Resumen Se presenta el estudio de variabilidad de longitud, diámetro total, diámetro del lumen, espesor de pared y fracción de pared de las traqueidas de Pinus caribaea var. hondurensis proveniente de plantaciones de 25 años de edad establecidas en Uverito (estado Monagas,Venezuela). Se examinaron un total de seis individuos y se preparó tejido macerado en tres posiciones de la sección transversal: adyacencias de médula, punto medio (muestras en madera temprana y madera tardía) y adyacencias del cambium. Los resultados indican que el mayor diámetro promedio (total y del lumen) correspondió a la madera temprana, mientras que los mayores grosores y fracción de pared se concentraron hacia la madera tardía. En relación a la longitud de traqueidas aumenta desde la zona cercana a la médula hasta el punto medio de la sección transversal para, posteriormente, disminuir hacia las adyacencias del cambium y alcanzar valores muy similares a los del punto inicial. El patrón de variación de longitud de traqueidas indica que a partir del punto medio de la sección transversal comienza la formación de madura adulta.

Abstract This research is about variability of quantitative features (length, diameter, thickness, wall fraction) in tracheids of Pinus caribaea var. hondurensis from 25 years old plantations from Uverito (Monagas state, Venezuela). Six trees were studied and macerated tissue were prepared in three positions in cross section: near of pith, middle point of cross section and near of cambium. Higher diameter was observed in early wood and in late wood were found higher thickness wall. Tracheid length had an increment from the pith to middle point and, then, showed a reduction from middle point to cambium. According variation in tracheids length, adult wood appears from the middle point to cambium

Resumen Se desarrolló una metodología de secado para Pinus caribaea var. hondurensis, empleando horno de microondas doméstico (HMO), consistente de pulsos de radiación y períodos de enfriamiento, que consume 92% menos energía y 58% menos tiempo. Las propiedades físicas y mecánicas se midieron en condición seca al HMO, equilibrio higroscópico (EH) y secado convencional, ρverde: 1049 ± 74 kg/m3 (CH: 107 ± 18 %), ρsecaHMO: 555 ± 63 kg/m3 , ρEH: 565 ± 51 kg/ m3 (CH: 11,3 ± 0,8 %), Vverde: 58 ± 1 x10-6 m3 y VHMO: 51 ± 26 x 10-6 m3 y contracción volumétrica: 11 ± 3 %, no presentando diferencias significativas con respecto al secado convencional. Los valores de la compresión paralela al grano fueron: ELPHMO: 6 ± 2 x 106 kg/m2 , MRHMO: 6 ± 2 x 106 kg/m2 y MOEHMO: 4 ± 1 x 108 kg/m2 , ELPEH: 3,0 ± 0,5 kg/m2 , MREH: 3,5 ± 0,64 kg/m2 y MOEEH: 2,3 ± 0,6 kg/m2 ; tampoco mostraron diferencias con respecto al secado convencional. La única alteración anatómica observada fue un aumento de agrietamientos espiralados en las paredes de las traqueidas y no parece tener repercusión sobre las propiedades evaluadas. Se concluyó que la exposición al microondas no altera las propiedades estudiadas siendo un método confiable de secado.

Abstract A methodology was developed for drying Pinus caribaea var. hondurensis, using a domestic microwave oven (HMO) consisting of radiation pulses and cooling periods and consumes 92% less energy and 58% less time. The physical and mechanical properties were measured in the dry condition of HMO, hygroscopic equilibrium (HE) and conventional drying, ρgreen : 1049 ± 74 kg/m3 (CH: 107 ± 18%), ρdryHMO: 555 ± 63 kg/m3 , ρEH : 565 ± 51 kg/m3 (CH: 11.3 ± 0.8%), Vgreen : 58 ± 1 x 10-6 m3 , VHMO: 51 ± 26 x 10-6 m3 , and volumetric contraction: 11 ± 3%, which do not present significant differences with respect to conventional drying. The values of compression parallel to the grain were: ELPHMO: 6 ± 2 x 106 kg/m2 , MRHMO: 6 ± 2 x 106 kgm2 and MOEHMO: 4 ± 1 x 108 kg/m2 , ELPEH: 3,0 ± 0.5 kg/m2 , MREH: 3,5 ± 0.64 kg/m2 and MOEEH: 2,3 ± 0.6 kg/m2 , and not show differences with respect to conventional drying. The only anatomical alteration observed was an increase in spiral cracks in the walls of the tracheids and does not seem to have an impact on the evaluated properties. It was concluded that microwave exposure does not alter the studied properties and is a reliable method for drying.

