Quality of life for oncology patients during the terminal period. Validation of the HRCA-QL index

AIM: The evolution of performance status, disability, and quality of life (QL) according to the Hebrew Rehabilitation Center for Aged QL (HRCA-QL) index for cancer patients through their terminal period is described. The assessment of HRCA-QL validity and reliability is also described. DESIGN: A total of 200 cancer patients were followed up from the onset of their "terminal phase" until they died. Information on symptoms, performance, disability and QL were collected by patient's oncologists in hospital and by their family practitioners and community nurses when the patient was at home. Health measures were: the HRCA-QL index, Karnofsky performance status (KPS) and the Independence in Activities of Daily Living (IADL) index. RESULTS: The three indices were acceptable for a fair number of patients at the start of the terminal phase. Almost two-thirds had a KPS > or =60. With respect to the IADL index, the patients were independent in five of the six functions, with 80% having a HRCA-QL equal to or greater than 4. The median duration of the terminal period was 59 days. All three indices declined progressively, with marked deterioration in the last 2 weeks. The HRCA-QL index was highly correlated with KPS and the IADL index, had good internal consistency and showed an acceptable test-retest and inter-rater reliability. The HRCA-QL index was reactive to clinical changes. CONCLUSIONS: All three scales confirmed that terminal patients experience a progressive loss of performance, increase in dependence and deterioration of QL as they approach the end of life. Based in these results, we consider the HTCA-QL index valid for use in terminal cancer patients.     

Neuroimmunomodulation by nutrition in stress situations

Stress has long been suspected to play a role in the etiology of many diseases and may be detrimental to health. Nowadays, the communication between the neuroendocrine and the immune systems is well established and there is enough evidence that the magnitude of stress-associated immune dysregulation is large enough to have health implications. In stress conditions, modulation of the immune system by the central nervous system (CNS) is mediated by a complex network of signals, showing a relationship between stress and resistance to infection. On the other hand, an adequate balanced diet plays a crucial role in the management of stress, and nutrition seems to be a critical determinant in the interactions among CNS and the immune system under stress conditions. Thus, interactions among nutrition, CNS and the immune system could be a key to understand implications in physiological stress situations. The present article will briefly review nutrition approaches on stress-related immune response and CNS communication.     

Retinitis pigmentosa,mental retardation,marked short stature,and brachydactyly in two sibs

We present two siblings with retinitis pigmentosa, mental retardation, markedly short stature, and brachydactyly. This association of clinical findings appears to be distinct from previously described syndromes and seems to represent the pleiotropic effects of a single autosomal recessive gene.     

Shear bond strength of precoated and uncoated brackets using a self-etching primer

OBJECTIVE: To test the hypothesis that there are no significant differences in the shear bond strength or the adhesive remaining on the tooth after debonding between precoated and uncoated brackets using a self-etching primer. MATERIALS AND METHODS: APC Plus precoated brackets and uncoated brackets were bonded with Transbond XT adhesive using the self-etching primer Transbond Plus Self-Etching Primer (TPSEP). The brackets were bonded to extracted human premolars and categorized into two groups: (1) TPSEP/Transbond XT and (2) TPSEP/APC Plus. Shear bond strength was measured with a universal testing machine. The adhesive remnant on each tooth after debonding was quantified with image analysis equipment. Scanning electron microscope (SEM) observations of enamel surfaces treated with TPSEP were also carried out. RESULTS: No significant differences were observed in the shear bond strengths for the two groups evaluated (P < .05). TPSEP/APC Plus left significantly less adhesive on the tooth after debonding than did TPSEP/Transbond XT (P < .05). It was observed that SEM left a porous and potentially retentive surface. CONCLUSIONS: There was no significant difference in the bond strength of the two systems tested, but there was a significant difference in the percentage of area of adhesive remaining on the tooth.     

Sesquiterpene lactones as allelochemicals

Six new sesquiterpene lactones, annuolide H (3), helivypolides F, H-J (4, 11-13), and helieudesmanolide A (6), together with known compounds, were isolated from polar bioactive fractions of Helianthus annuus cv. SH-222 and Stella fresh leaf water extracts. Spectroscopic analysis of the new data for 1,2-anhydroniveusin A and 1-methoxy-4,5-dihydroniveusin A corrects some previous assignments. The compounds were tested using the etiolated wheat coleoptile bioassay, and the most active compounds were assayed in standard target species (STS) (Lepidium sativum, Allium cepa, Lactucasativa, Lycopersicon esculentum, and Triticum aestivum) from 5 x 10(-4) to 10(-5) M. The most phytotoxic compounds were helivypolide F and 15-hydroxy-3-dehydrodeoxyfruticin, both of which have a carbonyl group at C-3 conjugated with two double bonds.     

Genotypic resistance to lamivudine among hepatitis B virus isolates in Mexico

BACKGROUND: Drug resistance of hepatitis B virus (HBV) is an increasing clinical problem. Resistance to lamivudine in HBV isolates in Mexico has been poorly explored. OBJECTIVES: To characterize the mutation patterns associated with genotypic resistance to lamivudine and their prevalence among HBV isolates in Mexico. MATERIAL AND METHODS: Thirty-nine Mexican HBV isolates were analysed by PCR and line probe assay for detection of genetic variants in the polymerase open reading frame domains B and C (INNO-LiPA HBV DR; INNOGENETICS N. V., Ghent, Belgium). This assay detects wild-type and mutations at codons 180, 204 and 207 of the HBV polymerase gene, and at codon positions 171, 172, 195, 196, 198 and 199 of the HBV surface antigen (HBsAg). HBV isolates were obtained from HBsAg-positive serum samples of 15 chronic hepatitis patients, two haemodialysis patients with chronic HBV carriage, 20 men found positive for HBsAg when seeking HIV testing and two AIDS patients with chronic HBV infection. None of the participants had received antiviral therapy. RESULTS: Overall, HBV wild-type was found in 37 (94.9%) out of the 39 isolates studied. Two (5.1%) out of the 39 isolates showed mixed wild-type and mutant populations. These mutations occurred in isolates from one hepatitis patient and one haemodialysis patient. The isolate from the hepatitis patient showed a double mutation at codon positions 180 (L180M) and 204 (M204V), thus a 2.6% prevalence of genotypic resistance to lamivudine was found. The isolate from the haemodialysis patient showed a single mutation at codon position 180 (L180M). The two HBV mutant isolates were further analysed for genotype and both isolates were genotype H. CONCLUSIONS: HBV genotypic resistance to lamivudine exists in Mexican isolates. The results highlight the importance of testing for HBV resistance before treatment and have implications for a more rational use of drugs.