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Selected AbstractsAssessment of Adherence to Atovaquone-Proguanil Prophylaxis in TravelersJOURNAL OF TRAVEL MEDICINE, Issue 4 2010John C. DePetrillo MD Background. Malaria continues to be a serious, world-wide infection. Atovaquone-proguanil is one of the prophylactic agents recommended for travelers to endemic regions. However, little information is available regarding adherence with this medication. A large proportion of malaria cases reported from travelers is due to non-adherence to prescribed regimens. This study was undertaken to analyze adherence with atovaquone-proguanil prophylaxis and specific factors contributing to non-adherence. Methods. Men and non-pregnant women ,18 years of age were eligible for inclusion. Enrolled travelers received a prescription for atovaquone-proguanil prophylaxis and were contacted by telephone within 3 weeks of return to the United States. A questionnaire was prepared by the authors to determine if subjects were adherent with the medication. Additional data included demographics, duration of malarious travel, previous use of prophylactic agents, underlying medical conditions, concurrent medications, and reasons for non-adherence. Results. Complete data were available for 104/124 (84%) participants: 49 (47%) men, 55 (53%) women. Average duration of malarious travel was 12 days, and 19 (18%) travelers reported previous travel to a malarious region. Ninety-two (89%) subjects were completely adherent with their prophylactic atovaquone-proguanil course. Adverse effects were seen in 6 (5%) travelers. Conclusions. Adherence with atovaquone-proguanil malaria prophylaxis is high among travelers from a non-endemic region. Adverse effects are minimal. Non-adherence was primarily attributable to travelers' perception of need. [source] Left Atrial Ablation at the Anatomic Areas of Ganglionated Plexi for Paroxysmal Atrial FibrillationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 10 2010EVGENY POKUSHALOV M.D., Ph.D. Background:,Modification of left atrial ganglionated plexi (GP) is a promising technique for the treatment of paroxysmal atrial fibrillation (AF) but its therapeutic efficacy is not established. This study aimed at evaluating the effectiveness of anatomic GP modification by means of an implantable arrhythmia monitoring device. Methods:,In 56 patients with paroxysmal AF, radiofrequency ablation at anatomic sites, where the main clusters of GP have been identified in the left atrium, was performed. In all patients, an electrocardiogram monitor (Reveal XT, Medtronic Inc., Minneapolis, MN, USA) was implanted before (n = 7) or immediately after (n = 49) AF ablation. Results:,Average duration of the procedure was 142 ± 18 min and average fluoroscopy time 20 ± 7 min. In total, 53,81 applications of RF energy were delivered (mean of 18.2 ± 3.8 at each of the four areas of GP ablation). Heart rate variability was assessed in 31 patients. Standard deviation of RR intervals over the entire analyzed period, the root mean square of differences between successive RR intervals, and high frequencies decreased, while HRmin, HRmean, and LF to HF ratio increased immediately postablation; these values returned to baseline 6 months after the procedure. At end of 12-month follow-up, 40 (71%) patients were free of arrhythmia recurrence. Ten patients had AF recurrence, two patients had left atrial flutter, and four patients had episodes of flutter as well as AF recurrence. Duration of episodes of AF after ablation gradually decreased over the follow-up period. Conclusions:,Regional ablation at the anatomic sites of the left atrial GP can be safely performed and enables maintenance of sinus rhythm in 71% of patients with paroxysmal AF for a 12-month period. (PACE 2010; 33:1231,1238) [source] (217) Selective Nerve Root Injections Can Accurately Predict Level of Nerve Impairment and Outcome for Surgical Decompression: A Retrospective AnalysisPAIN MEDICINE, Issue 3 2001Kevin Macadaeg There remains significant controversy regarding the use of a vertebral selective nerve root injection (SNI) as a diagnostic and therapeutic tool. In addition, the frequency of use of such procedures in patients with radiculopathy has increased dramatically in the last few years. Based on a Medline review there has been no studies combining cervical and lumbar SNI results and comparing preoperative diagnosis to surgical findings and outcome. The purpose of this paper is to retrospectively examine and compare the sensitivity, specificity and predictive value of a good surgical outcome in patients who had an SNI and subsequent surgical intervention. 101 patients from a 1996 thru 1999 database, who were referred to 10 spine surgeons (2 orthopedic and 8 neurosurgeon) for either cervical or lumbar radiculopathy, and had SNI and various imagery studies and subsequent surgery. Patients receive SNIs at our institution if there is a discrepancy between physical exam and radiologic imagery or to confirm a putative pain generator in multilevel pathology. These patients were then retrospectively analyzed with regard to correlation to surgical level and surgical outcome. SNIs were performed by one of three pain specialists in our clinic. Approximation of the appropriate nerve root sleeve was performed using fluoroscopic imagery, a nerve stimulator and contrast. After nerve root stimulation and neurography, 0.5,0.75 cc of lidocaine 2% was injected. Pre- and post-procedural visual analog scale (VAS) pain scores were obtained from the non-sedated patient. A SNI was considered positive or negative if the patient had immediate appendicular pain relief of greater or less then ninety percent respectively. The study was designed to include only those patients that had a SNI, regardless of result, and subsequently had surgical decompression in an attempt to treat the pain that initially prompted the SNI. A statistical