due to other causes. In areas where the disease is endemic, it is essential to include acute melioidosis in the differential diagnosis of pulmonary nodules and chronic melioidosis in the differential diagnosis of cavitated chronic lung lesions.

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La melioidosis es una enfermedad endémica en el suroeste asiático y Oceanía y está causada por la infección por el bacilo gramnegativo Burkholderia pseudomallei. Se estudian 15 pacientes adultos de Colombia con diagnóstico microbiológico de melioidosis pulmonar. Se revisaron 15 radiografías de tórax y 10 tomografías computarizadas (TC) de tórax. De los 15 pacientes, el 87% tenía criterios de infección aguda y el 13%, de infección crónica. Los hallazgos más frecuentes en la radiografía de tórax fueron: consolidación (86%), nódulos (26%) y cavitación (20%). En la tomografía computarizada se encontraron áreas de consolidación y nódulos en el 90% de los casos. En el 60% de los pacientes, las áreas de consolidación fueron de predominio basal y central. En el 50% de los casos se evidenciaron áreas de cavitación. Se evidenció derrame pleural en el 60% y adenopatías mediastínicas en el 30% de los casos. En los pacientes con presentación aguda (n=8), los hallazgos visualizados incluyeron: nódulos (100%), patrón mixto con nódulos y consolidación (87%), derrame pleural (88%) y adenopatías mediastínicas (25%). Los pacientes con melioidosis crónica (n=2) presentaron cavitación. La infección pulmonar aguda por B. Pseudomallei cursa con manifestaciones radiológicas similares a neumonías de otra etiología. En zonas endémicas debe considerarse la posibilidad de melioidosis aguda en el diagnóstico diferencial de nódulos pulmonares, y de melioidosis crónica en el diagnóstico diferencial de lesiones pulmonares crónicas cavitadas.(AU)

Melioidosis is an endemic disease in Southeast Asia and Oceania caused by the gram-negative bacillus Burkholderia pseudomallei. We studied 15 adult patients from Colombia with microbiologically diagnosed pulmonary melioidosis. We reviewed 15 chest X-rays and 10 chest computed tomography (CT) studies. Of the 15 patients, 87% met the criteria for acute infection and 13% met the criteria for chronic infection. The most common findings on chest X-rays were consolidation (86%), nodules (26%), and cavitation (20%). On CT studies, consolidation and nodules were observed in 90% of cases; the areas of consolidation were predominantly located in the basal and central zones in 60%. Areas of cavitation were observed in 50%, pleural effusion in 60%, and mediastinal lymph nodes in 30%. In patients with acute pulmonary melioidosis (n=8), the findings observed were nodules (100%), mixed pattern with nodules and consolidation (87%), pleural effusion (88%), and mediastinal lymph nodes (25%). The two patients with chronic pulmonary melioidosis both had cavitation. Acute lung infection with B. Pseudomallei has radiologic manifestations similar to those of pneumonia due to other causes. In areas where the disease is endemic, it is essential to include acute melioidosis in the differential diagnosis of pulmonary nodules and chronic melioidosis in the differential diagnosis of cavitated chronic lung lesions.(AU)

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Introducción: La población mundial enfrenta el incremento de adultos mayores (AM) que crece de forma acelerada. Esto plantea oportunidades y desafíos dado que aumentará la demanda de atención médica y cuidados a largo plazo por la presencia de las enfermedades crónicas degenerativas y los síndromes geriátricos; además el AM experimenta eventos que pueden ser críticos y estresantes que pueden afectar su bienestar psicológico y social. Un factor que ha demostrado apoyar al individuo a enfrentar el estrés y se ha asociado con el bienestar es el sentido de coherencia. Objetivo: Conocer la relación y el efecto entre el sentido de coherencia y el bienestar psicológico y social en los AM del norte de México. Metodología:Estudio descriptivo correlacional con muestreo probabilístico proporcional al tamaño del estrato. Resul-tados: con una muestra integrada en un 77’3% por mujeres, el sentido de coherencia fue predictor positivo del bienestar psicológico (β = 0’45, p = 0’001) y social (β = 0’38, p = 0’001) en los AM. Conclusiones: El sentido de coherencia puede ayudar al AM a comprender, manejar y dar significado a los eventos que experimenta, a percibir su entorno como menos amenazador y alcanzar o mantener el bienestar psicológico y socia (AU)

