A single subcutaneous dose of tramadol for mild to moderate musculoskeletal trauma in the emergency department

BACKGROUND: Mild to moderate musculoskeletal trauma is a common cause for an emergency room visit, and frequent pain is one of the cardinal symptoms of consultation. The objective of this study is to assess the perception of a single subcutaneous dose of 50 mg tramadol for pain management in patients with mild to moderate musculoskeletal trauma, likewise to appraise the perception of pain by subcutaneous injection.METHODS: A total of 77 patients, who met inclusion criteria, received a single subcutaneous dose of tramadol. Pain control was evaluated based on the verbal numerical pain scale(0–10) at baseline, 20 and 60 minutes; similarly, pain perception was evaluated secondary to subcutaneous injection of the analgesic.RESULTS: On admission, the average pain perceived by patients was 8; twenty minutes later, 89% of the patients reported fi ve or less, and after sixty minutes, 94% had three or less on the verbal numerical pain scale. Of the patients, 88% reported pain perception by verbal numeric scale of 3 or less by injection of the drug, and 6.5% required a second analgesic for pain control. Two events with drug administration(soft tissue infection and mild abdominal rectus injection) were reported.CONCLUSION: We conclude that a single subcutaneous dose of tramadol is a safe and effective option for the management of patients with mild to moderate pain and musculoskeletal disease in the emergency department.

First histopathological study in kidneys of rodents naturally infected with Leptospira pathogenic species from Yucatan, Mexico

Objective: To report the renal histological lesions in synanthropic rodents, Mus musculus and Rattus rattus, naturally infected with Leptospira spp., captured in a rural community in Yucatan, Mexico. Methods: Kidney samples of synanthropic rodents were collected from a rural community in Yucatan, Mexico. Polymerase chain reaction was used to detect Leptospira spp. infection. Tissue kidney was fixed in 10% buffered formalin, processed according to the usual techniques for paraffin inclusion, cut and stained with hematoxylin and eosin, and examined using a conventional electronic microscope. Results: A total of 187 rodents were captured. Nine individuals(4.8%) were positive for Leptospira spp. in the molecular analysis. All renal lesions observed in the histopathological study had been reported previously for Leptospira spp. infection. Conclusions: The histopathological lesions are present in the kidneys, plus the results of the polymerase chain reaction confirm that these rodents are true carriers of Leptospira spp.

Conversion disorder in a neurological emergency department:Restrospective series

Objective: To observe the conversion disorder in a neurological emergency department. Methods: It is common that the initial approach to this patients include the use of various diagnostic exams. In this series we reviewed 94 patients that arrived a neurological emergency room in a 3 year period. Results: 72 patients were females (76%), and the initial presumptive diagnosis were: neurovascular syndrome in 36 patients (38.3%), convulsive disorder in 20 patients (21.28%), and conversive disorder in 8 patients (8.51%). 82 patients had motor symptoms and 61 sensitive symptoms. 88 patients (93%) required neuroimaging studies, 77 (81%) patients underwent through basic biochemical panels. Other tests performed were:electroencephalogram in 12 patients (12.77%), electromyography in 11 patients (11.7%), lumbar punction in 8 patients (8.04%) and regarding the medical consult in the care of these patients 11 were evaluated by 1 specialists, 35 (37.2%) by 2 different specialties, 42 (44.63%) patients required evaluation by 3, and 6 patients (6.38%) required evaluation by 4 different specialties. Conclusions: Based on this data, we conclude that conversion disorders require a lot of resources in the emergency room and that the similarities with neurological diseases demands a complete workup including expensive diagnostic tools. However, this patients can be discharged safely without requiring hospitalization.

Evaluation of the Results of Radical Management of a Cohort of 107 Patients with Hepatocellular Carcinoma in Colombia

Introduction: Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver and usually appears as part of liver cirrhosis (LC). Its management in the presence of LC is ideally with orthotopic liver transplantation. Surgical resection is indicated only in the presence of a tumor in a patient with a very good liver function and who for medical reasons cannot be carried to transplantation. Materials and Methods: A descriptive study of a prospective and consecutive series of patients undergoing surgery (resection or liver transplantation) for HCC in a hospital in the city of Medellin was performed, from June 2004 to January 2015. A multivariate analysis was carried out of factors associated with survival during the follow-up. Results: 116 surgical interventions for the management of HCC between June 2004 and January 2015 were performed. The analysis included 107 patients, of which 73% were men. The median age of all patients was 60 years. The factors that showed better survival were: patients undergoing transplantation, the presence of cirrhosis, tumor less than 5 cm in diameter, a unique and well-differentiated tumor;however, none of these factors achieved statistical significance. Conclusion: Both resection and liver transplantation, when well indicated achieve good 5-years of survival in patients with HCC.

Comparison of Secnidazole and Fenbendazole for the Treatment of Asymptomatic Giardia Infection in Dogs

The objetive of this study was to compare a single dose of secnidazole versus multiple doses of fenbendazole for the treatment of dogs with asymptomatic Giardia infection.Materials and methods:Twenty-four asymptomatic dogs with a positive test result for Giardia spp were randomized in two equal groups to receive a single dose of secnidazole at 30 mg/kg PO,or fenbendazole at 50 mg/kg PO q24h for 3 days.Hematological parameters were evaluated before and 8 days after treatment,and feces were re-examined at days 8,15,and 30 post-treatment by fecal flotation and antigen test.Results:The number of positive dogs in the fenbendazole group was:1(day 8)and 3(days 15 and 30).In the secnidazole group,the number of positive cases were:4(day 8),3(day 15),and 1(day 30).Conclusion:Treatment with secnidazole or fenbendazole,were effective between 75%and 92%to eliminate the excretion of Giardia cysts in canines together with hygienic measures to control,like disinfection with quaternary ammonium of patients and their environment.Further studies that include more animals and multiple fecal exams on consecutive days would be necessary to confirm its efficacy in dogs.

Completion thyroidectomy:is timing important for transcervical and remote access approaches?

Completion thyroidectomy(CT)is employed after lobectomy when histopathological results mandates total removal of the gland as in case of well differentiated thyroid carcinoma(DTC).It is also employed as a second stage thyroid surgery when unfavorable events occur as in recurrent laryngeal nerve injury or when the surgeon finds out the case is beyond his/her expertise in an attempt to protect the contralateral side and allowing time for recovery or for an expert surgeon to help.