Resumen El presente trabajo corresponde al estudio de la densidad de madera seca al aire en 6 árboles de Pinus caribaea var. hondurensis (Sénécl) W. Barret & Golfari (Pinaceae) provenientes de plantaciones de 25 años de edad establecidas en Uverito (estado Monagas, Venezuela). Se tomaron muestras en 3 posiciones de la sección transversal del tallo: adyacencias de médula (muestra de todo el anillo de crecimiento), y a la mitad del radio (muestra en madera temprana y madera tardía) y adyacencias de zona cambial (muestra de todo el anillo de crecimiento). La densidad se determinó bajo la Norma DIN 52-182. A través de la sección transversal se encontró un incremento de la densidad desde las adyacencias de médula hacia la zona cambial (0,595 en adyacencias de médula; 0,681 en el punto medio y 0,820 g/cm³ en las adyacencias de la zona cambial). Por otra parte, el peso específico de madera tardía (0,806 g/cm³) mostró valores notablemente superiores con respecto a la madera temprana (0,557 g/cm³). De acuerdo a la prueba de Tukey (α = 0,01), existen diferencias estadísticamente significativas entre el peso específico de adyacencias de médula con respecto a las cercanías del cambium; así como también las diferencias encontradas entre madera temprana y madera tardía del anillo de crecimiento tuvieron significancia estadística.

Abstract This paper deals about air-dry density in wood from six trees of Pinus caribaea var. hondurensis (Sénécl) W. Barret & Golfari (Pinaceae) from 25 years old plantations growing in Uverito (Monagas state, Venezuela). Samples were taken in three positions of cross section: near of pith (all growth ring), middle point (sample for early wood and sample for late wood) and near of cambium (all growth ring). Density was obtained according DIN 52-182. Density grows from pith to cambium (0,595 near of pith; 0,681 in middle zone and 0,820 g/cm³ near of cambium). In late wood, we found higher values in air-dry density (0,806 g/cm³) in comparation with early wood (0,557 g/cm³). According Tukey test (α = 0,01), there are significatives differences between airdry density in pith zone-cambial zone and between early and late wood.

Resumen Se presenta el estudio de la relación entre la densidad seca al aire y características cuantitativas de los vasos (frecuencia y diámetro de vasos, área de lumen) para diez especies de Malvaceae que crecen en Venezuela: Catostemma commune, Eryotheca globosa, Ochroma pyramidale, Pachira quinata, Guazuma ulmifolia, Apeiba tibourbou, Heliocarpus americanus, Uladendron codesurii, Sterculia apetala y Sterculia pruriens. La densidad se determinó en muestras acondicionadas al 12 % de humedad y para la medición de las características de los vasos se prepararon láminas de secciones transversales utilizando los procedimientos convencionales de microtecnia xilemática. Las mayores frecuencias y menores diámetros de vasos se presentaron en Guazuma ulmifolia y Uladendron codesurii; mientras que las menores frecuencias y mayores diámetros de vasos los presentaron especies de las subfamilias Bombacoideae y Sterculioideae. La densidad seca al aire mostró un alto grado de variación, encontrándose especies que van desde la categoría de muy baja densidad (Ochroma pyramidale, Pachira quinata, Apeiba tibourbou, Heliocarpus americanus, Sterculia apetala) hasta muy alta densidad (Uladendron codesurii). La relación entre la densidad y las características de los vasos presentó una baja correlación lo que indica la posible existencia de otras características anatómicas que ejercen mayor influencia sobre esta propiedad física.

