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Further investigation is required to medicine 54 092 buy duricef 500mg overnight delivery quantify the risks of list eriosis associated with fresh-cut products treatment wpw order duricef 500 mg mastercard. Enteric Pathogens (Family Enterobacteriaceae) Escherichia Coli Escherichia coli is part of the natural micro? However medications used for fibromyalgia purchase duricef 250mg without a prescription, there are also strains capable of causing gastrointestinal disease in humans medications bad for kidneys duricef 500 mg cheap. These strains are grouped as the enterotoxigenic, enterohemor rhagic, enteropathogenic and enteroinvasive strains of E. The infectious dose of this organism has been shown to be as low as two cells in 25 g of food, and it is now believed that the infectious dose is less than 100 cells/g food (Willshaw et al. Although the pathogenicity is not fully understood, it produces a number of verotoxins (cytotoxins to the African green monkey kidney cells), depending on the strain and enterohemolysin (Desmarchelier and Grau, 1997). It causes hemorrhagic colitis, hemolytic uremic syndrome (usually in children) and thrombocytopenia purpura (in adults). Other potential contamination sources are the water used, workers? hands and wind and dust con tamination, as described in a previous section (pages 190?197). Survival of the organism and mechanisms of contamination in the processing environment have not been studied. This organism may grow on pro cessed fruits such as watermelon and cantaloupe (del Rosario and Beuchat, 1995), shredded lettuce, sliced cucumbers and sprouts (Abdul-Raouf et al. Fluctuations in handling and storage temperatures of fresh-cut products, including cut fruits such as cantaloupe and other melons, may provide opportunity for this organism to survive, creating a public health risk. It is of some concern that most research on survival, detection and enumeration of Enterohemorrhagic E. The genus is divided into four species: Shigella dysenteriae, Shigella sonnei, Shigella? Noninvasive serovars and other Shigella species produce only low levels of cytotoxicity and show endotoxic and neurotoxic activity (Lightfoot, 1997; Lampel et al. Outbreaks of shigellosis are generally linked to water of food contaminated with human feces. Thus, fresh produce can become contaminated through the use of contaminated irrigation water, the use of raw sewage as fertilizers, insect transfer or human contact (Beuchat, 1998). Shigella species can survive on shredded lettuce under refrigeration for up to three days without populations decreasing and can also survive on sliced fruits, including watermelon and raw papaya (Escartin et al. Processed fruits and vegetables have been implicated in a number of outbreaks of shigellosis. Salad vegetables, cantaloupe and potato salad are examples of the associated products (Formal et al. Salmonella Within the genus Salmonella, differentiation into species is based on antigenic differences. There are currently over 2370 serovars recognized, however, only 200 are known to cause disease in humans, including Salmonella typhi, the causative agent in the disease typhoid (Jay et al. Food borne disease caused by nontyphoid serovars of Salmonella includes gastroenteritis and enterocolitis, with symptoms appearing from 8?72 h after food consumption. More severe complications include septicemia and onset of reactive arthritis (Jay et al. Salmonellae have been isolated from fresh produce, and fruits and vegetables have been linked to outbreaks of salmonellosis (Hedburg and Olsterholm, 1993; Beuchat, 1998). Fresh produce may become contaminated with salmonellae either from sewage and contaminated water or from handling by infected workers. Although there are no reported cases of salmonellosis from fresh-cut products, Salmonella can grow on the surface of alfalfa sprouts (Jaquette et al. Salmonellae do not grow in foods at less than 7?C and, therefore, should not pose a risk to public health in fresh-cut products, provided they are maintained at refrigeration tempera tures. Clostridium botulinum produces potent neurotoxins that produce a range of symptoms in humans, including nausea, diarrhea and vomiting and neurological symptoms such as blurred vision, dilated pupils, paralysis of motor nerves, loss of mouth and throat normal functions, lack of muscle coordination and other complications and possible death. Clostridium perfringens cells die at temperatures below 10?C but can grow at 15?C. The