Introduction: The world’s population faces an unprecedented phenomenon the proportional increase of elderly is growing fast. This phenomenon poses opportunities and challenges as the demand for medical attention and long-term care that will increase due to the presence of chronic degenerative diseases and geriatric syndromes; It is also common for the elderly to experience a series of events that can be critical and stressful and as a result affect their psychologi-cal and social well-being. Objective: To know the relationship and the effect between the sense of coherence and the psychological and social well-being in elderly of northern Mexico. Methodology: A descriptive correlational study was carried out with probabilistic sampling proportional to the size of each stratum. Results: in a sample of 77.3% of women, the Simple Linear Regression Model revealed that the sense of coherence was a positive predictor of psychological (β = .45, p = .001) and social (β = .38, p =. 001) in Elderly. Conclusions: The sense of coherence can help elderly to understand, manage and give meaning to the events they experience, to perceive their environment as less threatening and to achieve or maintain psychological and social well-being (AU)

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PURPOSE: Copper is a heavy metal that causes considerable deterioration to human health and ecosystems, so their elimination in water bodies is of great interest. Present investigation shows the efficiency of chicken feather as a natural adsorbent and its subsequent degradation in order to have an integral treatment and avoid the unconscious disposition. METHODS: Optimal conditions of adsorption process were determined using the Response Surface Methodology (RSM)-Box-Behnken design (BBD) with three variables (pH, temperature and adsorbent dose). After that, the optimal conditions were used to analize the adsorption isotherms by Langmuir, Freundlich and Temkin models; also thermodynamics parameters Gibbs free energy (ΔG°), enthalpy (ΔH°) and entropy (ΔS°) were obtained. Finally, the biodegradation of the residue denominated "adsorbent-adsorbate" complex was evaluated through monitoring the soluble protein production, keratinolytic activity, ninhydrin positive products, sulfhydryl groups, and gravimetrically analysis. RESULTS: The optimum conditions for the adsorption were 30°C and pH 3, the Langmuir model was better described the adsorption process at 30°C, while at 40°C was Temkin model. The chicken feather turned out a natural adsorbent competitive with respect to others used in the removal of copper in liquid systems; obtaining qmax of 7.84 and 11.48 mg/g at 30 and 40°C, respectively; it was also a favorable and spontaneous process. Finally the adsorbent used was degraded by a keratinolytic consortium. CONCLUSIONS: In this study, chicken feather was used as a low cost adsorbent for copper efficiently and with the feasibility that the adsorbent can be biodegraded and release the metal.

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Melioidosis is an endemic disease in Southeast Asia and Oceania caused by the gram-negative bacillus Burkholderia pseudomallei. We studied 15 adult patients from Colombia with microbiologically diagnosed pulmonary melioidosis. We reviewed 15 chest X-rays and 10 chest computed tomography (CT) studies. Of the 15 patients, 87% met the criteria for acute infection and 13% met the criteria for chronic infection. The most common findings on chest X-rays were consolidation (86%), nodules (26%), and cavitation (20%). On CT studies, consolidation and nodules were observed in 90% of cases; the areas of consolidation were predominantly located in the basal and central zones in 60%. Areas of cavitation were observed in 50%, pleural effusion in 60%, and mediastinal lymph nodes in 30%. In patients with acute pulmonary melioidosis (n=8), the findings observed were nodules (100%), mixed pattern with nodules and consolidation (87%), pleural effusion (88%), and mediastinal lymph nodes (25%). The two patients with chronic pulmonary melioidosis both had cavitation. Acute lung infection with B. Pseudomallei has radiologic manifestations similar to those of pneumonia due to other causes. In areas where the disease is endemic, it is essential to include acute melioidosis in the differential diagnosis of pulmonary nodules and chronic melioidosis in the differential diagnosis of cavitated chronic lung lesions.

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Harvesting the semitendinous-gracilis autograft has always been a challenge. Numerous techniques have been described, most of them using a needle. The boyfriend catcher technique or hitch is a quick, useful, safe and needle-free technique that does not harm the tendon and avoids punctures.

