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National Hospital (national + hospital)

Distribution by Scientific Domains

Medical Sciences	85%
Life Sciences	14%

Terms modified by National Hospital

national hospital ambulatory medical care survey

national hospital morbidity database

Selected Abstracts

Oral hygiene practices, periodontal conditions, dentition status and self-reported bad mouth breath among young mothers, Tanzania

INTERNATIONAL JOURNAL OF DENTAL HYGIENE, Issue 4 2006
EGS Mumghamba
Abstract:,Objectives:,To determine the oral hygiene practices, periodontal conditions, dentition status and self-reported bad mouth breath (S-BMB) among young mothers. Study participants and methods:,This was a cross-sectional descriptive study conducted at Muhimbili National Hospital, Dar es Salaam, Tanzania. A total of 302 postpartum mothers, aged 14,44 years, were interviewed on oral hygiene practices and S-BMB using structured questionnaire. Oral hygiene, dentition and periodontal status were assessed using the Community Periodontal Index probe and gingival recessions (GR) using Williams Periodontal probe. Results:,Tooth brushing practice was 99%; tongue brushing (95%), plastic toothbrush users (96%), chewing stick (1%), wooden toothpicks (76%), dental floss (<1%); and toothpaste (93%). The prevalence of plaque and gingival bleeding on probing was 100%, gum bleeding during tooth brushing (33%), calculus (99%), probing periodontal pocket depth (PPD) 4,5 mm (27%), PPD 6+ mm (3%), GR 1+ mm (27%) and tooth decay (55%). The prevalence of S-BMB was 14%; the S-BMB had higher mean number of sites with plaque compared to the no S-BMB group (P = 0.04). Factors associated with S-BMB were gum bleeding on tooth brushing (OR = 2.4) and PPD 6+ mm (OR = 5.4). Conclusion:,Self-reported bad mouth breath is a cause of concern among young mothers, and associated significant factors were gum bleeding on tooth brushing and deep periodontal pockets of 6+ mm. Further research involving clinical diagnosis of bad mouth breath and intervention through oral health promotion and periodontal therapy are recommended. Clinical relevance:,This study provides baseline information on oral health status and the complaint on bad mouth breath which necessitates in the future need for objective assessment, diagnosis and management of bad mouth breath for enhanced social and professional interaction without embarrassments. [source]

Cutaneous acanthamebiasis infection in immunocompetent and immunocompromised patients

INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 12 2009
Carlos Galarza MD
Background, Cutaneous acanthamebiasis is a rare infection and few patients have been reported worldwide. Methods, Observational and descriptive study carried out from March 1996 to February 2006 in patients with diagnosis of cutaneous free-living amebic infection caused by Acanthamoeba spp. The patients were diagnosed at the Dos de Mayo National Hospital (Lima-Peru) where skin biopsies, histopathologic studies and cultures were performed. The clinical and epidemiologic characteristics, diagnosis, treatment and evolution were recorded in a survey. Results, Five patients with cutaneous free-living amebic infection caused by Acanthamoeba spp. were identified. Skin lesions were ulceronecrotic (four patients), an infiltrative bluish plaque (one patient), and a periorbital tumor (one patient). Three patients were positive for human immunodeficiency virus (HIV), had only cutaneous involvement, and died of opportunistic infections. The two immunocompetent patients developed Acanthamoeba granulomatous encephalitis and meningoencephalitis that progressed to intracranial hypertension and death. Conclusion, The clinical manifestations of cutaneous free-living amebic infection caused by Acanthamoeba spp. appear to vary according to the underlying immunologic status. [source]

Influence of obstetric factors on the yield of mononuclear cells, CD34+ cell count and volume of placental/umbilical cord blood

