Hospital pharmacy supportive personnel utilization: a regional survey

The results of a regional survey of hospital pharmacy supportive personnel (technicians) are presented. The data represents the responses from 118 directors of pharmacy in hospitals within a 150-mile radius of Pittsburgh, Pennsylvania. A high percentage of the hospitals (92.4%) utilize pharmacy technicians in some capacity. In hospitals employing pharmacy technicians, on the average, there is approximately one technician for each pharmacist. The demand for technicians is relative strong with 120 job openings each year because of turnover and new positions. The requirements for employment vary, but most institutions minimally required a high school diploma or equivalent. The vast majority of hospital pharmacy technicians possess a high school diploma with only a small percentage having any additional training. Only about 15% of the hospitals have any type of formal pharmacy technician program and almost 80% of the directors are in favor of external continuing education programs. Regarding how best to train and educate hospital pharmacy technicians, 66% of hospital pharmacy directors feel that a formal college or university based program should be required. Approximately one-third of the hospitals have various levels of pharmacy technicians, and the most important criteria for determining levels are experience, technical responsibility, and seniority. Although only eight percent of the hospital pharmacy technicians have any formal training, 36% of the hospitals would start graduates of formal educational programs at higher entry level positions.     

Physical activity as a possible aggravating factor for athletes with varicocele: impact on the semen profile

The aim of the present study was to evaluate the influence of physical exercise on seminal parameters of male athletes with varicocele. Sixty healthy male volunteers (athletes and non-athletes, n = 30 + 30) and 60 volunteers affected by varicocele (athletes and non-athletes, n = 30 + 30) were randomly selected for a clinical study. All subjects provided at least two semen samples for routine microscopic analysis. Determinations for basal luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, oestradiol, total and free testosterone under resting conditions were also performed. In both groups with varicocele the percentage of total and progressive forward sperm motility and the percentage of normal spermatozoa were significantly reduced. The percentage of both progressive forward motility and normal spermatozoa were significantly lower in athletes with varicocele compared with non-athletes with varicocele (P < 0.05). Only athletes with varicocele had mean left testis volume significantly lower than the contralateral testis (P < 0.05). No modifications of hormonal parameters at rest were observed in any groups. Physical activity might represent an aggravating factor for spermatogenesis in athletes with varicocele. In countries where sport eligibility is granted by an authoritative body, these results suggest the need to establish general medical criteria to guarantee the continuation of an athlete's training whilst at the same time taking care of his reproductive health.     

In vitro infection of human epidermal Langerhans' cells with HIV-1.

Epidermal Langerhans' cells (LC) from human immunodeficiency virus type-1 (HIV-1)-infected patients harbour HIV-1 proviral DNA and RNA. In the present study, we investigated whether LC from epidermis of normal, HIV-seronegative subjects could be infected in vitro with HIV-1. Epidermal cells (EC) spontaneously detached from epidermal sheet cultures were enriched for LC (10-25% of CD1a+/CD4+ cells), deprived of contaminating T cells and then incubated with HIV-1IIIB. After 24 hr, purified LC and LC-depleted EC fractions were obtained by immunomagnetic separation. Polymerase chain reaction (PCR) analysis showed the presence of HIV-1 proviral DNA (gag) only in purified LC. In addition, LC-enriched EC, purified LC, LC-depleted EC or the non-permissive cell line, TF-1, the latter having being previously challenged with HIV-1IIIB for the same length of time as the EC, were co-cultivated with C8166 cells, and the co-cultures assessed for the presence of HIV DNA by PCR. Co-cultures of C8166 cells with purified LC or LC-enriched EC previously exposed to HIV-1IIIB exhibited a time-dependent increase in HIV proviral DNA. In contrast, PCR analysis of C8166 cells co-cultured with either LC-depleted EC or TF-1 cells gave negative results. Finally, C8166 cells co-cultured with HIV-infected LC formed syncytia, showed membrane budding and released numerous retroviral particles. The results indicate that LC from normal subjects can be infected in vitro with HIV and can transmit infection to myeloid cells. This in vitro model may help in understanding the regulation of HIV infection of LC.     

