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Background: Hepatic hemangiomas are benign vascular tumors of the liver, most of them asymptomatic. Surgical management includes enucleation, embolization, and liver resection. We present a case with symptomatic hepatic hemangioma susceptible to surgical treatment. Case Presentation: A 73-year-old man with chronic obstructive pulmonary disease and a history of two small hemangiomas started with pain in the right upper quadrant. Computerized tomography showed multiple hypodense lesions highly suggestive of hepatic hemangioma. Tumor markers were found at normal levels. A right hepatectomy guided with indocyanine green and intraoperative ultrasound was performed minimal bleeding and pulmonary complications. Conclusion: Hepatectomy for giant hemangiomas combined with ultrasound and indocyanine green is a feasible option in patients with comorbidities, decreasing bleeding risk, and allowing complete and surgical resection.

Del tomate de árbol (Cyphomandra betacea) afectado por el hongo Colletotrichum gloeosporioides se aislaron dos fitoalexinas, una de las cuales es el ácido benzoico. Este compuesto muestra una alta actividad fungistática contra el hongo causante de la enfermedad.

El flavonoide 7-metoxi-aromadendrin fue aislado de la resina de Eucalyptus tereticornius; este compuesto tiene una alta actividad a 250 ppm sobre larvas de Culex sp.

Resumen Objetivo Describir las caracteristicas sociodemograficas y clinicas de los pacientes tratados durante un periodo de diez anos con terapia electroconvulsiva con anestesia y relajacion (TECAR) en una clinica universitaria. Metodologia Se revisaron 276 historias clinicas de los pacientes tratados con TECAR entre 1997 y 2007 en la Clinica Universitaria Bolivariana de Medellin, Colombia. Los datos fueron recolectados con un instrumento disenado para tal fin y luego fueron analizados. Resultados En los diez anos, se realizaron mas de 2.000 sesiones de TECAR. La mayoria de los pacientes fueron mujeres (67,4%) entre 15 y 86 anos de edad; la principal indicacion fue el episodio depresivo mayor sin sintomas psicoticos (56,5%). Casi la mitad de los pacientes presentaron alguna complicacion menor y transitoria, y no se presento ningun deceso. En la totalidad de los procedimientos se utilizo preoxigenacion, anestesia intravenosa y relajacion muscular. Conclusiones La terapia electroconvulsiva realizada en un hospital de tercer nivel, con la participacion de un equipo interdisciplinario entrenado (psiquiatra, anestesiologo, auxiliar de enfermeria) y utilizando la tecnica modificada (oxigenacion, monitorizacion, anestesia general y relajacion muscular) es segura para algunas patologias psiquiatricas que no han respondido a medicamentos, o en casos en los que exista contraindicacion para los medicamentos.

La resina de P. foetida L., obtenida mediante cultivo de tejidos, no contiene flavonoides, a diferencia de la resina de las plantas silvestres de la cual se aislaron anteriormente diez de estas sustancias; sin embargo, se determinó que la resina sí contiene un ácido y un glicósido que son componentes normales de las plantas silvestres.

While the overall percentage of unused antiretroviral medicines returned to the hospital pharmacy is low, their cost is quite high. Adverse events, treatment failure, pharmacokinetic interactions, pregnancy, or treatment simplification are common reasons for unplanned treatment changes. Socially inefficient antiretroviral packages prevent the reuse of drugs returned to the hospital pharmacy. We defined antiretroviral package categories based on the excellence of drug packaging and analyzed the number of pills and costs of drugs returned during a period of 1 year in a hospital-based HIV unit attending to 2,413 treated individuals. A total of 6,090 pills (34% of all returned antiretrovirals) – with a cost of 47,139.91€ – would be totally lost, mainly due to being packed up in the lowest efficiency packages. Newer treatments are packaged in low-excellence categories of packages, thus favoring the maintenance of these hidden costs in the near future. Therefore, costs of this low-efficiency drug packaging, where medication packages are started but not completed, in high-cost medications are substantial and should be properly addressed. Any improvement in the packaging by the manufacturer, and favoring the choice of drugs supplied through efficient packages (when efficacy, toxicity, and convenience are similar), should minimize the treatment expenditures paid by national health budgets., Video abstract

