Randomized controlled trial of once vs. twice daily gentamicin therapy in newborn

OBJECTIVE

To compare the efficacy of once daily gentamicin administration to the conventional twice daily dosage schedule by estimation of serum gentamicin concentrations (SGC) in neonates.

DESIGN

Randomized controlled trial.

SETTING

Medical college hospital.

SUBJECTS

Seventy three neonates of gestational age>32 weeks at risk or with clinical features of sepsis.

METHODS

The subjects were divided into preterm and term groups. Babies in each of these groups were randomized to receive a single daily dose (4 mg/kg) or a twice daily dose (2.5 mg/kg) of injection gentamicin intravenously. Trough and peak SGC were estimated half an hour prior and one hour after the second dose. Statistical analysis was done using the equivalence method.

RESULTS

In preterm as well as term babies, the mean peak and trough gentamicin levels were comparable in the two regimens. There is statistically significant evidence to show that the effect of once daily and twice daily dosage is similar.

CONCLUSION

Once daily gentamicin administration is as effective as twice daily therapy and would be more cost effective.

Radiocontrast-induced nephropathy

Radiocontrast-induced nephropathy (RCIN) is a common cause of acute renal failure. It results from an ischemic injury to the medullary portion of the kidney secondary to intense renal vasoconstriction. Patients with pre-existing renal insufficiency, diabetes, congestive heart failure, taking certain medications, and exposed to large volumes of high osmolar contrast are at increased risk of developing RCIN. Prophylaxis of high-risk patients by careful hydration and avoidance of exacerbating factors can minimize the incidence of RCIN.

Treatment of tinea capitis with itraconazole capsule pulse therapy

BACKGROUND

The number of newly diagnosed cases of tinea capitis in children appears to be on the rise, particularly in urban centers.

OBJECTIVE

The purpose of this study was to assess the effectiveness, safety, and compliance of itraconazole pulse therapy for tinea capitis.

METHODS

Fifty subjects (48 children [less than 18 years of age] and 2 adults) with tinea capitis were treated with pulse itraconazole in a multicenter evaluation. Each pulse lasted 1 week, with 2 weeks between the first two pulses and 3 weeks between the second and third pulses. The decision to administer a second or third pulse was determined by the response of the subject at the time that the next pulse was due. During the 1-week pulse of active therapy, itraconazole (5 mg/kg/day) was dosed as follows: more than 40 kg, 200 mg per day (two capsules per day); 20 to 40 kg, 100 mg per day (one capsule per day); and 10 to 19 kg, 50 mg per day (one half of a capsule per day). The duration of the study was 12 weeks with mycologic evaluation at this time. Subjects who were classified as treatment failures at 12 weeks after the start of therapy were given the option of receiving an additional 1-week pulse of active therapy, with 3 weeks between successive pulses.

RESULTS

The causative organisms were Trichophyton tonsurans (41 subjects), T violaceum (7), T. soudanense (1), and T rubrum (1). Thirteen subjects were lost to follow-up, with 37 subjects (35 children and 2 adults) available for evaluation 12 weeks after the start of therapy. At this time, cure (clinical and mycologic) was observed in 30 (81%) of 37 subjects. When the tinea capitis was mild, cure was obtained after one pulse in two subjects and after two pulses in five subjects. With tinea capitis of moderate extent, complete cure was obtained after one pulse in one subject, two pulses in eight subjects, and after three pulses in seven subjects. When tinea capitis was severe, two and three pulses produced complete cure in one and six subjects, respectively. Of the seven subjects whose conditions failed to respond (three subjects with moderate disease and four subjects with severe disease), five subjects chose to receive extra itraconazole. Clinical and mycologic cure was observed after four pulses in four subjects and after five pulses in one subject. There were no associated clinical adverse effects with itraconazole therapy.

CONCLUSION

With tinea capitis, itraconazole pulse therapy is effective and safe and is associated with high compliance. The pulse regimen enables the duration of treatment to be individualized, according to the extent of disease and its rate of resolution.

Digestibility by dairy cows of monosaccharide components in diets containing either ground sorghum or sorghum grain treated with sodium hydroxide

Five cows in midlactation and equipped with ruminal and abomasal canulas were fed two isonitrogenous diets composed of 46% sorghum grain, either ground or treated with 4% NaOH, plus 39% wheat silage and 15% supplements. The DMI were 16.3 and 15.8 kg/d for cows fed the diets containing ground sorghum and treated sorghum, respectively. The digestibility of NDF polysaccharides was higher for cows fed the treated sorghum, but the digestibility of neutral detergent soluble alpha-glucans (starch) was higher for cows fed ground sorghum. Digestibility of total carbohydrate was 79% for cows fed the diet containing ground sorghum and 67% for cows fed the diet containing sorghum treated with NaOH. Ruminal pH was higher in cows fed the diet with treated sorghum, but total ruminal VFA concentration was higher in cows fed the diet containing ground sorghum. Profiles of individual ruminal VFA and NH3 concentration were similar for both treatments. Flow of NAN through the abomasum of cows fed ground sorghum was higher than that of cows fed the sorghum treated with NaOH, and N absorption in the intestine followed a similar trend. The data indicated a possible advantage for dairy cows fed ground sorghum than for those fed grain treated with NaOH.