analysis was then performed comparing preoperative data to surgical findings and outcome. Overall, 101 patients had SNIs who subsequently underwent surgical decompression. Average duration of symptoms prior to SNI was 1.5,12 months (4 months mean). Fifteen patients presented with cervical and 86 with lumbar radiculopathy. There were a total of 110 procedures performed on these patients. VAS scores of <2 and overall pain reduction openface> 90% with respect to their pre-procedural appendicular were used to determine if a SNI was positive, negative or indeterminate. All of these patients had an MRI or CT with or without a myelogram and all went to surgery. The results yield that SNIs are able to predict surgical findings with 94% and 90% sensitivity and specificity, respectively. A good surgical outcome was determined if the patient would do the surgery again, if they were satisfied or very satisfied and had a VAS of <3 at 6- and 12-month intervals. Our data revealed that a positive SNI was able to predict a good 6-month outcome with 95% and 64% sensitivity and specificity, respectively. At 12-months, similar results were obtained of 95% and 56%. Preoperative MRI results were also evaluated and revealed a 92% sensitivity in predicting surgical findings. We had 24 false positive MRI results and 0 true negatives. Interestingly we had 8 diabetic (IDDM or NIDDM) patients or nearly 8% of our total. The odds ratio of a diabetic having a bad outcome at 12 months was 5.4 to 1. Diabetics had a 50% likelihood of having a bad 12-month outcome versus 16% for non-diabetics with a p value of 0.066. We also looked at gender, smoking history and presence of cardiovascular disease and found no significant relationship with outcomes. Our data indicate that SNIs, when performed under rigorous method, is a highly valuable tool that can accurately determine level of nerve root impairment and outcome in patients being considered for surgical decompression. With a sensitivity of 94% and a specificity of 90%, SNIs offer a major advantage over other diagnostic modalities in patients with difficult-to-diagnose radiculopathies. [source] Conversion from valproic acid onto topiramate in adolescents and adults with epilepsyACTA NEUROLOGICA SCANDINAVICA, Issue 5 2009A. Schreiner Objective,,, To explore efficacy and tolerability outcomes of topiramate (TPM) in patients with epilepsy transitioning from valproic acid (VPA) because of insufficient efficacy and/or tolerability onto TPM. Methods,,, Multicenter, open label, single arm, non-interventional study examining patients (,12 years) with epilepsy, transitioning onto TPM from baseline mono-or combination therapy with VPA. TPM was added onto the existing antiepileptic drug (AED) treatment and started at a dose of 25 mg once daily. The dose was titrated up with 25 mg/day increments, once every 1,2 weeks, until a final dose between 50,200 mg/day was reached. Based on clinical judgment, the treating physician decided whether or not and when the existing AED treatment especially with VPA could be withdrawn. Documented were type and frequency of seizures, TPM dose, quality of life (QOLIE-10 questionnaire), subjective perception of improvement, and adverse events (AE). Results,,, One hundered and forty-seven patients (59% women, mean age 41 years) switched from baseline VPA treatment onto TPM because of insufficient efficacy (61%) and/or poor tolerability (81%). Average duration of follow-up was 20.3 weeks with an overall discontinuation rate of 16.3% of patients, mainly because of AE (in 8.2% of 147 patients). At study endpoint, the intended shift to TPM monotherapy was achieved in 70% of patients at a median dose of 150 mg/day. A seizure reduction of ,50% was achieved in 75% of patients in the last scheduled period (week 8,20), and 51% of patients entering that period remained seizure-free. Quality of life improved significantly as compared with baseline for all domains of QOLIE-10 (P < 0.001). Most frequent AEs were weight decrease (4.8%), paraesthesia and fatigue (4.1% each), speech disorder and headaches (2.7% each). Conclusions,,, In patients with epilepsy not satisfactorily treated with VPA, conversion to TPM was associated with improved seizure control as well as improvement in several aspects of quality of life. [source] Epidemiology of invasive and other pneumococcal disease in children in England and Wales 1996,1998ACTA PAEDIATRICA, Issue 2000E Miller The results of enhanced national surveillance of pneumococcal disease in children <15y of age in England and Wales are reported for the period 1996,1998. Of the 1985 cases of laboratory-confirmed invasive disease (annual incidence 6.6 per 100000 overall and 39.7 per 100000 in infants <1 y of age), 485 (24%) were meningitis (annual incidence of 1.6 per 100000 overall and 15.7 per 100000 in infants <1 y of age). Fifty-nine deaths in children with invasive disease were identified-3% of the total reports. Thirty-one different serogroups/types were identified, with organisms in the 7-valent conjugate vaccine responsible for 69% of the infections in children <5 y of age; this rose to 77% and 82%, respectively, for the 9-and 11-valent vaccines. Resistance to penicillin varied from 2.3% to 6.2% in different years, but erythromycin resistance remained constant at 17%. The vast majority of resistant isolates were in vaccine serotype/groups. Computerized hospital admission records for all children <15 y of age with a discharge diagnosis code indicating probable pneumococcal disease were also analysed for 1997. The annual incidence for cases with a code specifically mentioning S. pneumoniae was 9.9 per 100000 compared with 71.2 per 100000 for lobar pneumonia; the mean duration of stay for both was < 1 wk. The incidence of admission for pneumococcal meningitis (1.9 overall and 19.6 for infants < 1 y of age) was similar to that derived from laboratory reports and resulted in an average duration