Pathogenetic mechanisms of atopic dermatitis

Atopic dermatitis (AD) is a chronic inflammatory disease which results from complex interactions between genetic and environmental mechanisms. An altered lipid composition of the stratum corneum is responsible for the xerotic aspect of the skin and determines a higher permeability to allergens and irritants. Keratinocytes of AD patients exhibit a propensity to an exaggerated production of cytokines and chemokines, a phenomenon that can have a major role in promoting and maintaining inflammation. Specific immune responses against a variety of environmental allergens are also implicated in AD pathogenesis, with a bias towards Th2 immune responses. In particular, dendritic cells expressing membrane IgE receptors play a critical role in the amplification of allergen-specific T cell responses. Cross-linkage of specific IgE receptors on dermal mast cells provokes the release and synthesis of a vast series of mediators. Following their recruitment and activation into the skin, eosinophils are also thought to contribute relevantly to tissue damage. Thus, a complex network of cytokines and chemokines contributes to establishing a local milieu that favors the permanence of inflammation in AD skin.     

Early coding of reaching: frontal and parietal association connections of parieto-occipital cortex

The ipsilateral association connections of the cortex of the dorsal part of the rostral bank of the parieto-occipital sulcus and of the adjoining posterior part of the superior parietal lobule were studied by using different retrograde fluorescent tracers. Fluoro-Ruby, Fast blue and Diamidino yellow were injected into visual area V6A, and dorso-caudal (PMdc, F2) and dorso-rostral (PMdr, F7) premotor cortex, respectively. The parietal area of injection had been previously characterized physiologically in behaving monkeys, through a variety of oculomotor and visuomanual tasks. Area V6A is mainly linked by reciprocal projections to parietal areas 7m, MIP (medial intraparietal) and PEa, and, to a lesser extent, to frontal areas PMdr (rostral dorsal premotor cortex, F7) and PMdc (F2). All these areas project to that part of the dorsocaudal premotor cortex that has a direct access to primary motor cortex. V6A is also connected to area F5 and, to a lesser extent, to 7a, ventral (VIP) and lateral (LIP) intraparietal areas. This pattern of association connections may explain the presence of visually-related and eye-position signals in premotor cortex, as well as the influence of information concerning arm position and movement direction on V6A neural activity. Area V6A emerges as a potential 'early' node of the distributed network underlying visually-guided reaching. In this network, reciprocal association connections probably impose, through re-entrant signalling, a recursive property to the operations leading to the composition of eye and hand motor commands.     

Impact of the Rome II paediatric criteria on the appropriateness of the upper and lower gastrointestinal endoscopy in children

Aliment Pharmacol Ther 2010; 32: 582–590

Summary

Background The demand for paediatric gastrointestinal (GI) endoscopy has increased, resulting in a significant rise of overall costs. Aim To assess the clinical impact of the Rome II criteria for functional gastrointestinal disorders when selecting paediatric patients who underwent GI endoscopy. Methods The indications and findings of GI endoscopic procedures performed before and after the publication of the Rome II criteria were evaluated retrospectively. Results Upper GI endoscopy was performed in 1124 children, whereas colonoscopy was performed in 500 subjects. A total of 607 (54%) oesophago‐gastro‐duodenoscopies (OGDs) were positive and 517 (46%) were negative, whereas 306 (61.1%) colonoscopies were positive and 194 (38.9%) were negative. Of the 1624 procedures, 26% were considered inappropriate according to the Rome II criteria. Inappropriate procedures decreased significantly after publication of the Rome II criteria (OR, 3.7; 95% CI, 1.8–7.5). Of 1202 appropriate GI endoscopies, 502 OGD (62.7%) were significantly contributive, compared with only 105 (32.5%) of the 323 inappropriate procedures (OR, 3.5; 95% CI, 2.6–4.6), whereas 265 (65.8%) colonoscopies were significantly contributive, compared with only 41 (42.3%) of the 97 inappropriate procedures (OR, 2.6; 95% CI, 1.6–4.1). Conclusions The use of the criteria for functional gastrointestinal disorders makes a significant positive impact, they should reduce unnecessary paediatric GI endoscopy.