The differences in health concerns between mothers and health care professionals in a preventive community set up

To assess the degree to which mothers, nurses and pediatricians share common concerns regarding infants' health and well-being a cross-sectional survey with stratified demographic sampling was conducted. A 12–item questionnaire pertaining to health concerns was administered to 22 mothers of infants between 1 and 18 months of age, treated at six Well Baby community clinics with 36 nurses and 25 pediatricians. Mothers and health care professionals expressed significantly different concerns. Pediatricians and nurses shared a more similar order of concerns. However, they too differed on the degree of concern related to some of the health issues, i.e. nurses perceived the issues related to feeding, behaviour, skin, sleep and daily routines as significantly more important than did pediatricians. Additional efforts should be devoted to improve and clarify communication between mothers and health care professionals.     

Sobh Formula: A New Formula for Estimation of Creatinine Clearance in Healthy Subjects and Patients with Chronic Renal disease

Backgrounds: Cockcroft–Gault formula overestimates creatinine clearance (Ccr) in obese or edematous patients. This limitation urged us to develop a new formula that can overcome the limitation of Cockcroft–Gault formula. Methods: We developed a new formula suitable for rapid bedside estimation of creatinine clearance in healthy adults and elderly persons and patients with chronic renal disease considering the surface area as a reliable factor for estimation of creatinine clearance. This cross sectional study included 182 individuals (healthy persons and patients with chronic kidney disease). Ccr was estimated by different methods including 24 hours urine collection, Cockcroft–Gault equation, and our new formula, and ^99mTc-DTPA isotope clearance which was considered as a standard method for comparison between the other methods.Results: Our new formula had a statistically significant higher correlation coefficient with the standard ^99mTc-DTPA isotope clearance for all groups included in this study (r=0.97) than either Cockcroft–Gault formula (r=0.90) or 24 hours urine collection method (r=0.88). Conclusion: Our formula is a step forward for a better bedside assessment of kidney function in both healthy individuals and patients with chronic kidney disease.     

Floating left atrial mass in a patient with mitral stenosis

Mobile masses within the left atrial cavity are commonly caused by organized thrombi or left atrial myxoma. The use of transesophageal echocardiography has provided means for differentiation between the 2 conditions. We report a case of a left atrial mass in a female patient who presented with mitral stenosis and atrial fibrillation, and was diagnosed by transthoracic echocardiography (TTE). The mass appeared freely mobile but did not prolapse between the mitral leaflets due to the tightly stenosed valve orifice. In the presence of mitral stenosis, atrial fibrillation and dilated left atrium, the appearance of the mass was in keeping with mobile thrombus. Consequently, the patient was referred for surgical treatment and the mass removed through left atriotomy. Microscopic examination revealed a highly organized thrombus. We conclude that TTE is still a reliable tool in the diagnosis of large mobile atrial thrombi; TEE is needed when differentiation from atrial myxoma is difficult.     

Sjogren's syndrome: concomitant H. pylori infection and possible correlation with clinical parameters

OBJECTIVE: To identify whether or not there are clinical markers that correlate with Helicobacter pylori (H. pylori) infection in patients with Sjogren's syndrome (SS) and its implication to handling this group of patients. METHODS: Four groups of patients were studied. Group 1, 36 patients with primary SS; group 2, 31 patients with secondary SS; group 3, 46 patients with various connective tissue diseases not suffering from sicca symptoms, and group 4, 64 healthy controls. Clinical assessment was done and a score for disease manifestation was given for every SS patient. Serum IgG and IgM antibodies to H. pylori were assessed by ELISA. RESULTS: The prevalence and mean titer of H. pylori infection in patients with SS in group 1 (80.6%) and 2 (71%) were significantly higher than in group 3 (60.9%) and 4 (56.3%) (P < 0.01). There was significant correlation between H. pylori infection and age, disease duration, global score for disease status and C-reactive protein (CRP) in SS patients. On the other hand, there was no significant correlation with body mass index, and erythrocyte sedimentation rate (ESR). CONCLUSION: Patients with SS are more prone to have H. pylori infection in comparison to other connective tissue diseases. Serum antibody titer to H. pylori correlated with index for clinical disease manifestations, age, disease duration and CRP. Assessment of H. pylori infection in older patients suffering from active SS for a relatively long duration is recommended, especially those suffering form primary SS for more than 3 years.     

