Practice and Physician Characteristics Associated with Influenza Vaccination Delivery Rates Following a Patient Reminder Letter Intervention

As part of the “Provider and Patient Reminders in Ontario: Multi-strategy Prevention Tools” demonstration project, the purpose of this study was to explore the practice and physician characteristics associated with influenza vaccination rates following a reminder letter intervention for patients 65 years of age and older. Using a sample of 179 physicians, we estimated a multiple linear regression model to examine variables predictive of vaccination delivery rates. Several provider characteristics, including certification with the College of Family Physicians of Canada and practicing in an urban area, were predictive of the success of the reminder letter campaign. Examining other physician and practice factors associated with vaccination delivery following a reminder letter campaign may help improve such prevention efforts.     

ApoA- and apoB-containing lipoproteins and Lp(a) concentration in non-dialyzed patients with chronic renal failure

BACKGROUND: End-Stage renal disease is associated with accelerated atherosclerosis and a high incidence of cardiovascular disease. METHODS: The serum levels of lipids and apolipoproteins and Lp(a) were determined in 51 patients with chronic renal failure (CRF) with various advancement, without interference of factors which might disturb Lp(a) metabolism and with proteinuria less than 0.5 g/24 h. The patients studied were divided into two groups: patients with moderate renal failure (CRF-M) and creatinine levels of 2-6mg/dL n = 27; and predialysis patients with end stage renal disease (ESRD) and creatinine levels higher than 8.5 mg/dL n=24. RESULTS: In both studied groups serum concentrations of triglycerides (TG), total apoCIII, apoCIIInonB, apoB:CIII were statistically increased, (except total cholestrol (TC) and LDL-cholestrol (LDL-C), apoB, total apoE, apoEnonB, apoB:E), while the levels of HDL-cholestrol (HDL-C) and apoAl significantly decreased. Lipid and lipoprotein ratios as risk factors of atherosclerosis were similar in both groups. The TC/HDL-C ratio increased, while that of HDL-C/ apoAI and apoAI/apoCIII decreased. Serum Lp(a) concentrations were significantly increased in both studied groups. The medians and ranges of Lp(a) concentration were similar in both groups. Serum Lp(a) levels correlated with total cholesterol (r=0.295; p < 0.05), LDL-C (r = 0.312; p < 0.05) and apoB (r = 0.215; p < 0.05). In addition, no correlation was found between Lp(a) levels and albumin concentrations (r = 0.126; p = 0.421). CONCLUSION: Our results may indicate that the reduced levels of apoA-containing lipoproteins and increased TG-rich apoB-containing lipoproteins and Lp(a) indicated a clear atherogenic pattern in early renal disease. Increased Lp(a) concentration may result in nonspecific synthesis or catabolism disturbances. Measurement and monitoring of lipoprotein family profiles offers a new means for selecting appropriate therapies targeted for normalizing dyslipidemia in non-dialyzed patients.     

Comparative evaluation of safety and efficacy of pamidronate and zoledronic acid in multiple myeloma patients (single center experience)

