Perceived changes in psychological and physical symptoms after hospital clown performances in a cancer setting

Background: The therapeutic role of humor and hospital clowns has become a focus of interest in recent decades. Most of the research in the area has focused on children; here, we explore the influence of clown performances on adult cancer patients, their companions, and health-care staff.Methods: Ninety-nine cancer patients and 113 companions were assessed pre- and post-interventions performed by professional clowns; 31 health professionals were asked about the possible influence of the presence of clowns in hospital on their work.Results: Patients felt that clowning performances helped to reduce their level of psychological symptoms, but not their physical symptoms. Companions reported improvements in all the psychological symptoms explored. Health professionals reported that the presence of clowns in the workplace improved their well-being.Conclusions: Clowning performances helped to improve psychological functioning in all the populations studied, especially in companions. Adult hospitals should consider promoting clowning interventions to improve general well-being.

The role of posttraumatic stress and posttraumatic growth on online information use in breast cancer survivors

OBJECTIVE

Changes perceived as both positive (eg, posttraumatic growth [PTG]) and negative (eg, posttraumatic stress symptoms [PTSS]) have been associated with intensive Internet use among breast cancer survivors. In this multicenter study, we analyzed the role of PTG and PTSS on the amount of time spent looking for online cancer information, its content, and its psychological impact.

METHODS

Posttraumatic stress symptoms and PTG were assessed in 182 breast cancer survivors by using the Post-traumatic Stress Disorder Checklist and Post-traumatic Growth Inventory questionnaires. Subjects also completed a questionnaire about their behavior when looking for online illness-related information (ie, time spent, type of contents, and psychological impact).

RESULTS

Posttraumatic stress symptoms positively correlated with the amount of time spent looking for cancer-related information, including both medical and psychosocial content. By contrast, PTG showed no relationships with the amount of time, but with a predominant search for cancer-related psychosocial information. The psychological impact of online information was associated with participants' levels of PTG and/or PTSS. Whereas PTG was related to a decrease of women's hope, PTSS was linked to the perception of being less conscious or inadequately informed about the illness, thereby increasing feelings of distress.

CONCLUSIONS

Posttraumatic stress symptoms and PTG show relationships with the amount of time spent online, the type of information accessed online, and the psychological impact of Internet use. Health professionals should prescribe online information according to the psychological response to cancer. There is a need for professional-led online resources to provide patients with timely information as well as support sites to facilitate psychological adjustment.

Abstract P1-09-07: Effects of breast cancer treatment on markers of metabolic syndrome in a predominantly hispanic patient population

Background: Adjuvant chemotherapy improves survival in early breast cancer, however has been reported to contribute to weight gain and insulin resistance. Hispanics are reported to have higher levels of insulin resistance and features of metabolic syndrome as compared to caucasians and as such may be at higher risk of metabolic decompensation during treatment of their cancer. We sought to evaluate the effects of adjuvant/ neo-adjuvant breast cancer treatment on markers of metabolic syndrome in a predominantly hispanic population. Study was funded by the institutions department of medicine seed grant funds.

Methods: We enrolled 35 consecutive patients who were about to commence adjuvant or neo-adjuvant chemotherapy for breast cancer. Patients with diabetes mellitus or hyperlipidemia were excluded. Fasting glucose, HBA1C, insulin levels, HDL cholesterol, triglyceride levels, waist circumference and blood pressure were measured before starting chemotherapy and then every 3 months for 1 year. Results were analyzed using repeated measures ANOVA for normally distributed data. For data that was not normally distributed, Friedmans non parametric test was utilized.

A survey of dietary habits, exercise frequency and life style factors was administered before initiating treatment and at completion of the study.

Results:

Baseline characteristics: Of the 35 patients enrolled 31 were hispanics (89%). Median age was 47 years (33-68). 31 (82.8%) were over weight or obese. 13 (37%) had insulin resistance as assessed by HOMA (homeostatic model assessment)-IR, and 12 (34%) met the international diabetic federation (IDF) criteria for metabolic syndrome. 17% had stage 1, 52% had stage 2 and 31% had stage 3 disease. Most common chemotherapy regimen used was dose dense doxorubicin, cyclophosphamide and weekly paclitaxel.

No significant change was noted in the fasting glucose, HBA1C levels, insulin levels, HOMA-IR, weight or waist circumference at any point during the 1 year follow up. Triglyceride levels increased from a mean of 162.2mg/dl prior to therapy to 202.8mg/dl by 3 months, p=0.014. HDL-cholesterol fell from a mean of 50.6 mg/dl to 44mg/dl by 3 months, p=0.04.

Both triglyceride levels and HDL levels returned to baseline by 9 months and there was no change noted by 12 months. Overall 12 patients (34%) met the IDF criteria for metabolic syndrome before initiating adjuvant therapy as compared to 14 (40%) at 1 year.

Subgroup analysis of patients with preexisting metabolic syndrome, obesity or insulin resistance (HOMA-IR >3.8) showed similar results.

