The effect of cytokines on the replication of T. gondii within rat retinal vascular endothelial cells

Toxoplasma gondii infection of the eye can result in a recurrent necrotising retinochoroiditis (TR) which may lead to a permanent loss of visual acuity. The mechanisms responsible for the control of TR within the retina are unknown. The aim of this study was to examine the effects of cytokines on the replication of T. gondii RH strain tachyzoites within rat retinal vascular endothelial (rRVE) cells. Pretreatment of rRVE with IFNgamma, TNF or IL-1beta resulted in a significant decrease in T. gondii replication from day 2 onwards. There was no significant difference in nitric oxide (NO) production by IFNgamma, TNF or IL-1beta treated rRVE as compared to controls at any time point. By comparison, the addition of L-tryptophan to IFNgamma treated cultures significantly restored T. gondii replication from 48 h post inoculation. Thus, IFNgamma, TNF and IL-1beta can significantly inhibit the replication of T. gondii within rRVE. However, this inhibition appears to be independent of NO production. L-tryptophan catabolism may have a role in IFNgamma mediated inhibition of T. gondii replication in rRVE cells.

Efficacy of an ondansetron orally disintegrating tablet: a novel oral formulation of this 5-HT(3) receptor antagonist in the treatment of fractionated radiotherapy-induced nausea and emesis. Emesis Study Group for the Ondansetron Orally Disintegrating Tablet in Radiotherapy Treatment

A significant number of patients who are receiving radiotherapy experience the distressing side effects of emesis and nausea. Although prophylactic antiemetics are often given to patients who are receiving single-fraction, high-dose radiotherapy to the abdomen, a survey has revealed that antiemetic prophylaxis is not routinely offered to those receiving fractionated radiotherapy. Hence there is a need for an effective treatment of emesis for use in this group of patients. Ondansetron is an effective and well-tolerated antiemetic, which is used for the prevention of both chemotherapy and radiotherapy-induced emesis and nausea. This agent has been developed as a novel freeze-dried oral formulation. Ondansetron orally disintegrating tablets (ondODT) disperse rapidly when placed on the tongue. As the tablet does not need to be swallowed with water, it is a particularly useful formulation for patients who have difficulty with swallowing or who do not feel able to drink. This study was undertaken to investigate the efficacy of ondODT in the treatment of established emesis and nausea induced by radiotherapy. Two doses of ondODT, 8 mg and 16 mg, were compared with placebo in patients who developed emesis and/or moderate/severe nausea after receiving fractionated radiotherapy to sites located between the thorax and the pelvis. The study showed that ondODT was clinically superior to placebo in treating emesis and nausea successfully over a 12-hour period after taking the medication. There were no statistically significant differences between the two doses of ondODT. In the 2 hours after taking the study medication, patients who received ondODT (8 mg and 16 mg) had significantly fewer emetic episodes compared with those who received placebo. They also experienced significantly less nausea. In conclusion, ondODT 8 mg is effective in the treatment of radiotherapy-induced emesis and nausea and provides an effective alternative to the conventional ondansetron tablet.

Indocyanine green angiography in inflammatory eye disease

PURPOSE

The choroid plays an integral role in the evolution of a number of inflammatory eye diseases but only limited information is provided on the choroidal vasculature by fluorescein angiography.

METHODS

This study used indocyanine green (ICG) videoangiography to assess the degree of choroidal vascular involvement in inflammatory eye diseases and the results obtained were compared with fluorescein angiography.

RESULTS

A total of 34 patients were examined: 6 with retinal vasculitis and 28 with chorioretinitis of various aetiologies. Areas of active involvement of the choroid were seen as areas of hypofluorescence on ICG angiography, representing areas of inflammatory infiltrate and/or choroidal hypoperfusion. No leakage of ICG occurred from large choroidal vessels at any stage in any disease. In contrast to sodium fluorescein, there was no leakage of ICG from retinal vessels in active inflammation. An inflammatory choroidal neovascular membrane leaked fluorescein and fluoresced late with ICG.