risk to public health arises if products contaminated with these organisms are handled in such a way as to enable spore germination and outgrowth of the vegetative cell, for example, when temperature? Staphylococcus Aureus Staphylococcus aureus (Gram-positive cocci) has been isolated from vegetables and fresh-cut products (Abdelnoor et al. Campylobacter Campylobacter jejuni (Gram-positive spiral rods) is found in the intestinal tract of a wide variety of wild and domestic animals. It is a common cause of bacterial enteritis in many countries and is generally associated with food poisoning outbreaks involving animal products. There are some incidences of infection arising from contamination of fruits and vegetables (Bean and Grif? Cross-contamination between animal and vegeta ble products may occur where non-vegetable ingredients are added to salads. Although the optimum growth temperature is 42?C, it grows under microaerophilic conditions similar to those of packaged fresh-cuts. This pathogen is recognized to produce a wide range of clinical and immunological symptoms. The most common is enterocolitis, seen mainly in young children, and pseudoappendicitis, occurring in older children and adolescents (Barton et al. It may contaminate fresh produce from feces and through cross-contamination in processing establishments. They pose a potential risk to public health in fresh-cut products because of their ability to grow at low temperatures. Aeromonas Species Aeromonas are Gram-negative rod-shaped coccoid bacteria that are ubiquitous to most aquatic environments and occur in a wide variety of foods (Palumbo et al. Not all strains are pathogenic, and aeromonads are often responsible for spoilage of foods. Aeromonads may contaminate fresh fruits and vegetables from wash water and possibly through cross-contamination from seafood, meat or poultry. The organism causes a self-limiting illness characterized by diarrhea and mild fever. Vibrio Species Vibrio species (Gram-negative vibrio-shaped rods) occur predominantly in estuarine waters, and foodborne disease from these organisms are usually associated with? Of the 12 pathogenic species, Vibrio cholera causes the most severe disease, cholera (Kaysner, 2000). Vibrio parahemolyticus is often associated with disease outbreaks from under-cooked seafood. The potential risk of disease from this organism in association with fresh-cut products is from cross contamination during handling and mixing in retail establishments. They are excreted by infected individuals, and although they do not grow on food, they can survive in water and sewage and may subsequently contaminate food such as fruits and veg etables. Over 150 types of enteric viruses representing four viral families can be present in raw sewage, and they cause a range of diseases including respiratory infections, skin disorders, meningitis and gastroenteritis (Grohmann, 1997; Owen Caul, 2000). Other viruses linked to foodborne disease are astroviruses, enteroviruses, parvovi ruses and adenoviruses. The factors affecting the survival of viruses on fruits and vegetables are not known and should be studied in the future. Parasites are dependent on host organisms for sur vival, and although their life cycles vary, they must all pass through an animal or human host to survive and reproduce (Goldsmid and Speare, 1997). They may infect food from contaminated water or sewage, from food handlers or insects, or the parasite may be ingested by animals and be present in animal? Many parasites are worldwide in their distribution and are prevalent especially in Third World countries where sanitation and hygiene conditions are poor (Goldsmid and Speare, 1997). Protozoa most commonly associated with human infections are Giardia, Cryptosporidium, Cyclospora, Entamoeba, Toxoplasma, Sarocystis and Iso pora (Goldsmid and Speare, 1997; Beuchat, 1998; Taylor, 2000). All of these parasites cause diarrhea-like symptoms except Toxoplasma which causes fetal damage and glandular fever-like syndrome (Goldsmid and Speare, 1997). A number of helminths have also been associated with foods, including liver and intestinal? The epidemiology of these protozoa is not well understood and requires more detailed surveillance. Protozoa such as Giardia lamblia and Cyclospora cayetanensis have been linked with foodborne disease, where the food vehicle was fresh produce (Beuchat, 1998). Cryptosporidium has been found on a range of vegetables, including lettuce, cucumbers, carrots, and tomatoes (Monge and Chinchilla, 1996).

