Effects of adrenaline and alprenolol (Aptin®) on blood coagulation and fibrinolysis in man

Summary The effects of intravenous infusions of adrenaline alone, and after alprenolol (Aptin^®) pre-treatment, on whole blood clotting time, factor VIII, fibrinolysis, partial thromboplastin time (PTT), platelet count and fibrinogen have been studied in four healthy, fasting male subjects by double-blind technique using saline infusions as control. The adrenaline infusion caused increases in factor VIII levels, fibrinolysis and platelet counts and a decrease in whole blood clotting time. Alprenolol inhibited the effects of adrenaline on factor VIII and fibrinolysis in all subjects, and the effects on whole blood clotting time in all but one subject. The adrenaline-induced rise in platelet count was not significantly influenced by alprenolol pre-treatment. No effects were seen of the alprenolol infusion itself.     

Unmet need for recommended preventive health services among clients of California syringe exchange programs: implications for quality improvement

BACKGROUND: Comprehensive preventive services are recommended for injection drug users (IDU), including screening tests, vaccinations, risk reduction counseling, and sterile syringes. Syringe exchange programs (SEP) may facilitate receipt of preventive services by IDUs, but whether SEP clients receive recommended preventive care is not known. We examined use of recommended preventive services by clients of 23 SEPs throughout California. METHODS: Five hundred and sixty SEP clients were recruited from 23 SEPs throughout California between March and September 2003. Receipt of 10 recommended preventive services and source of care (SEP versus non-SEP providers) was ascertained from client interviews. RESULTS: On average, SEP clients received only 13% of recommended preventive services and 49% of clients received none of the recommended services. Of services that were received, 76% were received from SEPs. In multivariate analysis, use of drug treatment and more frequent SEP visits were associated with receipt of recommended preventive services by clients. CONCLUSIONS: SEPs are often the only source of preventive care for their IDU clients. Still, SEP clients fail to receive most recommended preventive services. Interventions to increase use of preventive services and improve the quality of preventive care received by IDUs, such as increased access to drug treatment and SEPs, are needed.     

Psychiatric Aspects of Ageing

Psychotic conditions due to structural brain disease of the senile and arteriosclerotic type are numerically less important than was formerly assumed. They account for about 25-30% of the psychiatric illnesses of the aged. Functional psychoses, particularly endogenous depressions, form an important part of these disorders. Their symptomatology and treatment are not essentially different from those of functional psychoses in the younger age groups. Among non-hospitalized old people, neurotic conditions represent the most frequently encountered type of mental disorders. Psychodynamic factors, operative in the older as well as the younger generations, and their interplay are responsible for the neurotic conditions of the elderly. These respond favourably to psychotherapy. Severe acute and subacute confusional states are caused in some aged people by physical and psychological stresses. These conditions have a serious prognosis but are amenable to proper treatment when diagnosed in time. They are the responsibility of the general practitioner and the general hospitals.     

Prevention of ovarian function damage by a GnRH analogue during chemotherapy in Hodgkin lymphoma patients

BACKGROUND: Frequent negative consequence of chemotherapy (CHT) is ovariandamage and premature ovarian failure (POF). Aim of this prospectivecase–control study is evaluation of GnRH analogue (GnRH-a)administration to patients with Hodgkin lymphoma (HL) duringCHT and prevention of ovarian damage depending upon CHT regimen. METHODS: Study group consists of 72 patients in fertile age (18–35years) with HL diagnosis treated in 2004–2005 by curativeCHT together with GnRH analogue (Triptorelin) administrationaccording to a standardized protocol. Patients were dividedinto three groups according to the stage of disease and treatedby three types of CHT regimens (A,B,C) with increased cytotoxicity.Ovarian function of all patients was assessed by gonadotrophinlevels (FSH, LH) analysis from peripheral blood before treatmentand also 6 and 12 month after it. The number of women with POFafter CHT in study group was compared with control group (n= 45, age 18–35 years) of patients treated in 2002–2003according to the same protocol but without protective GnRH analogueapplication. RESULTS: In study group with GnRH analogue administration during CHT,there was significantly (P < 0.001) fewer cases with POF6 and 12 month after the end of CHT (37.5% and 20.8%, respectively)than in control group (73.3% and 71.1%, respectively). Comparativeanalysis depending on cytotoxicity of CHT regimen used showedsignificant differences in percentage of patient with acquiredPOF between study and control group only in less aggressiveCHT protocols. CONCLUSIONS: Study showed a significant reduction of ovarian failure riskin women with HL treated with less aggressive CHT regimens plusa GnRH analogue.     

A bivariate genome-wide approach to metabolic syndrome: STAMPEED consortium

OBJECTIVE The metabolic syndrome (MetS) is defined as concomitant disorders of lipid and glucose metabolism, central obesity, and high blood pressure, with an increased risk of type 2 diabetes and cardiovascular disease. This study tests whether common genetic variants with pleiotropic effects account for some of the correlated architecture among five metabolic phenotypes that define MetS. RESEARCH DESIGN AND METHODS Seven studies of the STAMPEED consortium, comprising 22,161 participants of European ancestry, underwent genome-wide association analyses of metabolic traits using a panel of ～2.5 million imputed single nucleotide polymorphisms (SNPs). Phenotypes were defined by the National Cholesterol Education Program (NCEP) criteria for MetS in pairwise combinations. Individuals exceeding the NCEP thresholds for both traits of a pair were considered affected. RESULTS Twenty-nine common variants were associated with MetS or a pair of traits. Variants in the genes LPL, CETP, APOA5 (and its cluster), GCKR (and its cluster), LIPC, TRIB1, LOC100128354/MTNR1B, ABCB11, and LOC100129150 were further tested for their association with individual qualitative and quantitative traits. None of the 16 top SNPs (one per gene) associated simultaneously with more than two individual traits. Of them 11 variants showed nominal associations with MetS per se. The effects of 16 top SNPs on the quantitative traits were relatively small, together explaining from ～9% of the variance in triglycerides, 5.8% of high-density lipoprotein cholesterol, 3.6% of fasting glucose, and 1.4% of systolic blood pressure. CONCLUSIONS Qualitative and quantitative pleiotropic tests on pairs of traits indicate that a small portion of the covariation in these traits can be explained by the reported common genetic variants.