of stay of 2 wk. Conclusion: This surveillance has confirmed the substantial burden of morbidity attributable to pneumococcal disease in British children and the potential public health benefits that could be achieved by the use of pneumococcal conjugate vaccines. [source] The unmet treatment need of traumatized anterior teeth in selected secondary school children in Ibadan, NigeriaDENTAL TRAUMATOLOGY, Issue 1 2010Mojirade Deborah Ajayi The aim of this study was to assess the prevalence of damage to permanent anterior teeth in school adolescents, the average duration of trauma and to ascertain the level of the unmet treatment need. A total of 1532 secondary school children between the ages 12 and 19 years participated in the study. They were randomly selected from public secondary schools in five local government areas in Ibadan using a multistage sampling method. Participants were examined with the aid of mouth mirrors and probes under natural light. Traumatic anterior dental injuries were recorded by the same investigator (DMA) according to WHO classification. One hundred and sixty-five participants sustained injuries to their anterior teeth. Their mean age was 15.47 ± 2.09 years, with a male to female ratio of 1.5:1. The commonest cause was fall (78.8%) with road traffic accident being the least (1.8%). The tooth most commonly injured is the upper left incisor (48.0%) closely followed by upper right central (43.1%). Enamel fracture was seen in 46.5% and enamel,dentine in 42.6% of the traumatized teeth. Most (79.4%) of the children sustained injury to one tooth only. Of the participants, only 30 (18.2%) had previous dental consultation while only nine (5.5%) consulted the dentist following the trauma; however, none of the teeth had any form of restoration. Average time elapsed between trauma and dental examination was about 3.5 years. Many participants had had injury for about 2 years before dental examination. In conclusion, there is a high unmet treatment need of traumatized anterior teeth in the study population. [source] New reproductive anomalies in fruitless -mutant Drosophila males: Extreme lengthening of mating durations and infertility correlated with defective serotonergic innervation of reproductive organsDEVELOPMENTAL NEUROBIOLOGY, Issue 2 2001Gyunghee Lee Abstract Several features of male reproductive behavior are under the neural control of fruitless (fru) in Drosophila melanogaster. This gene is known to influence courtship steps prior to mating, due to the absence of attempted copulation in the behavioral repertoire of most types of fru -mutant males. However, certain combinations of fru mutations allow for fertility. By analyzing such matings and their consequences, we uncovered two striking defects: mating times up to four times the normal average duration of copulation; and frequent infertility, regardless of the time of mating by a given transheterozygous fru -mutant male. The lengthened copulation times may be connected with fru -induced defects in the formation of a male-specific abdominal muscle. Production of sperm and certain seminal fluid proteins are normal in these fru mutants. However, analysis of postmating qualities of females that copulated with transheterozygous mutants strongly implied defects in the ability of these males to transfer sperm and seminal fluids. Such abnormalities may be associated with certain serotonergic neurons in the abdominal ganglion in which production of 5HT is regulated by fru. These cells send processes to contractile muscles of the male's internal sex organs; such projection patterns are aberrant in the semifertile fru mutants. Therefore, the reproductive functions regulated by fruitless are expanded in their scope, encompassing not only the earliest stages of courtship behavior along with almost all subsequent steps in the behavioral sequence, but also more than one component of the culminating events. © 2001 John Wiley & Sons, Inc. J Neurobiol 47: 121,149, 2001 [source] PERSPECTIVE: MODELS OF SPECIATION: WHAT HAVE WE LEARNED IN 40 YEARS?EVOLUTION, Issue 10 2003Sergey Gavrilets Abstract Theoretical studies of speciation have been dominated by numerical simulations aiming to demonstrate that speciation in a certain scenario may occur. What is needed now is a shift in focus to identifying more general rules and patterns in the dynamics of speciation. The crucial step in achieving this goal is the development of simple and general dynamical models that can be studied not only numerically but analytically as well. I review some of the existing analytical results on speciation. I first show why the classical theories of speciation by peak shifts across adaptive valleys driven by random genetic drift run into trouble (and into what kind of trouble). Then I describe the Bateson-Dobzhansky-Muller (BDM) model of speciation that does not require overcoming selection. I describe exactly how the probability of speciation, the average waiting time to speciation, and the average duration of speciation depend on the mutation and migration rates, population size, and selection for local adaptation. The BDM model postulates a rather specific genetic architecture of reproductive isolation. I then show exactly why the genetic architecture required by the BDM model should be common in general. Next I consider the multilocus generalizations of the BDM model again concentrating on the qualitative characteristics of speciation such as the average waiting time to speciation and the average duration of speciation. Finally, I consider two models of sympatric speciation in which the conditions for sympatric speciation were found analytically. A number of important conclusions have emerged from analytical studies. Unless the population size is small and the adaptive valley is shallow, the waiting time to a stochastic transition between the adaptive peaks is extremely long. However, if transition does happen, it