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 1 2010
Atsuko Omori
Abstract Aim:, Placental/umbilical cord blood (CB) has been used increasingly not only for transplantations, but also in the field of life science research. However, little information is available on the biological characteristics of CB units collected in rural areas because no medical facilities are affiliated with CB banks. Little attention has been paid to the collection of CB units in rural areas compared to CB collected in metropolitan areas. CB is a precious source for life science research due to the recent low birth rate in Japan. Therefore, to efficiently utilize CB units, the purpose of the present study was to investigate the optimum obstetric factors associated with a higher yield of mononuclear/CD34+ cells per CB unit. Methods:, CB units were collected at a single hospital (Hirosaki National Hospital). A total of 126 CB units from 105 vaginal deliveries and 21 cesarean section deliveries were available for cell separation within 24 h. Mononuclear low-density (LD) cells were separated using Ficoll-Paque and then processed for CD34+ cell enrichment using magnetic cell sorting. Associations between the maternal/neonatal factors and the yield of LD/CD34+ cells were analyzed. Results:, Despite the larger net weight of CB collected from cesarean section deliveries, the total number of LD cells collected from vaginal deliveries was significantly higher than that collected from cesarean section deliveries. The total number of LD cells per CB unit from primigravidae was significantly higher compared with that collected from from multigravidae. Conclusion:, CB units from vaginal deliveries of primigravidae may be more favorable because they contain a higher yield of mononuclear cells. [source]

Utilization of hospital and outpatient care for adverse cutaneous reactions to medications

PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 10 2005
Robert S. Stern MD
Abstract Purpose To quantify hospitalizations, visits to office based physicians, hospital clinics and emergency departments with primary diagnoses of skin conditions that are often due to drug reaction. Methods I analyzed data from the National Hospital Discharge Summary (1997,2001), National Ambulatory Care Survey (1995,2000) and National Hospital Ambulatory Care Survey (1995,2000) to determine the number of hospitalizations and visits with primary diagnoses of skin conditions that are often attributed to drugs. Using statistical methods for surveys, I determined the demographic characteristics of patients with these diagnoses and compared them with patients seeking care for other reasons. Results In the United States, there are about 5000 hospitalizations each year with a primary diagnosis of erythema multiform, Stevens,Johnson Syndrome or Toxic Epidermal Necrolysis, of which 35% are specifically ascribed to drugs. Annually, there are more than 100,000 outpatient visits for these diagnoses and about two million visits for immediate hypersensitivity reactions that may be due to drugs. Outpatient visits for drug eruptions and drug allergies that include a skin component exceed 500,000 annually. Conclusions Skin conditions often attributed to drugs are frequent reasons for hospitalization and physician visits. Optimal care of the individual patients with these conditions requires careful attention to drugs as a possible cause. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Effectiveness of the Kampo kami-shoyo-san (TJ-24) for tremor of antipsychotic-induced parkinsonism

PSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 5 2000
Toshihiro Ishikawa MD
Abstract The aim of the present study was to evaluate the effectiveness of the Kampo medication kami-shoyo-san against tremor due to antipsychotic-induced parkinsonism. Kami-shoyo-san consists of several medicinal herbs that are known in traditional Chinese medicine to be effective in treating Parkinson's disease and convulsions. We gave kami-shoyo-san to eight patients at Higashiowari National Hospital who were exhibiting tremor, a symptom of antipsychotic-induced parkinsonism. The tremor was evaluated on a five-point scale before and after the administration of kami-shoyo-san, and the findings were compared statistically. The results showed a stastistically significant reduction in the tremor after the administration of kami-shoyo-san (P < 0.01), with 62.5% of patients showing an improvement of one point or more. The tremor did not worsen in any of the patients, and none complained of side-effects. Thus, kami-shoyo-san appears to be effective against the tremor from parkinsonism. Kami-shoyo-san consists of 10 medicinal herbs, including Radix Bulpleuri, Radix Paeoniae, Radix Angelicae Sinensis, and Radix Glycyrrhizae, which are effective in treating disturbances in muscular movement according to TCM theory. Of the 10 herbs contained in kami-shoyo-san, we believe the abovementioned ones are particularly effective in helping to reduce the tremor associated with parkinsonism. [source]

