Efficacy of terazosin in patients with benign prostatic hyperplasia.

Terazosin, a selective, long-acting alpha 1-adrenergic blocker, was evaluated in 44 men with benign prostatic hyperplasia. The dose was titrated from 2 to 20 mg nightly depending on improvement in symptoms and flow rate. All men completed at least 3 months of therapy, 26 had 6 months and 19 received 9-12 months of terazosin. There was an average increase of 2 ml/s in the peak urinary flow rate compared to baseline. This was statistically significant at the 3-month level. Residual urine decreased under treatment at each 3-month time interval. Prior to initiation of terazosin the mean was 165 ml, and it was 62, 100, and 41 ml at 3, 6 and 9 months respectively. There was a statistically significant improvement in both the obstructive and irritative symptom scores. Side effects were minimal; only 1 patient discontinued terazosin due to a hypotensive episode. Terazosin was found to be safe and effective in the dose range of 2-20 mg taken at bedtime in men with symptoms related to benign prostatic hyperplasia. The present study did not identify any baseline parameters such as initial prostate volume, peak flow rates, or obstructive or irritative symptom scores that correlated with clinical outcome.     

Cost-effectiveness of interventions for end-stage renal disease]

OBJECTIVE: The study reports the cost-effectiveness results of end-stage renal disease (ESDR) patients in Mexico in terms of years of life gained and quality of life and the economic cost with regards to three treatment alternatives that could be considered mutually exclusive: continuous peritoneal ambulatory dialysis (CAPD), hemodialysis (HD) and renal transplant (RT). METHOD: The economic costs were calculated by using the average cost case-management methodology and further, the probable of life expectancy and the quality of life were cross-sectionally assessed by means of the Quality Adjusted Life Years (QALY) measured by the Rosser Index. RESULTS: The results show that economic costs in US$ of the three treatment alternatives were: CAPD $5,643.07, HD $9,631.60, and RT $3,021.63. The probability of life expectancy for CAPD and RT for the first and third year were: 86.2% and 66.9%, and 89.9% and 79.6%, respectively. The QALY scores for patients were: CAPD 0.8794, HD 0.8640, and RT 0.9783. CONCLUSION: The intervention with the highest cost-effectiveness coefficient was the renal transplant (3,088.69), followed by the CAPD (6,416.95) and HD (11,147.68). A significant difference was found between the transplanted patients and patients undergoing dialysis. Finally, this study concluded that the RT offers the least expensive alternative and the greatest number of years of life gained as well as providing significant changes in the quality of life of ESRD patients.     

Impairment and coping in children and adolescents with chronic fatigue syndrome: a comparative study with other paediatric disorders

BACKGROUND: Functional impairment is a key feature of chronic fatigue syndrome (CFS) of childhood. AIM: To compare impairment, illness attitudes and coping mechanisms in childhood CFS and in other paediatric disorders. METHOD: Participants were 28 children and adolescents with CFS, 30 with juvenile idiopathic arthritis (JIA) and 27 with emotional disorders (ED). The measures used were interviews with children and parents, with detailed enquiry on impairment, including the Functional Disability Inventory (FDI), Illness Attitudes Scales (IAS), and Kidcope to measure coping styles in relation to common problems, illness and disability. RESULTS: Children with CFS reported significantly more illness impairment, especially in school attendance, than those with JIA and ED. They had higher 'worry about illness' scores on the IAS. On the Kidcope they named school issues (work, expectations, attendance) as illness- or disability-related problems more than the other two groups. Fewer CFS participants reported using problem solving as a strategy to cope with illness and disability than with other problems in their lives. More in the CFS than in the JIA group used emotional regulation to cope with illness and disability. Fewer in the CFS than in the ED groups used social withdrawal to cope with illness and self-criticism for disability, but more used resignation to cope with disability. CONCLUSION: Severe illness-related impairment, particularly through school non-attendance, and high levels of illness-related school concerns appear specific to CFS. CFS may also have characteristically high levels of generalised illness worry and particular styles of coping with illness and disability.     

Use of nitric oxide in the evaluation of pulmonary arterial hypertension]

The purpose of this article is to describe a patient with severe pulmonary artery hypertension, who was evaluated in the catheterization laboratory with the use of nitric oxide to check the degree of reversibility of the pulmonary hypertension. The patient is a 18 months old baby with atrio-ventricular canal and severe pulmonary hypertension, whose vascular resistance dropped from 8.75 Wood U/m2 to 1.32 Wood U/m2. With these findings the pulmonary artery hypertension was considered reversible and made him a good candidate for successful corrective surgery. The use of nitric oxide is very useful for the evaluation of the degree of reversibility of the pulmonary vascular resistance in cases with severe pulmonary artery hypertension with a left to right shunt.     