Analysis of the survey data showed 22 of the 35 patients (62%) had improved their dietary and exercise habits over the course of the study.

Conclusions: Contrary to other studies, we did not find a significant difference in most of the parameters of metabolic syndrome in a predominantly hispanic patient population. A transient increase in triglyceride levels and a decline in HDL cholesterol level was noted at 3 months, however resolved by the 9th month of treatment. Our data suggests that life style modification may mitigate most of the metabolic adverse effects of therapy and women, at the time of diagnosis, may be particularly motivated to make such changes.

Citation Format: Gaur S, Ochoa C, Sanchez L, Nahleh Z. Effects of breast cancer treatment on markers of metabolic syndrome in a predominantly hispanic patient population. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-09-07.

[General anaesthesia and obstetric bleeding in caesarean section. One year's experience in a university hospital]

INTRODUCTION

Obstetric haemorrhage is an important worldwide cause of morbidity and mortality. General anaesthesia for caesarean section is rarely used. Our goal is to analyse the incidence, causes and risk factors associated with general anaesthesia for caesarean section, and the prevalence of obstetric haemorrhage (HO), its risk factors and predictors of post-caesarean HO together with the use of blood in our hospital population.

METHODS

A retrospective study was conducted on all caesarean section discharge reports from PACU in 2008.

RESULTS

General anaesthesia was required in 12.4% of the patients. Epidural catheter failure as a cause of general anaesthesia was infrequent (2.8%) and within the recommended standards.

CONCLUSIONS

The most frequent indications for caesarean section under general anaesthesia included mainly life-threatening emergencies, and the most important risk factors for general anaesthesia, including coagulation disorders, bleeding in the third trimester, foetal distress and severe pre-eclampsia. General anaesthesia is a risk factor for transfusion, as is abruptio placentae, placenta previa and pre-eclampsia.

[Endovascular treatment of stenosis of the renal artery in transplanted kidney]

INTRODUCTION

The incidence of renal artery stenosis in the transplanted kidney (TRAS) varies between 2 and 23%, being the most frequent vascular complication following renal trasplantation. The delay in diagnosis and treatment can lead to functional graft loss. Percutaneous trasluminal angioplasty with stent (PTAS) is the treatment of choice to restore kidney perfusion.

MATERIALS AND METHODS

Retrospective review of renal transplant casuistic in our institution between September 2005 and August 2009. Were included patients with greater than 70% TRAS and impaired graft function, treated with PTAS. Follow-up at 3, 12 and 36 months was done with creatinine, glomerular filtration rate (GFR) and Doppler ultrasonography (DUS). Technical success was defined as correct stent placement associated with decreased flow, and clinical success as improve renal function during follow-up.

RESULTS

Incidence of TRAS was 7.3% (22/298), 60% PTAS subsidiary. 100% technical success and 84.6% clinical success, 15.4% without changes in renal function. 84% decreases flow rate greater than 70% by DUS, and 26% up to 60%. Wave changes from type III to type II were recorded in 69% and to type I in 33%.

CONCLUSIONS

The PTAS is a safe and effective procedure for the treatment of selected TRAS patients, as it preserves vascular permeability in short and medium term, ensuring the functionality of the graft. DUS is the method of choice for diagnosis and monitoring TRAS.

EUS-guided single-incision needle-knife biopsy: description and results of a new method for tissue sampling of subepithelial GI tumors (with video)

BACKGROUND

The diagnostic efficacy of current tissue sampling techniques for upper GI subepithelial tumors (SETs) appears to be limited. Better tissue acquisition techniques are needed to improve the diagnostic yield in this setting.

OBJECTIVE

Our purpose was to determine the safety and diagnostic yield of EUS-guided needle-knife incision and forceps biopsy (SINK biopsy) of upper GI SETs.

DESIGN

Retrospective database review.

SETTING

Academic tertiary-care referral center.

PATIENTS

This study involved 14 consecutive patients referred for EUS evaluation of upper GI SETs with previous unsuccessful attempts at tissue diagnosis by conventional forceps biopsy.

INTERVENTION

EUS-guided needle-knife incision and forceps biopsy.

MAIN OUTCOME MEASUREMENTS

The safety and diagnostic yield of this method, compared with EUS-guided fine-needle aspiration (EUS-FNA), when possible.

RESULTS

SINK biopsy provided tissue samples that were sufficient for definite histologic diagnosis in 13 of 14 cases (diagnostic yield 92.8%). There were 8 gastric GI stromal tumors. In 7 of 8, the size of SINK specimens allowed immunohistochemical analysis, and the evaluation of malignant potential was carried out by means of mitotic index determination in 5 cases (71.42%). SINK biopsies determined the pathological diagnosis of all (4 of 4) nonmesenchymal lesions. Eight patients underwent both EUS-FNA and SINK, with final histologic diagnosis determined in 6 of 8 cases (75%) by SINK versus 1 of 8 cases (12.5%) by EUS-FNA (Fisher exact test, P = .023). There were no procedure-related complications.