Hospitalized Nephrolithiasis after Renal Transplantation in the United States

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2003
Kevin C. Abbott
The national incidence of and risk factors for hospitalized nephrolithiasis (NEP) in renal transplant (RT) recipients has not been reported. We conducted a historical cohort study of 42 096 RT recipients in the United States Renal Data System between 1 July 1994 and 30 June 1998. The 1-year incidence of NEP (ICD-9 codes 592.x) after RT in 1997 was compared to the rate of NEP in the general population using the National Hospital Discharge Survey. Associations with time to hospitalizations for a primary diagnosis of nephrolithiasis were assessed by Cox Regression. NEP was uncommon after RT (104 cases per 100 000 person years in 1997). However, females, but not males, had a statistically significant increased risk of NEP compared to the general population (rate ratio for females, 2.84, 95% confidence interval, 2.35,3.58). Kidney stones were more common than ureteral stones, and percutaneous procedures were more common than ureteroscopy or extracorporeal shock wave lithotripsy (ESWL). The only risk factor identified for NEP was renal failure due to stone disease (only one case). NEP was uncommon after RT, but was still more common than in the general population. We identified differences in the presentation and management of NEP after RT in comparison to the general population. [source]

U.S. Trends in Obstetric Procedures, 1990,2000

BIRTH, Issue 3 2002
Lola Jean Kozak PhD
ABSTRACT: Background: During the 1980s the rate of obstetric procedures performed during delivery rose precipitously. This study follows the use of obstetric procedures through the 1990s to explore whether the patterns witnessed in the previous decade continued through the next. Methods: Data on total obstetric procedures and eight specific procedures (cesarean section, medical and surgical induction of labor, other artificial rupture of membranes, episiotomy, repair of current obstetric laceration, vacuum extraction, forceps delivery) were obtained from the National Hospital Discharge Survey, a nationally representative survey of discharges from short-stay non-Federal hospitals. Approximately 32,000 records for women with deliveries were included in the survey each year. Results: The total rate of all obstetric procedures did not change significantly from 1990 through 2000. However, as during the 1980s, rates increased for induction of labor, vacuum extraction, and repair of current obstetric laceration. Rates decreased for forceps delivery and episiotomy, also continuing 1980s trends. After a long period of increase, the rate of cesarean section declined from 1988 to 1995 but increased again from 1995 to 2000. Conclusions: Unlike the 1980s, the overall rate of obstetric procedures did not increase from 1990 to 2000, but the mix of obstetric procedures performed continued to change during this period. (BIRTH 29:3 September2002) [source]

Feasibility of using the national hospital discharge survey to estimate the prevalence of selected birth defects,,§

BIRTH DEFECTS RESEARCH, Issue 11 2006
Sheree L. Boulet
Abstract BACKGROUND: Nationally representative data on the prevalence of certain birth defects are largely unavailable. We evaluated the feasibility of using data from the National Hospital Discharge Survey (NHDS) to describe the prevalence of selected birth defects. METHODS: All live births recorded in the NHDS during 1999,2001 were included. The prevalence for selected birth defects was calculated using weighted ratio estimators. Prevalence ratios comparing the NHDS estimates to published national estimates from the National Birth Defects Prevention Network (NBDPN) were calculated. RESULTS: With the exception of common truncus, the NHDS prevalence for the selected defects was consistently lower than the NBDPN estimates. The prevalence ratios ranged from 0.38 for trisomy 18 and anopthalmia/micropthalmia to 1.16 for common truncus. The NHDS prevalence estimates for spina bifida without anencephaly (PR 0.89, 95% CI: 0.57,1.22) and gastroschisis/omphalocele (PR 0.94, 95% CF: 0.48,1.40) most closely approximated the NBDPN estimates. CONCLUSIONS: NHDS data underestimate the prevalence of most birth defects. Additional research is needed to determine whether NHDS estimates may be useful for evaluating trends in certain conditions. Surveillance systems employing active case-finding continue to provide more accurate estimates of birth defects prevalence. Birth Defects Research (Part A) 76:757,761, 2006. © 2006 Wiley-Liss, Inc. [source]

