One-day thyroid surgery: retrospective analysis of safety and patient satisfaction on a consecutive series of 1,571 cases over a three-year period

Short-stay thyroid surgery (<24 h hospital stay) is becoming increasingly popular but some potentially lethal complications are considered strong arguments against shortening hospitalization after thyroidectomy. The authors reviewed the data of 1,571 patients undergoing one-day thyroid surgery over a 3-year period to determine safety and patient satisfaction. There were 1,244 females and 327 males. Mean age was 43 years. Patient satisfaction was evaluated by a questionnaire given on discharge, while post-discharge surgical recovery was analyzed by the PSR scale. Total thyroidectomy was performed in 1,119 patients (71%), hemithyroidectomy in 450 (29%), isthmusectomy in 2. Morbidity occurred in 152 patients (9.6%). Surgical complications were transient hypocalcemia in 112 cases and permanent hypoparathyroidism in 3; monolateral transient nerve palsy occurred in 10 cases, bilateral in 3; definitive monolateral recurrent palsy in 4 cases. Bleeding requiring re-intervention occurred in 10 cases, wound complications in 5 cases, and intraoperative tracheal lesion in 1 patient. Among complicated patients, 129 (84.8%) were treated after discharge as outpatients. Conversion to inpatient treatment occurred in 28 patients (1.7%) (25 for surgical reasons). Four patients (0.2%) required hospital readmission. Patients were very satisfied in 84.2%, satisfied in 9.5%, poorly satisfied in 4.3%, completely unsatisfied in 2%. Postoperative recovery mean score by PSR scale resulted in 85.14% (0-100%). Our results confirm that the one-day surgery model is safe, effective, and highly agreeable in patients undergoing surgery for thyroid disease.     

Canine leishmaniasis in the Gargano promontory (Apulia,South Italy)

We examined 444 dogs by visiting farms and peripheral districts on the Gargano promontory (Province of Foggia, Apulia, South Italy). Clinical examination and immunofluorescence antibody test for leishmaniasis were performed. Bone marrow and lymph node samples obtained from 25 dogs with positive serological test were cultured on Tobie-Evans medium. The results obtained show both a higher seropositivity rate for canine leishmaniasis (14.4%) and a higher percentage of asymptomatic dogs with positive serological test (53.1%) compared to previous research in the same area. Seven strains isolated from infected dogs belonged to Leishmania infantum species zymodeme Montpellier 1. None of 82 sera of humans living in close contact with infected dogs were positive for leishmaniasis.     

In vitro and in vivo profiling of CHF5022 and CHF5074 Two beta-amyloid1-42 lowering agents.

Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) may delay or prevent the onset of Alzheimer's disease (AD). A subset of NSAIDs, including flurbiprofen, has been shown to selectively inhibit the production of beta-amyloid(1-42) (Abeta42), independently from their cyclooxygenase (COX) inhibiting activity. We evaluated the in vitro and in vivo profiles of CHF5022 and CHF5074, two flurbiprofen analogues. The in vitro Abeta inhibiting activity was evaluated in a human neuroglioma cell line (H4) carrying the double Swedish mutation (K595N/M596L) of the human amyloid precursor protein (APPsw). The in vitro anti-COX activity was evaluated using human recombinant enzymes isolated from transfected Sf-9 cells. The in vivo pharmacokinetic and pharmacodynamic profiles of the two compounds were evaluated in young APPsw transgenic mice (Tg2576) after oral gavage (100 or 300mgkg(-1) day(-1) for 4-5 days) and after medicated diet (375ppm for 4 weeks). R-Flurbiprofen was used as comparator. In vitro, CHF5022 and CHF5074 were found to be 3- and 7-fold more potent than R-flurbiprofen in inhibiting Abeta42 secretion (IC(50)s of 92, 40 and 268microM, respectively). Differently from R-flurbiprofen, CHF5022 and CHF5074 did not affect COX-1 (at 100microM) and COX-2 (at 300microM) activity. Similarly to R-flurbiprofen, no significant alteration in the expression profile of a subset of Notch intracellular domain-responsive genes was observed with either CHF5022 or CHF5074. In Tg2576 mice, CHF5022 was well tolerated when administered by oral gavage (100mgkg(-1) day(-1) for 5 days) or by medicated diet (56mg kg(-1) day(-1) for 4 weeks). R-Flurbiprofen was poorly tolerated in the diet (32mgkg(-1) day(-1)) with 55% of the animals dying during the first week of treatment. After 4-5 days of oral gavage, CHF5022 and CHF5074 plasma and brain levels at 3h were found to increase with the dose, leading to brain concentrations of about 10% and 5% of the corresponding plasma concentrations, respectively. In animals fed for 4 weeks with compound-supplemented diet, mean plasma (580microM) and brain (20microM) Cyrillic) concentrations of CHF5022 were 8 and 15 times higher than those of R-flurbiprofen. Plasma Abeta42 concentration was dose-dependently decreased by CHF5022 and CHF5074. Brain Abeta levels (formic acid-extractable) were not significantly affected by either compound, although Abeta42 levels tended to inversely correlate (P=0.105) with CHF5022 concentration in the brain. CHF5022 and CHF5074 thus appear to have a promising in vitro and in vivo profile. This warrants further evaluation of their long-term effects on Abeta brain pathology.     