LIMITATIONS

A single-center, retrospective analysis with small sample size.

CONCLUSION

SINK biopsy appears to be an easy, safe, and effective technique for determining the definitive pathological diagnosis, evaluation of the malignant potential, and planning management of SETs. It could be a reliable alternative to conventional FNA, providing larger samples that improve the histologic yield.

Incidence and prevalence of type 1 diabetes in children aged <15 yr in Castilla-Leon (Spain)

OBJECTIVES

To determine the incidence and prevalence of type 1 diabetes in children younger than 15 yr in the Autonomous Community of Castilla-Leon (Spain).

RESEARCH DESIGN AND METHODS

All type 1 diabetic cases with onset at <15 yr of age were recorded during 2003-2004. Identified case subjects were ascertained from several sources and the capture-recapture method was used to estimate the completeness of ascertainment. For prevalence, all patients younger than 15 yr with type 1 diabetes at the beginning and at the end of the study were identified.

RESULTS

Over the study period, 130 children aged 0-14 yr were diagnosed with type 1 diabetes. The average observed incidence of type 1 diabetes in this population was 22.22/100 000/yr (95% CI 14.57-29.81). Age-standardized incidence was 22.01/100 000/yr (95% CI 18.18-25.83). The highest incidence was observed in the 5-9 yr age-group (32.45/100 000/yr, 95% CI 24.31-40.59). The prevalence at the beginning and at the end of the study was 1.01/1000 and 1.18/1000, respectively.

CONCLUSION

Castilla-Leon appears to have one of the highest incidences of childhood type 1 diabetes in Spain, with recent incidence approaching those of some northern European countries.

Alternation of Antiretroviral Drug Regimens for HIV Infection. Efficacy, Safety and Tolerability at Week 96 of the Swatch Study

Introduction

Alternation of antiretroviral drug regimens has been proposed as a novel treatment strategy for HIV infection. However, some concerns persist regarding antiviral efficacy, adherence, toxicity and resistance evolution in the long term.

Methods

A total of 161 antiretroviral-naive HIV-1-infected patients were randomized to receive stavudine/ didanosine/efavirenz (group A) or zidovudine/lamivudine/ nelfinavir (group B) or to alternate between the two regimens every 3 months starting with regimen A (group C). Antiviral efficacy, adherence, safety and tolerability were analysed every 12 weeks.

Results

After 96 weeks, time to virological failure was significantly delayed in the alternating regimen compared with the standards of care regimens. Virological suppression was seen in 46%, 48% and 58% of patients in groups A, B and C, respectively, in the intention-to-treat analysis and in 75%, 76% and 97% in the on-treatment analysis (A vs C: P=0.014; B vs C: P=0.016; A vs B: P=0.849). At the end of the study, 94% of patients in group A and 92% in groups B and C reported an adherence greater than 95%. Alternating therapy was associated with a similar impact on CD4+ counts in comparison with the standards of care regimens, as well as a lower mitochondrial DNA/nuclear DNA (mtDNA/nDNA) ratio decrease in the mitochondrial substudy performed on 37 patients. The frequency and intensity of adverse events in the alternating group decreased during subsequent cycles.

Discussion

Our results favour the hypothesis that proactive therapy switching may delay the accumulation of resistance mutations. Moreover, the alternating regimen was well tolerated and adherence remained comparably high in all treatment groups. The lower mtDNA/nDNA ratio decrease observed in this group may imply a lower impact on mitochondrial toxicity than in standard regimens.

Abnormal verbal event related potentials in mild cognitive impairment and incipient Alzheimer's disease

BACKGROUND

It has been reported that patients with amnesia have a reduced effect of word repetition upon the late positive component of the event related potential (ERP), which peaks at around 600 ms after word onset.

OBJECTIVE

To study a word repetition ERP paradigm in subjects with mild cognitive impairment.

SUBJECTS

14 patients with mild cognitive impairment (mean mini-mental state examination score = 27); 14 normal elderly controls.

METHODS

Auditory category statements were each followed by a single visual target word (50% "congruous" category exemplars, 50% "incongruous") while ERPs were recorded. N400 (an ERP component elicited by semantically "incongruous" words) and LPC amplitude data were submitted to analysis of variance.

RESULTS

The latency of the N400 was slower in mild cognitive impairment. In normal controls, the ERPs to "congruous" targets showed a late positive component to new words, which was greatly diminished with repetition. This repetition effect in normal subjects started before 300 ms at right frontal sites, and peaked at approximately 600 ms post-stimulus over posterior sites. In contrast, the group with mild cognitive impairment had a reduced repetition effect (p < 0.02), which started around 500 ms, with a more central distribution. Further comparisons within the cognitive impairment group showed no appreciable congruous word repetition effect among seven individuals who subsequently converted to probable Alzheimer's disease. The congruous word repetition effect in the group with mild cognitive impairment was almost entirely accounted for by the non-converters. The amplitude of the congruous late positive component word repetition effect was significantly correlated (0.38 < or = r < or = 0.73) with several verbal memory measures.