Introduction: Cerebral ischemia is the third leading cause of death and the primary cause of permanent disability worldwide. Atorvastatin is a promising drug with neuroprotective effects that may be useful for the treatment of stroke. However, the effects of atorvastatin on specific neuronal populations within the nigrostriatal system following cerebral ischemia are unknown. Objective: To evaluate the effects of atorvastatin on dopaminergic and GABAergic neuronal populations in exofocal brain regions in a model of transient occlusion of the middle cerebral artery. Materials and methods: Twenty-eight male eight-week-old Wistar rats were used in this study. Both sham and ischemic rats were treated with atorvastatin (10 mg/kg) or carboxymethylcellulose (placebo) by gavage at 6, 24, 48 and 72 hours post-reperfusion. We analyzed the immunoreactivity of glutamic acid decarboxylase and tyrosine hydroxylase in the globus pallidus, caudate putamen and substantia nigra. Results: We observed neurological damage and cell loss in the caudate putamen following ischemia. We also found an increase in tyrosine hydroxylase immunoreactivity in the medial globus pallidus and substantia nigra reticulata, as well as a decrease in glutamic acid decarboxylase immunoreactivity in the lateral globus pallidus in ischemic animals treated with a placebo. However, atorvastatin treatment was able to reverse these effects, significantly decreasing tyrosine hydroxylase levels in the medial globus pallidus and substantia nigra reticulata and significantly increasing glutamic acid decarboxylase levels in the lateral globus pallidus. Conclusion: Our data suggest that post-ischemia treatment with atorvastatin can have neuro-protective effects in exofocal regions far from the ischemic core by modulating the GABAergic and dopaminergic neuronal populations in the nigrostriatal system, which could be useful for preventing neurological disorders. Introducción. La isquemia cerebral es la tercera causa de muerte y la primera de discapacidad permanente en el mundo. La atorvastatina es un fármaco neuroprotector prometedor para el tratamiento de la apoplejía; sin embargo, su acción sobre las poblaciones neuronales del sistema nigroestriatal después de la isquemia aún se desconoce. Objetivo. Evaluar el efecto de la atorvastatina sobre poblaciones gabérgicas y dopaminérgicas en regiones exofocales en un modelo de oclusión transitoria de la arteria cerebral media. Materiales y métodos. Se utilizaron 28 ratas Wistar macho de ocho semanas de edad. Los ejemplares con isquemia simulada y los ejemplares sometidos a isquemia fueron tratados con atorvastatina (10 mg/kg) y carboximetilcelulosa (placebo) administrados por medio de sonda a las 6, 24, 48 y 72 horas después de la reperfusión. Se analizó la inmunorreacción de la descarboxilasa del ácido glutámico y de la tirosina hidroxilasa en el globo pálido, el putamen caudado y la sustancia negra. Resultados. Los datos confirmaron el daño neurológico y la pérdida celular en el putamen caudado. Se incrementó la inmunorreacción de la tirosina hidroxilasa en el globo pálido medial y la sustancia negra pars reticulata , disminuyendo la inmunorreacción de la descarboxilasa del ácido glutámico en el globo pálido lateral de los animales isquémicos tratados con placebo; sin embargo, el tratamiento con atorvastatina pudo revertirla, lo que logró una disminución significativa de la tirosina hidroxilasa en el globo pálido medial y la sustancia negra pars reticulata y aumentando los niveles de descarboxilasa del ácido glutámico en el globo pálido lateral. Conclusión. Nuestros datos sugieren que la atorvastatina en el tratamiento posterior a la isquemia ejerce neuroprotección en las zonas exofocales, modulando las poblaciones neuronales gabérgicas y dopaminérgicas del sistema nigroestriatal, lo que podría prevenir trastornos neurológicos.

A new sesquiterpene related to the insecticide polygodial was obtained from P. punctatum leaves. Its structure was established as a tricyclic hemiacetal by means of 2D NMR spectroscopy. The compound was inactive against tick (Boophiilus microplus).

