Program to improve colorectal cancer screening in a low-income, racially diverse population: a randomized controlled trial

PURPOSE More effective strategies are needed to improve rates of colorectal cancer screening, particularly among the poor, racial and ethnic minorities, and individuals with limited English proficiency. We examined whether the direct mailing of fecal occult blood testing (FOBT) kits to patients overdue for such screening is an effective way to improve screening in this population. METHODS All adults aged 50 to 80 years who did not have documentation of being up to date with colorectal cancer screening as of December 31, 2009, and who had had at least 2 visits to the community health center in the prior 18 months were randomized to the outreach intervention or usual care. Patients in the outreach group were mailed a colorectal cancer fact sheet and FOBT kit. Patients in the usual care group could be referred for screening during usual clinician visits. The primary outcome was completion of colorectal cancer screening (by FOBT, sigmoidoscopy, or colonoscopy) 4 months after initiation of the outreach protocol. Outcome measures were compared using the Fisher exact test. RESULTS Analyses were based on 104 patients assigned to the outreach intervention and 98 patients assigned to usual care. In all, 30% of patients in the outreach group completed colorectal cancer screening during the study period, compared with 5% of patients in the usual care group (P <.001). Nearly all of the screenings were by FOBT. The groups did not differ significantly with respect to the percentage of patients making a clinician visit or the percentage for whom a clinician placed an order for a screening test. CONCLUSIONS The mailing of FOBT kits directly to patients was efficacious for promoting colorectal cancer screening among a population with high levels of poverty, limited English proficiency, and racial and ethnic diversity. Non-visit-based outreach to patients may be an important strategy to address suboptimal rates of colorectal cancer screening among populations most at risk for not being screened.     

“<Emphasis Type="Italic">Vivo para consumirla y la consumo para vivir</Emphasis>” [“I live to inject and inject to live”]: High-Risk Injection Behaviors in Tijuana,Mexico

Injection drug use is a growing problem on the US-mexico border, where Tijuana is situated. We studied the context of injection drug use among injection drug users (IDUs) in Tijuana to help guide future research and interventions. Guided indepth interviews were conducted with 10 male and 10 female current IDUs in Tijuana. Topics included types of drug used, injection settings, access to sterile needles, and environmental influences. Interviews were taped, transcribed verbatim, and translated. Content analysis was conducted to identify themes. Of the 20 IDUs, median age and age at first injection were 30 and 18. Most reported injecting at least daily: heroin (“carga,” “chiva”, “negra”), methamphetamine (“crico,” “cri-cri”), or both drugs combined. In sharp contrast to Western US cities, almost all regularly attended shooting galleries (“yongos” or “picaderos”) because of the difficulties obtaining syringes and police oppression. Almost all shared needles/paraphernalia [“cuete” (syringe), “cacharros” (cookers), cotton from sweaters/socks (filters)]. Some reported obtaining syringes from the United States. Key themes included (1) pharmacies refusing to sell or charging higher prices to IDUs, (2) ample availability of used/rented syringes from “picaderos” (e.g., charging approximately 5 pesos or “10 drops” of drug), and (3) poor HIV/AIDS knowledge, such as beliefs that exposing syringes to air “kills germs.” This qualitative study suggests that IDUs in Tijuana are at high risk of HIV and other blood-borne infections. Interventions are urgently needed to expand access to sterile injection equipment and offset the potential for a widespread HIV epidemic.     

A prospective controlled crossover trial of a new presentation (10% vs. 5%) of a heat-treated intravenous immunoglobulin

Thirty-five patients with primary or secondary immunoglobulin deficiency were included in a crossover study to test the tolerance, clinical efficacy, and safety of a liquid pasteurized 10% concentrated intravenous gammaglobulin versus a 5% concentrated presentation. No statistically significant differences were found between these parameters. Total serum immunoglobulin-(Ig)G and IgG subclass levels were similar in both groups. No modifications in serum alanine transferase (ALT) levels and viral status (HBsAg, HCV-RNA, p24 antigen or RNA for HIV) were observed throughout treatment. Adverse reactions were reported in 3 out of 70 infusions (4.3%), 2 in the experimental group and 1 in the control group. The maximum recommended rate of infusion for the 10% gammaglobulin is the same as for the 5% gammaglobulin product (0.04 ml/kg/min); generally speaking, this means that infusion time is halved. We conclude that a 10% gammaglobulin product is a well-tolerated, clinically efficacious and safe intravenous preparation, and that it could be a short infusion time alternative for primary and secondary antibody deficiencies.     

