Variation of the intraocular pressure in relation to time of death: Contribution to the determination of the true postmortem interval (PMI)

Introducción: La determinación del momento del fallecimiento, es un dato de singular importancia en Medicina Legal constituyendo por su complejidad en uno de los problemas que necesita evaluación objetiva en la Patología Forense. Material y Métodos: Se propone en el presente estudio utilizar un modelo vacuno para la toma de la presión intraocular sistematizada pre y post mortem y analizar su evolución en el tiempo como posible método incruento de aproximación al Verdadero Intervalo de Muerte (VIM). Se realizó un estudio prospectivo, observacional, descriptivo con 12 vacas. Para la toma de presión intraocular (PIO) se utilizó el tonómetro manual aplanático (Perkins) calibrado previamente para bovinos. Se midió la PIO a horas establecidas posmortem. Resultados: La PIO promedio a hora 0 en OD fue de 13,48 mm Hg y de 13,59 mm Hg en OS con mínima variación entre los diferentes casos y el promedio del valor final a las 30 hr fue de 6,41 y 6,45 mm Hg en OD y OS respectivamente. Se observa una disminución de la PIO según transcurre el tiempo de muerte, de manera regular, en todos los ojos. Discusión: El hecho de la uniformidad de la disminución de la PIO en función del tiempo permite que una PIO tomada horas después de la muerte se pueda extrapolar al momento de la muerte y poder considerar la toma de la Presión Intraocular como contribución a la aproximación del verdadero intervalo de muerte (VIM).Introduction: Postmortem Interval estiamtion is a measure of singular importance in Legal Medicine. Due to its complexity, it needs objective evaluation in Forensic Pathology. Methods: In this study we propose the use of a bovine model to sytematically measure premortem and postmortem Intra-Ocular Pressure (IOP) as well as analyze its evolution with time as a possible non-invasive method to estimate PMI. A prospective, descriptive, observational study was carried out, using 12 cows. For the determination of the IOP, the aplanatic manual Perkins tonometer calibrated for bovines was used. The measurement of the IOP was done at establisehd post-mortem intervals. Results: The mean IOP at hour 0 in OD was 13.48 mm Hg and 13.59 mm Hg in OS with minimal variation between groups; at hour 30 hr, the IOP was 6.41 and 6.45 mm Hg in OD and OS respectively. We observed a decrease of the IOP in al leyes, directly related to the elapsed time of death. Discussion. The uniformity of the IOP estimations in relation to postmortem interval allows us to consider it as a valuable parameter for postmortem interval even several hours after death.Fil: Gerometta, Rosana María del Rosario. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste; Argentina. Universidad Nacional del Nordeste. Facultad de Medicina; ArgentinaFil: Larroza, Gerardo Omar. Universidad Nacional del Nordeste. Facultad de Medicina; ArgentinaFil: Pimpinella, Pascual. Universidad Nacional del Litoral; ArgentinaFil: Genero, Sebastian. Universidad Nacional del Nordeste. Facultad de Medicina; Argentin

Estudio Descriptivo del Consumo de Esteroides Anabólicos en la población que asiste a gimnasios de la ciudad de Corrientes, Argentina