Four new phenalenone-type phytoalexins, named musanolones C-F, have been isolated from infected rhizomes of banana plants (Musa acuminata; AAA cultivar Grand Nain). These phytoalexins were biosynthesized de novo by the plants upon infection by Fusarium oxysporum f. sp. cubense race 4, Panama's disease causal agent. The structures of the new phytoalexins were elucidated using spectroscopic data and chemical correlations. Hydroxyanigorufone has been previously described as a constitutive natural product, from Anigozanthos rufus, but it was never described as a phytoalexin. The chemical shift for all of the hydrogen and carbon atoms in the musanolones C-F were unambiguously established by mono- and bi-dimensional, homo- and hetero-nuclear NMR experiments (1H NMR, 13C NMR, COSY, HMQC and HMBC). Preliminary in vitro assays of all the musanolones tested until now show a strong inhibitory activity on the growth of the germination tube of F. oxysporum f. sp. cubense race 4.

Introduccion. Los indicadores espacio-temporales de lesion son esenciales en el estudio neuropatologico y terapeutico de la isquemia cerebral. Objetivo. Optimizar la tecnica de dos modelos de isquemia cerebral (focal y global) y hacer un analisis comparativo de la progresion del dano cerebral, mediante marcadores de neurodegeneracion. Materiales y metodos. Se sometieron ratas Wistar a oclusion temporal de la arteria cerebral media o aoclusion de cuatro vasos, y se evaluaron comparativamente el tiempo quirurgico, la tasa de supervivenciay la recuperacion neurologica. Se utilizo trifenilo de tetrazolio para establecer la distribucion del infarto y tincion con Fluoro-Jade B® como marcador de neurodegeneracion. La inmunorreaccion de la astroglia se evaluo con el anticuerpo contra la proteina acidica fibrilar de la glia (Glial Fibrillary Acidic Protein,GFAP) y el anticuerpo AT-8 contra la proteina tau hiperfosforilada, 24, 48 y 72 horas despues de la isquemia. Resultados. Los modelos de isquemia utilizados requirieron menor tiempo quirurgico y hubo menorriesgo de muerte, respecto a estudios previos. En el modelo focal, las celulas positivas con Fluoro-Jade B® y los astrocitos reactivos, se evidenciaron en corteza e hipocampo a las 24 horas despues de la isquemia. En el modelo global, se observo tincion Fluoro-Jade B® positiva a las 24 horas, aumentando significativamente la reaccion de la GFAP a las 72 horas en corteza y a las 48 horas en el hipocampo. La reaccion contra la proteina tau hiperfosforilada aumento progresivamente y fue maxima a las 72horas en ambos modelos. Conclusiones. Los dos modelos de isquemia cerebral, oclusion temporal de la arteria cerebral media y oclusion de cuatro vasos, fueron optimizados. En estos modelos, los marcadores la tincion Fluoro-Jade B® y la GFAP permitieron detectar procesos de neurodegeneracion 24 horas despues de la isquemia, en tanto el marcador de proteina tau hiperfosforilada (AT-8) incremento progresivamente su reaccion hasta las 72 horas, lo cual sugiere la propagacion de la excitotoxicidad y la alteracion deenzimas implicadas en la fosforilacion de proteinas del citoesqueleto. http://dx.doi.org/10.7705/biomedica.v33i2.830

To describe the socio-demographic and clinical characteristics of patients undergoing Electroconvulsive Therapy with Anesthesia and Relaxation (ECTAR) for 10 years in a university clinic.Review of 276 medical records of patients who had undergone ECTAR between 1997 and 2007 at the Clínica Universitaria Bolivariana de Medellín, Colombia. Data was collected through an instrument designed for that purpose and then was analyzed.During 10 years, more than 2000 ECT procedures were performed; most of the patients were female 67.4%, between 15 and 86 years old. The first indication was a major depressive episode without psychotic symptoms (56.5%) almost half of the patients had a minor and temporary complication, and no major complications or deaths were reported. Pre-oxygenation, intravenous anesthesia and muscular relaxation were used in all procedures.The ECT used in a third-level hospital with participation of a trained, interdisciplinary team (psychiatrist, anesthesiologist, nursing assistants) and the use of the modified technique (oxygenation, monitoring, general anesthesia, and relaxation is safe for certain psychiatric pathologies disorders that have not responded to medication or when medication is counter-indicated.