CONCLUSIONS

The congruous word repetition ERP effect appears sensitive to the memory impairment in mild cognitive impairment and could have value in predicting incipient Alzheimer's disease.

Cost analysis in a clinical microbiology laboratory

The use of models for business management and cost control in public hospitals has led to a need for microbiology laboratories to know the real cost of the different products they offer. For this reason, a catalogue of microbiological products was prepared, and the costs (direct and indirect) for each product were analysed, along with estimated profitability. All tests performed in the microbiology laboratory of the "Virgen de la Concha" Hospital in Zamora over a 2-year period (73192 tests) were studied. The microbiological product catalogue was designed using homogeneity criteria with respect to procedures used, workloads and costs. For each product, the direct personnel costs (estimated from workloads following the method of the College of American Pathologists, 1992 version), the indirect personnel costs, the direct and indirect material costs and the portion of costs corresponding to the remaining laboratory costs (capital and structural costs) were calculated. The average product cost was 16.05 euros. The average cost of a urine culture (considered, for purposes of this study, as a relative value unit) reached 13.59 euros, with a significant difference observed between positive and negative cultures (negative urine culture, 10.72 euros; positive culture, 29.65 euros). Significant heterogeneity exists, both in the costs of different products and especially in the cost per positive test. The application of a detailed methodology of cost analysis facilitates the calculation of the real cost of microbiological products. This information provides a basic tool for establishing clinical management strategies.

New thiadiazine derivatives with activity against Trypanosoma cruzi amastigotes

The cytotoxicity of 18 new 1,2,6-thiadiazin-3,5-dione 1,1-dioxides was evaluated. This group of products was previously assayed against epimastigotes of Trypanosoma cruzi and some of them showed a high antiprotozoal activity. Thereafter 13 compounds with a high anti-epimastigote activity and low cytotoxicity were selected to be assayed against amastigotes. Some of the products showed the same or even lower cytotoxicity than nifurtimox and benznidazole, but most of them were very toxic for macrophages at 100 microg/ml. Only one of the compounds had an anti-amastigote activity similar to that of reference drugs at 10 microg/ml, but unfortunately this disappeared at lower concentrations.

Dopamine interaction in the absence and in the presence of Cu2+ ions with macrocyclic and macrobicyclic polyamines containing pyrazole units. Crystal structures of [Cu2(L1)(H2O)2](ClO4)4 and [Cu2(H-1L3)](ClO4)3*2H2O

The interaction with Cu2+ and dopamine of three polyazacyclophanes containing pyrazole fragments as spacers is described. Formation of mixed complexes Cu2+-macrocycle-dopamine has been studied by potentiometric methods in aqueous solution. The crystal structures of the complexes [Cu2(L1)(H2O)2](ClO4)4*2H2O (4) (L1 = 13,26-dibenzyl-3,6,9,12,13,16,19,22,25,26-decaazatricyclo[22.2.1.1(11,14)]octacosa-1(27),11,14(28),24-tetraene) and [Cu2(H-1L3)](HClO4)(ClO4)2*2H2O (6) (L3 = 1,4,7,8,11,14,17,20,21,24,29,32,33,36-tetradecaazapentacyclo[12.12.12.1(6,9).1(19,22).1(31,34)]hentetraconta-6,9(41),19(40),21,31,34(39)-hexaene) are presented. In the first one (4), each Cu2+ coordination site is made up by the three nitrogens of the polyamine bridge, a sp2 pyrazole nitrogen and one water molecule that occupies the axial position of a square pyramid. The distance between the copper ions is 6.788(2) A. In the crystal structure of 6, the coordination geometry around each Cu2+ is square pyramidal with its base being formed by two secondary nitrogens of the bridge and two nitrogen atoms of two different pyrazolate units which act as exobidentate ligands. The axial positions are occupied by the bridgehead nitrogen atoms; the elongation is more pronounced in one of the two sites [Cu(1)-N(1), 2.29(2) A; Cu(2)-N(6), 2.40(1) A]. The Cu-N distances involving the deprotonated pyrazole moieties are significantly shorter than those of the secondary nitrogens. The Cu(1)...Cu(2) distance is 3.960(3) A. The pyrazole in the noncoordinating bridge does not deprotonate and lies to one side of the macrocyclic cavity. One of the aliphatic nitrogens of this bridge is protonated and hydrogen bonded to a water molecule, which is further connected to the sp2 nitrogen of the pyrazole moiety through a hydrogen bond. The solution studies reveal a ready deprotonation of the pyrazole units induced by coordination to Cu2+. In the case of L2 (L2 = 3,6,9,12,13,16,19,22,25,26-decaazatricyclo[22.2.1.1(11,14)]octacosa-1(27),11,14(28),24-tetraene), deprotonation of both pyrazole subunits is already observed at pH ca. 4 for 2:1 Cu2+:L2 molar ratios. All three free receptors interact with dopamine in aqueous solution. L3 is a receptor particularly interesting with respect to the values of the interaction constants over five logarithmic units at neutral pH, which might suggest an encapsulation of dopamine in the macrocyclic cage. All three receptors form mixed complexes Cu2+-L-dopamine. The affinity for the formation of ternary dopamine complexes is particularly high in the case of the binuclear Cu2+ complexes of the 1-benzyl derivative L1.