CONCLUSION

ICG videoangiography provides useful information on the degree of choroidal involvement in inflammatory eye disease and is a valuable adjunct to fluorescein angiography.

A randomized trial of cognitive therapy and imaginal exposure in the treatment of chronic posttraumatic stress disorder

A randomized trial was performed in which imaginal exposure (IE) and cognitive therapy (CT) were compared in the treatment of chronic posttraumatic stress disorder (PTSD). Patients who continued to meet PTSD caseness at the end of a 4-week symptom-monitoring baseline period (n = 72) were randomly allocated to either IE or CT. There was a significant improvement in all measures over treatment and at follow-up, although there were no significant differences between the 2 treatments at any assessment. A significantly greater number of patients who showed worsening over treatment received IE, although this effect was not found at follow-up. Patients who worsened showed a greater tendency to miss treatment sessions, rated therapy as less credible, and were rated as less motivated by the therapist. It was concluded that either exposure or a challenge to cognition can result in symptom reduction, although neither resulted in complete improvement.

Prostate cancer screening in primary care

BACKGROUND

Little is known about the actual frequency with which men have prostate screening in primary care settings, nor are the determinants of screening understood.

METHODS

We examined the records of 50 consecutive primary care office visits by men aged 50 or older. Men were asked to complete a brief questionnaire outlining their previous use of prostate screening services and the factors that influenced screening.

RESULTS

Screening in the previous year with digital rectal examination (DRE) and prostate specific antigen (PSA) was reported by 46% and 30% of respondents, respectively. Most respondents (86%) had heard of prostate screening and most (78%) believed it was effective. The only factor predictive of screening with DRE in multivariate analysis was a doctor's discussion of screening (odds ratio, 4.8). Two factors were predictive of PSA screening--knowing someone who had prostate cancer (odds ratio, 12.8) and advancing age (odds ratio [per year], 1.1).

CONCLUSIONS

Many men are not having annual prostate screening. Men who were older, who reported knowing someone with prostate cancer, and whose doctors discussed screening, were more likely to have been screened in the past year.

The 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor fluvastatin: effect on human cytochrome P-450 and implications for metabolic drug interactions

Fluvastatin, a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, was metabolized by human liver microsomes to 5-hydroxy-, 6-hydroxy-, and N-deisopropyl-fluvastatin. Total metabolite formation was biphasic with apparent Km values of 0.2 to 0.7 and 7.9 to 50 microM and intrinsic metabolic clearance rates of 1.4 to 4 and 0.3 to 1.5 ml/h/mg microsomal protein for the high and low Km components, respectively. Several enzymes, but mainly CYP2C9, catalyzed fluvastatin metabolism. Only CYP2C9 inhibitors such as sulfaphenazole inhibited the formation of both 6-hydroxy- and N-deisopropyl-fluvastatin. 5-Hydroxy-fluvastatin formation was reduced by compounds that are inhibitors of CYP2C9, CYP3A, or CYP2C8. Fluvastatin in turn inhibited CYP2C9-catalyzed tolbutamide and diclofenac hydroxylation with Ki values of 0.3 and 0.5 microM, respectively. For CYP2C8-catalyzed 6alpha-hydroxy-paclitaxel formation the IC50 was 20 microM and for CYP1A2, CYP2C19, and CYP3A catalyzed reactions, no IC50 could be determined up to 100 microM fluvastatin. All three fluvastatin metabolites were also formed by recombinant CYP2C9, whereas CYP1A1, CYP2C8, CYP2D6, and CYP3A4 produced only 5-hydroxy-fluvastatin. Km values were approximately 1, 2.8, and 7.1 microM for CYP2C9, CYP2C8, and CYP3A, respectively. No difference in fluvastatin metabolism was found between the CYP2C9R144 and CYP2C9C144 alleles, suggesting the absence of polymorphic fluvastatin metabolism by these alleles. CYP1A2, CYP2A6, CYP2B6, CYP2C19, CYP2E1, and CYP3A5 did not produce detectable amounts of any metabolite. This data indicates that several human cytochrome P-450 enzymes metabolize fluvastatin with CYP2C9 contributing 50-80%. Any coadministered drug would therefore only partially reduce the metabolic clearance of fluvastatin; therefore, the likelihood for serious metabolic drug interactions is expected to be minimal.