Impact of dose-dense immunochemotherapy on prognosis of germinal center and non germinal center origin of diffuse large B cell lymphoma

Diffuse large B cell lymphoma (DLBCL) is the most common type of non-Hodgkin's lymphoma. Gene-expression profiling in DLCBL has brought insight into the biological heterogeneity of the disease. Two major subgroups have been identified: germinal center B (GCB) cell and non-germinal center (non-GCB). The aim of this study was to define retrospectively by immunohistochemistry the bcell origin of 69 patients treated with R-CHOP14 and to evaluate if dose-dense therapy could improve their clinical outcome. According to immunohistochemistry analysis 28 patients were derived from germinal center and 41 from non-germinal center. After a median period of observation of 46 months (range 3-101 months) the overall survival (OS) was 75% and progression-free survival (PFS) was 53% and no differences were observed according to cell origin. In conclusion, we can point out that intensification could enhance the efficacy of the R-CHOP regimen and improve overall survival in patients with non germinal lymphoma.     

The elderly prognostic index predicts early mortality in older patients with diffuse large B-cell lymphoma. An ad hoc analysis of the elderly project by the Fondazione Italiana Linfomi

The Elderly Prognostic Index (EPI) is based on the integration of a simplified geriatric assessment, hemoglobin levels and International Prognostic Index and has been validated to predict overall survival in older patients with diffuse large B-cell lymphoma (DLBCL). In this study, we evaluated the ability of EPI to predict the risk of early mortality. This study included all patients registered in the Elderly Project for whom treatment details and a minimum follow-up of 3 months were available. Three main treatment groups were identified based on the anthracycline amount administered: cases receiving >70% of the theoretical anthracyclines dose (Full Dose [FD] group), ≤70% (Reduced Dose [RD]) and palliative therapy (PT; no anthracyclines). The primary endpoint was early mortality rate, defined as death for any cause occurring within 90 days from diagnosis. We identified 1150 patients with a median age of 76 years (range 65–94). Overall, 69 early deaths were observed, accounting for 19% of all reported deaths. The cumulative rate of early mortality at 90 days was 6.0%. Comparing early with delayed deaths, we observed a lower frequency of deaths due to lymphoma progression (42% vs. 75%; p < 0.001) and a higher frequency due to toxicity and infections (22% vs. 4%, p < 0.001, and 22% vs. 3%, p < 0.001, respectively) for early events. A multivariable logistic analysis on 931 patients (excluding PT) confirmed an independent association of high-risk EPI (odds ratio [OR] 3.60; 95% confidence interval [CI] 1.15–11.2) and bulky disease (OR 2.08; 95% CI 1.09–3.97) with the risk of early mortality. The cumulative incidence of early mortality for older patients with DLBCL is not negligible and is mainly associated with non-lymphoma related events. For patients receiving anthracyclines, high-risk EPI and bulky disease are associated with a higher probability of early mortality.     

