Gatifloxacin 400mg as a single shot or 200mg once daily for 3 days is as effective as ciprofloxacin 250mg twice daily for the treatment of patients with uncomplicated urinary tract infections

The efficacy and safety of two oral dosing regimens of gatifloxacin compared with ciprofloxacin for the treatment of acute uncomplicated lower urinary tract infection was investigated in a double-blind, randomised study, in adult female patients who received either gatifloxacin (400 mg as a single shot or 3 days of 200 mg once daily) or ciprofloxacin (250 mg given twice daily for 3 days). Bacteriological and clinical responses were assessed 7-9 days after the end of treatment (EOT), and 4-6 weeks post-treatment (end of study, EOS). One thousand one hundred and two women were treated, 741 (248 in the gatifloxacin 400 mg group, 252 in the gatifloxacin 200 mg group, and 241 in the ciprofloxacin group) presented with bacteriological proof of infection and entered the efficacy analysis. The bacteriological response per patient at EOT in the three groups were 80% (177/220) [95% CI to ciprofloxacin -8.4%; 6.4%], 83% (184/222) [95% CI to ciprofloxacin -5.9%; 8.7%] and 81% (176/216), respectively. At the follow-up assessment they were slightly lower, 75% (167/224), 79% (169/213) and 79% (171/217), respectively. The clinical responses at EOT were 81% (197/243) [95% CI to ciprofloxacin -10.2%; 3.4%], 85% (213/250) [95% CI to ciprofloxacin -5.7%; 7.2%] and 85% (201/238), respectively. At EOS they were 82% (195/239), 88% (212/241) and 86% (200/233), respectively. The eradication rates for all initial pathogens at the EOT were 90.3% in the gatifloxacin 400 mg S.D. group, 90.6% in the gatifloxacin 200 mg group, and 88.3% in the ciprofloxacin group. All treatment groups showed a similar safety profile. The incidence of treatment-related adverse events was comparable, the majority of adverse events were of mild or moderate intensity and the medications were well tolerated. Both the administration of gatifloxacin 200 mg once daily for 3 days, and gatifloxacin 400 mg as a single shot were shown to be equivalent to ciprofloxacin 250 mg twice daily for 3 days for the treatment of acute uncomplicated lower urinary tract infections.

Nutritional and clinical evaluation of a modified soy protein with covalently bound branched-chain amino acids in cirrhotic sprague-dawley rats

Several studies suggested that branched-chain amino acids (BCAA) improve plasma amino acid imbalance as well as protein metabolism in patients with cirrhosis. However, commercial formulas supplemented with free BCAA have their limitations. We evaluated a modified soy protein diet with covalently bound BCAA (diet M) by comparing it with diets based on casein (diet C) or Hepatic Aid II (diet H; commercial formula) as protein sources. After 3 weeks of bile duct obstruction, 24 Sprague-Dawley rats divided into three groups received diets with 9% (w/w) protein/amino acids for 7 days. Nutritional and clinical parameters were determined. Nitrogen balance and weight gain (g)/protein intake (g) with diet M (0.19 +/- 0.31 and 1.33 +/- 1.43 g, respectively) were significantly higher (p < 0.05) than with diet H (-0.34 +/- 0.20 and -0.34 +/- 1.11 g), but comparable to those with diet C (0.04 +/- 0.38 and 0.20 +/- 0.93 g). Animals on diet M had a significantly (p < 0.05) increased plasma BCAA:aromatic amino acid ratio (1.8 +/- 0.3) as compared with those on diets H (1.3 +/- 0.1) and C (0.8 +/- 0.0). There were no significant differences in organ weight or liver function among the groups. We conclude that the BCAA-modified protein is an attractive option in the nutritional support of patients having cirrhosis.

Health policy. Honour bound

The government should sort out the inconsistencies in its health policies. NHS managers have a good record on implementing government policy. The health secretary needs to clarify his attitude to managers and address the loss of top people.

Tyrosinase mutants are capable of prodrug activation in transfected nonmelanotic cells

Tyrosinase has been suggested as a prodrug-converting enzyme for the treatment of melanoma. We hypothesized that tyrosinase expression in transfected nonmelanotic cells can be used in a gene therapy paradigm of prodrug activation. To verify our hypothesis, we used the following tyrosinase variants: (a) a full-length human tyrosinase clone (T); (b) a mutant lacking the COOH-terminal cytoplasmic domain (TdeltaC); (c) a mutant lacking the COOH-terminal transmembrane and cytoplasmic domains (TdeltaTC); and (d) a fusion with the eight COOH-terminal amino acids of lysosome-associated membrane protein-1 (TL). Expression of mutant and wild-type tyrosinases was induced by transfection in nontumorigenic human cells of epithelial origin (293HEK, MCF-10A adenoma, and NHDF-Ad human dermal fibroblasts) as well as in tumor cells (9L gliosarcoma, MCF7 adenocarcinoma, and HT-1080 fibrosarcoma). When compared with the wild-type tyrosinase transfectants, truncated mutant expression resulted in higher mRNA levels that paralleled higher enzyme activity of the truncated mutants. Two model tyrosinase prodrugs, hydroxyphenyl-propanol (HPP) and N-acetyl-4-S-cysteaminylphenol (NAcSCAP) inhibited proliferation and caused cell death of transfected cells in a dose-dependent manner. Effects of prodrug treatment were compared for tumorigenic cells and their nontumorigenic counterparts. Two truncated mutants (TdeltaC and TdeltaTC) showed low endogenous cytotoxicity and efficiently suppressed proliferation and induced cytotoxicity in transfected tumor cells in the presence of NAcSCAP. Overall, these results indicate that the developed tyrosinase mutants hold promise as prodrug activation systems for tumoral gene therapy.

