A relational database to store Poison Centers calls

Italian Poison Centers answer to approximately 100,000 calls per year. Potentially, this activity is a huge source of data for toxicovigilance and for syndromic surveillance. During the last decade, surveillance systems for early detection of outbreaks have drawn the attention of public health institutions due to the threat of terrorism and high-profile disease outbreaks. Poisoning surveillance needs the ongoing, systematic collection, analysis, interpretation, and dissemination of harmonised data about poisonings from all Poison Centers for use in public health action to reduce morbidity and mortality and to improve health. The entity-relationship model for a Poison Center relational database is extremely complex and not studied in detail. For this reason, not harmonised data collection happens among Italian Poison Centers. Entities are recognizable concepts, either concrete or abstract, such as patients and poisons, or events which have relevance to the database, such as calls. Connectivity and cardinality of relationships are complex as well. A one-to-many relationship exist between calls and patients: for one instance of entity calls, there are zero, one, or many instances of entity patients. At the same time, a one-to-many relationship exist between patients and poisons: for one instance of entity patients, there are zero, one, or many instances of entity poisons. This paper shows a relational model for a poison center database which allows the harmonised data collection of poison centers calls.     

The effects of chlorhexidine gel on Streptococcus mutans infection in 10-month-old infants: a longitudinal,placebo-controlled,double-blind trial

PURPOSE: This study investigated the long-term effects of 0.2% chlorhexidine gel, used as a weekly brush-on gel, on Streptoccocus mutans infection in 10-month-old infants. METHODS: The investigation followed the criteria of a placebo-controlled, double-blind, longitudinal clinical trial. Infants were recruited at birth and oral microbiological swabs were taken at 3 monthly intervals, together with medical, dental, dietary and brushing histories. Children who were found to be colonized with S. mutans were randomly assigned to either the chlorhexidine-gel group (N = 50) or placebo gel group (N = 46), and parents were instructed to brush the gel on the teeth once per week for 12 weeks. In another control group (N = 210), infants did not use either chlorhexidine or placebo gels. Saliva samples were cultured using S. mutans-selective tryptone-yeast extract-cysteine-sucrose-bacitracin (TYCSB) agar. The mean age of the children was 10.2 +/- 2.6 months at the start of the trial and subjects were followed until the ages of 18 months. RESULTS: In the children with initial low S. mutans counts of < 300 CFU/mL, there was a significant percentage reduction in S. mutans counts in the chlorhexidine-gel group compared to the placebo gel and no-gel control groups after 3 months of weekly gel brushing. However, no significant differences with the placebo group were observed after 15 months of follow-up. There were 39 children (41%) who achieved reduction of their S. mutans to 0 CFU/mL. Compared to those who remained infected with S. mutans, these children had higher toothbrushing frequencies (P < .001) and toothpaste use (P < .001), as well as lower frequencies of daily feeds (P < .01), and lesser weekly frequencies of sweet solids and liquids (P < .001). CONCLUSIONS: Children with relatively low initial S. mutans counts (< 300 CFU/mL) showed a reduction in S. mutans counts in the first 3 months when 0.2% chlorhexidine gel was brushed on the teeth weekly. No differences were observed when compared with the placebo and no-treatment groups at later follow-up periods.     

AZD1480: A Phase I Study of a Novel JAK2 Inhibitor in Solid Tumors

Background.

AZD1480 is a novel agent that inhibits Janus-associated kinases 1 and 2 (JAK1 and JAK2). The primary objective of this phase I study was to investigate the safety and tolerability of AZD1480 when administered as monotherapy to patients with solid tumors.

Methods.

Thirty-eight patients with advanced malignancies were treated at doses of 10–70 mg once daily (QD) and 20–45 mg b.i.d. .

Results.

Pharmacokinetic (PK) analysis revealed rapid absorption and elimination with minimal accumulation after repeated QD or b.i.d. dosing. Exposure increased in a dose-dependent manner from 10–50 mg. Maximum plasma concentration (C_max) was attained ∼1 hour after dose, and t_1/2 was ∼5 hours. Pharmacodynamic analysis of circulating granulocytes demonstrated maximum phosphorylated STAT3 (pSTAT3) inhibition 1–2 hours after dose, coincident with C_max, and greater pSTAT3 inhibition at higher doses. The average pSTAT3 inhibition in granulocytes at the highest dose tested, 70 mg QD, was 56% (standard deviation: ±21%) at steady-state drug levels. Dose-limiting toxicities (DLTs) consisted of pleiotropic neurologic adverse events (AEs), including dizziness, anxiety, ataxia, memory loss, hallucinations, and behavior changes. These AEs were generally reversible with dose reduction or treatment cessation.