Appropriateness of antibiotic prescriptions in community-acquired acute pediatric respiratory infections in Spanish emergency rooms

OBJECTIVE

To describe the variability and appropriateness of antibiotic prescriptions in community-acquired acute respiratory infections (ARI) during childhood in Spain.

METHODS

A descriptive, multicenter study of variability in clinical practice was conducted by evaluating a prospective series of pediatric patients attending the emergency rooms of 11 Spanish hospitals and diagnosed with community-acquired ARI. The appropriateness of the antibiotic prescriptions was assessed by comparing our clinical practice with consensus guidelines developed for this study.

RESULTS

We collected data from 6,249 ARI emergencies studied on 30 separate days. Antibiotics were prescribed in 58.7% of the ARI (bronchiolitis, 11.5%; bronchitis, 40.2%; pharyngotonsillitis, 80.9%; nonspecified ARI, 34.8%; pneumonia, 92.4%; otitis, 93.4%; sinusitis, 92.6%). The most commonly used antibiotics were amoxicillin/clavulanate (33.2%), amoxicillin (30.2%), cefuroxime axetil (8.5%) and azithromycin (6%). According to the consensus guidelines developed for this study, therapy was considered to be appropriate in 63.1% of the ARI (first choice, 52.1%; alternative choice, 11.0%) and inappropriate in 36.9%. The percentages of inappropriate prescription according to ARI groups were: bronchiolitis, 11.5%; bronchitis, 31.5%; pharyngotonsillitis, 54.8%; nonspecified ARI, 34.7%; pneumonia, 13.9%; otitis, 25.6%; and sinusitis, 22.2%.

CONCLUSIONS

There is excessive use of antibiotics in acute respiratory infections that are presumably viral in origin. An important number of ARI of potentially bacterial origin are treated with antibiotics that are not sufficiently efficacious or that have a broader spectrum than necessary.

[Independent predictive factors of acute and first year success after electrical cardioversion in patients with chronic atrial fibrillation]

OBJECTIVES

We retrospectively analyzed the predictive factors of successfully electrical cardioversion in patients with chronic atrial fibrillation.

METHODS

We included 118 patients, 68 men and 50 women, with a mean age of 65.1 years and a length of arrhythmia evolution of 83.3 days. These patients consecutively underwent electrical cardioversion in our Cardiology Department with a follow-up of one year to determine relapses. Structural cardiopathy was observed in 63.6% of the patients and 43.7% presented a left atrium between 4 and 5 cms. We analyzed the clinical and echocardiographic factors which predict the acute and first year success of electrical cardioversion.

RESULTS

The cardioversion was effective in 73.7% (CI 95%, 64.6%-81.1%) of the patients and 35.6% (CI 95%, 25.8%-46.6%) had a relapse within the first year. The inexistence of cardiomyopathy and therapy with amiodarone were predictive of acute success (p < 0.04 and p < 0.03, respectively). The length of arrhythmia evolution did not predict acute success but did so when relapses were analyzed. The size of the left atrium is predictive of both acute and long term success (p < 0.02 and p < 0.001, respectively). Logistic regression showed that the size of the left atrium and the patient's age were the only predictive factors of acute and first year success.

CONCLUSIONS

Electrical cardioversion is very efficient in the short-term, despite numerous relapses. Patient age and the size of left atrium are associated with acute and long-term success of cardioversion.

In vitro effects of anti-Trypanosoma cruzi compounds on HSP60 levels

The effect of nifurtimox and 5-nitro-2-thienylmalononitrile (5NO2TM), a novel compound with anti-Trypanosoma cruzi activity, upon vitality and HSP60 immunoreactivity of epimastigotes, has been determined. Both products showed no activity against epimastigotes at 0.1 microg/ml, while at 0.5 and 1 microg/ml, after 24 h of incubation, densities of these groups were significantly reduced, when compared to controls. An enhancement of HSP60 immunoreactivity was observed after 24 h in groups treated with 0.5 and 1 microg/ml nifurtimox. On the other hand, 5NO2TM had no effect.

The variability and appropriateness of the antibiotic prescription of acute otitis media in childhood. The Spanish Study Group for Antibiotic Treatments

OBJECTIVE

To know the variability of treatment of acute otitis media in Spain and the appropriateness of such with respect to consensus.