Abstract This research is about the relation between air dry density and quantitative features of vessels (frequency and diameter, lumen area) for ten species of Malvaceae from Venezuela: Catostemma commune, Eryotheca globosa, Ochroma pyramidale, Pachira quinata, Guazuma ulmifolia, Apeiba tibourbou, Heliocarpus americanus, Uladendron codesurii, Sterculia apetala and Sterculia pruriens. Density was determined in samples with moisture content equal to 12 % and measures of vessels features were realized in slides samples of cross sections using standards procedures in xylem microtechnique. Higher vessels frequencies and lower diameters were observed in Guazuma ulmifolia and Uladendron codesurii and lower frequencies and higher diameters were observed in species from Bombacoideae and Sterculioideae subfamilies. Air dry density shows a high variation, ranging from very low density (Ochroma pyramidale, Pachira quinata, Apeiba tibourbou, Heliocarpus americanus, Sterculia apetala) to very high density (Uladendron codesurii). A low correlation between density and vessels features was found and its possible that others wood anatomy features have a higher effect over wood density for Malvaceae.

Nemaline myopathy - a clinically and genetically complex heterogenous group of disorders - is described uncommonly in humans and rarely in animals, and is characterised by progressive muscle weakness. The diagnosis is confirmed by histological and/or ultrastructural identification of subsarcolemmal, thread-like, rod-shaped structures called nemaline rod bodies within more than 40% of skeletal muscle fibres. These rods contain the Z-line protein, α-actinin, that can be effectively stained in skeletal muscles using Gomori or Masson trichrome and negatively stained with periodic acid-Schiff. Similar rod-like bodies have been found in smaller numbers in dogs with endocrine disorders and occasionally in other conditions in humans. This report is of a six-month-old Pomeranian dog which had progressive exercise intolerance over a two-month period associated with severe disuse muscle atrophy of the thoracic limbs, as well as gradual pelvic limb weakness and regurgitation of food. Baseline diagnostics ruled out endocrinopathies and after histological and ultrastructural evaluation of thoracic limb muscles and nerve biopsies confirmed nemaline myopathy. The clinical course, diagnostic test results, ultrastructure of skeletal muscle and peripheral nerve, gross necropsy findings and histopathology using various stains are described and illustrated.

Abstract: Introduction: The evaluation and management of acetabular bone loss in total hip arthroplasty is a challenge for orthopedic surgeons, we wish in this study to determine the inter-observer concordance in the Paprosky classification for acetabular defects. Material and methods: Observational, descriptive, longitudinal, prospective study. It was performed using anteroposterior hip radiographs of patients scheduled for primary total hip arthroplasty or revision with acetabular bone defect, Sinapse local X-ray system, 20 X-rays were assessed per observer taken randomly (doctors assigned to the joint replacement service with minimum experience of five years) using the Paprosky classification spontaneously, (without previous classes) for acetabular defects, inter-observer concordance was assessed using Cohen’s Kappa coefficient. Results: An interobserver agreement was obtained on average for the Paprosky classification of acetabular defects using the Cohen’s Kappa coefficient, the concordance analysis was done using the statistical program statistical package for the social sciences of 0.237. Conclusions: Both the null hypothesis (Kappa greater than 0.80 value considered optimal) and the alternative hypothesis (Kappa from 0.41 to 0.80 value equal to moderate to good) did not agree with our study (Kappa equal to 0.237) value equal to mild, in addition , it was shown that the greater the acetabular defect, the lower the interobserver agreement in surgeons in our institution.

