Isolated native tricuspid valve endocarditis caused by viridans streptococcus.

The present report describes a case of native tricuspid valve endocarditis caused by viridans group streptococcus in a 43-year-old man who had recently undergone dental extraction. The patient had no history of intravenous drug use, heart disease or right heart catheterization. Although there have been scattered reports of unusual organisms, to the authors' knowledge, this is the first case of viridans group streptococcal endocarditis involving only the tricuspid valve after dental manipulation.     

Quality of life of osteoporotic patients treated in rheumatology rehabilitation in-patient units

There has been no report on demographic, social and quality of life data of osteoporotic patients attending rheumatology rehabilitation in-patient units in Hungary. Aim: The authors analyzed the data of osteoporotic patients treated in rheumatology rehabilitation departments as in-patients in four hospitals in Hungary. Methods: Demographic and social data were obtained by using a questionnaire developed by the authors, and quality of life was assessed with the use of the SF-36 questionnaire. The quality of life data of osteoporotic patients were compared to that obtained from patients with rheumatoid arthritis, osteoarthrosis and chronic low back pain who were treated in the same department at the same time. Results: Of the 253 patients who were asked to participate in the study, 211 patients filled out the questionnaires. 25.6% of the patients were male. 58% of the patients were younger than 60 years of age, and 40% of them were heavy physical workers earlier. More than 50% of the patients did not complete secondary school education, and only 6.7% of the patients had a per capita monthly income higher than 100 000 HUF. The quality of life of the osteoporotic patients assessed by SF-36 scored 34.7, which was significantly lower than that of the mean of the Hungarian population scoring 70-90. The SF-36 scores of osteoporotic patients were lower in all domains compared to the scores of patients with rheumatoid arthritis, osteoarthritis and low back pain, although the difference was significant only in the domain of physical activity. The affective role of patients with osteoporosis was significantly lower than those with rheumatoid arthritis and osteoarthritis. Conclusions: Osteoporotic patients attending in-patient rheumatology in-patient rehabilitation units in Hungary have poor quality of life comparable, even worse than that found in patients with rheumatoid arthritis, osteoarthritis and chronic low back pain.     

The effect of low-dose ritonavir monotherapy on fasting serum lipid concentrations

OBJECTIVES: Ritonavir (RTV) at doses of 400 mg twice a day (bid) or higher adversely affects serum lipids. However, the effect of RTV 100 mg bid on serum lipids is unknown. We conducted a study to evaluate the effect of RTV 100 mg bid on fasting serum lipid profiles in HIV-negative healthy volunteers. METHODS: Ritonavir 100 mg bid was administered for 14 days to 20 healthy HIV-seronegative adults with normal serum lipids. After a 7-day washout, lopinavir/ritonavir (LPV/RTV) 400/100 mg bid was administered for 14 days. Fasting serum lipid parameters were measured twice at baseline, after 14 days of RTV, and after 14 days of LPV/RTV, and comparisons were made at each time-point for levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, the total/HDL cholesterol ratio and triglycerides. RESULTS: After 14 days of RTV 100 mg bid, total cholesterol level increased by 10.2% (P<0.001), LDL cholesterol level increased by 16.2% (P<0.001), triglyceride levels increased by 26.5% (P<0.001), HDL cholesterol level decreased by 5.4% (P<0.01) and the total/HDL cholesterol ratio increased by 17.3% (P<0.001). The addition of LPV 400 mg bid to RTV 100 mg bid resulted in no significant further changes in LDL cholesterol or triglyceride level or total/HDL cholesterol ratio, but there were significant increases in both total cholesterol (8.0% increase; P=0.007) and HDL cholesterol levels (6.7% increase; P=0.008). CONCLUSIONS: Ritonavir dosed at 100 mg bid significantly increased the concentration of total cholesterol, LDL cholesterol, total/HDL cholesterol ratio and triglycerides and reduced HDL cholesterol concentration. The addition of LPV 400 mg bid to RTV 100 mg bid further increased both total and HDL cholesterol levels without affecting the total/HDL ratio.     

Oral Famciclovir for the Suppression of Recurrent Genital Herpes: A Randomized Controlled Trial

Context.— Recurrent genital herpes simplex virus (HSV) may be treated episodically, but this may not be sufficient for patients with frequent recurrences. Objective.— To determine the efficacy and safety of famciclovir in the suppression of recurrent genital HSV infection. Design.— A randomized, double-blind, placebo-controlled, parallel-group study. Setting.— Thirty university, hospital, or private outpatient referral centers in Canada and Europe. Patients.— A total of 455 patients (223 men, 232 women) aged 18 years or older with a history of 6 or more episodes of genital herpes during 12 of the most recent 24 months, in the absence of suppressive therapy, received study medication. Intervention.— Oral famciclovir, 125 mg or 250 mg 3 times daily or 250 mg twice daily, or placebo for 52 weeks. Main Outcome Measures.— Time to the first recurrence of genital HSV infection; the proportion of patients remaining free of HSV recurrence at 6 months; frequency of adverse events. Results.— In an intent-to-treat analysis, famciclovir significantly delayed the time to the first recurrence of genital herpes at all dose regimens (hazard ratios, 2.9-3.3;P< .001); median time to recurrence for famciclovir recipients was 222 to 336 days compared with 47 days for placebo recipients. The proportion of patients remaining free of HSV recurrence was approximately 3 times higher in famciclovir recipients (79%-86%) than in placebo recipients (27%) at 6 months (relative risks, 2.9-3.1;P <.001); efficacy was maintained at 12 months. Famciclovir was well tolerated with an adverse experience profile comparable to placebo. Conclusions.— Oral famciclovir (125 mg or 250 mg 3 times daily or 250 mg twice daily) is an effective, well-tolerated treatment for the suppression of genital HSV infection in patients with frequent recurrences.      