Osteolytic bone destruction, caused by the aberrant production and activation of osteoclasts, results in significant morbidity for patients with multiple myeloma (MM). Pamidronate [(3-amino-1-hydroxypropylidene)-1,1-bis-phosphonate] inhibits osteoclastic activity and reduces bone resorption. A potency of zoledronic acid (2-[imidazol-1-yl]-1-hydroxyethylidene-1,1-bisphosphonic acid, a new third generation bisphosphonate, as inhibitor of resorption was 850-fold greater than pamidronate, as was shown in preclinical models of bone resorption. Randomized, double-blind study was conducted to compare the efficacy and safety of zoledronic acid and pamidronate for treating myeloma bone disease. Since March 1999 the efficacy and safety of pamidronate and zoledronic acid is evaluated in MM patients all receiving anti-myeloma chemotherapy acc. to VMCP/VBAP alternating regimen. Nine patients with stage III myeloma and osteolytic lesions (3 female, 6 male, median age 57 years, range 52-67, with monoclonal protein: IgG-7, IgA-2) were randomly assigned (1:1:1 ratio) to treatment with either 4 or 8 mg of zoledronic acid via 15-minute intravenous infusion or 90 mg of pamidronate via 2-hour intravenous infusion every 3 to 4 weeks for 12 months. All patients have received 500 mg of calcium supplements and 500 IU of vit.D, orally, once daily, for the duration of administration of study medication. In extension phase of the study (June 2000-April 2002) patients did not received bisphosphonates. In 7 patients 18 cycles of assessed treatment was administered to each of them and one patient received 16 cycles. One patient died after receiving of 12 pamidronate therapy cycles at 11 month of the trial duration (and at 49 month since MM diagnosis and anti-tumour treatment). The patient's death occurred during the progression of plasma cell proliferation due to acute left ventricle cardiac failure. During the 12-month-period of bisphosphonate treatment skeletal related events (SRE) and progression of osteolysis occurred with the same frequency in 3 treatment groups. One patient experienced spinal cord compression and received radiation to bone and 2 patients experienced vertebral fracture. Time from study entry to the first SRE was 304 days in pamidronate and 366 and 392 days in 4 and 8 mg zoledronic acid group, respectively. The skeletal morbidity rate was identical in all treatment groups. Single hypocalcemic events occurred in 2 patients, mild hypertransaminasemia was observed in 3, worsening of renal function parameters in 2 patients (transient in one of them). Muscular pain and fever up to 39 degrees C (transient and self-limiting "flu-like" symptoms) occurred in 6 patients after several or some dozens of hours from study drug administration. Adverse events were similar in nature and frequency with zoledronic acid and pamidronate and were experienced by a similar proportion of patients in each treatment group. Median time of patient's observation duration after completing of administered treatment with zoledronic acid and pamidronate amounts to 20 months. At present actual median survival time of analysed patients since MM diagnosis is 42 months, since the beginning of treatment with pamidronate and zoledronic acid--33 months, and since completing treatment--20 months and is similar in 3 treatment groups. As was shown in our single center study in MM patients the safety and efficacy of pamidronate 90 mg and zoledronic acid 4 mg and 8 mg in monthly i.v. infusion are comparable. Thus the recommended dosage of zoledronic acid is 4 mg administered as a 15 minute i.v. infusion at intervals of 3 to 4 weeks.     

Studies on the influence of auxiliary substances on the physico-chemical characteristics of ophthalmic drugs. Part I. Studies on the influence of auxiliary substances on the critical micellar concentration of surfactants solutions in eye drops containing sulphacetamidum natricum

Interactions between Tweens, surfactants used in eye drops and the remaining compounds of the preparations were investigated. The interactions were assessed by means of the surface tension measurement method. Obtained results demonstrate that the substances used in the facture of the preparation affect the critical micellar concentrations of Tweens. Only hydroxyethylcellulose was found to exert a stabilizing effect on the critical micellar concentration of these substances. The amount of used surfactant should be taken into consideration in the manufacture of eye preparations.     

Antagonism of picrotoxin-induced changes in dopamine and serotonin metabolism by allopregnanolone and midazolam

The effects of allopregnanolone and midazolam, given intracerebroventricularly, on the behavioral and biochemical effects of picrotoxin, were examined in a model of neurotoxin-induced seizures, in mice. After acute injections, midazolam (ED(50)=39.8 nmol) and allopregnanolone (ED(50)=11.0 nmol) produced similar and dose-dependent protection against picrotoxin-induced seizures. Picrotoxin given intraperitoneally at the ED(85) dose decreased significantly the concentration of serotonin (5-HT), dopamine (DA), homovanilic acid (HVA) and 3,4-dihydroxyindolacetic acid (DOPAC), in the mouse striatum and the frontal cortex, in the period of time immediately preceding the onset of seizures. A single injection of allopregnanolone more potently, in comparison to midazolam, antagonized the biochemical action of picrotoxin, abolishing its effects on DA, HVA and 5-HT concentration, in the mouse striatum and the frontal cortex. These results for the first time provide a direct argument for an involvement of central dopaminergic and serotonergic systems in the seizure development. The present data add also to the accumulating evidence suggesting a favorable pharmacological profile for some neurosteroids currently considered to have a future role in the management of epilepsy.     

