Cardiac markers and point-of-care testing: a perfect fit

Biochemical markers are of increasing importance in diagnostic strategies for ruling in and ruling out acute myocardial infarction (AMI), particularly when electrocardiographic (ECG) findings do not allow a diagnosis. Point-of-care testing (POCT) or "near-patient" testing allows for diagnostic assays to be performed at the site of patient care delivery. The biochemical markers that are commonly used by physicians to aid in the diagnosis of AMI are myoglobin, CK-MB, troponin I, and troponin T. Currently available POCT assays possess comparable diagnostic performance to laboratory-based cardiac marker assays. This provides an opportunity for POCT to evolve into the standard of care for evaluating the greater than 6 million American patients presenting with chest discomfort. Full acceptance of this relatively new technology will not be realized until users reach a comfort level where utilization of these devices is foolproof and they have faith in the results.

Phase I and pharmacokinetic study of BMS-184476, a taxane with greater potency and solubility than paclitaxel

PURPOSE

To assess the feasibility, toxicity, pharmacokinetics, and preliminary activity of BMS-184476 administered as a 1-hour intravenous (IV) infusion every 3 weeks.

PATIENTS AND METHODS

Patients with advanced solid malignancies were treated with escalating doses of BMS-184476 as a 1-hour IV infusion every 3 weeks without premedication to prevent hypersensitivity reactions (HSR). Plasma sampling and urine collections were performed to characterize the pharmacokinetics and pharmacodynamics of BMS-184474.

RESULTS

Thirty-four patients were treated with 78 courses of BMS-184476 at five dose levels ranging from 20 to 80 mg/m2. Dose-limiting toxicity (DLT), consisting of severe neutropenia with fever, severe diarrhea, and/or severe mucositis, was experienced during course 1 by six of nine minimally pretreated patients treated at the 70 and 80 mg/m2 dose level. In contrast, of 15 assessable patients treated at the 60 mg/m2 dose level, which is the maximum-tolerated dose (MTD) of BMS-184476 on this administration schedule, only one heavily pretreated patient developed DLT (grade 4 neutropenia with fever and grade 3 diarrhea). One patient developed a grade 2 HSR during a second course of BMS-184476 at the 40 mg/m2 dose level. A previously untreated patient with an advanced cholangiocarcinoma experienced a partial response, and a patient with an untreated carcinoma of the gastroesophageal junction had a minor response. The pharmacokinetics of BMS-184476 seemed linear in the dose range studied. Mean +/- SD values for clearance, volume of distribution at steady-state, and terminal half-life were 220 +/- 89 mL/min/m2, 402 +/- 231 L/m2, and 40.8 +/- 21.8 hours, respectively.

CONCLUSION

The MTD and recommended dose for phase II evaluations of BMS-184476 is 60 mg/m2 as a 1-hour IV infusion every 3 weeks. The results of this study suggest that BMS-184476 may have several advantages compared with paclitaxel in terms of toxicity, pharmacokinetics, pharmaceutics, and administration and warrants further clinical development.

Privatization of local health department services: effects on the practice of health education

Local health departments (LHDs) are changing service delivery mechanisms to accommodate changes in health care financing and decreased public support for governmental services. This study examined the extent to which North Carolina LHDs privatized and contracted out services and the effects on the time spent on core functions of public health and activities of health educators. Questionnaires were mailed to the senior health educators in all LHDs. Sixty-nine responded, and 68% of LHDs had not privatized any services other than laboratory and home health. Clinical services were more commonly privatized than nonclinical services. Respondents perceived that privatization produces more time for LHDs to address the core public health functions and for health educators to engage in appropriate professional activities. Health educators in LHDs that had not privatized were more likely to be concerned about potential negative effects. This study suggests that privatization has generally had a positive effect on the roles of health educators in North Carolina LHDs.