A randomized trial of cognitive therapy and imaginal exposure in the treatment of chronic posttraumatic stress disorder

A randomized trial was performed in which imaginal exposure (IE) and cognitive therapy (CT) were compared in the treatment of chronic posttraumatic stress disorder (PTSD). Patients who continued to meet PTSD caseness at the end of a 4-week symptom-monitoring baseline period (n = 72) were randomly allocated to either IE or CT. There was a significant improvement in all measures over treatment and at follow-up, although there were no significant differences between the 2 treatments at any assessment. A significantly greater number of patients who showed worsening over treatment received IE, although this effect was not found at follow-up. Patients who worsened showed a greater tendency to miss treatment sessions, rated therapy as less credible, and were rated as less motivated by the therapist. It was concluded that either exposure or a challenge to cognition can result in symptom reduction, although neither resulted in complete improvement.

Single-dose oral ciprofloxacin versus placebo for prophylaxis during transrectal prostate biopsy

OBJECTIVES

To determine whether antimicrobial prophylaxis could prevent infections after transrectal needle biopsy of the prostate using automated biopsy devices.

METHODS

We conducted a prospective, randomized, double-blind, multicenter trial in which a total of 537 patients received either oral ciprofloxacin 500 mg or placebo before transrectal needle biopsy of the prostate. Repeated urine cultures and urinalysis were obtained at 2 to 6 days after biopsy and 9 to 15 days after biopsy. The primary determinant of efficacy was bacteriologic response (bacteriuria [more than 10(4) colony-forming units (CFU)/mL] versus no bacteriuria) at the 9- to 15-day follow-up evaluation.

RESULTS

Two hundred twenty-seven (84%) of 269 ciprofloxacin patients and 230 (86%) of 268 placebo patients were valid for efficacy analysis in which a mean of four biopsies was performed. Six ciprofloxacin-treated (3%) and 19 placebo-treated (8%) patients had bacteriuria (more than 10(4) CFU/mL) after the procedure (P = 0.009). Six ciprofloxacin recipients (3%) and 12 placebo recipients (5%) had clinical signs and symptoms of a urinary tract infection (UTI) (P = 0.15). In addition, no ciprofloxacin-treated patients compared with 4 placebo-treated patients (2%) were admitted to the hospital for febrile UTI after the procedure. Ciprofloxacin reduced the expected net costs of treating infectious complications after biopsy by $23 per patient for an overall annual savings of $68,195 in the five study groups when compared with placebo.

CONCLUSIONS

Single-dose oral ciprofloxacin reduced bacteriuria after biopsy compared with placebo in patients undergoing transrectal prostatic biopsy and provided an economic advantage. In addition, this study establishes the actual rate of bacteriuria after transrectal needle biopsy of the prostate without antibiotic prophylaxis to be 8% with a clinical rate of UTI of 5% and a hospitalization rate of 2%.

A multicenter, double-blind comparison of i.v. and oral administration of ondansetron plus dexamethasone for acute cisplatin-induced emesis. Ondansetron Acute Emesis Study Group