Resumen: Introducción: La evaluación y manejo de la pérdida ósea acetabular en la artroplastía total de cadera es un desafío para los cirujanos ortopédicos, deseamos en este estudio determinar la concordancia interobservador en la clasificación de Paprosky para defectos acetabulares. Material y métodos: Estudio observacional, descriptivo, longitudinal, prospectivo. Se realizó utilizando las radiografías anteroposteriores de cadera de pacientes programados para artroplastía total de cadera primaria o de revisión con defecto óseo acetabular, sistema de rayos X local Sinapse, se valoraron 20 radiografías por observador tomadas de manera aleatoria (médicos adscritos al servicio de reemplazos articulares con experiencia mínima de cinco años) utilizando la clasificación de Paprosky de manera espontánea (sin clases previas) de defectos acetabulares, se evaluó la concordancia interobservador mediante el coeficiente de kappa de Cohen. Resultados: Se obtuvo una concordancia interobservador en promedio para la clasificación de Paprosky de defectos acetabulares utilizando el coeficiente de kappa de Cohen, el análisis de concordancia se hizo empleando el programa estadístico Statistical Package for the Social Sciences de 0.237. Conclusiones: Tanto la hipótesis nula (kappa mayor de 0.80 valor considerado óptimo) como la hipótesis alternativa (kappa de 0.41 a 0.80 valor igual a moderada a buena) no concordaron con nuestro estudio (kappa igual a 0.237) valor igual a leve, además se demostró que a mayor defecto acetabular menor es la concordancia interobservador en cirujanos en nuestra institución.

Abstract: Introduction: Preventive analgesia in orthopedic surgery is becoming increasingly important because post-surgical pain management is more pleasant for the patient and allows them to initiate rehabilitation early. With this premise we consider the following hypothesis. The perception of post-surgical pain at two, 12 and 24 hours with local infiltration into the surgical wound with ropivacaine plus systemic analgesia will be less compared to patients who infiltrate with saline into the surgical wound plus systemic analgesia. Material and methods: A randomized double-blind, prospective randomized controlled clinical trial was conducted in the period January 2018 to August 2018. Results: The null hypothesis is rejected in the group valued at two hours and the null hypothesis is accepted in the groups valued at 12 and 24 hours. Conclusion: Ropivacaine infiltration is an effective method for managing postoperative pain for the first 2 hours in open shoulder surgery procedures.

Resumen: Introducción: La analgesia preventiva en cirugía ortopédica cada vez toma mayor importancia debido a que el control del dolor postquirúrgico es más grato para el paciente y le permite iniciar rehabilitación de forma temprana. Con esta premisa nos planteamos la siguiente hipótesis. La percepción del dolor postquirúrgico a las dos, 12 y 24 horas con infiltración local en la herida quirúrgica con ropivacaína más analgesia sistémica será menor en comparación con los pacientes que se infiltren con solución salina en la herida quirúrgica más analgesia sistémica. Material y métodos: Se realizó un ensayo clínico controlado aleatorizado doble ciego, prospectivo en el período comprendido de Enero de 2018 a Agosto de 2018. Resultados: Se rechazó la hipótesis nula en el grupo valorado a las dos horas y se aceptó la hipótesis nula en los grupos valorados a las 12 y 24 horas. Conclusión: La infiltración con ropivacaína es un método efectivo para el manejo del dolor postoperatorio durante las primeras dos horas en procedimientos de cirugía abierta de hombro.

Abstract: Introduction: The education process is understood as an activity focused on developing competencies through the use of educational tools and strategies that can be evaluated. The training of the residents in Traumatology and Orthopedics requires you to acquire knowledge and develop skills that will affect the diagnosis, treatment and prognosis of the patient. Therefore, what will be the evaluation of the educational intervention on the theoretical and practical knowledge in this group of physicians on the technique of taking, measuring and preparation of hamstring graft for the reconstruction of anterior cruciate ligament? Material y methods: A prospective, quasi-experimental study was conducted to evaluate the impact of educational intervention in 23 Traumatology and Orthopaedic residents on the use of hamstring in the anterior cruciate ligament reconstruction through theoretical sessions and Practice on cadaverous knees with preand post-intervention evaluations. Results: The correlation between the pre and post evaluation educational intervention, both theoretical and practical, was statistically significant (p = 0.004 and p = 0.4, respectively). Conclusion: The statistically significant correlation between preand post-educational intervention evaluations speaks of the value of learning strategies, in the case of this study, the intervention through a theoretical and practical session by a simulated patient promotes knowledge acquisition and development of skills.