[Some aspect of revisional hip arthroplasty on the basis of Register of removed orthopedic implants. One year data]

The selected epidemiological data concerning revisional hip arthroplasties analysis is presented. The data were collected at 25 Polish orthopaedic centers (some 27% of all centers performing primary THR) during the year 1998. Survival time of the artificial joint (the time between primary and revisional hip replacement) appears as the main criterion of THR result. Failed cemented THR dominate over cementless ones. Septic complications constitute 4.55% complications demanding revisional arthroplasty. Distinct increase in revisional THR is found 7 years after primary operation. An average survival time for arthroplasty was 10.3 years, a little longer for acetabular component.

Chief executives. Scapegoats in the wilderness

At least 40 chief executives have had their contracts terminated early in the past five years. Very few, if any, have gone through a disciplinary procedure. The most commonly stated reasons have been poor financial control and disagreements with chairs. This trend represents a considerable waste of talent. The experience required of a chief executive cannot be acquired overnight. The 'sudden death' of people at the top corrupts organisations and deprives them of continuity.

Cross-tolerance in drug response and differential changes in central nicotinic and N-methyl-D-aspartate receptor binding following chronic treatment with either (+)- or (-)-nicotine

The present study compared the effects of chronic treatment (21 days) with (+)-nicotine and (-)-nicotine on exploratory behaviours and body temperature in rats. Chronic treatment with either (+)- or (-)-nicotine induced tolerance in exploratory behaviours. A cross-tolerance between the two stereoisomers was also observed. Body temperature was differentially affected by chronic (+)- and (-)-nicotine, but cross-tolerance was still observed. In addition, nicotinic acetylcholine receptor (nAChR) and N-methyl-D-aspartate (NMDA) receptor binding in rats treated with (+)- and (-)-nicotine were measured by receptor autoradiography. Chronic treatment with (+)- and (-)-nicotine significantly increased nAChR binding in different brain regions. Furthermore, significant differences in the induction of nAChR binding by chronic (+)- and (-)-nicotine were detected in several brain regions. Chronic treatment with (+)-nicotine significantly increased NMDA receptor binding in the CA1 region of the hippocampus. However, (-)-nicotine had no effect on NMDA receptor binding in any of the regions analysed. These results demonstrate differences between chronic treatment with (+)- and (-)-nicotine in physiological responses such as body temperature and biochemical changes such as changes in nAChRs and NMDA receptor binding, although a cross-tolerance between the two enantiomers in behaviour and body temperature is also observed.

[Selected anatomical features of the foot with hallux valgus]

Hallux valgus is still an open problem consists of many unexplained questions related to, not only its etiopathogenesis and biomechanics but also to treatment of this deformity. The purpose of investigation: 1) To find out hallux valgus predisposing factors; 2) To recognise anatomic features of the foot in hallux valgus patients, basing on orthopaedic physical examination as well as to find out the frequency of the occurrence of foot skeleton disorders in rentgenometric and plantoconturographic (foot prints) measurements. 335 feet in 173 patients (females) treated operatively due to hallux valgus in Orthopaedic Department of Wrocław Medical Academy in years 1980-1994 were examined. Those patients were operated on according to Keller, Dega and McBride method. All the patients underwent preoperative orthopaedic physical examination as well as rentgenographic and plantoconturographic one. Such factors as heredity and Egyptian shape of the foot as well as metatarsal index "plus" were recognised as hallux valgus predisposing factors. Most of the parameters evaluated in orthopaedic, rentgenographic and plantocontourographic examination presented pathologic values that indicated pathology within foot in hallux valgus patients.

Middle management. Courtin' the middle

Middle managers are essential to organisations but are often unsupported by those above them and reviled by those they supervise. Effective middle managers keep top managers in touch with reality and reinterpret policy and strategy so operational staff understand the point. Organisations should reassure middle managers about the validity of their work and provide continuing education.

Baby listening devices and apnoea monitors

Two categories of monitor are available: baby listening devices, and specialist apnoea monitors. Baby listening devices are on the market in department stores, pharmacies and supermarkets. They cost in the range of approximately 20 Pounds-45 Pounds, and can be plugged in or portable. Though not a necessity on health or safety grounds, listening devices are popular with parents, who find them reassuring. Apnoea monitors are designed to sound an alarm if the baby stops breathing. They are generally only used in special circumstances, for example where there has been a previous cot death. Though parents can purchase an apnoea monitor direct from manufacturers, the monitors are more usually supplied when a baby is discharged from hospital and used under guidance from health professionals, e.g. through the Care of Next Infant (CONI) scheme.

Organisations. Knowing who's boss

A hierarchical structure in organisations reflects the natural order. A hierarchy does not have to denote an authoritarian management style. People need to know who their boss is. Lines of accountability on many hospital wards are unclear.