Insulin resistance among Brazilian schoolchildren: association with risk factors for cardiovascular diseases

Aim:  Our purpose was to evaluate Insulin Resistance (IR) and its association with risk factors for cardiovascular diseases (CVDs) among 161 (6- to 10-year-old) schoolchildren.
Methods:  This two-stage cross-sectional study evaluated: BMI, blood pressure, personal history (birth weight) and family history of CVDs. Children with at least one of the following criteria participated in the second stage: obesity, personal or family history. Insulin resistance was determined using Homeostasis Model Assessment (HOMA).
Results:  The HOMA distribution in terciles showed mean values for the first, second and third tercile of 0.41, 0.79 and 2.11 respectively. The HOMA distribution in the third tercile demonstrated statistically significant associations with overweight/obesity (p = 0.007), hypertension (p = 0.008) and low HDL (p = 0.02). Analysis of mean birth weight in each tercile and between terciles did not present any positive correlation (p = 0.213).
Conclusion:  Higher levels of HOMA (IR) were positively associated with risk factors for CVD among schoolchildren.     

Synthesis of glycose carbamides and evaluation of the induction of erythroid differentiation of human erythroleukemic K562 cells

A series of carbamides derived from 1,2:5,6-di-O-isopropylidene-D-gluco- and D-allofuranose as well as their 5,6-O-deprotected analogues (2 and 4) and methyl 3,4-O-isopropylidene-alpha- and beta-D-galactopyranosides (5 and 6) have been prepared in order to evaluate their ability to induce erythroid differentiation of human erythroleukemic K562 cells. Twenty out of 51 carbamides tested exhibit an appreciable activity as inducers of erythroid differentiation and have been fully characterized and described.     

Dose-Proportional Absorption of Etretinate After Doses of 25, 50, 75, and 100 mg

Twelve healthy male subjects received single oral doses of etretinate, ranging from 25 to 100 mg (1 to 4 × 25-mg capsules) in an open-label, four-way randomized crossover design. Plasma concentrations of etretinate and two active metabolites were determined by a specific high-performance liquid chromatographic (HPLC) method. Analysis of variance and orthogonal contrasts were used to assess dose proportionality. Mean (± %CV) maximum concentrations after 25- to 100-mg doses were 133 (50), 195 (33), 261 (53), and 446 (65) ng/ml, whereas AUC_0–12 values were 581 (46), 1090 (39), 1500 (52), and 2440 (63) ng · hr/ml, respectively. The test for proportionality indicated that C _max and AUC_0–12 increased proportionally with an increase in dose (P > 0.05).     

Evaluation of practices and knowledge among primary health care professionals in relation to child development surveillance

In the present study, the practices and knowledge of 40 physicians and 40 nurses from municipal health care units (UMS) and 40 physicians and 40 nurses from the Family Health Program (FHP) in Belém, Pará State, Brazil, all of whom working in primary health care, were evaluated in relation to child development surveillance. Measures of knowledge of child development showed an average of 63.7% correct answers for UMS physicians, 57.3% for FHP physicians, 62.1% for FHP nurses, and 54.3% for UMS nurses. Only 21.8% of mothers attending appointments mentioned that the health care professional had asked about their children s development, 27.6% of mothers reported that the health care professional had asked about or observed the child s development, and 14.4% mothers reported having received instructions on how to stimulate their children s development. According to this study, primary health care physicians and nurses in the municipality of Belém showed gaps in their knowledge of child development. Child development surveillance is not being conducted satisfactorily in primary health care in the municipality of Belém. It is thus necessary to raise the awareness of health care professionals concerning the problem and provide them with appropriate training.     

Factors associated to hospitalization of children under five years of age,São Paulo,Brazil

OBJECTIVE: In developing countries acute respiratory infection (ARI) is the leading cause of hospitalization among children under five years of age. Their underprivileged life conditions and restricted access to health care services are important determining factors. The objective of the study was to assess hospital morbidity and to identify factors associated to hospitalization of children under five years of age. METHODS: A data set derived from a cross-sectional study on health conditions of children under five years of age in the city of Embu, a county located in the metropolitan region of S?o Paulo, Brazil, was used. The inclusion criteria were one child per family (random selection). The exclusion criteria were missing data on any study variable. The sample size was 893 children. Data was collected using household interviews with mother or caretaker. Statistical analysis was performed using logistic regression models to identify factors associated with hospitalization. RESULTS/CONCLUSIONS: Sixty-five (7.7%) children were hospitalized. Of them, 41.5% were admitted with a respiratory tract disease, mainly due to an ARI (27.7 %). Factors associated to hospitalization included: low birth weight; perinatal problems; chronic illness; death of a sibling under the age of five; grandmother as day caretaker; living in overcrowded places, and mother's higher educational level.