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Procedure Medical Necessity Lumbar discectomy Lumbar discectomy (diskectomy)* treatment 6th feb purchase duricef 500 mg free shipping, foraminotomy symptoms 4 dpo bfp 250mg duricef amex, or (diskectomy) treatment tracker order genuine duricef on line, laminotomy surgery may be considered medically necessary foraminotomy medicine 360 order duricef discount, for the rapid (48 hours or less) progression of neurologic laminotomy impairment (eg, cauda equina syndrome, foot drop, extremity weakness, saddle anesthesia, sudden onset of bladder or bowel dysfunction). Related Information Lumbar Discectomy Lumbar discectomy refers to standard open discectomy or minimally invasive microdiscectomy. Microdiscectomy will be defined for the purpose of this policy as having the following features: (1) uses a small surgical incision (as opposed to an endoscopic port), (2) uses a specially designed microscope to achieve direct visualization of the vertebral column (as opposed to indirect visualization with an endoscope or other type of cameras), and (3) removes disc and other surgical products by direct visualization through the surgical incision. Microdiscectomy may be done with adjunctive devices, such as tubular retractors to improve visualization, or endoscopy to localize the correct areas to operate. However, removal of the disc itself must be done under direct visualization to be considered microdiscectomy. Radiculopathy Radiculopathy presents with a characteristic set of signs and symptoms based on history and physical exam. These nerve roots dangle in the spinal canal before exiting through the vertebral foramen and go to out to the lower part of the body. A rapid progression of neurologic symptoms is seen that may include but are not limited to severe sharp/stabbing debilitating low back pain that starts in the buttocks and travels down one or both legs. It is often accompanied by severe muscle weakness, inability to start/stop urine flow, inability to start/stop bowel movement, loss of sensation below the waist and absence of lower extremity reflexes. Discectomy (diskectomy): the removal of herniated disc material/disc fragments that are compressing a nerve root or the spinal cord. Dorsal rhizotomy: the cutting of selected nerves in the lower spine to reduce leg spasticity in patients with cerebral palsy. Foraminotomy (foraminectomy): the removal of bone and tissue to enlarge the opening (foramen) where a spinal nerve root exits the spinal canal. Hemilaminectomy: the removal of only one side (left or right) of the posterior arch (lamina) of a vertebra. Lamina: Bony arch of the vertebra that helps to cover and protect the spinal cord running through the spinal canal. Lumbar spinal stenosis: Abnormal narrowing of the spinal canal which puts pressure on the spinal cord and the nerve roots leaving the spinal cord. Spinal stenosis may cause pain, numbness or weakness in the legs, feet or buttocks. Lumbar spondylolisthesis: A condition where one of the vertebrae slips out of place by moving forward or backward on an adjacent vertebra. Isthmic spondylolisthesis is the most common form of spondylolisthesis due to a defect or fracture of the bone that connects the upper and lower facet joints (the pars interarticularis). The disorder may be congenital when the bone fails to form properly or acquired due to a stress fracture and slippage of part of the spinal column. It could be caused by trauma, inflammation, vascular issues, arthritis in the spine, or other causes. Neurogenic claudication (or pseudoclaudication): Symptoms of pain, paresthesia (numbness, tingling, burning sensation) in the back, buttocks and lower limbs and possible muscle tension, limping or leg weakness that worsens with standing/walking and is relieved by rest, sitting or leaning forward usually associated with lumbar spinal stenosis. Mostly bedbound patients Paresthesia: Abnormal sensations of the skin including burning, prickling, pricking, tickling, or tingling, and are often described as pins and needles. Radiculopathy: A progressive neurologic deficit caused by compression or irritation of a nerve root as it leaves the spinal column. Saddle anesthesia: A loss of feeling in the buttocks, perineum and inner thighs frequently related to cauda equina syndrome. Spinal cord/nerve roots: the spinal cord runs down through the spinal canal in the vertebral column. The spinal cord gives off pairs of nerve roots that extend from the cord, pass through spaces in between the vertebrae, and go out to the body. Vertebrae: the individual bones of the spinal column that consist of the cervical, thoracic and lumbar regions. Evidence