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Simultaneous determination of three herbicides (dicamba, 2,4-D, and atrazine) has been achieved by on-line solid-phase extraction (SPE) coupled to multisyringe chromatography (MSC) with UV detection. The preconcentration conditions were optimized; a preconcentration flow rate of 0.5 mL min(-1) and elution at 0.8 mL min(-1) were the optimum conditions. A C(18) (8 mm i.d.) membrane extraction disk conditioned with 0.3 mol L(-1) HCl in 0.5% MeOH was used. A 3-mL sample was preconcentrated, then eluted with 0.43 mL 40:60 water-MeOH. A C(18) monolithic column (25 mm × 4.6 mm) was used for chromatographic separation. Separation of the three compounds was achieved in 10 min by use of 0.01% aqueous acetic acid-MeOH (60:40) as mobile phase at a flow rate of 0.8 mL min(-1). The limits of detection (LOD) were 13, 57, and 22 µg L(-1) for dicamba, 2,4-D, and atrazine, respectively. The sampling frequency was three analyses per hour, and each analysis consumed only 7.3 mL solvent. The method was applied to spiked water samples, and recovery between 85 and 112% was obtained. Recovery was significantly better than in the conventional HPLC-UV method. These results indicated the reliability and accuracy of this flow-based method. This is the first time this family of herbicides has been simultaneously analyzed by on-line SPE-MSC using a monolithic column.

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Los microorganismos entéricos han sido frecuentemente reportados como patógenos en mamíferos, aves, peces, reptiles y humanos, a pesar de hacer parte de su flora normal intestinal. La Estación de Biología Tropical Roberto Franco (EBTRF), lidera el programa de recuperación del Caimán Llanero (Crocodylus intermedius), que se encuentra en inminente peligro de extinción; adicionalmente cuenta con una colección viva de Testudines que comprende más de 20 especies. Con el fin de determinar la presencia de potenciales enteropatógenos en el hábitat de los ejemplares, se obtuvieron 129 muestras ambientales y cloacales de las especies allí encontradas; se utilizó el medio de cultivo CHROMagar OrientaciónBD® para realizar los aislamientos y la identificación microbiológica. Los resultados muestran una mayor presentación de flora gram negativa predominando microorganismos de los géneros Escherichia coli (28%), Klebsiella sp (26%), Salmonella sp. (6%), Proteus sp (3%) y Citrobacter sp. (1%) Sin embargo, microorganismos del género Enterococcus sp. (gram positivo), fueron hallados en un mayor porcentaje (31%) en todas las muestras sin importar el origen de las mismas. Conscientes del riesgo que implica el aislamiento de microorganismos entéricos que pueden presentar un carácter zoonótico, se dio inicio a la implementación de un manual de bioseguridad para la Estación con el fin disminuir el riesgo para la población humana y animal.

Enteric microorganisms has been reported as pathogens for mammals, birds, fishes, reptiles and humans, in spite of being part of the normal intestinal flora. The Estación de Biología Tropical Roberto Franco (EBTRF), leads the program of recovery of the Caiman Llanero which is in imminent extinction danger and also it has an alive collection of Testudines with more than 20 species. With the purpose of evidencing the presence of potential enteropathogens in the habitat of the animals, we collected 129 environmental and cloacae samples from the animals of the Station and we proceeded to use CHROMagar OrientationBD® to isolate and identify enteric microorganisms. The results show a higher prevalence of Gram Negative Flora with predominance of Escherichia coli (28%), Klebsiella sp (26%), Salmonella sp (6%), Proteus sp (3%), and Citrobacter sp (1%). In spite Enterococcus sp. (Gram Positive) was present in a bigger percentage (31%) in all the samples without be important the origin of themselves. Aware of the risk for zoonotic microorganisms we beginning to the implementation of a biosecurity manual for the Station and this way to reduce all risk for the animal and human population.

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This study was carried out in order to obtain base-line data concerning the epidemiology of American Visceral Leishmaniasis and Chagas' Disease in an indigenous population with whom the government is starting a dwelling improvement programme. Information was collected from 242 dwellings (1,440 people), by means of house to house interviews about socio-economic and environmental factors associated with Leishmania chagasi and Trypanosoma cruzi transmission risk. A leishmanin skin test was applied to 385 people and 454 blood samples were collected on filter paper in order to detect L. chagasi antibodies by ELISA and IFAT and T. cruzi antibodies by ELISA. T. cruzi seroprevalence was 8.7% by ELISA, L. chagasi was 4.6% and 5.1% by IFAT and ELISA, respectively. ELISA sensitivity and specificity for L. chagasi antibodies were 57% and 97.5% respectively, as compared to the IFAT. Leishmanin skin test positivity was 19%. L. chagasi infection prevalence, being defined as a positive result in the three-immunodiagnostic tests, was 17.1%. Additionally, 2.7% of the population studied was positive to both L. chagasi and T. cruzi, showing a possible cross-reaction. L. chagasi and T. cruzi seropositivity increased with age, while no association with gender was observed. Age (p<0.007), number of inhabitants (p<0. 05), floor material (p<0.03) and recognition of vector (p<0.01) were associated with T. cruzi infection, whilst age ( p<0.007) and dwelling improvement (p<0.02) were associated with L. chagasi infection. It is necessary to evaluate the long-term impact of the dwelling improvement programme on these parasitic infections in this community.