Medical visits among adults with symptoms commonly associated with an overactive bladder

BJU INTERNATIONAL, Issue 3 2006
SUNNY H. KIM
OBJECTIVES To examine nationally representative data and thus obtain estimates of the use of healthcare providers associated with the overactive bladder (OAB) symptoms, a condition characterized by frequency, urgency and nocturia, with or with no urge incontinence, as although it is ranked among the 10 most common chronic medical conditions in the USA, the level of OAB-associated medical treatment remains largely unknown. METHODS To estimate the number of annual OAB-associated medical visits among patients aged ,18 years, three national databases in the USA (year 2000) were examined: the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, and the National Hospital Discharge Survey. Population estimates were constructed using design-based statistical analyses to account for the complex survey designs of data. RESULTS During 2000, adult Americans made 1.4 million (95% confidence interval 1.1,1.8 million) ambulatory visits to non-Federal office-based physicians with International Classification of Disease (ICD-9) coding indicative of OAB symptoms. Accounting for emergency and outpatient department visits, as well as non-Federal short-stay hospital discharges, the estimated number of medical visits with OAB-associated ICD-9 coding was <1.5 million. CONCLUSION The prevalence of OAB was estimated to be 34 million adult Americans. When 1.4 million ambulatory visits were compared with this prevalence, as few as 4% of adult Americans with OAB sought medical treatment during the year 2000. The present results therefore suggest a large unmet medical need among the population of adult Americans with OAB. [source]

Postoperative serum carcinoembryonic antigen levels in patients with pathologic stage IA nonsmall cell lung carcinoma

CANCER, Issue 4 2004
Subnormal levels as an indicator of favorable prognosis
Abstract BACKGROUND Elevated serum carcinoembryonic antigen (CEA) levels are sometimes attributable to the production of CEA by malignant cells, and in turn, the antigen itself can enhance the metastatic potential of malignant cells. The authors speculated that low serum CEA levels might be indicative of relatively low levels of malignant cells and a low probability of disease recurrence. This hypothesis led them to investigate whether low CEA levels in serum represented a useful prognostic factor for patients with pathologic Stage IA nonsmall cell lung carcinoma. METHODS Between 1993 and 2001, 724 patients underwent surgery for NSCLC at Toneyama National Hospital (Toyonaka, Japan). Of these patients, the 242 who were diagnosed with pathologic Stage IA disease were included in the current study. Smoking behavior, gender, age, tumor diameter, disease histology, and preoperative and postoperative serum CEA levels were chosen as study variables, with the cutoff level between subnormal and normal serum CEA levels set at 2.5 ng/mL and the cutoff level between normal and high serum CEA levels set at 5.0 ng/mL. Prognostic indicators were evaluated using a Cox hazard model. In addition, survival probabilities were calculated using the Kaplan,Meier method, and differences in survival were assessed by log-lank analysis. RESULTS Subnormal postoperative serum CEA levels were found to be an independent prognostic indicator (hazard ratio, 2.3; 95% confidence interval, 1.1,4.7; P = 0.03 for comparison with patients who had normal CEA levels) on multivariate analysis. Furthermore, the 5-year survival rate was 87% for patients with subnormal postoperative CEA levels (n = 146), compared with 75% for patients with normal postoperative CEA levels (n = 80) and 53% for patients with high postoperative CEA levels (n = 16) (P < 0.0001). CONCLUSIONS Among patients with pathologic Stage IA NSCLC, those who had an extremely favorable prognosis were distinguished by their subnormal postoperative serum CEA levels. Cancer 2004. © 2004 American Cancer Society. [source]

