A change in rabies post-exposure treatment guidelines after decision analysis in Israel

BACKGROUND: Rabies remains a significant public health problem in Israel. Some 16 000-20 000 persons come yearly to the district health offices after being bitten by animals and 16-18% receive rabies post-exposure treatment. A quality assessment of the rabies post-exposure prophylaxis decisions was never held in Israel before. The purpose of this study was to analyse the decision-making process and to update our rabies prevention guidelines accordingly. METHODS: A retrospective evaluation study of physicians' compliance with rabies post-exposure treatment guidelines in Haifa District Health Office, Ministry of Health, during 1/11/1999 to 31/12/2002. Records of all persons seeking advice (5037) following exposure to animals during the 3 years of the study were examined. Of these 2477 were eligible for the quality audit. The remaining files were analysed for the relative contribution of the different variables considered in the decision-making process. RESULTS: Observed agreement rate and Kappa coefficient were 0.984 and 0.803, respectively. The probability of recommending vaccination was greater when the exposure was from stray dogs as opposed to cats (OR = 48.9; 95% CI 17.9-133.3), if the wound was a bite rather than a scratch (OR = 29.0; 95% CI 19.5-43.2) or in a location defined as rabies enzootic as opposed to rabies free (OR = 7.6; 95% CI 5.8-10.1). CONCLUSIONS: The study demonstrated high compliance with the written guidelines. We weighted the relative importance of the variables determining the decisions. This information was used in formulating the updated guidelines.     

Design,synthesis of new chiral fluorine-containing β-hydroxysulfonamides from natural amino acids and study of their anti-inflammatory and analgesic activities

A series of new chiral fluorine-containing β-hydroxysulfonamides were conveniently synthesized in three steps, starting from natural L-amino acids, and evaluated for their anti-inflammatory and analgesic activities. The structures of these compounds were supported by FT-IR, ¹H, ¹³C and ¹⁹F NMR, elemental analysis and HRMS. Among the tested compounds, 4c, 4g and 4h exhibited promising anti-inflammatory activity. Moreover, compound 4h showed a significant analgesic activity. The structure–activity relationships of selected compounds were discussed.     

Relationship of very low serum 25-hydroxyvitamin D<Subscript>3</Subscript> levels with long-term survival in a large cohort of colorectal cancer patients from Germany

To investigate the association of serum 25-hydroxyvitamin D (25(OH)D₃) with survival in a large prospective cohort study of colorectal cancer (CRC) patients. The study population consisted of 2,910 patients diagnosed with CRC between 2003 and 2010 who participated in the DACHS study, a multicenter study from Germany with comprehensive long-term follow-up. 25(OH)D₃ was determined in serum samples collected shortly after cancer diagnosis by High Performance Liquid Chromatography-Electro Spray Ionization-Mass Spectrometry. Analyses of survival outcomes were performed using Cox regression with comprehensive adjustment for relevant confounders. The majority (59%) of CRC patients were vitamin D deficient (serum 25(OH)D₃ levels <30 nmol/L). During a median follow-up of 4.8 years, 787 deaths occurred, 573 of which were due to CRC. Compared to patients in the highest 25(OH)D₃ quintile (>45.20 nmol/L), those in the lowest 25(OH)D₃ quintile (<11.83 nmol/L) had a strongly increased mortality. Adjusted hazard ratios (95% Confidence Interval) were 1.78 (1.39–2.27), 1.65 (1.24–2.21), 1.32 (1.03–1.71) and 1.48 (1.18–1.85) for all-cause mortality, CRC-specific mortality, recurrence-free and disease-free survival, respectively. Subgroup analyses did not show any significant effect modification across strata defined by sex, age, stage, body mass index, or the late entry. Dose–response analyses showed a strong inverse relationship between serum 25(OH)D₃ levels and survival endpoints at 25(OH)D₃ levels <30 nmol/L, and no association with mortality at higher 25(OH)D₃ levels. Vitamin D deficiency is highly prevalent in CRC patients and a strong independent predictor of poor prognosis. The possibility of enhancing CRC prognosis by vitamin D supplementation, ideally combined with outdoor physical activity, should be evaluated by randomized controlled trials focusing on patients with vitamin D deficiency.     

Increased mitochondrial complex I activity in platelets of schizophrenic patients

It is believed that dopamine and alterations of energy metabolism in cortical and subcortical structures are involved in the pathophysiology of schizophrenia. Recently, we and others have shown that dopamine may affect energy metabolism by interacting with mitochondrial complex I activity in rats both in vivo and in vitro. In this study activity of complexes I and IV was assessed in mitochondria isolated from blood platelet of schizophrenic patients and compared to patients with affective disorders and healthy control subjects. Seventy-seven in-patients who met DSM-IV criteria for schizophrenia (in acute exacerbation), bipolar disorder depressed type (BP), or recurrent major depressive disorder (MDD) and 24 control subjects participated in the study. A highly significant increase (240%, p < 0.001) in complex I activity but not in complex IV, was detected in medicated and unmedicated schizophrenic patients compared to controls. No such change was observed in patients with affective disorders. The data demonstrate a specific and selective, alteration in platelet complex I activity in schizophrenic patients, which is not related to medication. If this abnormality in platelet mitochondria reflects brain alterations, it may further support the relevance of alterations in energy metabolism to the pathophysiology of schizophrenia. Finally in the lack of any clinically relevant biological marker for schizophrenia, complex I activity in platelets might become a useful peripheral marker for this disorder.     

麻醉后监护室护理质量敏感指标的构建

目的构建适用于麻醉后监护室(post anesthesia care unit,PACU)的护理质量敏感指标,为PACU治疗监测及管理提供标准、量化的依据。方法以\"结构-过程-结果\"理论模式为依据,借鉴美国国家护理质量指标数据库及其他国内外麻醉护理专家的研究成果形成指标初稿,运用德尔菲技术进行3轮专家咨询,结合帕累托定律确定指标的内容和科学的测量方法。结果构建了包含复苏时间中位数、收治各类麻醉患者比例、低体温干预有效率、术后疼痛干预有效率等11项指标的PACU护理质量敏感指标体系。3轮专家咨询的问卷有效回收率均为100%,专家权威系数分别为0.86、0.84、0.90,专家意见的肯德尔和谐系数分别为0.245、0.256和0.356 (P<0.01)。结论 PACU护理质量敏感指标涵盖麻醉后监护的关键内容,可操作性强,专科特色鲜明,具有科学性和实用性,可为基于数据的持续质量改进和提高PACU护理质量提供参考。