is very quick. Speciation can occur by mutation and random drift alone with no contribution from selection as different populations accumulate incompatible genes. The importance of mutations and drift in speciation is augmented by the general structure of adaptive landscapes. Speciation can be understood as the divergence along nearly neutral networks and holey adaptive landscapes (driven by mutation, drift, and selection for adaptation to a local biotic and/or abiotic environment) accompanied by the accumulation of reproductive isolation as a by-product. The waiting time to speciation driven by mutation and drift is typically very long. Selection for local adaptation (either acting directly on the loci underlying reproductive isolation via their pleiotropic effects or acting indirectly via establishing a genetic barrier to gene flow) can significantly decrease the waiting time to speciation. In the parapatric case the average actual duration of speciation is much shorter than the average waiting time to speciation. Speciation is expected to be triggered by changes in the environment. Once genetic changes underlying speciation start, they go to completion very rapidly. Sympatric speciation is possible if disruptive selection and/or assortativeness in mating are strong enough. Sympatric speciation is promoted if costs of being choosy are small (or absent) and if linkage between the loci experiencing disruptive selection and those controlling assortative mating is strong. [source] A 2-year follow-up of 233 very mild (CDR 0.5) Alzheimer's disease patients (REAL. FR cohort)INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 5 2008Fati Nourhashémi Abstract Objectives Making an early diagnosis of Alzheimer's Disease (AD) is becoming increasingly important. The Clinical Dementia Rating scale (CDR), a semi-structured interview with patient and caregiver, is a global rating scale designed for use in staging dementia. The primary objective of our study was to examine the evolution of AD in individuals with very mild AD (CDR 0.5) across a 2-year follow up. Methods A cohort of AD patients (n,=,682) living in the community were followed during 2 years in 16 centres of the French AD network. Each subject underwent extensive medical examination including the MMSE and CDR every 6 months. Results Two hundred and thirty-three AD patients were rated CDR 0.5 at baseline (mean MMSE score: 23.15,±,2.57). They were younger and reported an average duration of symptoms of approximately 0.8 years less than patients with CDR,,,1. During the 2-year follow-up, none of the AD CDR 0.5 subjects improved; 65% of them showed an increase in the CDR score. The rate of cognitive decline was similar between the AD CDR 0.5 and CDR,,,1 groups. The ADL decline was more significant in patients with CDR,,,1 at inclusion. Conclusions It is certainly possible to identify AD at a very early stage focusing on intra individual change in cognitive and functional impairment. Criteria with a high sensitivity and specificity for detecting AD at an early stage will help to further develop effective pharmacological and behavioural interventions for delaying the onset and progression of the disease. Copyright © 2007 John Wiley & Sons, Ltd. [source] Utility-adjusted analysis of the cost of palliative radiotherapy for bone metastasesJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 3 2003Michael B Barton Summary Palliative radiotherapy is effective in the treatment of bone metastases but is under-utilized, possibly because it is perceived to be expensive. We performed a cost-utility analysis of palliative radiotherapy for bone metastases, evaluating both the actual cost of radiotherapy as well as its impact on quality of life by adjusting for the variation in response to treatment. Hospital records between July 1991 and July 1996 were reviewed to ascertain the number of patients treated with palliative radiotherapy for bone metastases, the average number of fields of radiation delivered to each patient and the average duration of survival. Partial and complete response rates to palliative radiotherapy were obtained from a review of all published randomized controlled trials of radiation treatment of bone metastases. Utility values were assigned to the response rates, and an overall adjusted response rate to radiotherapy was derived. The cost of delivering a field of radiation was calculated. The total cost was divided by the total number of response months to give a utility-adjusted cost per month of palliative radiotherapy. The utility-adjusted cost per month of palliative radiotherapy of bone metastases was found to be AUS$ 100 per month or AUS$ 1200 per utility-adjusted life-year. This study demonstrates that, contrary to popular perception, palliative radiotherapy is a cost-effective treatment modality for bone metastases. [source] Effect of conditioning electrical stimuli on temporalis electromyographic activity during sleepJOURNAL OF ORAL REHABILITATION, Issue 3 2008F. JADIDI Summary, Inhibitory reflexes during voluntary contractions are well described; however, few studies have attempted to use such reflex-mechanisms to modulate electromyographic (EMG) activity in jaw-closing muscles during sleep. The aim was to apply a new intelligent biofeedback device (Grindcare®) using electrical pulses to inhibit EMG activity in the temporalis muscle during sleep. Fourteen volunteers participated who were aware of jaw-clenching activity as indicated by complaints from sleep partner, soreness or pain in the jaw-muscle upon awakening and tooth wear facets. The EMG activity was recorded from the temporalis muscle, online analysed and the frequency content determined using a signal recognition algorithm. Based on specific individual parameters for pattern recognition, an electrical square-wave pulse train, which was adjusted to a clear, but non-painful intensity (range 1,7 mA) was applied through the EMG