Stereotactic angiographic localization as an adjunct to surgery of cerebral mycotic aneurysms: case report and review of the literature

Less than 10% of all aneurysms affecting the arterial cerebral circulation are mycotic in nature. They occur in the setting of bacterial endocarditis and are the cause of considerable morbidity and mortality of affected patients. In selected cases surgery may play a curative role in the treatment plan. These aneurysms frequently arise in distal arterial branches, and their localization during surgery may at times prove laborious. We report the case of a mycotic aneurysm of a distal branch of the anterior cerebral artery surgically treated with the help of angiographic stereotactic localization. Stereotaxy should thus be regarded as a pertinent adjunct in selected cases of surgical treatment of distal mycotic cerebral aneurysms.

Dopamine DRD2/Cys311 is not associated with chronic schizophrenia

A mutation in the DRD2 receptor gene has been reported in association with schizophrenia in Japanese and Caucasian populations. The variation, Ser to Cys at codon 311, occurs in the third intracellular loop of the receptor and is therefore putatively functional. We report the results of screening US Caucasian schizophrenic and nonschizophrenic populations. We detected the occurrence of the DRD2 Cys311 variant in both schizophrenics and controls. Our data demonstrates no significant difference between the frequency of Cys311 in Caucasian schizophrenic and non-schizophrenic populations, indicating no association with schizophrenia.

Coping with stress: a physician's guide to mental health in aging

The mental and emotional health of people of all ages is related to how well they cope with or adapt to the stresses and changes in their lives. Although risks to health do increase with advancing age, stress is not an inevitable consequence of old age. However, two transitional stressors that are more common with increased age are the onset of illness and/or physical impairment and the death of loved ones. As recently as 1987, less than 1.5% of community-based mental health care went to persons over age 65. The elderly consistently report that when they do seek help with emotional problems, they first consult with their primary care physicians. Therefore, these physicians need to be knowledgeable about mental health in aging and familiar with mental health services their patients could use.

Performance of high producing dairy cows offered drinking water of high and low salinity in the Arava desert

The effect of supplying high producing Israeli Holstein cows with desalinated or salty water on milk composition and production was examined in the Arava desert of southern Israel. Daily water consumption of cows offered desalinated water was higher by 10.6 L than that of the group offered salty drinking water; DMI was similar for the two groups. Daily production of milk and 3.5% FCM was higher for the cows receiving desalinated water than for the cows receiving salty water; 35.2 versus 33.1 kg and 31.6 versus 29.8 kg, respectively. The percentage of protein in milk and the daily protein production were higher for the cows receiving desalinated water than for the cows receiving salty water: 2.89% and 1.01 kg versus 2.84% and .93 kg, respectively. The percentage of milk fat and the daily fat production were higher for the cows receiving desalinated water. These results indicate that water salinity negatively affects milk production. Improvement of water quality by desalination increased production of milk and milk constituents.

Effects of saline, mannitol, and furosemide on acute decreases in renal function induced by radiocontrast agents

BACKGROUND

Injections of radiocontrast agents are a frequent cause of acute decreases in renal function, occurring most often in patients with chronic renal insufficiency and diabetes mellitus.

METHODS

We prospectively studied 78 patients with chronic renal insufficiency (mean [+/- SD] serum creatinine concentration, 2.1 +/- 0.6 mg per deciliter [186 +/- 53 mumol per liter]) who underwent cardiac angiography. The patients were randomly assigned to receive 0.45 percent saline alone for 12 hours before and 12 hours after angiography, saline plus mannitol, or saline plus furosemide. The mannitol and furosemide were given just before angiography. Serum creatinine was measured before and for 48 hours after angiography, and urine was collected for 24 hours after angiography. An acute radiocontrast-induced decrease in renal function was defined as an increase in the base-line serum creatinine concentration of at least 0.5 mg per deciliter (44 mumol per liter) within 48 hours after the injection of radiocontrast agents.

RESULTS

Twenty of the 78 patients (26 percent) had an increase in the serum creatinine concentration of at least 0.5 mg per deciliter after angiography. Among the 28 patients in the saline group, 3 (11 percent) had such an increase in serum creatinine, as compared with 7 of 25 in the mannitol group (28 percent) and 10 of 25 in the furosemide group (40 percent) (P = 0.05). The mean increase in serum creatinine 48 hours after angiography was significantly greater in the furosemide group (P = 0.01) than in the saline group.