MATERIAL AND METHODS

A descriptive, multicentre, prospective study was carried out in the services of 11 Spanish hospitals. Children diagnosed with acute otitis media and treated on 30 days selected randomly between January and June 1997 were included. An analysis of treatment variability was made. The results were compared with consensus conference of a panel of experts.

RESULTS

Out of the 29436 emergencies studied on 30 days, 821 were diagnosed with acute otitis media. Fifteen point seven percent of the cases were already receiving antibiotics (22% amoxicillin clavulanate, 20% amoxicillin and 11% cefuroxime axetil). For the treatment, at discharge, of the 93% an antibiotic was prescribed (amoxicillin clavulanate in 41%, amoxicillin in 15%, cefuroxime axetil in 11%, cefaclor 6% and azithromycin 5%). Two point eight percent of the children were admitted. According to the guidelines of the panel of experts consulted, appropriateness was 61% for antibiotics of first choice, 12% for drugs of alternate use and 25% for inadequate treatment. The different hospitals presented significant variability in the type of antibiotic used and the appropriateness of such.

CONCLUSIONS

Acute otitis media is treated with antibiotics in 93% of the cases diagnosed in Spanish hospitals. The most commonly used antibiotics are amoxicillin clavulanate and amoxicillin alone. The prescription and its appropriateness present significant variability in the different hospitals studied.

Study on the decomposition products of thiadiazinthione and their anticancer properties

Study of the anticancer properties of thirty-four 3,5-disubstituted-tetrahydro-2H-1,3,5-thiadiazin-2-thione derivatives has been carried out by using cytotoxicity assays against HeLa, HT-29 and Hep G2 cells. The decomposition products of thiadiazinthione 1 m have been studied and their anticancer properties evaluated.

Assessment of antibiotic prescription in acute respiratory infections in adults. The Spanish Study Group on Antibiotic Treatments

OBJECTIVE

This study aims to ascertain the variability in the use of antibiotics for the treatment of acute respiratoryinfections in several hospital emergency services in Spain, as well as the appropriateness of antibiotics prescription through evaluation by a panel of experts using available scientific evidence.

METHOD

A cross-sectional study was carried out in the emergency services of 10 hospitals in different Spanish regions. We chose patients diagnosed as having acute respiratory infection, aged over 14 years. Among the collected variables were: type of respiratory infection, antibiotic prescription, comorbidity, qualification of the prescribing doctor and hospital admission. The consensus conference held by a panel of experts established first choice treatment and the alternative and inappropriate use for each respiratory infection, based on the available scientific evidence. All the observed prescriptions in our study were classified according to this pattern.

RESULTS

A sample of 2899 acute respiratory infections was studied (5.5% of all emergencies). Antibacterial agent treatment was prescribed in 82.6% of these, varying according to the infection between 98.5% of pneumonias and 49% of croup-influenza-common cold. The most commonly used antibiotics were amoxicillin-clavulanate and cefuroxime. The global percentage of inappropriate prescription was 40.5% (95% CI; 35.4-45.5). The prescriptions were inappropriate in 16.9% of cases of pharyngotonsillitis, 17.8% of chronic bronchitis, 26.9% of acute bronchitis, 29.3% of pneumonias, 30.8% of otitis and sinusitis and in 70.8% of croup, flu, common cold and non-specified infections. Significant variability among participating centres was observed, both in choice of antibiotics and in their degree of appropriateness.

CONCLUSIONS

There is excessive use of antimicrobial drugs in acute respiratory infections, and the majority are used for viral infections. There is indiscriminate use of broad spectrum antibiotics, which are valid in some infections but clearly inappropriate in others. Similarly, there are important differences in the choice of antibiotics and their degree of appropriateness among hospitals.

Response of pancreatic beta-cells to improved insulin sensitivity in women at high risk for type 2 diabetes

The purpose of this study was to examine the response of pancreatic beta-cells to changes in insulin sensitivity in women at high risk for type 2 diabetes. Oral glucose tolerance tests (OGTTs) and frequently sampled intravenous glucose tolerance tests (FSIGTs) were conducted on Latino women with impaired glucose tolerance and a history of gestational diabetes before and after 12 weeks of treatment with 400 mg/day troglitazone (n = 13) or placebo (n = 12). Insulin sensitivity was assessed by minimal model analysis, and beta-cell insulin release was assessed as acute insulin responses to glucose (AIRg) and tolbutamide (AIRt) during FSIGTs and as the 30-min incremental insulin response (30-min dINS) during OGTTs. Beta-cell compensation for insulin resistance was assessed as the product (disposition index) of minimal model insulin sensitivity and each of the 3 measures of beta-cell insulin release. In the placebo group, there was no significant change in insulin sensitivity or in any measure of insulin release, beta-cell compensation for insulin resistance, or glucose tolerance. Troglitazone treatment resulted in a significant increase in insulin sensitivity, as reported previously. In response, AIRg did not change significantly, so that the disposition index for AIRg increased significantly from baseline (P = 0.004) and compared with placebo (P = 0.02). AIRt (P = 0.001) and 30-min dINS (P = 0.02) fell with improved insulin sensitivity during troglitazone treatment, so that the disposition index for each of these measures of beta-cell function did not change significantly from baseline (P > 0.20) or compared with placebo (P > 0.3). Minimal model analysis revealed that 89% of the change from baseline in insulin sensitivity during troglitazone treatment was accounted for by lowered plasma insulin concentrations. Neither oral nor intravenous glucose tolerance changed significantly from baseline or compared with placebo during troglitazone treatment. The predominant response of beta-cells to improved insulin sensitivity in women at high risk for type 2 diabetes was a reduction in insulin release to maintain nearly constant glucose tolerance.