Withajardins A, B, C and D are withanolides with a new skeleton isolated from the leaves of Deprea orinocensis. Their structure and the absolute configuration of withajardin C were established by spectral analysis, including 2D-NMR and X-ray diffraction. The 13C NMR assignments of withajardins and acnistins were compared and biogenetic pathways to these compounds were formulated.

Withajardins A, B, C and D are withanolides with a new skeleton isolated from the leaves of Deprea orinocensis. Their structure and the absolute configuration of withajardin C were established by spectral analysis, including 2D-NMR and X-ray diffraction. The 13C NMR assignments of withajardins and acnistins were compared and biogenetic pathways to these compounds were formulated.

A new phytoalexin was induced and isolated from papaya fruit slices treated with copper salts; its structure was established as 3',5'-dimethoxy-4'-hydroxy-(2-hydroxy)acetophenone. This compound showed high antifungal activity against Colletotrichum gloesporioides, a pathogenic fungus of papaya.

Unexpected admission (UA) to the intensive care unit (ICU) among the ambulatory patient could be considered as an indicator of quality of attention on ambulatory services. However, the determinants associated with this rare complication are unknown. Objective. To identify the factors associated with UA to the ICU among the patients following ambulatory surgical procedures (ASP).Twenty one cases and 105 controls were selected from among 4,705 patients admitted for an ASP at a teaching hospital between January 2004 and May 2006. A case was that one with an UA to the ICU for monitoring and/or treatment after its ambulatory surgical procedure. Each case was paired with five controls according to type of procedure and date of accomplishment. Conditional logistic regression analyses were used to determine the potential factors associated with an UA to the ICU.Cases represented 0.4% of admitted ones for an ASP. Mean age of controls were 46.9 years and 52.4% were women. There were no statistically significant differences between cases and controls in relation to several clinical, biochemical and physical status variables (comorbidity, vital signs, biochemistry, surgical procedure, anesthetic, technical anesthetic, time of surgery, surgical bleeding). Fourteen patients were less than 48 hours at the ICU and there were no deaths.Most of UA to the ICU seem to be based on decisions non-related to general health status of patients and these are usually preventive. This decision is not based on scientific evidence. Admission to the ICU must be based on a multidisciplinary evaluation.

A new withanolide belonging to the withajardins series was isolated from Deprea orinocensis and identified by 2D NMR spectroscopic data. The compound has an unusual pattern of substitution in the A-ring.

Phenalenone-type phytoalexins were obtained for the first time from bananas and identified by COSY 1 H- 1 H, HMQC and HMBC techniques, and X-ray analysis, among other methods. The aminoglycoside kanamycin was studied as a phytoalexin inducer in banana leaves and fruit and compared with the effects produced by the fungus Mycosphaerella fidjiensis. The phenyl side chain in banana phytoalexins is not in the same position as in other plant phenalenones and so an alternative biogenetic pathway has been proposed and is currently being verified