INTRODUCCIÓN: Los esteroides anabólicos son sustancias sintéticas con efectos virilizantes y anabolizantes, además de múltiples efectos a nivel cardíaco, músculoesquelético, sexual, genital, hepático, renal y psicológico. Los principales consumidores son atletas con alta exigencia física con riesgo de abuso y adicción los mismos. OBJETIVOS: Conocer la prevalencia del consumo en la población que asiste a gimnasios de la ciudad de Corrientes, grupos etarios de mayor riesgo, motivos de consumo, fuentes de información para el mismo y efectos adversos de los mismos. MATERIALES Y MÉTODOS: Universo de 200 individuos masculinos entre 15 y 55 años que asistían regularmente a gimnasios de la ciudad de Corrientes a los que se les realizó encuestas anónimas con 14 preguntas cerradas analizando las variables: edad, vía de administración, anabólico consumido, razones para consumir, fuentes de información utilizadas y efectos adversos atribuidos a su uso. RESULTADOS: Prevalencia: 6,5 %. Rangos etarios: 15-19 años (31%), 20-24 años (23%), 25-29 años (15%), 30-34 años (8%), 35-39 años (8%), 45-49 años (15%). Anabólicos más consumidos: Dianabol (46%), Testosterona (23%), Nandrolona (23%) y Estazolol (8%). Fuentes de información: Internet (77%), entrenadores (69%), nutricionistas (23%), farmacéuticos (23%) y médicos (15%). Razones para el consumo: rendimiento físico (77%) y estética (54%). Efectos adversos: trastornos psicológicos (62%), acné y pérdida de cabello (46%), menor deseo sexual, (31%), mayor deseo sexual (15%), problemas de erección (8%). DISCUSIÓN: Se observa una clara prevalencia de consumo de esteroides anabólicos en la población, siendo los adolescentes el grupo de mayor riesgo donde el aspecto físico es un factor de alta influencia. CONCLUSION: El consumo de esteroides anabólicos es más notable en la población joven, donde su madurez psicológica tiene un rol importante. Estos, en su mayoría, obtienen información de medios poco fidedignos como Internet. Los trastornos psicológicos representan los efectos negativos más relevantes a corto plazo, ya que implican conductas inapropiadas. En conjunto, lo expuesto argumenta la necesidad del compromiso de la sociedad en general para la prevención y educación en el uso de esteroides anabólicos.INTRODUCTION: Anabolic steroids are synthetic substances with virilizing and anabolic effects and multiple effects on the heart, musculoskeletal, sexual, genital, hepatic, renal and psychological. The main consumers are highly physically demanding athletes at risk of abuse and addiction the same. OBJECTIVES: To determine the prevalence in the population attending gyms in Corrientes city, the higher groups risk, consumer reasons, sources of information and adverse effects. MATERIALS AND METHODS: The population of 200 male individuals between 15 and 55 years who regularly attended gyms in Corrientes city were conducted with 14 closed questions analyzing the variables: age, way of administration, anabolic consumed, reasons for consuming, sources used and adverse effects attributed to its use. RESULTS: Prevalence: 6.5%. Age ranges: 15-19 years (31%), 20-24 years (23%), 25-29 years (15%), 30-34 years (8%), 35-39 years (8%), 45 - 49 years (15%). The more important anabolics consumed are: Dianabol (46%), Testosterone (23%), Nandrolone (23%) and Estazolol (8%). Sources of information: Internet (77%), coaches (69%), nutritionists (23%), pharmacists (23%) and doctors (15%). Reasons to consume: physical performance (77%) and esthetics (54%). Adverse effects: psychological disorders (62%), acne and hair loss (46%), decreased sexual desire (31%), increased sexual desire (15%), erection problems (8%). DISCUSSION: There is a clear prevalence of anabolic steroid use in the population, with adolescents at greatest risk where physical appearance is a highly influential factor. CONCLUSION: Young people are the most important consumer of anabolic steroids in this group , where psychological maturity has an important role. These group get information from media such as the Internet. Psychological disorders represent the most significant negative effects in the short term, just as involve inaproppiate conduct. The above information argues the society need to commitment for prevention and education in the use of anabolic steroids.Fil: Dominguez, Eliana. Universidad Nacional del Nordeste. Facultad de Medicina; ArgentinaFil: Fernandez, Pedro Nicolás. Universidad Nacional del Nordeste. Facultad de Medicina; ArgentinaFil: Gimenez, Jose. Universidad Nacional del Nordeste. Facultad de Medicina; ArgentinaFil: Gerometta, Rosana María del Rosario. Universidad Nacional del Nordeste. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Amoxicilina: la existencia de diferentes presentaciones comerciales como factor determinante del uso irracional del medicamento