A total of 530 patients were treated in this multicenter, double-blind, double-dummy, parallel group study to compare the anti-emetic efficacy and safety of a once daily ondansetron oral regimen with a once daily i.v. dosing regimen over a 24 h period, administered to patients prior to receiving cisplatin (50 mg/m2 or greater) chemotherapy. Patients were randomized to receive a single dose of ondansetron plus dexamethasone given either orally (ondansetron 24 mg and dexamethasone 12 mg, n=262) or i.v. (ondansetron 8 mg and dexamethasone 20 mg, n=268). Complete control of emesis (i.e. no emetic episodes, no rescue and no premature withdrawal) was achieved for 85% of patients (224 of 262) in the oral group and 83% (223 of 268) in the i.v. group. No nausea was reported in 70% of patients in the oral group and 68% in the i.v. group. There were no statistically significant differences between the two groups for any of the assessments of efficacy, which included time to first emetic episode, number of emetic episodes and the worst grade of nausea occurring over the 24 h study period. Once daily ondansetron oral and i.v., in combination with dexamethasone, was well tolerated in this study. In conclusion, once daily oral ondansetron 24 mg plus dexamethasone is equally effective in the control of emesis and nausea induced by highly emetogenic chemotherapy as once daily ondansetron 8 mg i.v. plus dexamethasone.

Antagonistic effects of FGF4 on BMP induction of apoptosis and chondrogenesis in the chick limb bud

In an effort to define the roles of bone morphogenic proteins (BMPs) and fibroblast growth factors (FGFs) during chick limb development more closely, we have implanted beads impregnated with these growth factors into chick limb buds between stages 20 and 26. Embryos were sacrificed at the time the bone chondrocyte condensations first appear (stages 27-28). Implantation of beads containing BMPs at the earlier stages (20-22) caused apoptosis to occur, in the most severe cases leading to complete limb degeneration. Application of FGF4, either in the same, or in a different bead, prevented the BMP-induced apoptosis. We argue that the apoptosis observed on removal of the AER prior to stage 23 of development could be brought about by BMPs. The action of epithelial FGF in preventing BMP-mediated apoptosis in the mesenchyme would define a novel aspect of epithelial-mesenchymal interactions. Implanting the BMP4 beads into the core of the limb bud a day later (stages 25-26) caused intense chondrogenesis rather than apoptosis. FGF4 could again nullify this effect and by itself caused a reduction in bone size. This is the reverse of the functional relationship these growth factors have in mouse tooth specification (where it is BMP4 that inhibits the FGF8 function), and suggests that the balance between the effects of FGFs and BMPs could control the size of the chondrocyte precursor cell pool. In this way members of these two growth factor families could control the size of appendages when they are initially formed.

Predictive factors for neonatal morbidity in neonates with an umbilical arterial cord pH less than 7.00

OBJECTIVE

Fewer than 50% of neonates with an umbilical arterial pH < 7.00 have neonatal complications. Our objective was to identify clinical predictive factors for adverse outcomes in this group of neonates.

STUDY DESIGN

In this case-control study both cases and controls had an umbilical arterial cord pH < 7.00. Cases were defined as those neonates who had seizures, grade 3 to 4 intraventricular hemorrhage, gastrointestinal dysfunction, respiratory distress syndrome requiring intubation, sepsis, or death. Controls had an umbilical arterial cord pH < 7.00 and no complications. A multivariable prediction model was created, with variables having an association with adverse outcome by bivariate analyses, attempting to predict which neonates in this umbilical arterial pH range are at greatest risk for adverse outcomes.

RESULTS

We identified 73 of 10,705 neonates born between July 1992 and October 1996 with an umbilical arterial cord pH < 7.00. Thirty-five neonates met our case definition, and the remaining 38 composed the control group. Cases had significantly lower arterial pH values and 1- and 5-minute Apgar scores, greater arterial base deficit values, and a higher incidence of abruptio placentae and maternal cocaine use. More cases were delivered before 34 weeks. There were three neonatal deaths, two cases of grade 3 or 4 intraventricular hemorrhage, five cases of gastrointestinal dysfunction, and four cases of neonatal seizures. In our predictive model for adverse neonatal outcome, an arterial base deficit > or = 16 mmol/L and a 5-minute Apgar score < 7 had a sensitivity and a specificity of 79% and 80.8%, respectively.