Diagnostic delays and mis-management in cluster headache

ACTA NEUROLOGICA SCANDINAVICA, Issue 3 2004
A. Bahra
Objectives , Cluster headache is a stereotyped form of primary headache that while common in terms of neurologic illnesses is much less common as a cause of disabling headache than migraine. Materials and methods , We directly interviewed 230 patients with cluster headache. National support groups contributed 76% and 24% came from the National Hospital for Neurology and Neurosurgery Headache Clinic. Results , Seventy-two percent were men and 28% women, giving a male to female (M:F) ratio of 2.5:1. Episodic cluster headache (ECH) was recorded in 79% while 21% had chronic cluster headache (CCH). The mean time to diagnosis has dropped from 22 years in the 1960s to 2.6 years in the 1990s, although the mean number of GPs seen before a diagnosis was made remains at three. Conclusions , While there has been improvement in the time to diagnosis for cluster headache, a number of physicians will be consulted, and better education is likely to reduce the overall patient suffering. [source]

Retinopathy of prematurity: postmenstrual age at threshold in a transitional economy is similar to that in developed countries

CLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 2 2008
Susan Mary Carden FRANZCO
Abstract Background:, To analyse the timing of threshold disease in infants requiring treatment for retinopathy of prematurity in a transitional economy. Methods:, Design: Retrospective, observational, cohort study. Setting: National Hospital of Paediatrics, Hanoi, Vietnam. Study population: Premature infants in the Neonatal ward requiring laser treatment for threshold retinopathy of prematurity. Main outcome measures: Chronological age and postmenstrual age at treatment. Results:, From January 2002 to November 2004, 42 infants from the National Hospital of Paediatrics required laser surgery for threshold retinopathy of prematurity. The mean ± standard deviation (SD) of birth weight was 1369 ± 184 g (range 1000,1700); the mean ± SD of gestation at birth was 30 ± 1.8 weeks (range 27,34); and the mean ± SD of postmenstrual age at which treatment occurred in these infants was 36.2 ± 2.5 weeks (range 31.4,42). A further 58 infants were transferred from other hospitals for laser surgery between January 2004 and October 2004. The mean ± SD of birth weight was 1325.5 ± 237.2 g (range 800,1900); the mean ± SD of gestation at birth was 30 ± 1.7 weeks (range 28,35); and the mean ± SD of postmenstrual age at which treatment was given in these infants was 36.3 ± 2.3 weeks (range 32.71,44.3). Discussions:, Despite the relative maturity of the gestation of these infants compared with infants in developed countries who develop severe retinopathy of prematurity, the timing of treatment for threshold disease appears to be related to postmenstrual age. [source]

Rotavirus hospitalisation in New Zealand children under 3 years of age

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 4 2006
Keith Grimwood
Objective: To describe the epidemiology of severe rotavirus gastroenteritis and to estimate the hospitalisation rates of this illness in New Zealand children under 3 years of age. Methods: Children under 3 years of age with acute diarrhoea admitted to 1 of 8 study hospitals between 1 May 1998 and 30 April 2000 were surveyed. Their socio-demographic, treatment and length-of-stay data were recorded and stool samples tested by a rotavirus-specific enzyme-linked immunoassay. National hospital discharge data for infectious diarrhoea (International Classification of Diseases, ninth revision, 003,009) were reviewed, allowing population-based estimates for rotavirus-related hospitalisation in New Zealand. Results: Of 2019 enrolled children, 1138 (56.4%) provided stools for testing, and of these 485 (42.6%) tested rotavirus positive. Rotavirus detection varied significantly by age (26.8% for 0 to 5 months, 42.5% for 6 to 11 months and 52.1% for children aged 12 to 35 months; P < 0.001), and by season (51.2% in winter/spring vs. 24.5% in summer/autumn; P < 0.001). While those infected with rotavirus were more likely to be dehydrated (50.6% vs. 37.4%; P < 0.001), their median hospital stay was similar (1.0 vs. 2.0 days; P = 0.09) to other children with acute gastroenteritis. The estimated national hospitalisation rate for rotavirus diarrhoea in children under 3 years, standardised for age and season, was 634 (95% CI 597, 672) per 100 000. In New Zealand, rotaviruses result in 1 in 52 children being hospitalised by 3 years of age. Conclusions: Rotavirus diarrhoea is an important, potentially vaccine-preventable cause of hospitalisation in New Zealand children, especially during winter and spring seasons. [source]