Review Description Back pain, with and without radicular symptoms, is one of the most common medical reasons that members seek medical care and may affect 8 out of 10 people during their lifetime. Age-related disc degeneration, facet joint arthrosis and segmental instability are leading causes of chronic back pain. The most common symptoms of spinal disorders are regional pain and range of motion limitations. A small subset of patients may experience radiating pain in addition to decreased range of motion and low back discomfort. For example, the pain intensity changes with increased physical activity, certain movements or postures and decreases with rest. However, night-time back pain may be present in the absence of serious specific spinal disorders. The precise location and originating point of back pain is often difficult for patients to describe. Several conditions may cause pinched or compressed nerves in the low back area putting pressure on the spinal cord that may cause tingling, muscle weakness and sudden loss or impairment of bowel and bladder function. Normally, the spinal cord is protected by the back bones (vertebrae) that form the spine, but certain injuries to and disorders of the spine may cause cord compression, affecting its normal function. The spinal cord may be compressed by bone, the collection of blood outside a blood vessel (hematomas), pus (abscesses), tumors (both noncancerous and cancerous), or a herniated/ruptured or malformed disc. These injuries and disorders may also compress the spinal nerve roots that pass through the spaces between the back bones or the bundle of nerves that extend downward from the spinal cord (cauda equina). The spinal cord may be compressed suddenly, causing symptoms in minutes or over a few hours or days, or slowly, causing symptoms that worsen over many weeks or months. Lumbar spine decompression is a broad definition of surgical procedures performed on the bones in the lower (lumbar) spine to relieve the pinched or compressed spinal cord and/or nerve(s). The goal is to decompress? the spinal cord and/or nerve root(s) that are causing disabling pain and/or weakness due to damage to the spinal cord (myelopathy). During a lumbar decompression surgery the surgeon removes portions of the intervertebral disc and/or adjacent bone and tissue in the lower spine to give the nerve root more space. Surgical procedures for spinal decompression include lumbar discectomy, foraminotomy, laminotomy, and lumbar laminectomy. Background Lumbar Discectomy (Diskectomy) Discectomy is a surgical procedure in which one or more intervertebral discs are removed. Extrusion of an intervertebral disc beyond the intervertebral space can compress the spinal nerves and result in pain, numbness, and weakness. Discectomy is intended to treat symptoms by relieving pressure on the affected nerve root(s). Discectomy can be performed by a variety of surgical approaches, with either open surgery or minimally invasive techniques. Disc Herniation Extrusion of an intervertebral disc beyond the intervertebral space can compress the spinal nerves and result in symptoms of pain, numbness, and weakness. The natural history of untreated disc herniations is not well-characterized, but most herniations 3 will decrease in size over time due to shrinking and/or regression of the disc. Clinical symptoms will also tend to improve over time in conjunction with shrinkage or regression of the herniation. Treatment Because most disc herniations improve over time, initial care is conservative, consisting of analgesics and a prescribed activity program tailored to patient considerations. Other potential nonsurgical interventions include opioid analgesics and chiropractic manipulation. Epidural steroid injections can also be used as a second-line intervention and are associated with short 4 term relief of symptoms. A small proportion of patients will have rapidly progressive signs and symptoms, thus putting them at risk for irreversible neurologic deficits. These patients are considered to be surgical emergencies, and expedient surgery is intended to prevent further neurologic deterioration and allow for nerve recovery. Other patients will not progress but will have the persistence of symptoms that require further intervention. It is estimated that up to 30% of patients with sciatica will continue to have pain for 5 more than 1 year. For these patients, there is a high degree of morbidity and functional disability associated with chronic back pain, and there is a tendency for recurrent pain despite treatment. Therefore, treatments that have more uniform efficacy for patients with a herniated disc and chronic back pain are needed.