CONCLUSION

Neonatal morbidity in neonates with an umbilical arterial cord pH < 7.00 can be predicted by a high arterial base deficit value and low 5-minute Apgar score.

Questions & answers about database searching

Bibliographic databases such as RNdex, CINAHL, and MEDLINE help you find current clinical practice information beyond what is available in textbooks and reference manuals. There are many options for accessing these information resources, including some that are convenient and affordable for students. By learning basic search principles and techniques for searching these databases, you can save yourself time and be more successful in locating the information you need. Important search skills include being able to identify the component parts of your search topic, locate relevant subject headings in a database thesaurus, and use logical connectors to combine topic components. The better your skills at searching for information, the easier your study and research assignments will be. The information seeking skills you learn now will be applicable in the future too, as information resources evolve and as your learning needs change. Developing competence in database searching will help prepare you for a rich life of learning as you pursue your career as a nursing professional.

Postcesarean endometritis. Clinical risk factors predictive of positive blood cultures

OBJECTIVE

To identify peripartum risk factors that are predictive of positive blood cultures in patients with postcesarean endometritis.

STUDY DESIGN

A retrospective review of 179 patients diagnosed with postcesarean endometritis was conducted. Patients with positive and negative blood cultures obtained at the time of diagnosis were compared. Patient's charts were reviewed for intrapartum, intraoperative and postpartum factors. Chi-square and nonpaired Student's tests were used when appropriate, with P < .05 considered significant.

RESULTS

During this period, 179 (20%) postcesarean patients developed endometritis. One hundred sixty-eight (94%) of those patients had blood cultures. Eleven (6.5%) were positive; however, one of these grew a skin contaminant and was disregarded. When patients with positive blood cultures were compared to those with negative blood cultures, length of labor, number of vaginal examinations, postoperative day when the diagnosis was established, estimated blood loss at the time of cesarean delivery, presence of intrapartum chorioamnionitis, number of hours of ruptured membranes, white blood cell count at the time of diagnosis, use of prophylactic antibiotics, development of wound infection or other infectious etiologies were not shown to be predictive. There were no positive blood cultures among patients with a temperature < 38.5 degrees C. At a temperature < 38.8 degrees C, 1/126 (0.79%) had a positive blood culture. At a temperature > or = 38.8 degrees C, 9/42 (21.4%) had a positive blood culture (P < .001). Approximately $5,890 was spent on obtaining positive blood cultures in patients with temperatures < 38.8 degrees C. In contrast, $218 was spent per positive blood culture obtained from patients with a temperature > or = 38.8 degrees C.

CONCLUSION

The traditional practice of obtaining blood cultures at a temperature > or = 38.0 degrees C is not justified but elevating the threshold to 38.8 degrees C is equally effective and less costly.

Reduction of right atrial peak systolic velocity in growth-restricted discordant twins

OBJECTIVE

The objective of this study was to measure blood flow velocity changes through the tricuspid valve in intrauterine growth-restricted twins.

STUDY DESIGN

Discordant twins were evaluated by measurement of tricuspid valve flow velocities. Twin pairs with one intrauterine growth-restricted fetus caused by uteroplacental insufficiency and one appropriately grown fetus were included in the analysis. Fetuses with chromosomal or structural abnormalities and confirmed twin-twin transfusion syndrome were excluded. Eighteen pairs met these criteria. Student's t test was used for comparison of flow velocities.

RESULTS

Peak ventricular diastolic flow velocities through the tricuspid valve in the twin with intrauterine growth restriction and the appropriately grown twin were 35.8 +/- 4.43 cm/sec and 34.0 +/- 6.7 cm/sec, respectively (p = 0.35). The atrial peak systolic flow velocity values were 42.1 +/- 1.2 and 50.3 +/- 1.2, respectively (p = 0.049).

CONCLUSIONS

The velocity of blood flow through the tricuspid valve during atrial systole is lower in growth-restricted twins than in appropriately grown cotwins when growth restriction is caused by uteroplacental insufficiency. Its potential in differentiating discordancy from the other causes remains to be explored.