CONCLUSIONS

In patients with chronic renal insufficiency who are undergoing cardiac angiography, hydration with 0.45 percent saline provides better protection against acute decreases in renal function induced by radiocontrast agents than does hydration with 0.45 percent saline plus mannitol or furosemide.

Prenatal correlates of indigent mothers' attitudes about spoiling their young infants: a longitudinal study

The purpose of this study was to investigate factors associated with indigent mothers' attitudes about spoiling their young infants. Mothers who believe that young infants can be spoiled may be more likely to misperceive their infants' basic needs for nurturing and thus undermine their infants' sense of security and trust. One hundred twenty-nine consecutive pregnant women who were at approximately 15 weeks' gestation completed measures to assess depressive symptoms (Center for Epidemiologic Studies Depression Scale) and social support (Maternal Social Support Index). One hundred seventeen mothers (91%) completed a simple three-question Spoiling Index when their infants were about 1 month old. Fifty-eight percent were single, never married, 73% multiparous, 66% Euro-American, 28% African-American, and 84% at least 20 years old. Fifty-eight percent of mothers believed infants younger than 5 months old could be spoiled. After including maternal age, race, marital status, prenatal social support, and number of prenatal clinic visits in the hierarchical logistic regression model, "spoilers" were more likely to be primigravida mothers (odds ratio = 2.71; 95% confidence interval, 1.05 to 7.06) and more likely to be depressed during pregnancy (odds ratio = 2.83; 95% confidence interval, 1.29 to 6.19). Primigravida indigent mothers and mothers with higher levels of prenatal depressive symptoms are more likely to believe they can spoil their young infants.

Characterization of the prenylated protein methyltransferase in human endometrial carcinoma

The processing of ras and of other GTP-binding proteins includes a final reversible step in which the carboxy terminal prenylated cysteine is methylated by the enzyme prenylated protein methyltransferase (PPMTase). The significance of this modification and of the role of PPMTase in human tumors has yet to be fully elucidated. Here we characterize the PPMTase of human endometrial carcinomas (tumors in which the frequency of ras gene mutations is relatively high) and compare it to the PPMTase of the normal endometrium. Our results show that in both types of tissues the enzyme is bound to the membranes. It can utilize synthetic substrates such as N-acetyl-S-farnesyl-L-cysteine (Km = 18-20 microM) and is blocked by the PPMTase inhibitor S-farnesylthioacetic acid (Ki = 2 microM). In vitro methylation assays and [alpha-32P]GTP blot-overlay assays showed that the major endogenous PPMTase substrates are small GTP-binding proteins. Methylation of these proteins in vitro is blocked by farnesylthioacetic acid. The kinetic properties of PPMTase from the carcinomas and the normal tissues are very similar. However, levels of PPMTase activity (but not of its endogenous substrates) are higher in the carcinomatous endometrium than in the normal one. The elevated enzyme activity is restricted to the crude mitochondrial fraction (8.0 +/- 0.4 vs. 5.4 +/- 0.1 pmol N-acetyl farnesylcysteine methyl ester formed/min/mg protein by the carcinoma and by the normal endometrial preparations, respectively). As this fraction is enriched in plasma membranes, it appears that the elevated enzyme activity could be related to ras protein methylation; if so, selective methylation blockers might inhibit the growth of endometrial carcinomas.

Electromyographic analysis of standing posture and demi-plié in ballet and modern dancers

Surface electromyography was used to analyze lower extremity muscle activity during standing posture and demi-plié in first position with lower extremities turned out, in five ballet and seven modern female professional dancers. In standing posture, increased electromyographic (EMG) activity above baseline was detected most frequently at the medial gastrocnemius (54% standing repetitions) and tibialis anterior (29%) electrodes (all dancers); in ballet dancers, increased EMG activity during standing was significantly less frequent at the medial gastrocnemius, but more frequent at the tibialis anterior, than in modern dancers. In demi-plié, the tibialis anterior had a discrete peak of EMG activity at midcycle in all dancers (97% demi-pliés). All dancers also had midcycle EMG activity in both vastus lateralis and medialis (100% demi-pliés). At the end of rising phase of demi-plié, ballet dancers had greater EMG activity than at midcycle in vastus lateralis (100% demi-pliés) and medialis (92%); in modern dancers, end-rising phase voltage was lower than at midcycle for vastus lateralis (71% demi-pliés) and medialis (83%). Genu recurvatum > or = 10 degrees was observed at the beginning and end of demi-plié in all ballet dancers, but not in modern dancers. There was marked variation of EMG activity during demi-plié in the lateral gastrocnemius, medial gastrocnemius, gluteus maximus, hamstrings, and adductors. The results support the hypothesis that ballet and modern dancers have different patterns of muscle use in standing posture and demi-plié, which in part may be a result of differences in genu recurvatum and turnout between the two groups.