Incidence and characteristics of lower limb amputations in people with diabetes

DIABETIC MEDICINE, Issue 4 2009
S. Fosse
Abstract Aims To estimate the incidence, characteristics and potential causes of lower limb amputations in France. Methods Admissions with lower limb amputations were extracted from the 2003 French national hospital discharge database, which includes major diagnoses and procedures performed during hospital admissions. For each patient, diabetes was defined by its record in at least one admission with or without lower limb amputation in the 2002,2003 databases. Results In 2003, 17 551 admissions with lower limb amputation were recorded, involving 15 353 persons, which included 7955 people with diabetes. The crude incidence of lower limb amputation in people with diabetes was 378/100 000 (349/100 000 when excluding traumatic lower limb amputation). The sex and age standardized incidence was 12 times higher in people with than without diabetes (158 vs. 13/100 000). Renal complications and peripheral arterial disease and/or neuropathy were reported in, respectively, 30% and 95% of people with diabetes with lower limb amputation. Traumatic causes (excluding foot contusion) and bone diseases (excluding foot osteomyelitis) were reported in, respectively, 3% and 6% of people with diabetes and lower limb amputation, and were 5 and 13 times more frequent than in people without diabetes. Conclusions We provide a first national estimate of lower limb amputation in France. We highlight its major impact on people with diabetes and its close relationship with peripheral arterial disease/neuropathy and renal complications in the national hospital discharge database. We do not suggest the exclusion of traumatic causes when studying the epidemiology of lower limb amputation related to diabetes, as diabetes may contribute to amputation even when the first cause appears to be traumatic. [source]

Professional approaches to stroke treatment in Japan: a relationship-centred model

JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2006
Brian Taylor Slingsby M.P.H.
Abstract Rationale, To examine how stroke professionals in Japan approach rehabilitation therapy. Methods, This qualitative study was based on Grounded Theory. Data collection included (1) non-participatory observation, (2) non-structured interviews, and (3) semi-structured interviews. A national hospital located in an urban area of the prefecture of Kanagawa in Japan specializing in the treatment of stroke and other neurological disorders. Stroke professionals (doctors, nurses, clinical psychologists, physiotherapists, occupational therapists and speech therapists), patients and patients' families. Results, (1) Professionals recognized patient motivation as a factor related to rehabilitation outcome, but believed it to be a direct product of fostered fiduciary relationships and effective patient interaction. (2) Professionals regarded fiduciary relationships as the most important determinant of rehabilitation outcome. (3) Professionals adapted their behaviour and communication style in aims of fostering fiduciary relationships. These findings informed a three-component model of care: the Relationship-centred Model. Conclusions, The Relationship-centred Model describes how stroke professionals in Japan approach rehabilitative therapy. This model of care may be preferred by patients in other countries who also favour a family-centred approach to decision making. [source]

Transitions from hospital to residential aged care in Australia

AUSTRALASIAN JOURNAL ON AGEING, Issue 4 2009
Rosemary Karmel
Aim:, To investigate movement of people from hospital into residential aged care. Methods:, An innovative record linkage method was implemented to create a national database to investigate transitions from hospital into aged care. Results:, In 2001,2002, 3.2% of hospitalisations for people aged 65+ ended with admission into residential aged care. A further 5.5% were for people already living permanently in care. Nationally, more people were admitted into permanent care from hospital than from the community. Factors important in predicting admission to aged care from hospital included length of hospital stay, diagnoses, region of usual residence and hospital jurisdiction. Conclusion:, Individually, national hospital and aged care datasets do not provide adequate information on movement between the sectors. Linking the data allowed the first national investigation into movement from hospital into aged care. Results indicate the importance of investigating interactions of service provision (both supply and demand driven) at the local level. [source]

Trends in Labor Induction in the United States: Is It True That What Goes Up Must Come Down?

