Helicobacter pylori infection in symptomatic HIV-seropositive and -seronegative patients: a case-control study

We conducted a case-control study in a Greek hospital to evaluate the prevalence and morbidity of Helicobacter pylori in HIV-infected patients. HIV-seropositive patients were infected by H. pylori less often than HIV-seronegative controls [12/58 (20.7%) versus 38/58 (65.5%),p < 0.001]. The mean CD4 count was lower for H. pylori-negative than H. pylori-positive HIV-infected patients (p < 0.007). Also, among HIV patients, prior use of antibiotics or proton pump inhibitors was more common in those without H. pylori infection, however, this difference was not statistically significant (p = 0.06). The grading of the density of H. pylori infection and the grading of the histomorphological findings according to the Sydney classification were similar between HIV-seropositive and -seronegative patients with H. pylori infection.     

Angiotensin II Type 1 Receptor Inhibition is Associated with Reduced Tachyarrhythmia-Induced Ventricular Interstitial Fibrosis in a Goat Atrial Fibrillation Model

Background Using a goat animal model, we tested the hypothesis that angiotensin-II inhibition reduces fibrotic degeneration of both the atrial and ventricular myocardium as well as AF induction susceptibility. Methods We studied three groups of five goats over a 6-month period. The study animals in the first two groups were implanted with a pacemaker capable of maintaining AF with burst pacing. Additionally, in one group, goats were administered candesartan (AF+candesartan group). The third group (SR group) of animals served as control. Animals were tested for AF induction on day 0, 1, 30, 90 and 180. A “Vulnerability Index” (VI) for AF induction was calculated, defined as the ratio of total time in AF per number of bursts needed to induce sustained AF, in each session. At the end of the study, all four heart chambers were examined and fibrosis quantified. Results Both AF goat groups developed cardiomegaly due to tachy-cardiomyopathy. Although, the VI was significantly increased in AF group over time (28.8 ± 43 to 284.7 ± 291, p = 0.045), this was not the case for AF+candesartan group (30.3 ± 40 to 170.8 ± 243, p = 0.23). Histology revealed a significant increase of fibrous tissue in goats with induced AF, noticeable in all four heart chambers, compared to controls. However, the degree of fibrosis was significantly lower in AF animals on candesartan. Conclusions Our study demonstrated a beneficial effect of angiotensin II inhibition on tachyarrhythmia-induced ventricular fibrosis. It is also consistent with previous studies indicating a reduction in burst-induced AF susceptibility in goats and confirms the favorable effects in atrial structural remodeling.     

One-stage repair with a new integrated stent-Dacron prosthesis for type B aortic dissection

We describe one-stage repair for a dilated chronic type B aortic dissection in a 55-year-old man by means of a new integrated stent-graft-Dacron prosthesis (Jotec, Hechingen, Germany).     

Musculoskeletal Training for Orthopaedists and Nonorthopaedists: Experiences in India

In India, health policies, services, health indices, and medical education are improving despite the country’s enormous population and limited resources. Orthopaedic training in India should be geared to serve the predominantly rural population (72% of total population) living in some 550,000 villages, but unless the basic amenities improve in villages and towns, orthopaedists will remain averse to serving in these areas. Traditional practitioners play an important role in musculoskeletal trauma care in villages and even some town and city areas, and hence cannot be ignored. We suggest a stratified system of orthopaedic training for medical graduates, postgraduates, and paramedics with a well-defined need-based curriculum, and a clear cut division of labor, terms, and conditions to suit the stratified social and demographic structure of India. This stratified system is intended to provide appropriate musculoskeletal trauma care services to the rural population, reduce neglected and mismanaged trauma, consequently avoiding subsequent orthopaedic disability, and reduce the financial burden of managing these cases. This system also intends to prevent overloading of teaching hospitals and apex institutes and ensure availability of subspecialized orthopaedic services in the country at designated centers. Traditional practitioners shall be periodically educated regarding safe orthopaedic practices, which are anticipated to yield improved trauma care services. Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.     