electrodes, if jaw-clenching activity was detected. All volunteers had baseline EMG recordings for five to seven consecutive nights, followed by 3-weeks EMG recordings with the feedback turned on, 2 weeks without the feedback and finally 3 weeks with the biofeedback on. There were no session effects on the average duration of sleep hours (P = 0·626). The number of EMG episodes/hour sleep was significantly reduced during the two sessions with biofeedback (54 ± 14%; 55 ± 17%, P < 0·001) compared with baseline EMG activity and the session without biofeedback. The present study suggests that biofeedback with electrical pulses does not cause major disruption in sleep and is associated with pronounced reduction in temporalis EMG activity during sleep. [source] The natural history of hidradenitis suppurativaJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 5 2000JM Von Der Werth Abstract Aim,To investigate aspects of the natural history of hidradenitis. Background,The natural history of hidradenitis suppurativa (HS) is not well known. There is incomplete published data on the average age of disease onset, progression of the disease, average monthly incidence and duration of boils, and factors that relieve or exacerbate disease symptoms. Study design,Questionnaire-based survey among HS patients identified from hospital records of three hospitals in Nottinghamshire, UK. Results,One hundred and ten of 156 questionnaires (70.5%) were returned, 93 from females and 17 from males. The average patient's age was 40.1 years and the average reported age of disease onset was 21.8 years. At the time of the survey patients had suffered an average disease duration of 18.8 years. Most patients (98 of 110) still had experienced active disease within the past year. There was some evidence that in women the condition has a tendency to ease or subside after the menopause. Forty-four per cent of women felt that their condition was aggravated by menstruation. Thirty-eight per cent of patients gave a positive family history of the disorder. The average duration of painful boils was 6.9 days. In addition, 62% of patients acknowledged the presence of permanently painful boils that failed to subside. Patients developed a median of two boils per month. Factors that could aggravate the condition were primarily sweating or heat, stress or fatigue and tight clothing or friction. Factors that could improve the condition consisted largely of a variety of medical treatments and a number of life-style measures, such as swimming or baths. Twenty-four per cent of patients had failed to find anything at all to help their condition, despite an average disease duration of almost 19 years. Conclusions,The study highlights several of the factors that make HS one of the most distressing dermatological diseases, such as the average monthly incidence of painful lesions, their average duration and the chronicity of the disease. It seems striking that the mean duration of an HS boil (6.9 days) roughly equals the duration of an average course of antibiotics. The postulated response of HS to oral antibiotics may thus simply have its explanation in the natural history of the condition itself. [source] Beneficial effect of transcranial magnetic stimulation on sleep in Parkinson's disease,MOVEMENT DISORDERS, Issue 6 2009Karin D. van Dijk MD Abstract Sleep disorders are common in Parkinson's disease (PD) and have profound negative influences on quality of life. Sleep structure in healthy participants can be changed by repetitive transcranial magnetic stimulation (rTMS), but this has never been studied systematically in PD. Therefore, we characterized sleep in PD patients and examined effects of rTMS using a combination of actigraphy and a pressure sensitive pad. Thirteen PD patients received 5 Hz rTMS over the motor or parietal cortex. Actigraphic sleep estimates were obtained before, during and after rTMS, as well as compared with 8 healthy, age-matched controls. Motor symptoms and mood were evaluated before and after rTMS. Mixed-model regression analyses indicated that PD patients slept shorter (350 ± 17 vs. 419 ± 24 min., P = 0.02), more fragmented (fragmentation index 41 ± 4 vs. 22 ± 2, P = 0.0004) and had a lower sleep efficiency (77 ± 2 vs. 86 ± 2%, P = 0.002) and longer nocturnal awakenings (3.4 ± 0.2 vs. 2.3 ± 0.2 min., P = 0.003) than healthy controls. rTMS over the parietal, but not over the motor cortex improved sleep fragmentation (P = 0.0002) and sleep efficiency (P = 0.0002) and reduced the average duration of nocturnal awakenings (P = 0.02). No change of motor symptoms or mood was observed. Disturbed sleep in PD patients may partly be reversed by parietal rTMS, without affecting motor symptoms or mood. © 2009 Movement Disorder Society [source] Choosing the Best Training Programme: Is there a Case for Statistical Treatment Rules?,OXFORD BULLETIN OF ECONOMICS & STATISTICS, Issue 2 2010Jonas Staghøj Abstract When treatment effects of active labour market programmes (ALMPs) are heterogeneous in an observable way across the population, the allocation of the unemployed into different programmes becomes particularly important. In this article, we present a statistical model that can be used to allocate unemployed into different ALMPs. The model presented is a duration model that uses the timing-of-events framework to identify causal effects. We compare different assignment rules, and the results suggest that a significant reduction in the average duration of unemployment may result if a statistical treatment rule is introduced. [source] Patients diagnosed with Kawasaki disease before the fifth day of illness have a higher risk of coronary artery aneurysmPEDIATRICS INTERNATIONAL, Issue 4 2002Yuichi Nomura Abstract Background: A fever lasting for at least 5 days is an essential characteristic of the original diagnostic criteria ofKawasaki disease (KD). However, it is not difficult for an