Resumen: Introducción: El proceso de educación se entiende como una actividad enfocada a desarrollar competencias mediante el empleo de herramientas y estrategias educativas que pueden ser sometidas a evaluación. La formación del médico residente de Traumatología y Ortopedia le exige adquirir conocimientos y desarrollar destrezas que repercutirán en el diagnóstico, tratamiento y pronóstico del paciente. Por lo tanto, ¿cuál será la evaluación de la intervención educativa sobre los conocimientos teóricos y prácticos en residentes de la especialidad de traumatología y ortopedia sobre la técnica de toma, medición y preparación de injerto de isquiotibiales para la reconstrucción de ligamento cruzado anterior? Material y métodos: Se realizó un estudio prospectivo, cuasiexperimental para evaluar el impacto de la intervención educativa en 23 residentes de Traumatología y Ortopedia sobre el uso de isquiotibiales en la reconstrucción de ligamento cruzado anterior mediante sesiones teórica y práctica en rodillas cadavéricas con evaluaciones pre- y postintervención. Resultados: La correlación entre la evaluación pre- y postintervención educativa, tanto teórica como práctica, fue estadísticamente significativa (p = 0.004 y p = 0.4, respectivamente). Conclusiones: La correlación estadísticamente significativa entre evaluaciones pre- y postintervención educativa refiere el valor de las estrategias de aprendizaje, en el caso de este estudio, la intervención a través de una sesión teórica y práctica mediante un paciente simulado (práctica necroquirúrgica) promueve la adquisición de conocimientos y el desarrollo de habilidades y destrezas.

RESUMEN La familia Asteraceae es una de las más ricas en Venezuela. Pentacalia es el género con mayor cantidad de especies dentro de la misma y su principal área de distribución corresponde a los estados Mérida, Táchira y Trujillo. A pesar de su importancia, son pocos los estudios de anatomía xilemática para Pentacalia. El objetivo de este trabajo es la descripción anatómica de la madera de ocho especies de Pentacalia: P. cachacoensis, P. greenmaniana, P. imbricatifolia, P. mason-halei, P. pachypus, P. quirorana, P. reflexa y P. venezuelensis con el fin de encontrar caracteres útiles para su identificación. Las muestras fueron colectadas en los páramos de los estados Táchira y Mérida y en selva nublada de Mérida. La preparación del material se hizo utilizando los procedimientos de microtecnia xilemática y la descripción se realizó de acuerdo a lo estipulado por la asociación internacional de anatomistas de la madera. Las especies se pueden separar en dos grupos de acuerdo a la presencia o ausencia de estructura estratificada y dentro de cada grupo se pueden establecer diferencias con base en caracteres cualitativos y, en algunos casos, es necesario separar con base en caracteres cuantitativos. Sólo P. pachypus y P. venezuelensis no se pudieron separar utilizando características anatómicas de la madera.

ABSTRACT The family Asteraceae is one of the most diverse in Venezuela. Pentacalia is the genus with the highest number of species in the family and its principal distribution area is in Mérida, Táchira and Trujillo states. In spite of its importance, there are few studies about wood anatomy for Pentacalia. The aim of this research was describe the wood anatomy of eight species of Pentacalia: P. cachacoensis, P. greenmaniana, P. imbricatifolia, P. mason-halei, P. pachypus, P. quirorana, P. reflexa and P. venezuelensis to find useful features for identification. Samples were collected in andean paramos of Mérida and Táchira states and cloudy forest in Mérida state. Samples were prepared using standard procedures of xylem microtechnique and description was made according international association of wood anatomists. Species studied can be separated in two groups according the presence or absence of storied structure and in each group, we found differences in qualitative features and, in some cases, is necessary the separation using quantitative features. Only P. pachypus and P. venezuelensis can not be separated using wood anatomical features.