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Multiple antigen peptides (MAPs) containing epitopes of the major surface protein of the malaria sporozoite, the circumsporozoite (CS) protein, have been shown in previous studies to elicit antibody-mediated protection against sporozoite challenge in experimental murine and simian hosts. For the preparation for a phase I trial of a P. falciparum (T1B)4 MAP, which contains T and B cell epitopes from the CS repeat region, pre-clinical immunogenicity and adjuvant formulation studies were carried out in mice and Aotus monkeys. The (T1B)4 MAP was found to be immunogenic in three different species of owl monkeys, Aotus nancymae, A. vociferans and A. nigriceps. Optimal antibody responses were obtained in A. nancymae immunized s.c. with (T1B)4 MAP emulsified in Freund's, in which peak titers of over 10(6) were obtained in individual monkeys. MAP immunized A. vociferans also developed high levels of anti-sporozoite antibodies, although the kinetics and the magnitude of the response differed from A. nancymae. (T1B)4 MAP adsorbed to alum (aluminum hydroxide), a formulation that is acceptable for human use, was less immunogenic in naive A. nancymae, as well as A. nigriceps. The injection of MAPs/alum, however, significantly enhanced antibody responses in sporozoite-primed monkeys, suggesting that the administration of the MAP vaccine may be an effective means to increase the low levels of antibody present in individuals living in malaria endemic areas. The addition of a co-adjuvant QS-21, a purified saponin, significantly increased the immunogenicity of the alum-adsorbed MAP in both mice and monkeys, providing a vaccine formulation suitable for phase I trials in human volunteers.

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BACKGROUND: Recent work has shown significant enhancement in myocardial contrast intensity with brief ultrasound pulsing gated to a discrete portion of the cardiac cycle over conventional 30 Hz imaging. We hypothesized that limiting ultrasound imaging to less than every cardiac cycle would further intensity the myocardial echo-contrast effect. We therefore sought to determine the best pulsing frequency for ultrasound imaging to achieve optimal myocardial perfusion after the intravenous administration of FSO69 using fundamental and second harmonic imaging. METHODS AND RESULTS: In 13 male mongrel dogs, myocardial contrast opacification was determined while varying the cardiac cycle-triggering frequency of ultrasound imaging after intravenous injections of FSO69. Resulting myocardial echo-contrast intensities with a cardiac cycle-triggering frequency of every beat during end-diastole were compared with those with a cardiac cycle-triggering frequency of every third and fifth beat. Myocardial opacification, measured by background-subtracted peak intensity and visual scoring, was significantly greater when ultrasound imaging was triggered to every third and fifth beats compared with every beat. These benefits were seen with imaging in both the fundamental and second harmonic modes. Optimal myocardial opacification with FSO69 was achieved with injections as low as 0.1 ml, a dose that produced significant acoustic shadowing in only 24% of the injections. The degree of myocardial opacification was not significantly affected when the images were acquired during end-systole or end-diastole. CONCLUSIONS: Electrocardiogram-gated ultrasound imaging to every third or fifth cardiac cycle greatly improves myocardial opacification compared with imaging each cardiac cycle. This benefit was increased twofold to threefold with the use of second harmonic imaging as compared with fundamental imaging.

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During myocardial infarction, lack of myocardial opacification after reperfusion has been associated with poor or no recovery of function. We have previously documented the presence of perfusion abnormalities after brief coronary occlusions without infarction and the absence of perfusion abnormalities after prolonged occlusions with infarction. To characterize myocardial perfusion patterns immediately after reperfusion, we studied 53 animals in two groups in a coronary occlusion-reperfusion model. Temporary occlusions (group 1, 15 minutes; group 2, 30 to 360 minutes) were performed, followed by reperfusion with and without dobutamine. Myocardial contrast echocardiography was performed with aortic root injections of sonicated 5% serum human albumin (Albunex) during each intervention. Group 1 dogs showed no evidence of myocardial infarction. In group 2, 26 of 40 dogs had infarctions. After reperfusion, no perfusion abnormalities were seen in 13 of 26 group 2 dogs with infarctions; perfusion abnormalities were identified after reperfusion in 2 of 13 group 1 and in 8 of 14 group 2 dogs without infarctions. In animals subjected to prolonged ischemia, the absence of perfusion abnormalities after reperfusion did not rule out the presence of necrosis. Similarly, in animals without infarction subjected to ischemia, the presence of a perfusion defect after reperfusion did not represent the presence of necrosis but an abnormal microvascular reserve. These results suggest that early after reperfusion, assessment of perfusion by myocardial contrast echocardiography has significant limitations in the evaluation of myocardial viability and salvage.