Fat-Free Mass Depletion and Inflammation in Patients with Bronchiectasis

Fat-free mass depletion has been related to increased inflammatory activity and to increased morbidity and mortality in chronic respiratory diseases. The aims of our study were to determine the nutritional status and serum levels of adipocytokines and inflammatory cytokines in patients with bronchiectasis of any etiology and their relation with respiratory parameters. A cross-sectional study was designed that included patients aged >14 years with diagnostic criteria for bronchiectasis. Anthropometric parameters; a diet questionnaire; hand grip dynamometry; levels of leptin, adiponectin, interleukin-6 (IL-6), tumor necrosis factor-α, and ultrasensitive C-reactive protein; as well as respiratory parameters (ie, clinical, radiologic, and spirometric values) were assessed. Ninety-three clinically stable patients were recruited, 43 with cystic fibrosis, 31 with noncystic fibrosis bronchiectasis, and 19 with cystic fibrosis transmembrane conductance regulator-related bronchiectasis. Fat-free mass depletion was present in 31% of patients, with no differences according to the etiology of the bronchiectasis. Correlations were found between inflammatory cytokines (ie, IL-6) and exacerbations, bronchorrea, forced expiratory volume in 1 second, and Bhalla score. Patients with worse respiratory disease severity, malnutrition, and diabetes had significantly higher levels of IL-6. Adiponectin correlated significantly and positively with fat mass and fat mass index and negatively with fat-free mass, fat-free mass index, and hand dynamometry. Leptin correlated positively with body mass index, fat mass and fat mass index, and negatively with fat-free mass, fat-free mass index, and dynamometry. Patients with bronchiectasis present a high percentage of fat-free mass depletion, independent of the etiology of the disease. The levels of inflammatory cytokines (especially IL-6) may be useful markers of disease severity. Adiponectin levels were higher in patients with fat-free mass depletion.     

Role of ABC transporters in veterinary drug research and parasite resistance

A considerable body of research has been carried out in order to throw light on the pharmacological and toxicological impact of ATP-binding cassette (ABC) drug efflux transporters such as P-glycoprotein and Breast Cancer Resistance Protein (BCRP/ABCG2/MXR). Most studies focus on their role in rendering cancer cells resistant to anticancer drugs. Drug transporters are expressed in many tissues and they are strongly involved in the oral bioavailability, and the hepatobiliary, direct intestinal and renal excretion of many drugs. In veterinary therapy, some anti parasitic drugs and/or their metabolites, such as ivermectin, moxidectin, albendazole sulfoxide, which are widely used, have been shown to be actively transported by efflux pumps. This interaction plays an important role in drug disposition since its inhibition has been shown to increase the drug bioavailability in some domestic species. Moreover, some authors have reported that parasite resistance to anthelmintic drugs may be mediated by parasite P-glycoprotein efflux. In addition, the importance of milk residues for human nutrition has aroused increasing concern about the inadvertent transfer of drugs and other substances into mammary milk of domestic animals, potentially posing a health risk to consumers. Recently, the important role of BCRP in the secretion of its substrates in milk has been demonstrated.     

Analysis of ginkgolides and bilobalide in food products using LC-APCI-MS

A method was developed for the extraction and quantification of five marker compounds characteristic of Ginkgo biloba. Five ginkgo terpene trilactones: bilobalide and ginkgolides A, B, C, and J, were selected as marker compounds for this study. Initial studies produced a simple methanol extraction method for determination of gingko markers in solid dietary supplements. Five dietary supplements were analyzed and the results were later compared to the concentrations detected in the analysis of beverages. Beverage samples were prepared by extracting the ginkgo terpene trilactones using an optimized solid phase extraction (SPE) method. The extracts were analyzed using LC–atmospheric pressure chemical ionization (APCI)–MS in the negative ionization mode. The limits of detection of the extraction method ranged from 6.8 to 3.2 ng mL⁻¹. Using the optimized method, 14 drinks and 3 tea products were analyzed. Concentrations of total marker compounds in drinks ranged between 1685 and 21.4 ng mL⁻¹ with individual ginkgo terpene trilactones being detected at ppb concentrations. Analysis of brewed tea products presented much higher total marker compound concentrations ranging from 8.12 and 16.6 μg mL⁻¹. Analytical results reproducibility data, and recovery of the SPE method are presented.     