Introduction : Antiretroviral drugs in Spain are delivered by law only in hospital pharmacies. Commercial packages meet variable quality standards when dispensed drugs are returned due to treatment changes or adherence problems Nearly 20–25% of the initial regimens will be changed at 48 weeks for different reasons. We evaluated the economic impact on public health system of the inability of using returned drugs due to inefficient packaging. Materials and Methods : We defined socially efficient packaging as the best adapted one to being delivered in unit dose to outpatients and classified: Class A - Drug packed in unit doses with complete info (name of drug, dosage in mg, lot, and expiring date) in each unit, maintaining complete information of the drug if returned when the external package is opened. Class B - packed in blisters with complete info in the blister, but not in unit doses, without special conservation conditions (should be re-packed in unit doses in the pharmacy before its dispensation to assure a class A excellence). Class C - packed in plastic containers with complete info written only on a label over the container, would allow repackaging only before its initial delivery, but not when returned. Class D - drug packed in plastic containers with manufacturer's warning that the product cannot be placed outside of the original package due to special conditions of conservation (fridge, humidity) that doesn't allow a unit dose repackaging or reusing an opened container. We analysed a 12-month period (July 2011–June 2012) in a hospital-based HIV outpatient pharmacy that serves 2413 treated individuals. Results : Patients generated 23,574 visits to pharmacy, and received 48,325 drug packages, with 2.529.137 pills delivered. The patients suffered 1051 treatment changes for any reason. A total amount of 122.945€ in treatment were returned to pharmacy in opened packages during the study period. 47.139.91€ would be totally lost, mainly due to being packaged in class C and D boxes, the equivalent of treating 78 patients with rilpivirine/TDF/FTC during 1 month. Class A and B packages in bad condition represented only 1.1% of the cost. However, 75.805€ came from returned packages in good condition that could potentially be reused. Most of the treatment changes were not foreseeable. Conclusions : A significant economic budget is lost through socially inefficient antiretroviral packages. Newer treatments are packaged in C and D categories, therefore maintaining these hidden costs in the near future. Any improvement in the excellence of packaging by the manufacturer, and favouring the choice of drugs supplied through efficient packages (when efficacy, toxicity and convenience are similar) should minimize the treatment expenditures paid by national health budgets. (Published: 2 November 2014) Citation : Abstracts of the HIV Drug Therapy Glasgow Congress 2014 Llibre-Codina, JM et al. Journal of the International AIDS Society 2014, 17(Suppl 3) :19609 http://www.jiasociety.org/index.php/jias/article/view/19609 | http://dx.doi.org/10.7448/IAS.17.4.19609

Background Antiretroviral treatment administered within 48–72 h after exposure might reduce the risk of acquiring HIV infection. Due to the urgency of an initiating treatment, some of these PEP treatments are prescribed in the emergency department (ED) by a non-HIV specialist. Therefore, PEP starter packs were created to ensure the correct treatment until the visit to an HIV specialist. Purpose To describe the use of PEP treatment starter packs in ED. We also calculated the cost savings resulting from dispensing daily packs until the HIV specialist visit. Materials and methods The PEP treatment was agreed between the HIV team and pharmacy department according to European ART clinical practice guidelines. Daily PEP kits containing lopinavir/ritonavir, emtricitabine and tenofovir are prepared in the pharmacy department and are available in ED with enclosed information for the patient. If a patient arrives at the ED with suspected exposure, PEP kits are dispensed until the visit to the HIV specialist. Data were collected since the introduction of PEP packs in December 2011 from hospital electronic records. Treatment cost was calculated from manufacturer sales price plus 4% VAT. Results 36 PEP were initiated. 64% male, with a mean age of 33.7 (17–52). After visiting the HIV specialist, 27 (75%) patients remained on the same treatment while 9 (25%) were changed: 4 (11%) patients from lopinavir to darunavir, 3 (8%) to atazanavir and 2 (6%) to raltegravir. 7 (20%) patients changed due to gastrointestinal side effects, 1 (2.5%) for drug interactions and 1 (2.5%) for unknown reasons. Treatment with lopinavir/ritonavir, emtricitabine and tenofovir cost 800.6 €/month; therefore PEP kits have saved the hospital 7,205.49 € from those patients who changed treatment. Conclusions PEP kits have guaranteed that the correct treatment is supplied in the ED. Treatment is well tolerated, nevertheless in some patients must be changed. Accordingly, dispensing daily packs instead of full drug containers seems to be a cost-effective strategy. No conflict of interest.

