The association between preterm newborn hypotension and hypoxemia and outcome during the first year

Ninety-eight newborn infants, less than 34 weeks at birth, were studied to examine the relationship between newborn hypotension and hypoxemia and brain damage. Heart rate, blood pressure and oxygen tension were recorded continuously during the 96 h following delivery. Outcome measures included neuropathology in children who died, and motor and cognitive development at one year corrected age in children who survived. There were 22 children with a minor and 27 with a major abnormal outcome. There was a relationship between newborn hypotension, newborn hypoxemia and low birth weight, and a major abnormal outcome. The probability of a major abnormal outcome increased from 8% in newborns with no hypotension or hypoxemia, to 53% in children with both hypotension and hypoxemia. These findings support the contention that combinations of sustained newborn hypotension and hypoxemia are important factors in the development of brain damage, accounting for a major abnormal outcome.     

Prevalence and determinants of electrocardiographic abnormalities in sub-Saharan African individuals with type 2 diabetes

Aim

This study assessed the prevalence and determinants of electrocardiographic abnormalities in a group of type 2 diabetes patients recruited from two referral centres in Cameroon.

Methods

A total of 420 patients (49% men) receiving chronic diabetes care at the Douala General and Yaoundé Central hospitals were included. Electrocardiographic abnormalities were investigated, identified and related to potential determinants, with logistic regressions.

Results

The mean age and median duration of diagnosis were 56.7 years and four years, respectively. The main electrocardiographic aberrations (prevalence %) were: T-wave abnormalities (20.9%), Cornell product left ventricular hypertrophy (16.4%), arrhythmia (16.2%), ischaemic heart disease (13.6%), conduction defects (11.9%), QTc prolongation (10.2%) and ectopic beats (4.8%). Blood pressure variables were consistently associated with all electrocardiographic abnormalities. Diabetes-specific factors were associated with some abnormalities only.

Conclusions

Electrocardiographic aberrations in this population were dominated by repolarisation, conduction defects and left ventricular hypertrophy, and were more related to blood pressure than diabetes-specific factors.     

Influence of lipophilicity on the diffusion of cephalosporins into the cerebrospinal fluid

Summary— The aim of this quantitative structure-activity relationship (QSAR) study was to investigate the influence of lipophilicity on the diffusion of cephalosporins into the cerebrospinal fluid (CSF). The lipophilicity was expressed as the chromatographic capacity factor (log k'_w) determined by high-performance liquid chromatography in a reversed-phase system. The penetration of eight cephalosporins into CSF was studied in male Wistar rats receiving the drugs intramuscularly (1.5 mg/kg). One hour after administration, CSF and blood samples were collected, and concentrations of free drug were measured in CSF (C_CSF) and in plasma (C_P). A significant parabolic relationship was sought between lipophilicity (log k'_w) and the capacity of diffusion across the blood-brain barrier expressed as log (C_CSF/C_P). The cephalosporins exhibiting a moderate lipophilicity diffused well into CSF. A pharmacokinetic study was performed at 1, 2 and 4 h after administration of three cephalosporins: cefazolin, ceftriaxone and cefsulodin. These compounds were choosen according to their lipophilicities (low, moderate and high values, respectively). The AUC_0–4h for both free plasma (AUC_P) and cerebrospinal fluid (AUC_CSF) concentrations were determined. The AUC_CSF/AUC_P ratio presented a maximum value for a strongly albumin bound cephalosporin, ceftriaxone. In our experimental conditions, the ideal lipophilicity (log k'_w) range for diffusion of cephalosporins from plasma into CSF was between 1.6 and 1.8.     

Osteoporosis: radiographic detection of fluoride-induced extra-axial bone formation

New bone formation in the peripheral skeleton was detected radiographically in 67% (22/33) of patients studied for new periarticular pain among 72 patients with osteoporosis being treated with fluoride, 66-88 mg/d, for 6 or more months. Changes included periosteal and endosteal new bone formation as well as trabecular thickening and were localized in areas of high mechanical stress. Sufficient mineral deposition for radiographic detection required 6 or more months of fluoride treatment. Radiologists must differentiate fluoride-induced new bone formation from other-processes, such as fractures and tumor, and elicit information on fluoride intake in suspicious cases.