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Propiverine compared to medicine 1900 duricef 250mg visa oxybutynin in neurogenic detrusor overactivity-results of a randomized medications joint pain 500mg duricef with mastercard, double-blind medications vs medicine order 250mg duricef, multicenter clinical study symptoms tonsillitis order 500 mg duricef visa. Effect of controlled release oxybutynin on neurogenic bladder function in spinal cord injury. Efficacy and safety of tolterodine in people with neurogenic detrusor overactivity. Long-term efficacy and safety of tolterodine in children with neurogenic detrusor overactivity. Comparative efficacy and safety of extended-release and instant release tolterodine in children with neural tube defects having cystometric abnormalities. Efficacy, tolerability and safety of propiverine hydrochloride in children and adolescents with congenital or traumatic neurogenic detrusor overactivity: a retrospective study. Propiverine vs oxybutynin for treating neurogenic detrusor overactivity in children and adolescents: results of a multicentre observational cohort study. Efficacy and tolerability of propiverine hydrochloride extended release compared with immediate-release in patients with neurogenic detrusor overactivity. Efficacy, tolerability and safety profile of propiverine in the treatment of the overactive bladder (non-neurogenic and neurogenic). Darifenacin is also effective in neurogenic bladder dysfunction (multiple sclerosis). The effect of darifenacin on neurogenic detrusor overactivity in patients with spinal cord injury. Comparative study of the efficacy and safety of muscarinic M3 receptors antagonists in the treatment of neurogenic detrusor overactivity. Efficacy and safety of transdermal and oral oxybutynin in children with neurogenic detrusor overactivity. Efficacy and safety of oxybutynin transdermal system in spinal cord injury patients with neurogenic detrusor overactivity and incontinence: an open-label, dose-titration study. Safety and efficacy evaluation of oxybutynin topical gel in children with neurogenic bladder. The effect of intravesical oxybutynin on the ice water test and on electrical perception thresholds in patients with neurogenic detrusor overactivity. Intravesical atropine compared to oral oxybutynin for neurogenic detrusor overactivity: a double-blind, randomized crossover trial. Pharmacokinetics of intravesical versus oral oxybutynin in healthy adults: results of an open label, randomized, prospective clinical study. Tadalafil enhances the inhibitory effects of tamsulosin on neurogenic contractions of human prostate and bladder neck. Vardenafil decreases bladder afferent nerve activity in unanesthetized, decerebrate, spinal cord injured rats. Management of lower urinary tract dysfunction in multiple sclerosis: A systematic review and Turkish consensus report. Rehabilitation in practice: neurogenic lower urinary tract dysfunction and its management. Is the use of parasympathomimetics for treating an underactive urinary bladder evidence-based? Taming the cannabinoids: new potential in the pharmacologic control of lower urinary tract dysfunction. Cannabinor, a selective cannabinoid-2 receptor agonist, improves bladder emptying in rats with partial urethral obstruction. Tamsulosin: efficacy and safety in patients with neurogenic lower urinary tract dysfunction due to suprasacral spinal cord injury. Combination of a cholinergic drug and an alpha-blocker is more effective than monotherapy for the treatment of voiding difficulty in patients with underactive detrusor. Takeda M, Homma Y, Araki I, et al; Japanese Naftopidil Neurogenic Lower Urinary Tract Dysfunction Study Group. The average frequency of catheterizations per day is 4-6 times (15) and the catheter size most often used are between 12-16 Fr. Ideally, bladder volume at catheterization should, as a rule, not exceed 400-500 mL. This approach may reduce adverse effects because the anticholinergic drug is metabolised differently (33) and a greater amount is sequestered in the bladder, even more than with electromotive administration (34,35). The dosage is 1-2 mMol capsaicin in 100 mL 30% alcohol, or 10-100 nMol resiniferatoxin in 100 mL 10% alcohol for 30 minutes. Resiniferatoxin has about a 1,000-fold potency compared to capsaicin, with less pain during the instillation, and is effective in patients refractory to capsaicin. Clinical studies