[Multicenter study of the variability and adequacy of antimicrobial therapy for community-acquired pneumonia in adults]

We performed a study to evaluate the variability and adequacy of prescribing antibiotics in community-acquired pneumonia (CAP) in 10 Spanish hospitals. We studied 452 patients with CAP. Initial empirical administration of antibiotics was prescribed in 90.7&#37; of the cases, 82.5&#37; as monotherapy. Macrolides and third and second generation cephalosporins were the most widely used groups of antibiotics. Penicillin and amoxicillin were only prescribed in 1. 7&#37; of the patients. A significant variability between hospitals was observed. Reference patterns for the use of antibiotics in CAP were devised by a panel of experts. According to the recommendations of this panel, 29&#37; of the total prescriptions were not adequate, with this percentage reaching 65&#37; in outpatients older than 65 years or with comorbidity. This was mainly due to the fact that monotherapy with erythromycin, which was considered inadequate, was the most widely prescribed treatment.

Nematocide activity of 6,7-diarylpteridines in three experimental models

The in vitro nematocide activity of seventeen 6,7-diarylpteridines has been tested using three different experimental models, Caenorhabditis elegans, Nippostrongylus brasiliensis and Heligmosomoides polygyrus. The method of evaluation of inhibition in the secretion of acetylcholinesterase by H. polygyrus seems to be the most indicated to avoid false positives. The in vivo activities, against Trichinella spiralis, of the most in vitro active pteridines have been assayed. All pteridine derivatives bearing 6,7-di-p-bromophenyl substituents have shown in vitro nematocide activities in the three experimental models used. Amongst all the pteridines tested in vivo, only 2,4-pteridinedithione derivatives exhibited moderate activity.

Synthesis and antichagasic properties of new 1,2,6-thiadiazin-3,5-dione 1,1-dioxides and related compounds

In a search for antichagasic drugs, 14 new 4-(nitroarylidene)-1,2,6-thiadiazin-3,5-dione 1,1-dioxide derivatives were synthesized and tested in vitro against the epimastigote form of Trypanosoma cruzi and some of them showed important antiprotozoan activity. Attempts to synthesize new 4-(nitroarylidene)-3,5-diamino-1,2,6-thiadiazine 1,1-dioxides were unsuccessful. The antichagasic properties of nitroarylidene-malononitrile and nitroarylidene-cyanoacetamide derivatives, thus obtained, were also tested. The cytotoxic properties against Vero cells of compounds which showed remarkable in vitro antichagasic activity were evaluated. All compounds tested exhibited high toxicity percentages at 100 micrograms/ml. However, compound 3c showed in vitro antichagasic and cytotoxic properties such as nifurtimox at the dose of 10 micrograms/ml.

Synthesis and antiprotozoan properties of new 3,5-disubstituted-tetrahydro-2H-1,3,5-thiadiazine-2-thione derivatives

In a search for antiprotozoan compounds, 34 new 3,5-disubstituted-tetrahydro-2H-1,3,5-thiadiazine-2-thione derivatives were synthesized and tested in vitro against Trypanosoma cruzi and Trichomonas vaginalis. Some of them showed important antiprotozoan activity. In vivo assays of compounds which showed remarkable in vitro activity against T. vaginalis were carried out.

Imidazothiadiazine dioxides: synthesis and antiviral activity

A new series of imidazothiadiazine dioxides, including the first acyclonucleosides derived from this heterocycle moiety, has been synthesized. A wide-spectrum antiviral screening was performed. Some of the N-1 benzyl imidazothiadiazines and the new acyclonucleosides showed interesting anti-CMV or anti-HIV activity. These structures could be considered as new lead compounds for antiviral drug research.

[Practice variation and appropriateness study of antimicrobial therapy for acute pharyngotonsillitis in adults]

OBJECTIVE

Infectious pharyngotonsillitis is usually managed with antibiotics by general practitioners and pediatricians both in primary care and the emergency services. In the present work we try to assess the antibiotic variability and appropriateness in the management of acute pharyngotonsillitis among several emergency services in our country related to scientific evidence based in an expert panel criteria.

METHOD

A transversal trial was carried on in ten emergency services of our country. We included patients older than fourteen years an analyzed the following variables: type of respiratory infection, antibiotic prescription, comorbidity, physician's status and hospital admission. The antibiotics were classified in three levels according to the expert panel criteria: first election, alternative use and inappropriate use. We compared the antibiotic treatments to these three levels.