Escitalopram/reboxetine combination in depressed patients with substance use disorder

Acting pharmacologically on different transmitter systems has been suggested to have some advantages in patients with substance abuse and may possibly address a larger spectrum of symptoms. One major drawback of using antidepressants addressing several neurotransmitters is that the relative activities on the different neurotransmitters cannot individually be adjusted. Combining antidepressants targeting different neurotransmitter systems may allow adapting the effect on each neurotransmitter system corresponding to patients' response and tolerance. Three cases of patients presenting a substance use disorder with comorbid major depression episodes are presented, who were treated with a reboxetine/escitalopram combination and who showed a rapid response of their depressive syndrome.     

Preoperative rofecoxib oral suspension as an analgesic adjunct after lower abdominal surgery: the effects on effort-dependent pain and pulmonary function

Rofecoxib is a selective cyclooxygenase-2 inhibitor that reduces pain and inflammation without inhibiting platelet function. We examined its effects on effort-dependent pain, postoperative morphine requirements, and pulmonary function in 48 patients recovering from open abdominal surgery. Spirometric measurement of forced expiratory volume(1) and vital capacity (FVC) were assessed preoperatively. One hour before the induction of a standardized general anesthetic, patients were given either placebo oral suspension (Group A), or rofecoxib oral suspension (25 mg [Group B] or 50 mg [Group C]) in a double-blinded manner. Postoperative pain control was provided with IV morphine in the postanesthesia care unit and IV-patient-controlled analgesia morphine on the patient care unit. Morphine dose, pain intensity at rest, and pain after respiratory effort (postoperative spirometry) were assessed at 12 and 24 h after study drug administration. The patient-controlled analgesia morphine dose at 24 h was reduced 44% in Group B (30.3 +/- 17.5 mg) and 59% in Group C (22.1 +/- 16.5 mg) versus Group A (53.7 +/- 31.1 mg); P < 0.01 (A versus B). At 12 h, pain scores at rest and after spirometry were lower in Groups B and C than in A (P < 0.05). At 24 h, resting pain scores were lowest in Group C (P < 0.05). Twelve-hour FVC was best preserved in Group C (P < 0.03). There were no inter-group differences in adverse effects or perioperative blood loss. Rofecoxib oral suspension provided a morphine-sparing effect, as well as improvements in pain control and 12-h FVC in patients recovering from open abdominal surgery. IMPLICATIONS: Rofecoxib belongs to class of analgesics known as cyclooxygenase-2 inhibitors that reduce pain and inflammation with less risk of bleeding than standard nonsteroidal antiinflammatory drugs. We found that patients treated with rofecoxib 25 or 50 mg before open abdominal surgery required less IV morphine during the first day of recovery. Despite reductions in morphine requirements, rofecoxib-treated patients reported lower pain intensity scores at rest and after a vigorous cough. In the 50-mg group, improvements in pain control correlated with greater preservation of baseline cough effectiveness (vital capacity) at 12 h. These findings may offer clinical advantages in patients with preexisting pulmonary disease.     

Canine ureteral replacement with long acellular matrix tube: is it clinically applicable?

PURPOSE: We evaluated the effectiveness of acellular matrix used as a tube for replacement of a relatively long segment of the canine ureter. MATERIALS AND METHODS: Acellular matrix was obtained by excision of the whole ureter of donor dogs that were sacrificed and not included in the study group. Retrieved ureters were treated to have complete cell lysis, while maintaining the fiber framework. The study included 10 mongrel dogs in which a 3 cm segment was excised from 1 ureter and replaced by a tube of acellular matrix of the same length and width. The new tube was sutured proximal and distal by watertight interrupted sutures around a 5Fr Double-J stent (Medical Engineering Corp., New York, New York) that remained for 6 weeks. Excretory urography was done 1 and 2 weeks after stent removal and the dogs were then sacrificed. Before sacrifice the ureter was exposed and carefully examined, and the whole specimen was excised for histopathological examination. RESULTS: All dogs survived surgery except 1, which died 1 week postoperatively of a malpositioned stent and urinary ascites. There was no clinically apparent postoperative complications during the presence or after the removal of the ureteral stents. One week after stent removal excretory urography showed ipsilateral mild to moderate hydroureteronephrosis in 3 dogs and no dye excretion in 6 with a normal contralateral kidney. One week later no dye excretion was detected in all except 1 dog, which showed more radiological deterioration. At the time of sacrifice there was moderate to marked hydroureteronephrosis above the level of the new tube in all dogs. Although the graft was intact in all subjects, marked shrinkage was observed. On ureteral calibration there was significant narrowing of the lumen up to complete occlusion. At 8 weeks histopathological examination showed extensive fibrosis. CONCLUSIONS: An acellular matrix tube is not able to replace a 3 cm segment of the canine ureter.