experienced physician to confirm the diagnosis of KD before the fifth day offever. The aim of this study is to investigate the effect of intravenous gamma globulin therapy (IVGG) in KD initiated before the fifth day of illness. Methods: A total of 125 patients treated with IVGG were divided into group A (IVGG was initiated before the fifth dayof illness, n= 46) and group B (IVGG was initiated at the fifth day or after, n= 79). Patients' characteristics,laboratory findings, treatments and outcomes were compared between the groups. Results: White blood cell count value, C-reactive protein and Harada's score showed no difference between thegroups. A significantly higher average value of alanine aminotransferase (ALT) was observed in group A. Although the treatments were identicalin both groups, the average duration of fever from the initial day of IVGG in group A was significantly longer than in group B. Theincidence of aneurysm in group A was significantly higher than that in group B. Stepwise regression analysis using aneurysm as a dependentvariable revealed that group A and ALT were significant. Conclusions: Patients diagnosed with KD before the fifth day of illness showed a poor response to IVGG. This observationmight be related to high ALT values. Further examination concerning the modification of treatment in such patients is necessary. [source] Are immigrants, ethnic and linguistic minorities over-represented in jobs with a high level of compensated risk?AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 9 2010Canada study using census, Results from a montréal, workers' compensation data Abstract Objectives Few Canadian data sources allow the examination of disparities by ethnicity, language, or immigrant status in occupational exposures or health outcomes. However, it is possible to document the mechanisms that can create disparities, such as the over-representation of population groups in high-risk jobs. We evaluated, in the Montréal context, the relationship between the social composition of jobs and their associated risk level. Methods We used data from the 2001 Statistics Canada census and from Québec's workers' compensation board for 2000,2002 to characterize job categories defined as major industrial groups crossed with three professional categories (manual, mixed, non-manual). Immigrant, visible, and linguistic minority status variables were used to describe job composition. The frequency rate of compensated health problems and the average duration of compensation determined job risk level. The relationship between the social composition and risk level of jobs was evaluated with Kendall correlations. Results The proportion of immigrants and minorities was positively and significantly linked to the risk level across job categories. Many relationships were significant for women only. In analyses done within manual jobs, relationships with the frequency rate reversed and were significant, except for the relationship with the proportion of individuals with knowledge of French only, which remained positive. Conclusions Immigrants, visible, and linguistic minorities in Montréal are more likely to work where there is an increased level of compensated risk. Reversed relationships within manual jobs may be explained by under-reporting and under-compensation in vulnerable populations compared to those with knowledge of the province's majority language. Am. J. Ind. Med. 53:875,885, 2010. © 2010 Wiley-Liss, Inc. [source] Latest news and product developmentsPRESCRIBER, Issue 14 2007Article first published online: 19 OCT 200 Studies suggest risk of bone loss with SSRIs Two cross-sectional studies have suggested the SSRI antidepressants may be associated with an increased risk of bone loss (Arch Intern Med 2007;167:1240,5 &1246,51). In 2722 older women (mean age 79) living in the community who were participating in the Study of Osteoporotic Fractures cohort study, use of SSRIs was associated with a significant increase in the rate of loss of hip bone density compared with nonusers(0.82 vs 0.47 per cent per year). The rate of loss among women taking a tricyclic antidepressant was also 0.47 per cent per year. Excluding women with more severe depression did not alter the findings. In 5995 men aged 65 or older taking an SSRI in another study, mean bone density was 3.9 per cent lower at the hip and 5.9 per cent lower in the lumbar spine compared with no use of antidepressants. Use of a tricyclic antidepressant or trazodone was not associated with increased bone loss. The authors comment that the degree of bone loss is comparable with that associated with corticosteroids. Serotonin transporters have been identified in osteoblasts and osteocytes. Risk of rare birth defects with SSRIs Two US case-control studies have found qualified evidence that use of SSRIs during the first trimester may be associated with a small increase in the risk of rare neonatal defects (N Engl J Med 2007;356:2675,83 & 2684,92). The Slone Epidemiology Center Birth Defects Study identified 9849 infants with birth defects and 5860 without and found no significant association between SSRI use overall and defects previously attributed to SSRIs (craniosynostosis, omphalocele or heart defects). There was some evidence that sertraline and paroxetine may cause specific defects, but this was based on few cases and the absolute risk remained low. The National Birth Defects Prevention Study identified 9622 infants with major birth defects and 4092 controls. There was no significant association with heart defects but the odds of anencephaly, craniosynostosis and omphalocele were each significantly increased by a factor of 2,3. The authors say the absolute risk remains small and their findings require confirmation. UK data do not support MI link with rosiglitazone An interim analysis of a UK clinical trial of rosiglitazone (Avandia) has found no evidence that it is associated with an increased