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Hispanic elders are a large, rapidly growing subgroup of the Hispanic population in Texas. This population continues to suffer from a high incidence of non-insulin-dependent diabetes mellitus, with similar or lower rates of cardiovascular disease than non-Hispanic whites have. Barriers that may modify potentially effective diagnostic or appropriate treatment plans include communication problems, access issues, and use of informal health-care services. Knowledge and attention to these issues may improve compliance and decrease morbidity of this cohort. This article summarizes important information affecting the health of Hispanic elders in Texas and alerts practitioners to issues that may affect the care of their older Hispanic patients.

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OBJECTIVE: To assess the risk behaviors, knowledge, and beliefs regarding human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) among women and their sexual partners who were Mexican-American men who used intravenous drugs. DESIGN: Survey of male methadone users and their female sexual partners. PARTICIPANTS AND SETTING: Mexican-American male clients at a methadone clinic in Los Angeles, Calif, were consecutively recruited for the study. A method similar to partner contact tracing was used to identify female subjects. One hundred subjects, representing 50 male-female pairs of sexual partners, answered identical questionnaires. The responses from females were compared with those from their male partners. RESULTS: Seventy-four percent of the females disclosed that they used intravenous drugs, and 88% knew that their male partners were intravenous drug users. Of subjects who used intravenous drugs, 73% (27/37) of females and 88% (44/50) of males currently injected themselves and shared uncleaned needles. Seventy-six percent of females and 84% of males never used a condom during the previous year, and about 20% of both sexes had more than one sexual partner. Even though most of the females understood how HIV was transmitted and recognized themselves as at risk for AIDS, they continued to share needles unsafely and place themselves at risk for acquiring HIV infection through sex. CONCLUSION: This group of females and their male sexual partners engaged in multiple behaviors that may contribute to the further propagation of HIV infection.

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Although the Mexican-American elderly represent a large and rapidly growing subgroup of the ethnic aged, national prevalence data of major chronic diseases among this population are sparse. Data based on physical examinations from three older groups of the southwestern portion of the 1982-1984 Hispanic Health and Nutrition Examination Survey (HHANES) were reviewed to determine rates of hypertension, diabetes mellitus, arthritis, and heart disease. The results show a higher prevalence of diabetes and lower prevalence of heart disease and hypertension when compared with the general population, coinciding with data from previous studies. Findings for the prevalence of arthritis varied widely from other studies, however, and proportions were lower than expected. Further research on arthritis in the Mexican-American elderly is necessary to determine whether protective mechanisms that may lead to a lower prevalence of this disease exist in this ethnic subgroup.

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We conducted a retrospective evaluation of 442 infant circumcisions performed in an ambulatory setting. Procedures done with the Gomco clamp (Gomco Division, Allied Health Care, Buffalo, NY) and the Plastibell device (Hollister, Inc, Libertyville, Ill) were compared with respect to the frequency of complications. The overall complication rate was 6.8%. Bleeding requiring action by a physician occurred in 3.4% of cases and was significantly more common with the Gomco clamp than with the Plastibell device (p less than 0.05). There were no statistically significant differences between the two methods in the rate of infection or other complications. The rate of complications is comparable to previous studies of inpatient circumcision.

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Clinical teaching does not fit neatly into traditional teaching-learning models. The interaction between a resident and an attending physician is of particular interest because it has several functions including education, supervision, socialization, and quality control. The purpose of this study was to observe, classify, and record verbal teaching and learning behaviors in the resident-attending physician interaction. During a 12-month period, 125 observations of resident-attending physician interactions were recorded; the average length of the interactions was 4.27 minutes. The six most frequent resident verbal behaviors compared by postgraduate year level did not vary significantly. Only one of the six most frequent attending physician verbal behaviors varied significantly. In the average interaction of about 4 minutes, three fourths of the interaction was on patient care issues, leaving little time for teaching. There are many unanswered questions about the resident-attending physician interaction and its contribution to the training of a physician.

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