have shown that resiniferatoxin has limited clinical efficacy compared to botulinum toxin A injections in the detrusor (41). Daily stimulation sessions of 90 minutes with 10 mA pulses of 2 ms duration at a frequency of 20 Hz (44,45) are used for at least 1 week (45). It appears that patients with peripheral lesions are the best candidates, that the detrusor muscle must be intact, and that at least some afferent connection between the detrusor and the brain must still be present (44,45). Also, the positioning of the stimulating electrodes and bladder filling are important parameters (46). The toxin injections are mapped over the detrusor in a dosage that depends on the preparation used. This can be achieved by surgical interventions (bladder neck or sphincter incision or urethral stent) or by chemical denervation of the sphincter. Botulinum toxin sphincter injection can be used to treat detrusor sphincter dyssynergia effectively by injection in a dosage that depends on the preparation used. Balloon dilatation: although favourable immediate results were reported (61), no further reports since 1994 have been found. Sphincterotomy: by staged incision, bladder outlet resistance can be reduced without completely losing the closure function of the urethra (53). Sphincterotomy also needs to be repeated at regular intervals in a substantial proportion of patients (63), but is efficient and without severe adverse effects (61-64). Secondary narrowing of the bladder neck may occur, for which combined bladder neck incision might be considered (65). When the detrusor is hypertrophied and causes thickening of the bladder neck, this procedure makes no sense. Stents: Implantation of urethral stents causes the continence to be dependent on the adequate closure of the bladder neck only (66). Although the results are comparable with sphincterotomy and the stenting procedure has a shorter surgery time and reduced hospital stay (67,68), the costs and possible complications or re-interventions (67,69,70) are limiting factors in its use. Despite early positive results with urethral bulking agents, a relative early loss of continence is reported in patients with neuro-urological disorders (66,71-75). Urethral inserts: Urethral plugs or valves for management of (female) stress incontinence have not been applied in neuro-urological patients. The experience with active pumping urethral prosthesis for treatment of the underactive or acontractile detrusor was disappointing (76). The value of intermittent catheterisation in the early management of traumatic paraplegia and tetraplegia. Clean, intermittent self-catheterization in the treatment of urinary tract disease. A study comparing sterile and nonsterile urethral catheterization in patients with spinal cord injury. The no-touch? method of intermittent urinary catheter insertion: can it reduce the risk of bacteria entering the bladder? Clean intermittent catheterization in spinal cord injury patients: long-term follow-up of a hydrophilic low friction technique. Physical predictors of infection in patients treated with clean intermittent catheterization: a prospective 7-year study. Intermittent catheterization practices following spinal cord injury: a national survey. Residual urine volume: correlate of urinary tract infection in patients with spinal cord injury.

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Se realizo en el Jardin Botanico Plan de la Laguna; para lo cual se presento una muestra de la especie vegetal recolectada que incluyo: raiz symptoms 3 months pregnant order duricef from india, tallo medications during breastfeeding purchase duricef 500mg free shipping, hojas medications used for anxiety buy duricef with visa, flores y semillas de la planta la cual fue clasificada como Mirabilis Jalapa symptoms ibs buy duricef 250 mg amex. Se armo el aparato de reflujo; y se ajusto la temperatura a 70?C reflujando la muestra vegetal durante 2 horas consecutivas. Pasado este periodo se procedio a filtrar la solucion del extracto en papel Whatman numero 40 y luego se concentro en el rotavapor a un volumen de 40 mL; posteriormente se realizaron al extracto las siguientes pruebas organolepticas y fisicoquimicas: color, olor, sabor, pH y solubilidades; en agua, etanol, glicerina, mezcla hidroalcoholica y propilenglicol. Prueba de tricloruro de hierro: A 2 mL de extracto agregar 3 gotas de tricloruro de hierro el resultado sera positivo