INTRODUCCION: La Amoxicilina, un antibiótico de amplio espectro, según consensos internacionales, debe ser usada en esquemas de 500 mg cada 8 hs, 750 mg cada 12 hs, 875 mg cada 12 hs, ó 1000 mg cada 12 hs por 7 a 10 días. En la actualidad, los esquemas impuestos por las diferentes presentaciones comerciales, existentes en la República Argentina, generalmente no se ajustan a estos supuestos. Esto podría tener consecuencias negativas en el uso racional del medicamento. OBJETIVOS: Conocer las presentaciones comerciales de Amoxicilina en comprimidos existentes actualmente en el mercado argentino, contrastar la posibilidad de completar el esquema terapéutico con el uso propuesto por las diferentes presentaciones y relacionar esto con el uso irracional del medicamento. MATERIALES Y METODOS: Se realizó el estudio en base al análisis de diferentes presentaciones comerciales de Amoxicilina en comprimidos del mercado argentino obtenidos de motores de búsqueda informáticos y material bibliográfico. Se procesaron los datos en planilla de cálculos y se realizaron análisis estadísticos. RESULTADOS: Existen 20 laboratorios, 74 productos y 13 tipos de presentaciones comerciales según dosis y cantidad de comprimidos. Se determinó que 5 tipos de presentaciones comerciales (26%) se ajustan al esquema de tratamiento aceptado y 8 tipos (74%) no concuerdan con el esquema terapéutico consensuado. DISCUSION: Del total de los tipos de presentaciones de Amoxicilina, la mayoría (74%) no cumple el esquema de tratamiento, un porcentaje menor (26%) se ajusta a las normas internacionales de uso racional de Amoxicilina. CONCLUSION: El uso irracional del medicamento por esquemas incompletos podría derivar en mayor resistencia bacteriana, reacciones adversas al medicamento, incumplimiento de los días de tratamiento necesarios y la necesidad de comprar más de un envase, encareciendo el tratamiento. El motivo por el que existe un uso indebido podría no ser solo por la gran cantidad de presentaciones comerciales sino también por el desconocimiento de médicos sobre los tipos de presentaciones existentes en el mercado y la falta de información impartida al profesional para evitar esto. Son pertinentes más estudios sobre el uso racional de Amoxicilina para evitar estas posibles consecuencias.INTRODUCTION: Amoxicillin, a broad-spectrum antibiotic, according to international consensus, should be used in schemes of 500 mg every 8 hours, 750 mg every 12 hours, 875 mg every 12 hours, or 1000 mg every 12 hours during 7 to 10 days. Currently, the schemes of different commercial presentations, existing in Argentina, don´t correspond to these assumptions. This may have a negative impact on rational drug use. OBJECTIVES: To determine the commercial tablets presentations currently on the Argentine market, test the possibility to finish the therapeutic regimen with the use proposed by the different presentations and relate this to the use irrational use of medicine. MATERIALS AND METHODS: The study was based on the analysis of different commercial presentations of Amoxicillin in the Argentine market tablets obtained from computer search engine and bibliography. The data was processed in spreadsheet and were performed statistical analyzes. RESULTS: There are 20 companies, 74 products and 13 types of commercial presentations as dosage and number of pills. It was determined that five types of business presentations (26%) are in accordance with accepted treatment regimen and 8 types (74%) do not agree with the consensus treatment regimen. DISCUSSION: Of all the types of presentations of Amoxicillin, the majority (74%) does not meet the treatment schedule, a smaller percentage (26%) are conform to international standards of rational use of Amoxicillin. CONCLUSION: The irrational use of medicine could result in incomplete schemes increased bacterial resistance, adverse drug reactions, breach of treatment day required, and to buy more than one container, that casuesmore expensive treatment. The reason that there is abuse may be is not because the many business presentations but also by the lack of doctors on the types of presentations on the market and the lack of information given to professional to avoid this. Further studies are relevant on the rational use of Amoxicillin to avoid these potential consequences.Fil: Domínguez, Eiana Belén. Universidad Nacional del Nordeste. Facultad de Medicina; ArgentinaFil: Fernández, Pedro Nicolás. Universidad Nacional del Nordeste. Facultad de Medicina; ArgentinaFil: Giménez, José Florentino. Universidad Nacional del Nordeste. Facultad de Medicina; ArgentinaFil: Gerometta, Rosana María del Rosario. Universidad Nacional del Nordeste. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Reduction of Steroid-Induced Intraocular Pressure Elevation in Sheep by Tissue Plasminogen Activator