RESULTS

2,869 patients were diagnosed of acute respiratory infection, 356 (12.4%) with pharyngotonsillitis. Commonly the patients were prescribed antibiotics (315; 81%) and the most used were amoxicillin-clavulanate (33%), amoxicillin (16%), penicillin (7%), cefuroxime (6%), erythromicin (4%) and cefixime (3%). Among the 315 prescriptions, 98 (32%) were first election, 147 (50%) alternative use and 50 (17%) inappropriate use.

CONCLUSIONS

Most of the patients suffering of pharyngotonsillitis were empirically prescribed antibiotics probably many of these cases were non-bacterial pharyngotonsillitis. Alternative and inappropriate use of antibiotics was high.

Synthesis and anti-HIV properties of 1,2,4,6-thiatriazin-3-one 1,1-dioxide nucleosides

Synthesis of 1,2,4,6-thiatriazine 1,1-dioxide nucleosides is now reported for the first time. In order to know the conformation of the nucleosides, a NMR study has been carried out. Anti-HIV-1 and HIV-2 properties of the nucleosides have been tested. These compounds have not shown activity at subtoxic concentrations.

Anthelmintic activity of 6,7-diaryl-pteridines

In a search for new anthelmintic compounds, some 6,7-diaryl-pteridines were synthesized from the corresponding diaminopyrimidines and aromatic aldehydes. Their anthelmintic activity was tested in vitro against Caenorhabditis elegans and Heligmosomoides polygyrus and in vivo against Trichinella spiralis. Structure-activity relationships are discussed.

Impact of a daily 10-minute strength and flexibility program in a manufacturing plant

In summary, employees' flexibility and mood showed modest improvements following the implementation of a plant-wide, 10-minute, daily flexibility and strength program. The initial six-week pilot study, administered prior to the plant-wide program implementation, successfully assessed program feasibility, assessed the efficiency of program implementation, identified administrative and logistical concerns, and generated pilot data needed to secure managerial support. Despite the noted significant increases in grip strength in the pilot study, no increases were observed following the six months of plant-wide implementation. This may be related to the differences in low average pretest grip strength for the pilot study compared to the higher scores for the main study population. The pilot study subjects may have received a sufficient exercise stimulus to increase grip strength over the course of six weeks. In contrast, this may not have been the case for the main study subjects due to their higher initial mean grip strength. An increased number of exercises designed to directly impact grip strength may be needed to improve this parameter.

[Fasting and postprandial lipids and lipoproteins during the chronic administration of antihypertensive drugs]

To evaluate the effect of various antihypertensive drugs on fasting and postprandial lipids and lipoproteins, we studied 39 normolipidemic hypertensive patients, 28 men and 11 women aged 52.3 +/- 9.0 and 58.5 +/- 7 years, respectively. After four weeks of placebo administration, lipids and lipoproteins were measured in the fasting state and every three hours for a period of nine hours after intake of a standardized fat mixed load (65 g/m2). Following this test, the patients were randomly assigned to one of four treatment groups: group I metoprolol (n = 10), 100 mg/day; group II nicardipine (n = 9), 90 mg/day; group III captopril (n = 11), 75 mg/day. At the end of week four of treatment the fasting and postprandial lipid measurements were repeated. Blood pressure mean values were significantly (p < 0.05) reduced in the four treatment groups. We found no statistically significant lipids or lipoproteins changes neither in the fasting nor in the postprandial state, but a trend toward lower concentrations in the postprandial lipemia after treatment was observed in three groups (metoprolol, nicardipine and captopril), whereas no change was observed in the chlorthalidone group. These data confirm that fasting lipids and lipoproteins in normolipidemic hypertensive patients are not unfavorably changed by low doses of the drugs studied. In addition, we inform that postprandial lipemia is not affected by these four drugs in the doses used.

Anthelmintic activity of pyrazinothiadiazine dioxide derivatives

In a search for new anthelmintic compounds, some pyrazinothiadiazine dioxide derivatives were synthesized. Their anthelmintic activity was tested against larva and preadult stages of Trichinella spiralis. The mode of action and acute toxicity of these compounds were investigated. Structure-activity relationships are discussed.

Synthesis and antiprotozoal properties of 1,2,6-thiadiazine 1,1-dioxide derivatives

The synthesis and spectroscopical data of 1,2,6-thiadiazine 1,1-dioxides, designed as antiprotozoal agents, are reported. The in vitro trichomonacidal and trypanocidal activities of new compounds and their precursors were evaluated against Trichomonas vaginalis and Trypanosoma cruzi. The chemoprophylactic activity on mice treated with blood infected with T. cruzi and their mortality percentage were tested. Compounds 2 and 8b show a higher chemoprophylactic activity and lower mortality percentage than Nifurtimox used as reference drug.