Efficiency of a multidisciplinary team care approach through a short hospitalization of patients with poorly controlled diabetes mellitus: a 12 months prospective monocentric study

A multidisciplinary team is composed of various healthcare professionals that ensure a multifaceted approach on a group of patients. Standards for diabetes medical care note the importance of multidisciplinary diabetes care teams. We applied our model of multidisciplinary approach by structuring it in a determined five days hospitalization. The aim of this study was to determine if the interdisciplinary approach applied on a short hospitalization is of benefit in patients with poorly controlled diabetes mellitus. Sixty-seven patients were included and ensured a short hospitalization in which they received a multiple educational advice and a treatment adaptation. Sixty-one patients out of 67 (91%) were retained for evaluation with sufficient data at one year, i.e. 9% of patients with poor compliance. Evolution in glycosylated haemoglobin (HbA1c), weight and treatments was analyzed. After a 12 months follow-up, we observed significant improvement in HbA1c (-1.73%; p < 103) without weight loss (BMI=-0.42 kg/m2), p=0.28). HbA1c mean levels correlated negatively to body mass index (BMI) during the regular follow-up (r=-0.22, p=0.05). More than 90% of patients with poorly controlled diabetes mellitus responded to the multi-disciplinary approach with a decrease in HbA1c.

Evaluating the presence of SARS-CoV-2 RNA in the particulate matters during the peak of COVID-19 in Padua, northern Italy

The airborne transmission of SARS-CoV-2, the etiologic agent of the current COVID-19 pandemic, has been hypothesized as one of the primary routes of transmission. Current data suggest a low probability of airborne transmission of the virus in open environments and a higher probability in closed ones, particularly in hospitals or quarantine facilities. However, the potential diffusion of the virus in open environments, especially using particulate matter (PM) as a transport carrier, generated concern in the exposed populations. Several authors found a correlation between the exceeding of the PM10 concentration limits in some Italian cities and the prevalence of Covid-19 cases detected in those areas. This study investigated the potential presence of SARS-COV-2 RNA on a representative series of PM samples collected in the province of Padua in Northeastern Italy during the first wave of COVID pandemic. Forty-four samples of PM2.5 and PM10 were collected between February 24 and March 9, 2020 and analyzed with RT-qPCR for SARS-CoV-2 RNA. The experimental results did not indicate the presence of SARS-CoV-2 RNA in the outdoor PMs, thus confirming the low probability of virus airborne transmission through PM.

Effect of environmental conditions on the erosional resistance of cohesive sediment deposits in sewers

The potential to adjust sewer network operation in order to control the level of transported sediment in sewage so as to enhance the performance of end-of-pipe treatment works is now being investigated. However for this to become a practical management option there is a need to be able to understand the processes which control the movement of sediments that are found in many combined sewers. Crucial to this understanding is an ability to predict how sediments from in-sewer deposits, are released by the action of vigorous flows. This paper reports on a laboratory investigation that aimed to investigate the effect that the environmental conditions during deposit formation can have on the ability of fine-grained organic sediment within in-sewer deposits to resist erosion and subsequent release into transport.

Inhibitory effects of dronedarone on muscarinic K+ current in guinea pig atrial cells