risk of myocardial infarction (N Eng J Med 2007;357:28,38). A US meta-analysis (N Engl J Med 2007;356:2457,71) recently suggested that the odds of an MI or cardiovascular (CV) death in patients taking rosiglitazone were increased by 40,60 per cent compared with controls. The UK analysis of an ongoing nonblinded trial comparing rosiglitazone plus a sulphonylurea or metformin with sulphonylurea/metformin found no significant differences in the risk of MI or CV death. The risk of heart failure was doubled in patients taking rosiglitazone. The authors comment that, with a mean follow-up of 3.75 years, they had too few data to reach a conclusive finding. Switch piroxicam users to another NSAID The European Medicines Agency has advised prescribers to switch patients who are taking oral piroxicam to another NSAID. The advice follows a reappraisal of the safety of piroxicam when the 2006 review of all nonselective NSAIDs suggested it may be associated with increased risks of GI adverse effects and serious skin reactions. The advice does not apply to topical formulations. Piroxicam should not be prescribed for acute conditions and should not be first-choice for osteoarthritis, rheumatoid arthritis and ankylosing spondylitis. The maximum dose should be 20mg per day and treatment should be reviewed after 14 days. The MHRA states there is no need for urgent action; long-term treatment should be reviewed at the next routine appointment. OTC azithromycin? The MHRA is consulting on a request by a pharmaceutical company to reschedule azithromycin to pharmacy-only status for the treatment of known or suspected Chlamydia trachomatis infection in individuals aged 16 years or older. The applicant envisages supplies being made only when a nucleic acid amplification test (NAAT) is positive. Responses should be submitted to the MHRA (www.mhra.gov.uk) by 2 August. Computers can reduce prescribing errors Computerised prescribing reduces by two-thirds the rate of medication errors associated with handwritten prescriptions, a new review has found (Health Services Research 2007; online doi:10.1111/j.1475,6773. 2007.00751.x). There was some evidence that the risk of all errors, dose errors and adverse effects were reduced by computerisation. The greatest impact was seen in settings with very high error rates (>12 per cent) associated with handwritten prescriptions. However, the studies included produced heterogeneous results and the reduction in errors in prescribing for children was not statistically significant. Furthermore, computerisation did not reduce the rate of prescribing the wrong drug. Echinacea works for colds, new study finds The herbal remedy Echinacea does reduce the risk of catching a cold, according to a new metaanalysis (Lancet Infect Dis 2007;7:473,80). In 2006, a Cochrane review found insufficient evidence to support the benefits claimed for Echinacea. The new study, which additionally included experimentally-induced infections among the 14 trials analysed, found that Echinacea reduced the odds of catching a cold by about half and reduced the average duration of a cold by 1.4 days. Though inconclusive, the possibility of publication bias and heterogeneity between the trials could not be excluded. HRT may reduce cardiovascular risk after all A subgroup analysis of the Women's Health Initiative (WHI) suggests that HRT may reduce the risk of coronary heart disease if started soon after the menopause (N Engl J Med 2007;356:2591,602). The main analysis of WHI showed no cardiovascular benefit for HRT, a finding attributed to the relatively old mean age of participants (59). In the new analysis of 1064 women aged 50,59, HRT use was associated with a significant reduction in coronary artery calcification compared with nonuse, with greater effect associated with greater adherence. Reducing BP key to avoiding heart failure An angiotensin,II receptor blocker (ARB) is no better than other antihypertensives at avoiding the development of heart failure in individuals with hypertension, say US investigators (Lancet 2007;369:2079,87). Drugs that affect the renin-angiotensin system can reduce ventricular hypertrophy and may therefore prevent the development of heart failure in patients with hypertension. This study found similar improvements in diastolic function in 384 patients with hypertension and left ventricular dysfunction randomised to valsartan (Diovan) or placebo in addition to standard antihypertensive treatment for 38 weeks. The authors conclude that blood pressure reduction, not choice of drug, is the most important factor. Copyright © 2007 Wiley Interface Ltd [source] Epidemiology of post-injury multiple organ failure in an Australian trauma systemANZ JOURNAL OF SURGERY, Issue 6 2009David C. Dewar Abstract Background:, The epidemiology of post-injury multiple organ failure (MOF) is reported internationally to have gone through changes over the last 15 years. The purpose of this study is to describe the epidemiology of post-injury MOF in Australia. Methods:, A 12-month prospective epidemiological study was performed at the John Hunter Hospital (Level-1 Trauma Centre). Demographics, injury severity (ISS), physiological parameters, MOF status and outcome data were prospectively collected on all trauma patients who met inclusion criteria (ICU admission; ISS > 15; age > 18, head Abbreviated Injury Scale (AIS) <3 and survival >48 h). MOF was prospectively defined by the Denver MOF score greater than 3 points. Data are presented as % or Mean+/,SEM. Univariate statistical comparison was performed (Student t -test, X2 test), P < 0.05 was considered significant. Results:, Twenty-nine patients met inclusion criteria (Age 40+/,4, ISS 29+/,3, Male 62%), five patients developed MOF. The incidence of MOF among trauma patients admitted to ICU was 2% (5/204) and 17% (5/29) in the high-risk cohort. The maximum average MOF score was 6.3 +/,1, with the average duration of MOF 5+/,2 