si hay formacion de un color verde azul o negro grisaceo. Prueba de subacetato de plomo: A 2 mL de extracto agregar 1 mL de solucion subacetato de plomo como resultado positivo sera la formacion de un precipitado blanco. Prueba de dicromato de potasio: A 2 mL de extracto agregar 1 mL de solucion de dicromato de potasio. Prueba de solucion de gelatina: A 2 mL de extracto agregar 2 mL de solucion de gelatina obteniendo como resultado positivo una precipitacion de color blanco. Prueba de clorhidrato de quinina: A 2 mL de extracto agregar 2 mL de solucion de Clorhidrato de quinina formandose un precipitado blanco. Prueba de shinoda o de cianidina: Tomar 5 mL del extracto anadir un pedazo de magnesio metalico y 1 mL de Acido Clorhidrico concentrado. Prueba de amoniaco: Exponer a vapores de Amoniaco los petalos de Mirabilis jalapa los petalos que contienen flavonas o flavonoles varian de blanco a amarillo. Las chalconas y las auronas viran de amarillo a rojo, las que contienen antocianinas viran a rojo intenso. Prueba de hidroxido de sodio: En un tubo de ensayo colocar 5 mL de extracto y anadir 0. Metodo de la espuma: Pesar 1 gramo de flores de Mirabilis jalapa colocarlo en un tubo de ensayo, anadir 5 mL de agua destilada. Si es una espuma de 3 cm arriba de la superficie del liquido y persiste por mas de 15 minutos. Colocar el filtrado en una ampolla de separacion y hacer 2 extracciones con 20 mL de acetato de etilo a cada uno. Prueba de Legal: A 2 mL de la capa de acetato de etilo, llevar a sequedad, agregar 2 o 3 gotas de piridina, 1 o 2 gotas de nitroprusiato de sodio en solucion al 0. Prueba de Liebermann Burchard: A 2 mL de la capa de acetato de etilo, agregar 1 mL de cloroformo y agitar suavemente. Anadir 1 mL de anhidrido acetico y 3 gotas de acido sulfurico concentrado y observar el color del anillo desarrollado al minuto; resultado positivo formacion de un anillo, rojo que pasa a violeta y azul. Observacion: esta prueba es exotermica (libera calor) por lo que debe realizarse en bano de hielo. Al filtrado hidroalcoholico hacerle 3 extracciones con 150 mL de cloroformo eliminando el exceso de subacetato de plomo con repetidos lavados al extracto cloroformico con agua, en un embudo de separacion; eliminar el cloroformo, llevar a sequedad obteniendose un producto resinoso que contendra a las sesquiterpenlactonas. Prueba de Legal: Colocar 1 o 2 mL de capa cloroformica; llevar a sequedad, agregar 2 o 3 gotas de piridina, de 2 a 5 gotas de nitroprusiato de sodio 0. Tecnica: Limpiar y desinfectar con Texapon N/70 al 2% y Cloruro de benzalconio al 2% el area de pesada y fabricacion. En el estudio bibliografico que se realizo, se escogio diferentes materias primas, ya que la literatura describe que poseen caracteristicas apropiadas, en la elaboracion de bases para cremas, se realizaron varios ensayos y se selecciono el excipiente mas adecuado. Tecnica: Limpiar y desinfectar con texapon N/70 al 2% y cloruro de benzalconio al 2 % el area de pesada y fabricacion. Inicialmente se habia propuesto formular el tonico y las cremas a concentraciones de 10 y 20 % de extracto, pero al realizar los primeros ensayos se observo que los productos no presentaron buenas caracteristicas organolepticas; por lo cual se efectuaron ensayos a concentraciones mas bajas iniciando con un 5 % hasta un 2 %. Ensayo Ensayo Ensayo Ensayo 1 2 3 4 Extracto de flores Principio de Mirabilis activo. El aparato debe detectar en milivoltios y en unidades de pH a traves del par de electrodos. El pH se define convencionalmente como el logaritmo negativo de la actividad del ion Hidrogeno. Para las mediciones del pH se utiliza ampliamente el electrodo de vidrio porque da una respuesta inmediata a los cambios rapidos de las concentraciones de iones Hidrogeno aun en soluciones poco regulada. Olor: Se colocar 10 gotas de la locion en un vidrio reloj, percibir en forma directa el olor, colocando el vidrio reloj a unos centimetros de la nariz. Color: Se colocar 10 mL de el tonico en un beaker de 30 mL observar el color directamente a traves del beaker. C) Prueba de estabilidad fisica aparente: Para realizar esta prueba, se coloco una muestra del tonico en un estante situado en un lugar fuera del alcance de la luz durante un lapso de 60 dias a temperaturas entre 30 y 32? C y otra muestra sin exposicion a la luz en similares condiciones, ademas se colocaron otras dos muestras en una region mas caliente (San Miguel) con