A pilot scheme for an integrated falls prevention service

The National Service Framework for the Older Person (Department of Health 2001) set standards for reducing the number of falls and serious injury. One way this might be achieved is through provision of a Specialist Falls Service. This paper describes a 3 year pilot project to introduce an Integrated Falls Service using money obtained from the local Health Authority Health Improvement fund.The article describes a partnership approach with the local council, therapy services and other agencies. The target group and referral mechanisms are discussed and costings given. A variety of interventions will be employed to include assessment and targeted exercises with education sessions. Hip protectors are available for high risk patients. Several indices will be used to evaluate this pilot scheme including balance measurements, confidence scales, supported interviews and diaries. Final evaluation will be in March 2004.     

Enterotoxigenic Escherichia coli (ETEC) in hospitalised Arab infants from Judea area-West Bank, Israel

Enterotoxigenic Escherichia coli and other related enterotoxigenic species were isolated from 176 (44%) of 399 infants hospitalised in ‘Caritas Baby Hospital’ in Bethlehem, during April–December 1993. Ninety four of the patients infected by ETEC, were clinically evaluated. Most of them suffered from diarrhoea, quite often with fever and vomiting. Dehydration occurred in 58.3% of the patients and failure to thrive (FTT) in 28.5% of them. Severe illness resulted in marasmus in five patients and in the death of two others. Most of the ETEC strains (84%) were of ST toxin type. Correlation was found between the degree of toxigenity and the severity of the gastroenteritis. The most prevalent ETEC ‘O’ serogroups were 0–6, 0–20, 0–8, 0–86, 0–126, 0–128 and 0167. Colonization Factors Antigens (CFAs) were identified in 36% of the isolates, CFAI was characteristic of group 0–126 and 0–128. In the principal O-groups there were high percentages of sensitivity to the antibiotics ceftriaxone, nalidixic-acid, gentamicin and norfloxacin, with resistance to anoxycillin, tetracycline and cotrimoxazole.     

A utilization and cost-benefit analysis of an aminoglycoside kinetics monitoring service.

Utilization and cost-benefit analysis of an aminoglycoside kinetics monitoring service were performed. Utilization was reviewed for 161 patients using the service between May 1, 1986 and April 30, 1987. The cost-benefit analysis used a cohort of 48 matched patients for the same time period. Pharmacy-based dosing recommendations were compared to physician-based dosing recommendations. According to specific guidelines, most pharmacy-based dosing recommendations were acceptable (91%) and followed either in full (76%) or in part (13.6%). According to specified criteria, gentamicin could have been substituted for tobramycin in 29.4% of courses of therapy. No statistically significant benefits (p less than 0.05) were associated with pharmacy-based recommendations, which cost $47.43 each, or $26.48 more than a physician-based recommendation. Although the service yields appropriate recommendations and is well received, our results suggest that further studies must be conducted to define methods by which a cost-benefit ratio greater than one may be realized.     

Synthetic CCK8 analogs with antagonist activity on pancreatic receptors: in vivo study in the rat, compared to non-peptidic antagonists.

The cholecystokinin octapeptide (CCK8)-derived synthetic peptides Boc-Tyr(SO3H)-Nle-Gly-DTrp-Nle-Asp-O-CH2-CH2-C6H5 (JMV179) and Boc-Tyr(SO3H)-Nle-Gly-DTrp-Nle-Asp-NH-CH2-CH2-C6H5 (JMV167) are antagonists of peripheral cholecystokinin (CCK) receptors in vitro. In the present study, antagonist activity of these peptides was studied on rat pancreatic secretion in vivo, and compared to those of other peptidic molecules and to the non-peptidic antagonists L364718, D-, L-, DL-lorglumide, and proglumide. The decreasing order of antagonist potencies on amylase release in vitro was L364718 greater than JMV179 greater than lorglumide greater than JMV167 greater than proglumide; JMV179 was 25 times less potent than L364718 and 300 times more potent than JMV167. The decreasing order of antagonist potencies on protein output in pancreatic juice in vivo was L364718 greater than JMV167 greater than JMV179 greater than lorglumide greater than proglumide; JMV167 was two times more potent than JMV179 and only 8 times less potent than L364718. Increased potency of JMV167, relative to JMV179 under in vivo conditions, is probably due to the slower rate of catabolism of the phenylethylamide group, relative to the phenylethylester group, since the metabolite issued from hydrolysis of the ester bond was totally inactive. This study shows that it is possible to obtain peptidic CCK antagonists, which are active and potent in vivo, and provides a quantitative measurement of potency changes occurring in vivo for several peptidic and non-peptidic antagonists.