Effects of pentylenetetrazol-induced kindling of seizures on rat emotional behavior and brain monoaminergic systems

The influence of pentylenetetrazol (PTZ)-induced kindling of seizures on the rat emotional behavior, the brain monoamine turnover rate measured in vitro, and correlation between behavioral and biochemical parameters, were examined in rats. The repeated administration of PTZ (35 mg/kg, ip) evoked kindled seizures in rats (Stage 4 or 5 of clonic-tonic convulsions-maximum). PTZ kindling caused selective changes in the rat emotional behavior, present in some models of anxiety only (a decreased freezing time in the conditioned freezing test and a decreased spontaneous and aversively conditioned ultrasonic vocalization). Simultaneously, PTZ kindling decreased the concentration of homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) in the prefrontal cortex, decreased the DA (HVA/DA ratio) turnover rate in the striatum, and inhibited the serotonin (5-HT) metabolism (5-HIAA/5-HT ratio) in the hippocampus and the prefrontal cortex. Correlations between dopamine (DA) or 5-HT regional metabolic rates in brain structures and animal behavior were either abolished or reversed in PTZ-kindled animals. It is concluded that both DA and 5-HT systems contribute to the emotional effects of PTZ-induced kindling of seizures. The hypothesis is put forward that PTZ kindling-induced inhibition of the serotonergic innervation may lead to the compensatory increase in 5-HT(1A) receptors in the dentate gyrus of the hippocampus, thus evoking the anxiolytic-like changes in animal behavior.     

Molecular and clinical consequences of in vivo silicones biodegradation

The object of the publication is the presentation of data referring to in vivo silicones biodegradation and their potential clinical and molecular consequences. Summing up, one needs to state that the products of silicones biodegradation are not biologically indifferent. In particular, different types of silanols are inhibitors of proteolytic enzymes and regulators of many metabolic processes as well as affect the cell growth and division, which distinctly indicates the potentially strong pharmacological action. The main objective of the molecular consequences of the biodegradation of siloxanes was the verification what impact siloxanes of various molecular weights and of various chain lengths exert on the conformational stability of biological molecules.     

Correlation of brain stem evoked response audiometry (BERA) with Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS)

The diagnostic value of electric responses from the brain stem (BERA) in neurosurgical patients is still a matter for debate in the literature. Therefore in the study an attempt was made to determine the relationship between GCS scores and BERA recordings. Participants in the study were 64 patients with various types of brain damage. Evoked potentials from the brain stem were registered using the Hortmann BERAmodul apparatus. To facilitate the interpretation of results a special scale was developed for quantitative measurement of changes in BERA recordings. Abnormalities in BERA recordings were reflected in changes in GCS scores, and correlation between the two dimensions was found to be statistically significant. The relationship between BERA recordings and GOS scores was also significant: pathological changes in BERA recordings assessed as severe were associated with an unfavorable therapeutic outcome in the GOS. The presented findings indicate auditory evoked brain stem response (BERA) usefulness for objective evaluation of brain-damaged patients' clinical state.     

Traumatic stress severity

Since 1980, a new outlook on stress was applied in connection with the changes in psychiatric concepts and the notion that a traumatic experience may cause specific psychological symptoms varying from the content and source of other psychiatric disorders. The understanding of the trauma, defined by the objective traits of the stressor, separated it from stress as defined by the subjective individual's decision. This was against the current theory of Selye in which the stress reaction is a homogenous entity as a whole, defined by a subjective evaluation of the event, independently of the objective traits. The paper examines new directions in the studies on the meaning of trauma for the person who survived it. According to these studies, the trauma and its consequences cannot be viewed solely in a narrow pathogenic and symptomatic frame. Modern directions of studies on stress led to a model integration of physiological, behavioural and psychological reactions and the trauma itself was to be seen in a cultural and historical context. Today's biopsychocultural model of understanding trauma consists in a complex of common actions from various systems and backgrounds. They comprise the following factors: physical (biological), intrapsychic, interpersonal (familial, social, religious, cultural), educational-professional, economical, political. These systems coexist in a time frame, in common relations and connections. They all affect the capability to evaluate danger, which gives different strategies of coping with oneself. Studies on PTSD give arguments for understanding of the full influence that a trauma can have on a person, and allow for an unlimited outlook on the traumatic situation--its biological, social and existential aspects.