Variegated transgene expression in mouse mammary gland is determined by the transgene integration locus

Mice carrying an ovine beta-lactoglobulin (BLG) transgene secrete BLG protein into their milk. To explore transgene expression stability, we studied expression levels in three BLG transgenic mouse lines. Unexpectedly, two lines exhibited variable levels of transgene expression. Copy number within lines appeared to be stable and there was no evidence of transgene rearrangement. In the most variable line, BLG production levels were stable within individual mice in two successive lactations. Backcrossing demonstrated that genetic background did not contribute significantly to variable expression. Tissue in situ hybridization revealed mosaicism of transgene expression within individual mammary glands from the two variable lines; in low expressors, discrete patches of cells expressing the transgene were observed. Transgene protein concentrations in milk reflected the proportion of epithelial cells expressing BLG mRNA. Furthermore, chromosomal in situ hybridization revealed that transgene arrays in both lines are situated close to the centromere. We propose that mosaicism of transgene expression is a consequence of the chromosomal location and/or the nature of the primary transgene integration event.

Reuse in sterile sites of single-use medical devices: how common is this in Australia?

OBJECTIVE

To determine to what extent Australian hospitals reuse in sterile sites medical devices labelled "single use only"; to assess the adequacy of cleaning and sterilising procedures before reuse; and to estimate the possible incidence of cross-infection and the costs of not reusing these devices.

DESIGN

A self-administered questionnaire survey.

SETTING

All Australian hospitals (419) with more than 45 beds and undertaking medical and surgical procedures.

METHODS

Questionnaires were sent to hospital infection control practitioners in 1994 requesting information about reuse in sterile sites of single-use medical devices, the extent of reuse, the cleaning and sterilising processes involved, and the reasons for reuse.

RESULTS

Responses were received from 168 hospitals (40%). Reuse occurred in 64 (38%), and another 33 hospitals had been reusing medical devices 12 months before our survey (i.e., 97/168 hospitals [58%] were either reusing them at the time of our survey or had been doing so 12 months previously). More large (> 300 beds) metropolitan public hospitals (9/14; 64%) reported reusing than did smaller (50/143; 41%) or private hospitals (15/47; 32%). At six of the 64 hospitals where reuse occurred, the process of cleaning and/or sterilization of these devices was not satisfactory; from the information we received, both cleaning and sterilization were satisfactory in only 38 hospitals (59%). Examination of the 14 most commonly reuse devices showed that the structure of 13 of these may compromise cleaning (and therefore sterilization). The main reason given for reuse was cost saving. Assuming a 2% prevalence of transmissible infections in blood, and an infection transmission risk of 1/500, we estimate that each year in Australia there may be 40 cases of cross-infection for every one million procedures performed with reused devices (0.004%).

CONCLUSIONS

Reuse of medical devices labelled "single use only" is common in Australian hospitals. Most devices appear to be unsuitable for reuse. Complete cessation of this practice of reusing single-use medical devices would stop potential cross-infection, but this would cost and estimated $2.5 million or more per case prevented

Pregnancy outcome in active duty seagoing women

The effect of working on the outcome of pregnancy has been previously addressed. Very few studies have looked at the effect of specific work conditions on pregnancy, and to our knowledge no studies have reviewed the pregnancy outcomes of women stationed on-board a submarine tender. In order to study the pregnancy outcomes of such women, we performed this study. All women (N = 140) who delivered in the 18 months between February 1991 and August 1992 and were stationed on-board either the USS E.S. Land or the USS Hunley were studied. Their pregnancy, delivery, and newborn records were reviewed. These women received excellent prenatal care. However, many risk factors were identified that were much higher than national averages. We conclude that pregnant sailors stationed on-board submarine tenders are at high risk for certain adverse pregnancy outcomes. Further studies are needed to determine if this difference persists when sailors at sea commands are compared to sailors stationed at shore commands.