BIRTH, Issue 2 2004
IN THE LITERATURE
Commentary on: Zhang J, Yancey MK, Henderson CE. U.S. national trends in labor induction, 1989,1998. J Reprod Med 2002;47:120,124. MacDorman MF, Mathews TJ, Martin JA, Malloy MH. Trends and characteristics of induced labour in the United States, 1989,98. Paediatr Perinat Epidemiol 2002;16:263,273. Kozak LJ, Weeks JD. U.S. trends in obstetric procedures, 1990,2000. Birth 2002;29:157,161. Abstract:,Three recent studies examined the national trend in labor induction in the United States. All show a doubling in the rate of induction during the 1990s, although vital statistics data show a consistently higher trend than that obtained from national hospital discharge data. Neither data source adequately documents the full range of indications for induction, its timing, hospital staffing considerations, and other factors that may play a role. Although rates of induction of labor may be leveling off, despite a lack of scientific evidence for its widespread use, rates are likely to remain at current levels for the next few years. [source]

Feasibility of using the national hospital discharge survey to estimate the prevalence of selected birth defects,,§

Appropriate dosing of antiarrhythmic drugs in Japan requires therapeutic drug monitoring,

JOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 1 2005
M. Takada PhD
Summary Objective:, In general, drugs are used in accordance with an approved dosage regimen in expectation of an appropriate balance between efficacy and toxicity. However, dose control of drugs with a narrow therapeutic range and marked intersubject variability in pharmacokinetics should be established through individualization of dosing based on therapeutic drug monitoring (TDM). The purpose of this study was to examine differences between the approved dosage regimen and the doses of antiarrhythmic drugs and digoxin used in clinical practice and to examine the influence of TDM on dosing. Methods:, Prescription research of antiarrhythmic drugs was performed at five national hospitals in Japan. Prescriptions for antiarrhythmic drugs (cibenzoline, disopyramide, pirmenol, mexiletine, aprindine, flecainide, pilsicainide, amiodarone and digoxin) were counted for the study period. The mean dose and dose distribution of the drugs were determined in each hospital. Comparisons were made of mean dose obtained in the study with the dosage approved by the authority. In addition, the percentage of patients that received TDM was determined. Results:, A difference was seen between the approved dosage and the actual dose. For all drugs except flecainide, the mean dose was smaller than the approved dosage. For all drugs except digoxin, remarkable variations were seen in the dose distribution among the hospitals. Digoxin showed a similar dose distribution among the five hospitals. Overall, the percentage of patients that received TDM was low except for Hospital A. However, TDM of digoxin was relatively common at four of the hospitals. Conclusions:, It is concluded that, with the exception of digoxin, the appropriate dosing regimen for antiarrhythmic drugs is not yet established. The establishment of appropriate dosing regimens for antiarrhythmic drugs requires the more widespread adoption of TDM. [source]

Cryptosporidium Species and Genotypes in HIV-Positive Patients in Lima, Peru

THE JOURNAL OF EUKARYOTIC MICROBIOLOGY, Issue 2003
Vitaliano A. Cama
ABSTRACT: Cryptosporidium parasites from a cross-sectional study conducted in two national hospitals in Lima, Peru were genetically characterized to deteimine the diversity of Cryptosporidium spp. in HIV-positive people. A total of 2,672 patients participated in this study and provided 13,937 specimens. Cryptosporidium oocysts were detected by microscopy in 354 (13.3%) of the patients. Analysis of 951 Cryptosporidium - positive specimens from 300 patients using a small subunit rRNA-based PCR-RFLP tool identified 6 genotypes; Cryptosporidium hominis was the species most frequently detected (67.5%), followed by C. meleagridis (12.6%) and C. parvum (11.3%). Cryptosporidium canis (4.0%), C. felis (3.3%), and Cryptosporidium pig genotype (0.5%) were also found. These findings indicate that C. hominis is the predominant species in Peruvian HIV-positive persons, and that zoonotic Cryptosporidium spp. account for about 30% of cryptosporidiosis in these patients. [source]