Palliative cancer patients and their families on the Internet: motivation and impact

Increasingly, palliative patients and their families are going online. A series of cases are presented to explore the reasons they go online and the effects of their online activity, both harmful and beneficial. This paper highlights the need to take this growing phenomenon and its effects on patient care seriously, and identifies key areas that need to be explored further.     

The Toronto Cardiac Rehabilitation and Secondary Prevention Program: 1968 into the new millennium

Given our approach to the cardiac rehabilitation process, which is reflected in the program structure and services and our high patient volume, this program model is effective for us. The model permits us to treat relatively large number of patients with relatively small numbers of staff. On average, a patient attends 32 supervised exercise sessions at the Centre over the course of 12 months. This is actually fewer supervised sessions than the popular model of 3 times per week for 12 weeks. However, the 12-month program provides an additional 9 months to work with patients on heart-healthy lifestyle modifications. At the same time, we realize our model is not the model of choice for all people in all settings for a variety of reasons. We trust that some elements of our program may be of interest and beneficial to some readers. Undoubtedly, the program will continue to evolve and develop into the future. Currently, we are conducting a cardiac rehabilitation outcomes study in an effort to determine the appropriate duration of cardiac rehabilitation to achieve optimal physiological, psychological, and cost benefits for patients. This study involves more than 700 patients and the results are intended to help us further refine the program structure and selected program elements. As the new millennium approaches, healthcare system reforms and continuing changes in the delivery of medical care to cardiac patients present opportunities, challenges, and some uncertainties for cardiac rehabilitation. To continue our services to patients and the medical community, cardiac rehabilitation programs will need to identify and develop even more innovative and effective concepts in response to ever-changing local, regional, and national issues.     

Hormonal interactions in ovarian cancer

According to the epidemiologic literature and the laboratory characterization of receptor content and molecular interactions, there is a relationship between the microenvironment of ovarian cancer and steroid hormones. Advances in our knowledge of the molecular-hormonal nature of ovarian cancer will help in designing a rationale for clinical trials in appropriate subsets of patients. However, currently, development of successful therapies and prevention strategies for women at risk remains a true challenge.     

Modulation of glutathione and glutamate-L-cysteine ligase by methylmercury during mouse development.

The antioxidant tripeptide glutathione has been proposed to be important in defense against oxidative stress and heavy metal toxicity. We evaluated alterations in glutathione regulation and synthesis associated with low-level chronic methylmercury (MeHg) exposure in the developing mouse fetus. Female C57Bl/6 mice were given 0, 3, or 10 ppm MeHg in the drinking water for 2 weeks prior to breeding and throughout pregnancy. Fetuses were collected on gestational days (gd) 12 and 16. Total glutathione, reduced glutathione (GSH), oxidized glutathione (GSSR), and glutamate-L-cysteine ligase (Glcl) activity were assessed in yolk sacs and fetuses at gd 16. Western and Northern blots for Glcl-catalytic (Glclc) and Glcl-regulatory (Glclr) subunits were performed on gd 12 and gd 16 fetuses. There were no changes in total glutathione in gd 16 mouse fetuses with exposure, but there were dose-related decreases in GSH and increases in GSSR. In contrast, visceral yolk sacs exhibited an increase in total glutathione in the low-dose groups, but no changes in the high-dose group. There were no changes in Glcl activity in fetuses, but there was a 2-fold increase in Glcl activity in yolk sacs from both low-dose and high-dose groups. There was a 2-fold induction in GLCLC: mRNA and protein in the gd 16 yolk sacs at both 3 and 10 ppm MeHg. No treatment-related changes in Glclr protein in either gd 12 or gd 16 yolk sacs or fetuses were found. Thus, the yolk sac is capable of up-regulating Glclc and GSH synthetic capacity in response to MeHg exposure. This increase appears to be sufficient to resist MeHg-induced GSH depletion in the yolk sac; however fetal glutathione redox status is compromised with exposure to 10 ppm MeHg.     

An examination of the utility of the AUDIT in people with schizophrenia

OBJECTIVE: To examine the reliability and validity of the Alcohol Use Disorders Identification Test (AUDIT) compared to a structured diagnostic interview, the Composite International Diagnostic Interview (CIDI; 12-month version) in psychiatric patients with a diagnosis of schizophrenia. METHOD: Patients (N = 71, 53 men) were interviewed using the CIDI (Alcohol Misuse Section; 12-month version) and then completed the AUDIT. RESULTS: The CIDI identified 32.4% of the sample as having an alcohol use disorder. Of these, 5 (7.0%) met diagnostic criteria for harmful use of alcohol, 1 (1.4%) met diagnostic criteria for alcohol abuse and 17 (23.9%) met diagnostic criteria for alcohol dependence. The AUDIT was found to have good internal reliability (coefficient = 0.85). An AUDIT cutoff of > or = 8 had a sensitivity of 87% and specificity of 90% in detecting CIDI-diagnosed alcohol disorders. All items except Item 9 contributed significantly to discriminant validity. CONCLUSIONS: The findings replicate and extend previous findings of high rates of alcohol use disorders in people with severe mental illness. The AUDIT was found to be reliable and valid in this sample and can be used with confidence as a screening instrument for alcohol use disorders in people with schizophrenia.     