Conclusions.

Whether the DLTs were due to inhibition of JAK-1/2 or to off-target effects is unknown. The unusual DLTs and the lack of clinical activity led to discontinuation of development.     

Sevoflurane improves the neuroendocrine stress response during laparoscopic pelvic surgery

PURPOSE: Stress response to surgery is modulated by several factors, including magnitude of the injury, type of procedure (e.g., laparoscopy vs laparotomy) and type of anesthesia. Our purpose was to compare intra- and postoperative hormonal changes during isoflurane vs sevoflurane anesthesia, in a clinical model of well defined operative stress (laparoscopic pelvic surgery). METHOD: In this prospective randomized clinical study, 20 women requiring laparoscopic pelvic surgery for benign ovarian cysts received either a standard isoflurane plus fentanyl (Group A) or sevoflurane plus fentanyl anesthesia (Group B). Blood samples were collected preoperatively, 30 min after the beginning of surgery, at the end of surgery after extubation, and two and four hours after the end of surgery. Intra- and postoperative plasma levels of norepinephrine, epinephrine, adrenocorticotropic hormone (ACTH), cortisol, growth hormone (GH) and prolactin (PRL) were measured. RESULTS: Catecholamine levels and postoperative pain were similar in both groups. Nonetheless, in comparison to Group A, Group B showed a significant decrease of ACTH, cortisol and GH levels (A vs B at the end of surgery: ACTH 160 +/- 45 vs 100 +/- 40 pg.mL(-1); cortisol 45 +/- 8 vs 23 +/- 7 microg.dL(-1); GH 3 +/- 2 vs 0.8 +/- 0.4 ng.mL(-1); P < 0.001 for all), but enhanced PRL levels (A vs B, at 30 min after the beginning of surgery: 139 +/- 54 vs 185 +/- 22 ng.mL(-1); at the end of surgery: 100 +/- 27 vs 141 +/- 45 ng.mL(-1); P < 0.001 for both). CONCLUSIONS: In the clinical setting of low stress laparoscopic surgery, the type of volatile anesthetic significantly affected the stress response; the changes associated with sevoflurane suggested a more favourable metabolic and immune response compared to isoflurane.     

Passivrauchen unter experimentellen Bedingungen und in Feldversuchen

Schlussfolgerungen Problem Nummer 1 des Passivrauchens sind Belästigungen durch Gerüche sowie Reizwirkungen in den Augen und Atemwegen. Unsere Versuche mit gesunden VP zeigen, dass eine Luftverunreinigung durch Tabakrauch, welche von 5 ppm CO begleitet ist, bei rund 15 bis 20 % der Personen zu deutlichen objektiven und subjektiven Reizerscheinungen in den Augen Anlass gibt.Wenn die Luftverunreinigung durch Tabakrauch unter einem Pegel von 2 ppm CO liegt, dann sind Reizwirkungen und Belästigungen für den gesunden Menschen als gering und zumutbar zu bewerten.Diese Schlussfolgerungen sind nur gültig für erwachsene und gesunde Personen. Welche Grade der Luftverunreinigung durch Tabakrauch für kranke Personen oder Kleinkinder zumutbar sind, ist noch eine offene Frage.

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Passive smoking under experimental conditions and in a field study

Summary The degree of annoyance and irritations has been investigated on subjects exposed for 1 hour to constant concentrations of cigarette smoke as well as in 3 restaurants of Zurich.

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Exposition passive à la fumée de tabac dans des conditions experimentales et dans la vie courante

Résumé Le degré de gène et d'irritations a été étudié chez des sujets exposés pendant une heure à des concentrations constantes de fumée de cigarettes ainsi que dans 3 restaurants de la ville de Zurich.

     

Possible mechanisms underlying age-related resistance to bovine babesiosis

Calves infected with the tick-borne parasites Babesia spp. do not develop severe clinical babesiosis. Instead they display persistent low parasitaemias without any apparent ill-effects. This age-related resistance not only benefits the host, but also furthers parasite transmission. Both calves and adult animals respond with a Th I immune response to primary infection. Here we hypothesize that the difference in the outcome of infection may at least partly be explained by the localization and timing of the inflammatory response: in calves NO production occurs early and appears to be concentrated in the spleen. On the other hand, there is evidence that a delayed and systemic inflammatory response occurs in adult animals that is ineffectual and probably contributes to the pathogenesis. An improved understanding of the possible mechanisms that underlie this phenomenon may lead to new approaches for the treatment and immune prophylaxis of the disease.