Dronedarone (SR33589), an amiodarone-like noniodinated antiarrhythmic agent, is undergoing clinical trials in atrial fibrillation. Because vagal activation plays a role in the pathophysiology of supraventricular arrhythmias, we have assessed the ability of dronedarone (0.01, 0.1, and 1 microM), compared with amiodarone (0.1, 1, and 10 microM) to inhibit the muscarinic acetylcholine receptor-operated K+ current (I(K(ACh))) in single cells isolated from guinea pig atria (patch-clamp technique). I(K(ACh)) was activated by extracellular application of carbachol (10 microM) or by intracellular loading with GTP-gamma-S (100 microM). Dronedarone and amiodarone reduced the carbachol-induced I(K(ACh)) with an IC50 (concentration required for 50% inhibition) slightly above 10 nM and 1 microM, respectively. Dronedarone also inhibited the GTP-gamma-S induced K+ current by 28% and 58% at 0.01 and 0.1 microM, respectively. These data suggest that dronedarone inhibits I(K(ACh)) by depressing the function of K(ACh) channel itself or associated GTP-binding proteins. Compared with amiodarone, dronedarone is approximately 100 times more potent on I(K(ACh)) and seems more selective in inhibiting I(K(ACh)) with respect to its antagonism of other inward and outward currents reported in the literature. This relative high potency of dronedarone to reduce I(K(ACh)) may be involved, at least in part, in the antiarrhythmic action of dronedarone against atrial fibrillation.

[Distal traumatic avulsion of the triceps brachii. Apropos of a treated cases]

Traumatic distal avulsion of triceps brachii is a rare injury, usually due to a fall on the outstre ched elbow, with sudden contraction of the triceps muscle. Examination reveals pain, swelling, and a palpable depression just proximal to the olecranon. Lateral X rays show avulsed osseous material. Surgical therapy was advisable for complete avulsion. In this case, the authors used absorbable sutures for this reinsertion. Immediate surgical repair always achieves good results.

A comparative analysis of physiological responses at submaximal workloads during different laboratory simulations of field cycling

The purpose of this study was to evaluate the relationships between heart rate (fc), oxygen consumption (VO2), peak force and average force developed at the crank in response to submaximal exercise employing a racing bicycle which was attached to an ergometer (RE), ridden on a treadmill (TC) and ridden on a 400-m track (FC). Eight male trained competitive cyclists rode at three pre-determined work intensities set at a proportion of their maximal oxygen consumption (VO2max): (1) below lactate threshold [work load that produces a VO2 which is 10% less than the lactate threshold VO2 (sub-LT)], (2) lactate threshold VO2 (LT), and (3) above lactate threshold [workload that produces a VO2 which is 10% greater than lactate threshold VO2 (supra-LT)], and equated across exercise modes on the basis of fc. Voltage signals from the crank arm were recorded as FM signals for subsequent representation of peak and average force. Open circuit VO2 measurements were done in the field by Douglas bag gas collection and in the laboratory by automated gas collection and analysis. fc was recorded with a telemeter (Polar Electro Sport Tester, PE3000). Significant differences (P < 0.05) were observed: (1) in VO2 between FC and both laboratory conditions at sub-LT intensity and LT intensities, (2) in peak force between FC and TC at sub-LT intensity, (3) in average force between FC and RE at sub-LT. No significant differences were demonstrated at supra-LT intensity for VO2. Similarly no significant differences were observed in peak and average force for either LT or supra-LT intensities. These data indicate that equating work intensities on the basis of fc measured in laboratory conditions would overestimate the VO2 which would be generated in the field and conversely, that using fc measured in the laboratory to establish field work intensity would underestimate mechanical workload experienced in the field.

SR47063, a potent channel opener, activates KATP and a time-dependent current likely due to potassium accumulation

(i) We studied the effects of a new cromakalim analogue, SR47063, in guinea-pig ventricular cells. The experiments were carried out in whole-cell patch clamp with internal and external solutions supposedly similar to the physiological ones. (ii) SR47063 reversibly activated a time-independent current reversing near the potassium equilibrium potential, and a time-dependent current reversing at a more positive potential. Both currents were blocked by application of glibenclamide. (iii) The time-independent and the time-dependent currents were activating for the same concentration of agonist in every cell, this concentration being very different from cell to cell. (iv) The amplitude of the time-dependent current was shown to depend directly neither on agonist concentration nor on potential, but rather on the amplitude of the current flowing during the prepulse before the test pulse. (v) We conclude that SR47063 is a potent KATP channel opener acting at concentrations lower than one micromolar, and that the time-dependent current is likely due to accumulation and depletion of potassium in restricted areas of the cells.