Response to treatment and survival of patients with non-small cell lung cancer undergoing somatic EGFR mutation testing

Somatic mutations in the epidermal growth factor receptor (EGFR) gene are associated with clinical response and prolonged survival in patients with non-small cell lung cancer (NSCLC) treated with EGFR tyrosine kinase inhibitors (TKIs). We began screening patients for somatic EGFR mutations by DNA sequencing as part of clinical care in 2004. We performed a retrospective cohort study of 278 patients with NSCLC referred for EGFR testing over a 10-month period. Tumor samples underwent direct DNA sequence analyses of EGFR exons 18 through 24. We determined the clinical characteristics and EGFR mutation status of the patients and analyzed their response to therapy and survival. EGFR somatic mutations were identified in 68 (24%) of patients. A minimal smoking history was the strongest clinical predictor of harboring a mutation. In multivariable analyses, each pack-year of smoking corresponded to a 5% decreased likelihood of having an EGFR mutation. Among 92 patients with unresectable disease undergoing subsequent systemic therapy, EGFR mutations were associated with an increased response rate to EGFR TKIs (p < .0001) but not chemotherapy. Overall survival was significantly prolonged in EGFR mutation-positive patients (p = .001), with a median survival of 3.1 years compared with 1.6 years in mutation-negative patients, after adjusting for age, gender, and stage at diagnosis. Integrating molecular profiling into clinical care is feasible in NSCLC patients and provides useful clinical information.     

Disruption of prepulse inhibition of the startle reflex by the preferential D<Subscript>3</Subscript> agonist ropinirole in healthy males

Rationale Emerging evidence from agonist–antagonist studies suggests a role for the dopamine D₃ receptor subtype in the regulation of PPI in animals, but such evidence is lacking for human subjects. Objectives This study examines the effect of the preferential D₃ agonist ropinirole on PPI in humans. Methods PPI was tested in 12 healthy men in three sessions associated with ropinirole 0.25 mg, ropinirole 0.5 mg, or placebo according to a balanced, crossover, double-blind design. Two prepulses (75- and 85-dB white noise bursts) and two lead intervals (50 and 80 ms) were employed. Results Ropinirole 0.5 mg significantly reduced prepulse inhibition (PPI) with both prepulses at the 80-ms lead intervals. There was no effect of treatment on startle amplitude and habituation. Conclusions These results suggest a role for the dopamine D₃ receptor in the mediation of human PPI, although a contribution from ropinirole’s agonistic activity at the D₂ receptor cannot be entirely excluded. Firm conclusions on the role of the D₃ receptor in the modulation of human PPI can only be drawn with the use of genetic approaches or more selective ligands for this receptor.     

Re-writing Oral Pharmacokinetics Using Physiologically Based Finite Time Pharmacokinetic (PBFTPK) Models

Pharmaceutical Research - To develop physiologically based finite time pharmacokinetic (PBFTPK) models for the analysis of oral pharmacokinetic data. The models are based on the passive drug...     

Norton, Waterlow and Braden scores: a review of the literature and a comparison between the scores and clinical judgement

Aims and objectives. To consider the validity and reliability of risk assessment scales for pressure ulcers. Background. Pressure ulcers are a major problem worldwide. They cause morbidity and lead to mortality. Risk assessment scales have been available for nearly 50 years, but there is insufficient evidence to state with any certainty that they are useful. Design. A literature review and commentary. Methods. Bibliographic databases were searched for relevant papers, a critical review was completed on relevant papers. Results. There is contradictory evidence concerning the validity of risk assesment scales. The interaction of education, clinical judgement and use of risk assessment sakes has not been fully explored. It is not known which of these is most important, nor whether combining them results in better patient care. Conclusions. There is a need for further work. A study exploring the complex interaction of risk assessment scales, clinical judgement and education and training is introduced. Relevance to clinical practice. Nurses may be wasting their time conducting risk assessment scoring if clinical judgement and/or education are sufficient to assess pressure ulcers risk.