PURPOSE. To investigate whether tissue plasminogen activator (tPA) can prevent and/or reverse steroid-induced IOP elevation in an ovine model. METHODS. Three animal groups were subjected to bilateral steroid-induced IOP elevation using thrice daily topical ocular prednisolone administration. In the first group (N ¼ 8), one eye each of two sheep was injected intravitreally with 100 lg, 200 lg, 500 lg, or 1 mg human recombinant tPA, while contralateral eyes received vehicle. In the second group (N ¼ 2), one eye was injected intravitreally with tPA (100 lg), while contralateral eyes received vehicle containing L-arginine. In the third group (N ¼ 4), each animal received intravitreal tPA in one eye concurrently with initiation of bilateral steroid administration. IOP was monitored for the duration of the experiment. Tissues from eyes of the third group were used to determine relative gene expression. RESULTS. In the first and second groups, IOP decreased by 9.7 (62.8) and 9.7 (61.6) mm Hg, respectively, 24 hours after tPA administration. In the third group, tPA-treated eyes did not develop IOP elevation with DIOP of 11.8 (61.3) mm Hg 8 days later. In all tPA-treated eyes, IOP remained low until the end of the study. mRNA levels in the trabecular meshwork were decreased for plasminogen activator tissue (PLAT), increased for matrix-metalloproteinase 1 (MMP-1), and stable for plasminogen activator inhibitor 1 (PAI-1), MMP-2, MMP-9, and MMP- 13 in tPA-treated eyes compared with contralateral controls. PAI-1 mRNA levels in ciliary processes also remained similar. CONCLUSIONS. Recombinant human tPA is effective in both preventing and reversing steroidinduced IOP elevation in sheep. Tissue plasminogen activator may be useful as a therapeutic agent in steroid-induced glaucoma.Fil: Gerometta, Rosana María del Rosario. University Of New York; Estados Unidos. Universidad Nacional del Nordeste. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Kumar, Sandeep. State University Of New York; Estados UnidosFil: Shah, Shaily. State University Of New York; Estados UnidosFil: Alvarez, Larry. State University Of New York; Estados UnidosFil: Candia, Oscar. State University Of New York; Estados UnidosFil: Danias, John. State University Of New York; Estados Unido

Controller therapy for asthma: montelukast versus fluticasone

Introducción: El asma es un trastorno inflamatorio crónico de las vías aéreas. Esta inflamación genera un aumento asociado de la hiperreactividad de las vías aéreas a una variedad de estímulos y una limitación del flujo aéreo. El tratamiento controlador del asma tiene como objetivos lograr y mantener control de los síntomas, prevenir las exacerbaciones, mantener la función pulmonar lo mas cerca posible a la normalidad, evitar efectos adversos de la medicación, prevenir obstrucción irreversible de la vía aérea y disminuir la mortalidad. Los medicamentos utilizados para este fin son los antinflamatorios dentro de los cuales se incluyen los grupos de corticoesteroides, cromonas y antileucotrienos. Objetivo: El objetivo de esta revisión bibliográfica es indicar las evidencias encontradas sobre mayor efectividad en este cuadro clínico entre Fluticasona y Montelukast. Material y métodos: Se realizó una revisión bibliográfica, en la cual se utilizo para la búsqueda de información las bases de datos PUBMED, MEDLINE y BIBLIOTECA VIRTUAL DE SALUD artículos científicos publicados en los últimos 5 años que comparan el tratamientote ambos fármacos. Conclusión: El fármaco más efectivo como monoterapia para el tratamiento controlador del asma en niños es la fluticasona frente al montelukast, por lo que esta es considerada la terapia de primera línea.Introduction: Asthma is a chronic inflammatory disorder of the airways. This inflammation is an associated increase in Nonspecific hyperresponsiveness airway to a variety of stimuli and airflow limitation. The asthma controller therapy aims to achieve and maintain control of symptoms, prevent exacerbations, maintaining lung function as close as possible to normal, avoid adverse effects of medication, prevent irreversible obstruction of the airway and reduce mortality . Medicines used for this purpose are the anti-inflammatory within which groups include corticosteroids, chromones and leukotriene. Objective: Fluticasone (inhaled corticosteroid) and montelukast (antileukotriene) are commonly used drugs for the treatment of pediatric asthma controller so that the objective of this review is to summarize the evidence on which of the two showed greater effectiveness in the treatment. Methods: A literature review, which was used to search for information databases PUBMED, MEDLINE and HEALTH LIBRARY scientific articles published over the past 5 years, comparing treatment with fluticasone and montelukast. Conclusion: The most effective drug as monotherapy for asthma controller therapy in children is fluticasone compared with montelukast, so this is considered first-line therapy.Fil: Acevedo, Maria E..Fil: Cano, Alejandra A..Fil: Lopez, Vanina A..Fil: Viola, Luciana S..Fil: Gerometta, Rosana María del Rosario. Universidad Nacional del Nordeste. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

A decrease in the permeability of aquaporin zero as a possible cause for presbyopia