BACKGROUND: The large-scale migration of doctors, including surgeons, from South Africa, has had a major impact on healthcare resources in this country. Although previous studies have suggested that the University of Cape Town (UCT) is of the main institution contributing to this "brain drain", the extent of the problem has not been documented previously. The aim of this study was to investigate where UCT trained surgical registrars go after completing their training. METHOD: General surgery registrars who trained at UCT and who wrote and passed the FCS final examination between 1992 and 2011 were included in the study. The data for this study were obtained from the examinations office of the Colleges of Medicine of South Africa. The number of registrars writing and passing the final examination, the number of registrars who went overseas, the number of registrars in private practice, and the number of registrars in subspecialist practice, were recorded. RESULTS: A total of 102 UCT-trained registrars wrote and passed the FCS final examination during the study period. Only 13% of the South African UCT-trained registrars left the country. Only 31% of the registrars who remained in South Africa went into private practice. A large proportion of the UCT-trained registrars (43%) elected to subspecialise. CONCLUSION: "Brain drain" with respect to UCT-trained surgical registrars was not as extensive as anticipated.

BACKGROUND: Termination of pregnancy (TOP) remains a controversial issue, regardless of legislation. Access to services as well as psychological effects may vary across the world. OBJECTIVES AND METHODS: To better understand the psychological effects of TOP, this study describes the circumstances of 102 women who underwent a TOP from two socioeconomic sites in Johannesburg, South Africa, one serving women with few economic resources and the other serving women with adequate resources. The relationship between demographic characteristics, resilience and symptoms of post-traumatic stress disorder (PTSD) and depression before, 1 month after and 3 months after the procedure was also examined. RESULTS: Time since TOP, age, chronic burden, resilience and the interaction of site with religion and site with chronic burden were significant. In addition, site differences were found for religion and chronic burden in predicting depression scores. Women from both sites had significant decreases in depression scores over time. The interaction of time with site was not significant. Higher chronic burden scores correlated with higher depression scores. No variables were significant in the bivariate analysis for PTSD. CONCLUSION: Resilience, religion and chronic burden emerge as significant variables in women undergoing a first-trimester TOP, and warrant further assessment in studies of this nature.

BACKGROUND: A key objective of the Nephrology Sister Centre Programme between the renal units in Cardiff and Addis Ababa, sponsored by the International Society of Nephrology, is to facilitate development of the local clinical service in Ethiopia specifically focused on the management of acute kidney injury (AKI). OBJECTIVES: To examine the relationship between AKI risk factor recognition and monitoring of renal function in three hospitals in Ethiopia. METHODS: Cross-sectional data were gathered regarding renal function monitoring, recording the presence of AKI risk-associated comorbidities and prescription of nephrotoxic medications across the disciplines of medicine, surgery, obstetrics and gynaecology. RESULTS: Patients were more likely to have their renal function checked at the hospital with specialist services. Across all centres, the highest proportion of patients who had renal function measurements were those admitted to a medical ward. There was a positive relationship between documented comorbidities and the measurement of renal function but not between the prescription of nephrotoxic drugs and measurement of renal function. CONCLUSION: There was great variability in the extent to which doctors recognised the presence of risk factors for the development of AKI. Failure to identify these risk factors represents a lost opportunity to identify patients at high risk of developing renal injury who would benefit from renal function monitoring.

OBJECTIVES: Although common worldwide, intravaginal cleansing is associated with poor health outcomes. We sought to describe intravaginal cleansing among women attending a sexually transmitted infection (STI) clinic in Jamaica. METHODS: We examined intravaginal cleansing ("washing up inside the vagina", douching, and products or materials used) among 293 participants in a randomized trial of counselling messages at an STI clinic in Kingston. We focussed on information on intravaginal cleansing performed in the 30 days and three days preceding their baseline study visit. We describe reported cleansing behaviours and used logistic regression to identify correlates of intravaginal cleansing RESULTS: Fifty-eight per cent of participants reported intravaginal cleansing in the previous 30 days, and 46% did so in the three days before baseline. Among those who cleansed in the previous 30 days, 88% reported doing so for hygiene unrelated to sex, and three-fourths reported generally doing so more than once per day. Soap (usually with water) and water alone were the most common products used for washing; commercial douches or detergents were reported infrequently. Intravaginal cleansing in the three days before the baseline visit was positively associated with having more than one sex partner in the previous three months (adjusted odds ratio [AOR], 1.9; 95% CI, 1.1, 3.2), and negatively associated with experiencing itching in the genital area at baseline (AOR, 0.6; 95% CI, 0.4, 1.0). CONCLUSIONS: A large proportion of women attending STI clinics in Jamaica engage in frequent intravaginal cleansing, indicating a need for clinicians to discuss this topic with them accordingly.