[Digestive arterial obstructive diseases in three young women]

The authors report three cases of severe intestinal ischaemia occurring in young women (age 29-44), all of them being smokers. In all cases, intestinal ischaemia was recognized lately and lead to death within two years. The occlusive arterial lesions concerned nearly exclusively the intestinal arteries. Microscopic lesions were heterogeneous and non-specific. In a case, an occlusive intimal fibrosis was noted; in another case, fibrosis of the media and the adventitia was observed; and in the last case, the lesions were suggestive of thromboangiitis obliterans. The authors advocate for the systematic recording of cases of intestinal ischaemia in young women, in order to identify the risk factors and pathogenic features of this rare condition.

[Aging and procedural memory. Study of a series of tests on microcomputers]

The authors have assessed perceptual motor tasks involving the learning of the mouse control by locking at a Macinthosh computer screen during three consecutive sessions. Tests were performed by 102 control subjects aged between 16 and 85 years. Concerning age, there was a significant time difference (ANOVA) but improvement was the same for all subjects. Educational level and IQP results didn't influence procedural performance. Men were faster in three tasks. We can argue that implicit learning abilities appear before explicit memory and within the adult life span there appears to be little significant deterioration in implicit memory abilitie.

Efficacy and tolerability of imipenem-cilastatin versus ceftazidime plus tobramycin as empiric therapy of presumed bacterial infection in neutropenic cancer patients

The efficacy and tolerability of monotherapy with imipenem-cilastatin (I-C) were compared with that of ceftazidime plus full-course therapy with an aminoglycoside (tobramycin) (C&T) in the treatment of presumed bacterial infection in neutropenic cancer patients. A total of 106 adult patients diagnosed with presumed bacterial infection and an underlying malignancy with an absolute neutrophil count (ANC) < 500/mm3 were enrolled in this open-label study. A total of 131 febrile episodes occurred. Forty-five patients in the I-C group and 41 in the C&T group, who were well matched on demographic and baseline characteristics, were evaluable for efficacy and safety. Seventy-two hours after the start of therapy, no significant between-group differences in treatment outcomes, including withdrawals or deaths, were seen. Thirty-five (78%) of 45 patients in the I-C group and 29 (71%) of the 41 in the C&T group had successful outcomes at the final evaluation. Superinfection occurred in 8 (18%) I-C patients and 3 (7%) C&T patients. Within the subgroup of patients with an initial ANC < 100/mm3, the final evaluation showed no significant differences in treatment outcome between groups. Of the 131 in the safety population 30 (46%) I-C patients and 28 (42%) C&T patients had one or more adverse experiences; drug-related adverse events occurred in 25 (38%) patients in the I-C group and 11 (17%) patients in the C&T group. The data suggest that imipenem-cilastatin should be considered for initial empiric therapy of presumed bacterial infection in neutropenic cancer patients.

Evidence that large granular lymphocytes of donor origin mediate acute graft-versus-host disease

We have studied the phenotype of mononuclear cells infiltrating target organs of mice with acute graft-versus-host disease after bone marrow transplantation from H-2-identical donors. Infiltrating mononuclear cells with characteristics of large granular lymphocytes (LGL) were frequently found in close association with dead or dying epithelial cells in the skin, liver, and colon. The phenotype of these putative effector cells was Thy-1+, ASGM1+, Mac-1+, Lyt-1-, Lyt-2-, Ia-, which is characteristic of LGL. Differences in the Thy-1 allele between donor and host were used to demonstrate that these cells were of donor origin. Analysis of cytolytic function in GVHD splenocytes indicated high natural killer activity and low cytolytic T lymphocyte (CTL) activity. These findings suggest that an important effector cell in systemic acute graft-versus-host disease is a large granular lymphocyte of donor origin.