days. Two patients had respiratory and cardiac failure, two patients had failure of respiratory, cardiac and hepatic systems, while one patient had failure of respiratory, hepatic and renal systems. One MOF patient died, all non MOF patients survived. MOF patients had longer ICU stays (20+/,4 versus 7+/,0.8 P= 0.01), tended to be older (60+/,11 versus 35+/,4 p=0.07). None of the previously described independent predictors (ISS, base deficit, lactate, transfusions) were different when the MOF patients were compared with the non-MOF patients. Conclusion:, The incidence of MOF in Australia is consistent with the international data. In Australia MOF continues to cause significant late mortality and morbidity in trauma patients. MOF patients have longer ICU stay than high-risk non MOF patients, and use significant resources. Our preliminary data challenges the timeliness of the 10-year-old independent predictors of post-injury MOF. The epidemiology, the clinical presentation and the independent predictors of post-injury MOF require larger scale reassessment for the Australian context. [source] Courtship dances in the flies of the genus lispe (Diptera: Muscidae): From the fly's viewpointARCHIVES OF INSECT BIOCHEMISTRY AND PHYSIOLOGY (ELECTRONIC), Issue 1 2006Leonid Frantsevich Abstract Two predatory fly species, Lispe consanguinea Loew, 1858 and L. tentaculata DeGeer, 1776, inhabit the supralittoral zone at the shore of a fresh-water reservoir. Both species look alike and possess similar "badges," reflective concave silvery scales on the face. Flies occupy different lek habitats. Males of the first species patrol the bare wet sand on the beach just above the surf. Males of the second species reside on the more textured heaps of algae and stones. Courtship and aggressive behaviour of males was video-recorded and analysed frame by frame. Visual stimuli provided by the conspecific partner were computed in the body-fixed space of a fly observer. Males of L. consanguinea perform long pedestrian dances of pendulating circular arcs (frequency 2 s,1, median radius 2.5 cm, linear velocity 0.130 m/s). Right and left side runs are equally probable. Circular runs are interrupted by standby intervals of average duration 0.35 s. The female views the male as a target covering 2 by 2 ommatidia, moving abruptly with the angular velocity over 200 °/s in a horizontal direction down the path of about 50° till the next standpoint. Dancing is evenly distributed around the female. On the contrary, the male fixates the image of the female within the narrow front sector (median ±10°); the target in his view has 6,7 times less angular velocity and angular span of oscillations, and its image in profile overlays 6,8 by 2 ommatidia. If the female walks, the male combines tracking with voluntary circular dances. Rival males circle about one another at a distance shorter than 15 mm, but not in close contact. Males of L. tentaculata are capable of similar circular courting dances, but do so rarely. Usually they try to mount any partner immediately. In the latter species, male combat consists of fierce wrestling. Flies of both species often walk sideward and observe the partner not in front but at the side. Arch. Insect Biochem. Physiol. 62:26,42, 2006. © 2006 Wiley-Liss, Inc. [source] A test for Allee effects in the self-incompatible wasp-pollinated milkweed Gomphocarpus physocarpusAUSTRAL ECOLOGY, Issue 6 2009GARETH COOMBS Abstract It has been suggested that plants that are good colonizers will generally have either an ability to self-fertilize or a generalist pollination system. This prediction is based on the idea that these reproductive traits should confer resistance to Allee effects in founder populations and was tested using Gomphocarpus physocarpus (Asclepiadoideae: Apocynaceae), a species native to South Africa that is invasive in other parts of the world. We found no significant relationships between the size of G. physocarpus populations and various measures of pollination success (pollen deposition, pollen removal and pollen transfer efficiency) and fruit set. A breeding system experiment showed that plants in a South African population are genetically self-incompatible and thus obligate outcrossers. Outcrossing is further enhanced by mechanical reconfiguration of removed pollinaria before the pollinia can be deposited. Self-pollination is reduced when such reconfiguration exceeds the average duration of pollinator visits to a plant. Observations suggest that a wide variety of wasp species in the genera Belonogaster and Polistes (Vespidae) are the primary pollinators. We conclude that efficient pollination of plants in small founding populations, resulting from their generalist wasp-pollination system, contributes in part to the colonizing success of G. physocarpus. The presence of similar wasps in other parts of the world has evidently facilitated the expansion of the range of this milkweed. [source] Increasing antimicrobial resistance,an emerging problem in the treatment of shigellosisCLINICAL MICROBIOLOGY AND INFECTION, Issue 12 2007S. K. Niyogi Abstract Shigellosis is a major cause of diarrhoea-related morbidity and mortality, especially in developing countries. Effective antibiotic treatment reduces the average duration of illness by reducing faecal excretion of the bacterium and preventing further transmission and potentially lethal complications. Treatment of shigellosis is currently limited by the high prevalence of multidrug-resistant strains of Shigella. Although fluoroquinolones are currently effective in treating adults, resistance to fluoroquinolones among Shigella spp. is emerging, and their use in children is subject to limitations. Azithromycin and third-generation cephalosporins are also effective in the treatment of shigellosis, but monitoring of Shigella isolates to detect the emergence of resistance is essential. [source] | ||||||||||||||||||||||||||||