OBJETIVOS: Aunque común mundialmente, la limpieza intravaginal se halla asociada con pobres resultados de salud. Buscamos describir la limpieza intravaginal entre mujeres que asisten a una clínica de infecciones de transmisión sexual (ITS) en Jamaica. MÉTODOS: Examinamos la limpieza intravaginal ("lavado del interior de la vagina", ducha, y productos o materiales usados) entre 293 participantes en una prueba aleatoria de mensajes de counseling en una clínica de ITS en Kingston. Las participantes proporcionaron la información sobre la limpieza intravaginal realizada en los 30 y tres días que precedieron a su visita para el estudio inicial. Describimos las conductas de limpieza reportadas y la regresión logística usada para identificar los correlatos de la limpieza intravaginal. RESULTADOS: Cincuenta y ocho por ciento de las participantes reportaron la limpieza intravaginal en los 30 días anteriores, y el 46% lo hicieron en los tres días antes del inicio del estudio. Entre aquéllas que realizaron la limpieza en los 30 días anteriores, el 88% reportó haberlo hecho por razones de higiene independientes de la vida sexual, y tres cuartos reportaron hacerlo de manera general más de una vez al día. Jabón (normalmente con agua) y agua solamente fueron los productos más comunes usados para el lavado. Las duchas comerciales o detergentes no fueron reportadas muy frecuentemente. La limpieza intravaginal en los tres días antes de la visita del estudio inicial estuvo positivamente asociada con tener más de una pareja sexual en los tres meses anteriores (odds ratio ajustado [AOR], 1.9; 95% CI, 1.1, 3.2), y negativamente asociado con experimentar comezón en el área genital al inicio del estudio (AOR, 0.6; 95% CI, 0.4, 1.0). CONCLUSIONES: Un gran número de mujeres que asisten a las clínicas de ITS en Jamaica practican frecuentemente la limpieza intravaginal, lo cual indica la necesidad de que los médicos clínicos discutan este asunto con ellas.

Zoo animals, including tigers, have been reported to suffer from barbiturate intoxication, with pentabarbitone being most commonly recorded. Clinical signs range from mild ataxia to general anaesthesia with recovery over hours to days with several factors affecting hepatic barbiturate metabolism and tissue partitioning. Botulism is an often fatal intoxication in man, animals, birds and certain fish. The occurrence in carnivores is uncommon to rare, with only 2 reports found of botulism in felids. This report relates to 3 adult captive cohabiting tigers that simultaneously developed signs of abdominal discomfort, progressive ataxia, recumbency and comatose sleep resembling stage 2 anaesthesia, alternating with periods of distracted wakefulness and ataxic movements. These signs occurred 4 days after being fed the carcass of a horse that had ostensibly died of colic and not been euthanased. The male tiger that was the dominant animal in the feeding hierarchy was worst affected and had to be given intravenous fluids. The female that was lowest in hierarchy was unaffected. After 48-72 hours of treatment at the Onderstepoort Veterinary Academic Hospital the females could eat and made an uneventful recovery. The male tiger showed partial recovery but died during the night a few hours after drinking water on his return to the owner. Necropsy revealed severe oesophageal dilation and impaction with decaying grass; some of this material and water were present in the pharynx and trachea, and had been aspirated causing acute widespread bronchopneumonia. Colon content tested negative for common pesticides but, together with liver, tested positive for barbiturate. Serum taken on the day of admission had tested negative for barbiturate and the residual serum from the 3 animals later tested negative for botulinum toxin. Colon and oesophageal content from the male at necropsy were positive for Clostridium botulinum toxin type C by the mouse bioassay neutralisation test, confirming that this male had had concomitant barbiturate toxicity and botulism, and had succumbed to aspiration bronchopneumonia secondary to pharyngeal, laryngeal and oesophageal paralysis and oesophageal impaction.