The crystalline lens appears to be a simple organ with the sole role of focusing light upon the retina. However, numerous studies have underscored its dynamic nature with a host of compartmentalized physiological processes. As the individual ages, the normal lens develops two inescapable processes, presbyopia and cataracts. Yet, to date, there is no uniform explanation for presbyopia and many factors have been proposed as contributors including continuous enlargement of the lens, loss of power of the ciliary muscle and hardening of the lens fibers. Proposed explanations are incomplete and need experimental confirmation. This paper analyzes the possible causes for presbyopia and proposes a new one for it: a decrease in the permeability of aquaporin zero (AQP-0) also known as major intrinsic protein (MIP). Based on original findings of our laboratory, this paper proposes that a fluid flow exists inside the avascular lens. This fluid enters and leaves the lens during the accommodation process. We believe that for this to occur the lens utilizes the permeability of aquaporin zero which is abundant in the membrane of the fiber cells. Volume change due to fluid traversing the surface of the lens occurs during accommodation. We present the hypothesis that increasing the permeability of AQP-0 would facilitate accommodation. Therefore, defects in AQP-0 permeability may be a cause for presbyopia. We would also like to propose that it is possible to visualize and measure the fluid volume lost during un-accommodation and determine if the fluid is lost across the anterior, posterior or both surfaces. An age-related loss in lens water permeability could reduce fluid fluxes during the shape changes of accommodation potentially contributing to presbyopia.Fil: Gerometta, Rosana María del Rosario. Universidad Nacional del Nordeste; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste; ArgentinaFil: Candia, O.A.. Icahn School of Medicine at Mount Sinai; Estados Unido

Tissue plasminogen activator reduces the elevated intraocular pressure induced by prednisolone in sheep

We have previously shown that tissue plasminogen activator (tPA) injected in the vitreous of sheep, reduced or prevented the elevation of the intraocular pressure (IOP) normally produced by the instillation of 1% prednisolone. We now report the effect of tPA when injected into the anterior chamber (AC) in amounts of 0.01, 0.001 and 0.0001 μg diluted in a volume of 50 μL. Lyophilized tPA, obtained as Actilyse 50 mg from Boehringer Ingelheim containing arginine was utilized. The Actilyse was diluted in balanced salt solution to obtain the desired amount of tPA in 50 μL. An identical solution containing only arginine was prepared to inject into the contralateral eye as a control. Six sheep of the Corriedale breed were selected. At the beginning of the study all eyes received instillation of 1% prednisolone 3 times/day for 10 days to elevate their IOP from 10 mm Hg to about 23 mm Hg. Then, 0.0001 μg was injected into one of the eyes and its effect was followed for up to 55:00 h while the instillation of prednisolone continued in both eyes. The same protocol was implemented for the 0.001 and 0.01 μg amounts after extended washout and IOP was over 22 mm Hg. The injection of 0.0001 μg into the AC had no effect on an IOP of 23.0 mm Hg at 6:00 and 30:00 h after injection. 0.001 μg of tPA reduced IOP from 23.1 to 18.6 mm Hg at 6:00 h but IOP recovered to 22.3 mm Hg at 30:00 h. Injection of 0.01 μg produced a marked and prolonged reduction of IOP. From a baseline of 23.0, IOP was reduced to 14.0, 14.7, 21.2, and 20.9 mm Hg at 5.0, 23.0, 27.0 and 45.5 h, respectively. The 0.423 μg of arginine, which is associated with 0.01 μg tPA, was injected alone and had no effect. Recombinant human tPA injected in the AC is effective in reversing steroid-induced IOP elevation in sheep. The reduction of IOP elevation may be the result of an effect on extra-cellular matrix turnover in the TM. These findings suggest that tPA may by useful as a therapeutic agent in steroid-induced glaucomas.Fil: Candia, Oscar A.. Mount Sinai School of Medicine, New York; Estados UnidosFil: Gerometta, Rosana María del Rosario. Universidad Nacional del Nordeste. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Danias, John. State University Of New York; Estados Unido

Model systems for the study of steroid-induced IOP elevation

Steroid-induced IOP elevation affects a significant number of patients. It results from a decrease in outflow facility of the aqueous humor. To understand the pathophysiology of this condition a number of model systems have been created. These include ex-vivo cell and organ cultures as well as in-vivo animal models in organisms ranging from rodents to primates. These model systems can be used to investigate specific aspects of steroid-induced IOP elevation. This brief review summarizes the strengths and limitations of the various model systems and provides examples of where these systems have been successfully used to advance our understanding of steroid-induced IOP elevation.Fil: Rybkin, IIya. SUNY Downstate; Estados UnidosFil: Gerometta, Rosana María del Rosario. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional del Comahue. Facultad de Medicina; Argentina. Icahn School of Medicine at Mount Sinai; Estados UnidosFil: Fridman, Gabrielle. SUNY Downstate; Estados UnidosFil: Candia, Oscar. Icahn School of Medicine at Mount Sinai; Estados UnidosFil: Danias, John. SUNY Downstate; Estados Unido