Effect on outcome of the presence or absence of chest pain at initiation of recombinant tissue plasminogen activator therapy in acute myocardial infarction. The Thrombolysis in Myocardial Infarction Investigators

To ascertain whether the outcome of patients with suspected myocardial infarction differs when chest pain is still present at initiation of thrombolytic therapy, participants in the Thrombolysis in Myocardial Infarction Phase II study, all of whom presented within 4 hours of symptoms onset, were retrospectively divided into 2 groups: (1) those with chest pain present at onset of intravenous thrombolysis, n = 3,000; and (2) those who were free of chest pain on beginning intravenous thrombolytic therapy, n = 337. Patients free of chest pain were older (58 vs 57 years, p = 0.01), more often women (23 vs 17%, p = 0.01), had fewer electrocardiographic leads with ST elevation (3.8 vs 4.1, p < 0.001), and the presenting event was confirmed less often as myocardial infarction than as chest pain without infarction (88 vs 96%, p < 0.001). There were no significant differences between the 2 groups for in-hospital death, reinfarction, recurrent ischemic events, stroke, overall hemorrhagic complications, coronary angioplasty or bypass surgery. At 6-weeks follow-up, more pain-free patients had resting ejection fraction > 0.55 (35 vs 31%, p = 0.001) and fewer developed congestive heart failure (12 vs 20%). At 1-year follow-up, fewer pain-free patients developed congestive heart failure (15 vs 21%, p = 0.009), but no differences existed between the 2 groups in frequency of death, reinfarction, coronary angioplasty, bypass surgery or anginal class. Thus, there are several observations in patients who were free of chest pain at onset of lytic therapy. (1) The majority developed enzymatic or electrocardiographic evidence of acute myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Successful aging: how to help your patients cope with change

Collaborative work between physicians and social workers can be very valuable in helping patients to "age successfully." For many patients, the medical consequences of chronic disease are compounded by social problems, such as isolation and loss of self esteem. Social workers attempt to help people cope with the stresses of aging by gaining some degree of control over their lives. Keys to successful aging include being flexible and adaptable in the face of change, being connected in a confidante relationship with at least one other person, and feeling that life has a purpose beyond mere survival. Social workers provide such mental health services as counseling, support, and conflict resolution. They can also assist in the time-consuming work of finding needed community resources.

C-type natriuretic peptide receptors and signaling in rectal gland of Squalus acanthias

Recent evidence suggests that the newly described natriuretic peptide, C-type natriuretic peptide (CNP), may be the circulating form of natriuretic peptide in the shark. In the shark CNP has a major site of action in the rectal gland, which augments chloride secretion in response to stimulation by volume loading or CNP infusion. We therefore examined the shark rectal gland for natriuretic peptide receptors and determined the presence of guanylate cyclase-linked receptors and non-guanylate cyclase-linked receptors for CNP in this tissue. CNP binds with uniform high affinity (dissociation constant of 78 +/- 11 pM) to receptors of high density (receptor density of 61 +/- 0.7 fmol/mg protein) in plasma membranes prepared from the rectal gland. By use of rat atrial natriuretic peptide (rANP) as a competing ligand, two classes of receptors become apparent in this population, both of which have similar affinity for CNP, but different affinities for rANP. The low-molecular-weight natriuretic peptide receptor-specific peptide, des-[Gln116,Ser117,Gly118, Leu119,Gly120]rANP-(102-121), binds to 50% of the receptors in the rectal gland, but fails to bind to the remaining 50% even at micromolar concentrations. Porcine brain natriuretic peptide (pBNP) binds with uniformly diminished affinity to all receptors, whereas the unrelated peptide, porcine vasoactive intestinal peptide, does not bind these receptors. The importance of the integrity of the ring structure of CNP is underlined by the significant loss of affinity when the peptide ring is opened.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of tributyltin chloride on vascular responses to atrial natriuretic peptide

The effects of tributylin chloride (TBT) on vascular smooth muscle responses to norepinephrine, nitroprusside (SNP) and atrial natriuretic peptide (ANP) were studied in isolated aortic rings of rats. TBT did not interfere with norepinephrine-induced contraction or SNP-induced vasorelaxation. However, TBT produced a dose-dependent inhibition of ANP-induced vasorelaxation. Inhibition was not observed with inorganic tin chloride, SnCl2. The inhibition of vasorelaxation was accompanied by a parallel inhibition of ANP-induced cGMP generation. SNP-induced generation of cGMP was not affected by TBT. TBT did not interfere with binding of ANP to its receptor in bovine adrenal glands suggesting that the effects of TBT were mediated by direct interaction with membrane-bound guanylate cyclase.