Cerebral MRI on fetuses submitted to repeated cocaine administration during the gestation: an ovine model

OBJECTIVE: The purpose of the study was to compare prenatal care attendance in European Union countries, Hungary and Norway. STUDY DESIGN: We analysed live births or deliveries from national registers in five countries, national surveys in five countries, and regional register or surveys in three countries. RESULTS: The frequency of no prenatal care was lower than 0.5% in 10 countries, 0.9% in Hungary, 2.1% in Greece and 2.6% in Portugal. Late prenatal care varied from 3.1% in Finland to 29.2% in Ireland. Late care among women with parity 4 and more varied from 7.7% in Finland to 41.5% in Hungary. Among women under 20 years old, late care varied from 11.8% in Finland to 39.5% in Portugal. The median number of prenatal visits varied from seven in Greece to 14 in Finland. CONCLUSION: Prenatal care attendance varies widely among European countries. Late attendance is frequent in many countries.     

Prognosis of diabetic patients on dialysis: analysis of Lombardy Registry data

METHODS.: This 1993 Lombardy Registry Report refers to all of the dataregarding treated diabetics collected between 1 January 1983and 31 December 1992 by means of individual patient questionnairessent to all of Lombardy's 44 Renal Units (100% replies). RESULTS.: The acceptance rate of diabetics for dialysis increased from5.6 in 1983 to 10.4 patients per million population in 1992for a total of 731 patients (379 type I, 352 type II). The yearlypercentage of new diabetics increased from 9 to 11%, and theproportion of patients with two or more risk factors increasedfrom 14.7% in 1983–1987 to 22.0% in 1988–1992. Theuse of peritoneal dialysis declined over the 10-year periodfrom 50% in 1983–1984 to 30% in the last 2 years. Thedifference in age of the patients on peritoneal and haemodialysistended to decrease. The survival of all diabetic patients was82% at 1 year, 48% at 3 years, and 28% at 5 years. The relativedeath risk of the patients on peritoneal dialysis compared tothose on haemodialysis, after taking into account age and themain comorbid conditions (type of diabetes, severe vasculardisease, cirrhosis and the generic other risk factors), didnot differ significantly from one, as estimated by the Cox proportionalhazard regression model (344 events). The main causes of deathof these patients were cardiovascular diseases (about 50.0%),cachexia (from 17.2% in 1983/1984 to 22% in 1991/1992), andinfections (about 11%). The mean hospitalization rate was higherin diabetics than in patients with standard nephropathies (i.e.in 45–64-year-old patients: 32.8 versus 13.9 days/patient-year). CONCLUSION.: Multivariate analysis showed that age, type of diabetes, severevascular disease, cirrhosis, and the generic other risk factorswere significantly related to survival; but diabetic patientswithout any baseline risk factors also had a poor prognosisand morbidity was very high in absolute terms. Medical caretherefore needs to be improved in order to reverse prognosticrisk factors and prevent cardiovascular and non-cardiovascularevents.     

Randomized, double-blind, phase III, controlled trial comparing levobupivacaine 0.25%, ropivacaine 0.25% and bupivacaine 0.25% by the caudal route in children

Background. The rationale for replacing racemic bupivacainewith the s-enantiomers levobupivacaine and ropivacaine is toprovide a wider margin of safety with the same analgesic efficacyand less postoperative motor block. In a randomized, double-blind,phase III, controlled trial we compared the caudal administrationof levobupivacaine 0.25% and ropivacaine 0.25% with bupivacaine0.25% in children. Methods. Ninety-nine ASA I–II children less than 10 yrold scheduled for elective sub-umbilical surgery were randomizedto receive caudal block with bupivacaine 0.25%, ropivacaine0.25% or levobupivacaine 0.25%. The primary outcome of the studywas the clinical efficacy of the caudal block during the operation.Secondary outcome measures were analgesic onset time, pain reliefafter the operation and residual motor blockade. Results. The proportion of children with effective analgesiaduring the operation was similar among groups. There were nosignificant differences in the analgesic onset time of the caudalblock. Bupivacaine produced a significant incidence of residualmotor block compared with levobupivacaine or ropivacaine atwake-up (P<0.01). There were no significant differences inthe number of patients receiving rescue analgesia after surgery.However, analgesic block lasted significantly longer in patientsreceiving bupivacaine (P=0.03). Conclusion. During sub-umbilical surgery, caudal levobupivacaine,ropivacaine and bupivacaine provided comparable analgesic efficacy.Bupivacaine produced a higher incidence of residual motor blockadeand a longer analgesic block than ropivacaine and levobupivacaine.      

Synthesis and chemiluminescent high throughput screening for inhibition of acetylcholinesterase activity by imidazo[2,1-b]thiazole derivatives

The synthesis of a new series of imidazo[2,1-b]thiazole derivatives is described. They were tested as acetylcholinesterase inhibitors by means of a chemiluminescent method suitable for high throughput screening. The compounds without quaternization had no appreciable inhibitory potency probably because they are poorly soluble in water. The corresponding quaternized compounds were good inhibitors with activity related to the spacer employed.