Antibody responses in adult and neonatal BALB/c mice to immunization with novel Bordetella pertussis vaccine formulations

A balanced or Th-1 type immune response is required for effective clearance of many pathogens such as Bordetella pertussis, the causative agent of whooping cough. Since current acellular pertussis vaccines induce limited Th-1 type immune responses, novel vaccine formulations are needed to induce protective immunity in the infant in the earliest stages of life. Here, we developed a novel vaccine platform consisting of genetically detoxified pertussis toxoid (PTd) with multiple adjuvant components including CpG oligodeoxynucleotides, polyphosphazenes, and cationic innate defence regulator peptides. Co-formulation with these immunomodulators increased the serum IgG2a and IgG1 antibody titres in adult mice when compared to immunization with each of the selected adjuvants or immunization with PTd antigen alone. When used in combination, these adjuvants were able to induce a superior IgG2a response in both adult and neonatal mice, when compared to antigen alone or commercial vaccines. The increased response observed when using this adjuvant formulation was also initiated earlier and, moreover, was maintained over a period of greater than 22 months. The adjuvant platform also showed an ability to induce an immune response in a greater number of mice as compared to antigen alone. This suggests that this uniquely adjuvanted vaccine induces a stronger and more balanced immune response with an earlier onset of this response than vaccination with PTd antigen alone.     

Elastofibroma dorsi as a cause of shoulder pain or snapping scapula.

Elastofibroma dorsi is a benign soft tissue tumor, not well-known because of its low incidence, located in the chest wall in the subscapular area. In 10 patients with elastofibroma dorsi, the clinical symptoms were snapping scapula or shoulder pain. In three of the patients, the previous diagnosis was shoulder impingement, and the patients were treated without success. The clinical diagnosis was confirmed by magnetic resonance imaging. Surgical treatment resolved the symptoms in all patients. This tumor should be considered in the differential diagnosis of snapping scapula or shoulder impingement.     

Clinical, radiological and cerebrospinal fluid presentation of neurocysticercosis: a prospective study

The wide clinical spectrum of neurocysticercosis has led to many attempts at clinical, radiological, CSF and other classifications. Based on an objective review of the relevant literature and on a prospective study of 42 patients with active neurocysticercosis, a new classification is proposed, based on clinical, tomographic, magnetic resonance and CSF evidence of viability of cysts. The first step is to define whether the disease is active or not. Inactive disease may be parenchymal calcifications or hydrocephalus. Active disease may be intraparenchymal, extraparenchymal or mixed. Statistical analysis of 42 cases with active disease shows intraparenchymal disease to occur in younger patients, perhaps more frequently in females, and to have a better prognosis than extraparenchymal of mixed disease. The latter appears to have the worst prognosis. Therapeutic implications are that only active disease warrants etiological therapy. There remain doubts about the best therapy for some infrequent subtypes of extraparenchymal and mixed disease.     

Thymectomy and immunosuppression in myasthenia gravis: a prospective study

Between 1982 and 1988 24 women and 6 men with myasthenia gravis were included in a prospective and standardized diagnostic and therapeutic protocol. Age varied between 10 and 74 years (34 +/- 16, mean +/- standard deviation). Three patients with the ocular form were treated with pyridostigmine. Four patients with the generalized form and advanced age received steroids and/or azathioprine. Twenty-three patients with the generalized form underwent thymectomy followed by prednisone and/or azathioprine. One patient died after complex thymectomy for invasive thymoma. Another died soon after admission in myasthenic/cholinergic crisis. Two other patients had minor complications of thymectomy. Of 19 patients followed for 1-60 (mean 24) months, 11 (58%) are in remission, one of them without any medication.