Scanning electron microscopy of<Emphasis Type="Italic"> Ithyoclinostomum dimorphum</Emphasis> (Trematoda: Clinostomidae), a parasite of<Emphasis Type="Italic"> Ardea cocoi</Emphasis> (Aves: Ardeidae)

Scanning electron microscopy is used for the first time to study the surface topography of Ithyoclinostomum dimorphum (Diesing, 1850), collected from Ardea cocoi Linnaeus, 1766 on the floodplain of the upper Paraná River Basin, Brazil. The body surface exhibits annular furrows, ridges and sensory papillae but no spines, and the tegument is reticulate. The oral sucker is terminal, bears radial furrows and is surrounded by a collar. The ventral sucker is located close to the oral sucker but lacks a collar. When extruded, the cirrus can be seen to bear papillae in its base, and the aperture of the ejaculatory duct is visible distally. The excretory pore is dorso-subterminal. Various incrustations and secretions are present on the body surface. These detailed observations make it possible for to us speculate on the functional significance of some of our findings in relation to the large size and contractile nature of these worms, and their ability to survive and mate in an apparently hostile environment.     

Antibody response to postexposure prophylaxis in infants born to hepatitis B surface antigen-positive women

BACKGROUND: Annually 20,000 infants are born to hepatitis B surface antigen (HBsAg)-positive US women. Without prophylaxis 30% risk chronic hepatitis B virus infection, and 25% of those risk dying from resulting liver cirrhosis or liver cancer as adults. METHODS: We attempted to interview each HBsAg-positive pregnant woman reported to the health department between 1992 and 1997, to provide their infants with immunoprophylaxis at birth and in the clinic or home and to serotest at 9 to 15 months of age. RESULTS: Of 879 women reported, 92% enrolled; 787 delivered 796 live infants; 91% of infants received hepatitis B immunoglobulin; 98, 95 and 89% received hepatitis B vaccine (HepB) Doses 1, 2 and 3, respectively; and 80% were serotested. Of these 2.2% were HBsAg-positive and 97% had antibody to HBsAg (anti-HBs) of > or =10 mIU/ml. Anti-HBs concentrations measured in 504 infants were 10 to 99 mIU/ml (25%), 100 to 999 mIU/ml (43%) and > or =1000 mIU/ml (29%). Serotesting was less likely among infants of mothers <20 years of age [odds ratio (OR) 2.5]; white, non-Hispanic (OR 2.8); or with a household income of <$15,000/year (OR 2.0). Lower antibody titers were found when serotesting at 4 to 12 months than at <4 months after HepB-3 (OR 1.8 to 4.4), with HepB-3 receipt <6 months after HepB-2 (OR 2.5) and when household income was <$15,000/year (OR 2.1). CONCLUSIONS: Centralized case management with home visits resulted in high rates of complete immunoprophylaxis and postvaccination testing among infants born to HBsAg-positive women. Perinatal immunoprophylaxis was immunogenic under routine public health use, with higher anti-HBs titers occurring in infants tested <4 months postvaccination. Because infants in households with low income had higher rates of nonprotective antibody responses, they may benefit from extra efforts to ensure that serotesting is conducted postvaccination.     

Risk factors for overweight in children from Southern Brazil

Risk factors for overweight were investigated in a cross-sectional survey of children aged 12-59 months in the Southern Brazilian city of Porto Alegre (n = 2,660). Odds ratios (OR) for overweight, defined by weight/height > 2 z-scores of the NCHS standards, were estimated for socioeconomic and demographic conditions, social environment, and childhood health events. Prevalence of overweight was 6.5%. In the multivariate model, the odds of overweight were positively associated with maternal education (schooling > 12 years, OR = 2.36; 95%CI: 1.21-4.60; 9-11 years, OR = 2.07; 95%CI: 1.16-3.70) and family income per capita > 2 times the minimum wage (OR = 1.86; 95%CI: 1.13-3.08) and negatively associated with maternal work (OR = 0.72; 95%CI: 0.52-0.99). Odds were higher for children born large-for-gestational-age (OR = 2.29; 95%CI: 1.36-3.85) and lower for children born small (OR = 0.57; 95%CI: 0.33-0.99), as compared to those born with adequate birth weight for gestational age. Paternal schooling, parental occupation, and maternal age at the child's birth were associated with overweight in the unadjusted model only. Programs are needed to prevent overweight during childhood, with special attention to families and children at increased risk.