temperaturas que oscilan entre 35 a 38? Posteriormente se efectuaron los controles de calidad fisicoquimicos y microbiologicos. Preparacion de la muestra: (12) Agregar 10 mL de muestra a un frasco que contenga 90 mL de buffer fosfato pH 7. Prueba preparatoria: Para la reaccion de esta prueba se debe efectuar los pasos siguientes: Mantenimiento de los microorganismos: Se debe hacer resiembras cada dos semanas en agar nutritivo inclinado y se debe mantener en refrigeracion. Se diluira con solucion salina esteril hasta obtener una turbidez del 25% de tramitancia a una longitud de onda de 580 nm. Procedimiento para la prueba preparatoria: Pesar 10 gramos de la muestra en un frasco que contenga 90 mL de diluyente (peptona al 1% y tween 20 al 2% dilucion 1: 10). De la dilucion anterior, se tomaran 10 mL agregandolo a un frasco que contenga 90 mL de buffer fosfato pH 7. Pipetear 1 mL de las diluciones 1: 10 y 1: 1000 de la muestra a tubos que contengan 9 mL de caldo casoy. Despues del periodo de incubacion, realizar resiembras en Agar Cetrimide para observar la morfologia de las colonias de Pseudomona aeroginosa. Despues del periodo de incubacion, realizar resiembras en agar stafilococcus 1: 10 para observar la morfologia caracteristicas de las colonias de Stafilococus aureus. De la dilucion anterior agregar 10 mL en un frasco que contenga 90 mL de buffer fosfato pH 7. De las diluciones 1: 10 y 1: 1000 transferir 1 mL a placas de petri agregar de 18 a 20 mL de agar para recuento en placa derretido y enfriado a una temperatura aproximadamente a 45?C, rotar suavemente para una homogenizacion completa y se dejara enfriar hasta solidificacion del medio. Colocar 1 mL de la dilucion 1: 10 de la muestra, en un tubo con 9 mL de caldo casoy, incubar a 37?C por 24 horas. Pipetear 1 mL de la dilucion 1: 10 de la muestra en 9 mL de caldo casoy encubar a 37?C por 24-48 horas. Del crecimiento anterior estriar sobre agar Stafilococcus 110 o Agar Baird Parker, incubar a 37?C por 24-48 horas comparar la morfologia de las colonias. Si la morfologia no corresponde o si no hay crecimiento, se concluye que la crema esta libre de Stafilococcus aureus. Para emulsiones de aceite/agua mezclar un gramo de producto, en 9 mL de agua en un beaker de 100 mL A continuacion determinar el pH de la mezcla resultante. Para emulsiones agua/aceite hacer la agitacion vigorosa de la mezcla de 1 gramo de el producto con 9 mL de agua en un beaker de 100 mL y luego determinar el pH de la muestra resultante utilizando un peachimetro. Si el pH se determina mediante papel pH se reporta como una parte de la muestra para 9 partes de agua. En un beaker pesado adicionar un gramo de crema y 20 mL de agua aproximadamente, pasar a una ampolla de separacion y extraer con cloroformo realizando tres extracciones. Filtrar cloroformo en un embudo recibiendolo en el beaker tarado; evaporar en hot plate cerrado hasta que ya no se perciba el olor a cloroformo; colocar en estufa a 105? Pesar aproximadamente un gramo de producto dentro de un crisol previamente tarado calentar sobre un bano de vapor por 30 minutos; continuar calentando a 105? Especificacion: El promedio del contenido neto de los diez contenedores no es menor que la cantidad rotulada y el contenido neto de cualquier contenedor individual no es menor del 90 %, de la cantidad rotulada cuando esta sea 60 gramos o menos. El contenido promedio de los 30 contenedores no es menor que la cantidad rotulada y el contenido neto de no mas de 1 de 30 contenedores, es menor del 90 % de la cantidad rotulada cuando esta es 60 gramos o menos. Homogeneidad: Colocar una gota de la muestra en papel, glassin, extender con una espatula y observar a la luz. Untuosidad: Colocar una pequena cantidad de producto sobre la piel de la mano o bien sobre la piel del antebrazo extender y observar su adhesion. La fase continua de las emulsiones puede colorearse con un colorante hidrosoluble, por ejemplo: el azul de metileno que produce un color azul oscuro si la emulsion es aceite/agua. Con un colorante soluble en aceite, por ejemplo: el rojo sudan o rojo escarlata; produce un color rojo intenso si la emulsion es agua/aceite. De esta forma se identifican al microscopio, aunque a menudo con dificultad, las emulsiones mixtas. Al cabo de unas horas se observa: Las emulsiones de aceite/agua producen un borde palido ancho (debido al flujo del agua).

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