A sensitive immunoassay for flunitrazepam and metabolites

The objective of this study was to develop an immunoassay that would be capable of detecting flunitrazepam and/or cross-reacting metabolites in urine and comparing the results with those obtained by gas chromatography-mass spectrometry. Doses of Rohypnol varying between 0.5 and 4 mg were given to volunteers, and urine was collected for up to two weeks postingestion. These samples were analyzed by an ELISA that was developed using an antibody raised to flunitrazepam and a drug-enzyme conjugate prepared by attaching 7-aminoflunitrazepam to horseradish peroxidase. Significant levels of flunitrazepam and/or cross-reacting metabolites were detected in urine for up to one week after ingestion. The immunoassay is selective with only diazepam cross-reacting at a level of 1000 microg/L.     

Investigation of cytokine levels and their association with SCORAD index in adults with acute atopic dermatitis

Background Atopic dermatitis (AD) is a chronic inflammatory skin disease with increasing frequency over the last decades, especially in adults. Cytokines orchestrate atopic skin inflammation. Objectives The aim of this study was to compare serum levels of cytokines in adult patients with acute AD (AD1) with other groups of AD patients and controls and investigate the possible association between such cytokines and disease severity. Methods We measured cytokine levels using flow cytometry in 21 adult patients with acute AD, 12 adults with chronic AD, 10 children with acute AD and 10 healthy adults. Results Flow cytometry analysis of cytokines revealed that interleukin 10 (IL‐10), IL‐6, interferon γ (IFN‐γ) and IL‐4 levels were significantly decreased in AD1 group compared with controls, whereas IL‐2 and tumour necrosis factor (TNF) did not differ. Comparison of AD1 group with adults chronic phase group showed that IgE, eosinophil and IL‐2 levels remained unaltered, whereas IL‐10, IL‐6, IFN‐γ, IL‐4 and TNF were significantly decreased. SCORAD and IgE levels were significantly increased, IL‐10, IL‐6 and IFN‐γ were decreased and TNF, IL‐2, IL‐4 and eosinophil levels remained unchanged in AD1 group compared with children acute phase group. Within AD1 group correlation analysis revealed that IgE and TNF levels were significantly associated with AD severity. Coefficient of determination analysis revealed that TNF and IgE levels could explain 49.14% and 35.28% of the variance of SCORAD. Conclusions These data indicate that serum IgE and TNF levels correlate with AD severity and that serum cytokines are downregulated in AD1 group. Further studies are clearly needed to elucidate cytokines’ role in adults with AD .     

Efficacy,safety and tolerability of green tea catechins in the treatment of external anogenital warts: a systematic review and meta‐analysis

Background External anogenital warts (EGWs) are non‐malignant skin tumours caused by human papillomavirus. They are one of the fastest growing sexually transmitted diseases. Current treatments are unsatisfactory. Green tea sinecatechin Polyphenon E ointment is a botanical extract from green tea leaves exhibiting anti‐oxidant, anti‐viral and anti‐tumour properties. Objective The aim of this study was to integrate valid information and provide basis for rational decision making regarding efficacy and safety of green tea extracts in the treatment of EGWs. Methods A systematic search in electronic databases was conducted using specific key terms. Main search was performed independently by two reviewers. The accumulated relevant literature was subsequently systematically reviewed and a meta‐analysis was conducted. Results Three randomized, double‐blind, placebo‐controlled studies evaluating efficacy and safety of Polyphenon E 15% and 10% in the treatment of warts were included in the systematic review and meta‐analysis. A total of 660 men and 587 women were enrolled. Regarding primary outcome, both Polyphenon E 15% and 10% demonstrated significantly higher likelihood of complete clearance of baseline and baseline and new warts compared with controls. No significant heterogeneity was detected. Recurrence rates were very low. Commonest local skin sign was erythema and local skin symptom was itching. Conclusions Efficacy of Polyphenon 15% and 10%, at least for the primary endpoint, is clearly indicated. Polyphenon E treatment exhibits very low recurrence rates and appears to have a rather favourable safety and tolerability profile. Recommendations for future studies should include evaluation of the efficacy of green tea catechins in the treatment of internal anogenital warts and direct comparison with its principal comparator, imiquimod.     

Possibility for error in FDA diffusion assays.

Computational procedures specified for the FDA single-dose diffusion assay for antibiotics may cause substantial error in estimated sample potency. An unrecognized mistake in reference solution concentration is the source of error. It is caused by correcting responses from standard and sample plates differently. The error can be avoided by correcting both standard and sample responses to the observed reference response.