Hemodynamic response to SR 42128A in normal and sodium-depleted baboons

Hemodynamic changes following intravenous administration of SR 42128A (SR), a potent renin inhibitor, were evaluated in normal (N) and sodium-depleted (SD) anesthetized baboons. SR, at 9 mg/kg, decreased arterial pressure (AP) only in the SD group. This effect persisted for at least 2.30 h. At this dose, SR decreased the systemic vascular resistance (SVR) and increased the cardiac output in the SD group more than in the normal group. In both groups, heart rate was slightly increased. However, in the normal group, the highest dose (12 mg/kg) induced the same hemodynamic responses as the dose of 9 mg/kg in the SD group. Every time, plasma renin activity (PRA) was inhibited. Thus, in SD baboons, SR produced a hypotensive effect more pronounced than in the normal group. The dose-related effect on AP seemed to be correlated with the change in SVR. We can conclude that total inhibition of PRA is necessary but not sufficient, under normal conditions, to get an adequate lowering of SVR and a hypotensive effect.

Amelioration of acute graft vs host disease due to minor histocompatibility antigens by in vivo administration of anti-interleukin 2 receptor antibody

Lethal acute graft vs host disease (GVHD) elicited by minor histocompatibility antigens was studied in a murine model of bone marrow transplantation (B10.BR----CBA). The severity of GVHD was reduced by both clinical and histologic parameters when transplant recipients received injections of a monoclonal antibody directed against the interleukin 2 receptor. This study suggests that anti-interleukin 2 receptor antibodies may be useful in clinical marrow transplantation and provides additional evidence that monoclonal antibodies that block T cell function in vitro may be of therapeutic value in vivo.

Amelioration of acute graft vs host disease due to minor histocompatibility antigens by in vivo administration of anti-interleukin 2 receptor antibody

Lethal acute graft vs host disease (GVHD) elicited by minor histocompatibility antigens was studied in a murine model of bone marrow transplantation (B10.BR----CBA). The severity of GVHD was reduced by both clinical and histologic parameters when transplant recipients received injections of a monoclonal antibody directed against the interleukin 2 receptor. This study suggests that anti-interleukin 2 receptor antibodies may be useful in clinical marrow transplantation and provides additional evidence that monoclonal antibodies that block T cell function in vitro may be of therapeutic value in vivo.

Stability of trimethoprim-sulfamethoxazole injection in two infusion fluids

The concentrations over time of trimethoprim (TMP) and sulfamethoxazole (SMZ) in solution after preparations of admixtures of TMP-SMZ in 5% dextrose injection (D5W) and in 0.9% sodium chloride injection (NS) were measured. Admixtures (50 ml) containing three TMP concentrations (0.64 mg/ml, 1.6 mg/ml, and 3.2 mg/ml) and three SMZ concentrations (3.2 mg/ml, 8.0 mg/ml, and 16 mg/ml) were prepared in D5W or NS, representing 1:25 v/v, 1:10 v/v, and 1:5 v/v dilutions of TMP-SMZ injection, respectively. Aliquots of each admixture were obtained immediately upon dilution and after 0.5, 1, 2, 4, 8, and 24 hours. The aliquots were filtered and assayed for TMP and SMZ by high-pressure liquid chromatography. Each mixture was inspected visually for any changes in clarity or color, and the pH of each admixture was measured over time. The concentration of SMZ in all admixtures remained constant over 24-hour study period. The TMP concentration did not change significantly (less than 10% of initial concentration) after 1:25 v/v dilutions in either D5W or NS for up to four hours. With a dilution of 1:10 v/vv D5W TMP was stable at D5W for up to two hours. TMP precipitated rapidly in dilutions of 1:5 v/v in either D5W or NS. The pH of the admixtures ranged from 9.39 to 10.10. D5W is the preferred diluent for TMP-SMZ injection if a dilution ratio of 1:10 v/v is desired. Either D5W or NS may be used if a dilution ratio of 1:25 v/v is desired.