Winston Quinones, Gustavo Escobar, Fernando Echeverri *, Fernando Torres, Yoni Rosero,Vi ctor Arango, Gloria Cardona and Adriana GallegoDepartment of Chemistry, Universidad de Antioquia, P. O. Box 1226, Medellin, ColombiaTel.: (57+4)2105658, Fax: (57+4)2330120, E-mail: echeveri@catios.udea.edu.coReceived : 18 January 2000 ; revised form 14 July 2000 / Accepted : 14 July 2000 / Published : 26 July 2000Abstract: Several perinaphthenone/phenylphenalenone compounds were synthesized to es-tablish a relationship between structure and antifungal activity against Mycosphaerella fijie n-sis. Substitutions on the unsaturated carbonyl system or addition of a phenyl group reducedantibiotic activity.Keywords: phenylphenalenones, synthesis, antifungal activity, Mycosphaerella fijiensis .IntroductionPhytoalexins are natural antibiotic compounds proposed as fungicides or templates for production ofnew pesticides [1]. Recently, the search for novel antifungal compounds has received special attentionas a result of an enhanced microbial resistance to current pesticides.Banana plants are affected by the pathogenic fungi Fusarium oxysporum var. cubensis type 4 andMycosphaerella fijiensis , causal agents of the diseases named Black Sigatoka and Panama Disease, r e-spectively. These diseases can drastically reduce banana production by as much as ca. 20% [2]. Undercolonization by these microorganisms or treatment of the leaves with kanamycin, banana plants producetwo types of phytoalexins, 9-phenylphenalenones (also known as musanolones [3]) and 4-phenylphenalenones [4], The main aim of the present work was to synthesize several structurally-relatedcompounds and to determine the relationship between phytoalexin structure and their antifungal effectsagainst M. fijiensis .Results and DiscussionThe planned synthetic approach involved a 1,4-addition of a Grignard reagent to a perinaphthenone,followed by reduction with DDQ, epoxidation with

Ten flavonoids were isolated from Passiflora foetida L. resin. One of them, ermanin, has a high deterrent activity at 40 ppm against Dione juno larvae.

A new phytoalexin was induced and isolated from papaya fruit slices treated with copper salts; its structure was established as 3',5'-dimethoxy-4'-hydroxy-(2-hydroxy)acetophenone. This compound showed high antifungal activity against Colletotrichum gloesporioides, a pathogenic fungus of papaya.

Josep M Llibre,1,2 Gloria Cardona,3 José R Santos,2 Angels Andreu,3 Josep O Estrada,4 Jordi Ara,4 Xavier Bonafont,3 Bonaventura Clotet1,21HIV Unit, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain; 2Lluita contra la SIDA Foundation, Badalona, Barcelona, Spain; 3Hospital Pharmacy, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain; 4Hospital Management, University Hospital Germans Trias i Pujol, Badalona, Barcelona, SpainBackground: The current economic recession in European countries has forced governments to design emergency measures to reduce spending on drugs, including antiretroviral therapy (ART). Switching antiretroviral drugs for others that have the same efficacy and safety profile at a lower cost (cost-reduction measures, CRM) could prove to be a valid means of generating savings.Methods: Descriptive study of prospective consensus-based CRM undertaken in 2011 in a Catalonian hospital HIV unit among patients with prolonged plasma HIV-1 RNA

Carbon and proton atoms were fully assigned in this new type of withanolide by HMQC and HMBC experiments. The absolute configuration of acnitin A was determined by X-ray diffraction. Proton and 13 C NMR measurements are particularly useful in identifying members of this group of natural products. (Steroids 59 : 2997ndash;304, 1994)

Este artículo es una síntesis de un estudio realizado con un grupo de docentes en formación inicial en el cual se explora su conceptualización respecto a la enseñanza de conceptos científicos, en términos de posibles elementos de esquemas: anticipaciones, invariantes operatorios (conceptos en acción y teoremas en acción) e inferencias, cuando ingresan al curso de la práctica pedagógica. Los análisis y la interpretación de la información se realizaron en el marco de la Teoría de los Campos conceptuales de Gérard Vergnaud, con base en un cuestionario, mapas conceptuales y registros de sus experiencias: diarios de clase, entrevistas, transcripciones del discurso de clase y planificaciones en las que tratan de visibilizar las estructuras de sus organizaciones didácticas. En general se hallaron diferencias notables entre los conocimientos que declaran los docentes en formación y los que activan realmente en el aula de clases. This article is a synthesis of a study performed in a group of teachers in initial training, taking into consideration their conceptualization with respect to the teaching of scientific concepts explored in terms of possible scheme elements: anticipations, operational invariants- concepts in action and theorems in action- and inferences. Data analysis and interpretation was conducted under the Theory of Conceptual Fields by Gérard Vergnaud, based on a survey, concept maps and record of their personal experiences: class journals, interviews, class transcripts and lesson plans in which they try to visualize the structures of their didactic systems. In general we found remarkable differences between the knowledge that teachers in training declare and the knowledge these teachers really activated in the classroom.