Using the Internet to facilitate computerized patient records

This paper explores using the Internet to implement an electronic medical records system. It examines methods and technologies, security issues, current Web-based applications and system vendors, and describes how to implement a clinic-suitable system.

A phase I study of prolonged ambulatory infusion carboplatin with oral etoposide showing activity in prostate cancer

PURPOSE

This phase I study aimed to establish the dose for phase II trials of a dose-intense outpatient regimen of ambulatory carboplatin and oral etoposide.

PATIENTS AND METHODS

Cohorts of three patients received escalating doses of carboplatin 15, 20, and 23 mg/m2/day as a 3-week continuous ambulatory infusion with oral etoposide initially at 50 mg/day. Patients entered had prostate, colon, head and neck, breast, unknown primary cancers and mesothelioma.

RESULTS

At 23 mg/m2 of carboplatin, two patients had WHO grade 3 lethargy and myelosuppression, which were the dose-limiting toxicities. Six patients were entered at the dose recommended for phase II studies, carboplatin 20 mg/ m2/day and etoposide 50 mg/day for 21 days repeated every 6 weeks. This was well tolerated except for one patient with multiple bone metastases from prostate cancer experiencing grade 4 myelosuppression and a single patient with grade 3 constipation. Seven patients with hormone-resistant prostate cancer were entered into the study, one at 15 mg/m2, four at 20 mg/m2 and two at 23 mg/m2 of carboplatin, and received a median of four cycles of treatment. The only responses were seen in prostate cancer where there were two partial responses in patients with soft tissue predominant disease. Five patients who could be evaluated with initially elevated PSA exhibited falls of > or 50% after receiving the chemotherapy. All but one patient with prostate cancer experienced significant reduction in pain levels. The median time to progression of the patients with prostate cancer was 4 months.

CONCLUSIONS

Ambulatory infusion carboplatin and oral etoposide is a tolerable dose-intense outpatient regimen which warrants further testing in phase II trials including hormone-resistant prostate cancer.

[Protective activity of a bacterial plasmid, bearing the gene for the tick-borne encephalitis virus NS1 nonstructural protein]

Three intramuscular injections (50 micrograms each) with bacterial plasmid pMV45 carrying nonstructural gene of NS1 protein of tick-borne encephalitis (TBE) virus protected 88% Balb/c mice from lethal challenge with the virus. Antibodies to NS1 nonstructural protein were detected in the sera of vaccinated mice after the challenge. Absence of antibodies to E structural protein indicated absence of manifest infectious process in mice vaccinated with plasmid and challenged with a lethal dose of TBE virus.

Cranberry juice consumption may reduce biofilms on uroepithelial cells: pilot study in spinal cord injured patients

STUDY DESIGN

A pilot study of 15 spinal cord injured patients.

OBJECTIVE

To determine whether alteration of fluid intake and use of cranberry juice altered the bacterial biofilm load in the bladder.

SETTING

London, Ontario, Canada.

METHODS

Urine samples were collected on day 0 (start of study), on day 7 following each patient taking one glass of water three times daily in addition to normal diet, and on day 15 following each patient taking one glass of cranberry juice thrice daily. One urine sample was sent for culture and a second processed to harvest, examine by light microscopy and Gram stain non-squamous uroepithelial cells to generate bacterial adhesion per 50 cells data.

RESULTS

The results showed that cranberry juice intake significantly reduced the biofilm load compared to baseline (P=0.013). This was due to a reduction in adhesion of Gram negative (P=0.054) and Gram positive (P=0.022) bacteria to cells. Water intake did not significantly reduce the bacterial adhesion or biofilm presence.

CONCLUSION

The findings provide evidence in support of further, larger clinical trials into the use of functional foods, particularly cranberry juice, to reduce the risk of UTI in a patient population highly susceptible to morbidity and mortality associated with drug resistant uropathogens.

SPONSORSHIP

This study was funded by Ocean Spray Cranberries, Lakeville, MA, USA.