Neonatal hypoglycaemia: changing attitudes in the Northern Region

There has been a recent resurgence of interest in the significance of moderate hypoglycaemia in neonates; although old assumptions have been questioned, there are insufficient data for new and authoritative guidelines to be published. This longitudinal study was designed to test the hypothesis that there have been changes in attitudes among those caring for newborn babies in the 18 maternity units in one health Region. The data were collected by questionnaire in 1986 and 1991, and responses were complete. The results showed a significant shift to higher values in the definition of hypoglycaemia over the five years, in association with a tendency to feed babies earlier--although some units had not altered their policies.     

Developing staff into clinical practitioners

Developing clinical skills in pharmacy staff is a process that can enhance the services of a pharmacy department and improve the professional development and interest of the staff. Staff should be included in the development of a clinical philosophy and a training and ongoing development program that will achieve the desired goals should be planned. An MBO process may help to track the individual pharmacist's progress. Knowledgeable, motivated staff are the key ingredient in achieving success in providing pharmacy services.     

Daily,limited access to methamphetamine self-administration during pregnancy leads to increased methamphetamine sensitivity in adult offspring

Methamphetamine use by women, even throughout pregnancy, is common. But there is limited knowledge about the effects in prenatally methamphetamine-exposed children. This study investigated how prenatal methamphetamine exposure in rats, via maternal i.v. self-administration, affected the sensitivity of adult offspring to methamphetamine in comparison with controls. The offspring were generated from dams either self-administering methamphetamine daily under limited-access conditions prior to and throughout pregnancy, or their respective saline-yoked control dams. Spontaneous and methamphetamine-induced locomotor activity was assessed in male and female offspring of both exposure groups after a range of methamphetamine doses. In a separate group of offspring, acquisition of i.v. methamphetamine self-administration, responding under fixed and progressive ratio schedules of methamphetamine reinforcement, and reinstatement of extinguished drug-seeking behavior were assessed. Methamphetamine dose-dependently increased locomotor activity in both exposure groups. However, methamphetamine-exposed males showed significantly enhanced locomotor activity compared with controls at 1 mg/kg, and methamphetamine-exposed females showed significantly enhanced locomotor activity compared with controls at 3.2 mg/kg. Methamphetamine-exposed offspring of both sexes acquired methamphetamine self-administration faster and showed overall higher levels of methamphetamine-induced reinstatement compared with controls. Taken together, these results indicate that prenatal methamphetamine exposure to relatively low levels alters methamphetamine sensitivity in male and female adult offspring.     

Erythromycin prolongs the QTc interval among patients with pneumonia

Erythromycin is commonly used to treat simple community-acquired pneumonia. We measured the prolongation in QT(c) intervals in EKGs associated with intravenous erythromycin administration among patients hospitalized for simple pneumonia (DRGs 89 and 90). We reviewed the medical records of 50 patients who received at least 5 days of intravenous erythromycin, and found 15 with readable paired EKGs, at least one taken during the period of erythromycin administration and at least one other obtained when the patient had no erythromycin. The mean QT(c) interval in lead II for EKGs taken without erythromycin was 0.422 s and the average prolongation of the QT(c) interval associated with erythromycin administration was 0.046 s (P<0.01). The administration of erythromycin was thus associated with an increase in QT(c) intervals to a mean of 0.468 s, a value considered to be abnormally prolonged. We conclude that erythromycin prolongs the QT(c) interval among patients hospitalized with pneumonia in the same manner previously reported for healthy volunteers in an experimental setting. The magnitude of this erythromycin-induced QT(c) prolongation raises QT(c) intervals into the abnormal range. Although no patient in this small study suffered an adverse effect from the QT(c) prolongation, the magnitude of this effect is sufficiently large to raise clinical concerns.     

Using automated pharmacy records to assess the management of tuberculosis

We used automated pharmacy dispensing data to characterize tuberculosis (TB) management for 45 health maintenance organization (HMO) members. Pharmacy records distinguished patients treated in HMOs from those treated elsewhere. For cases treated in HMOs, they provided useful information about appropriateness of prescribed regimens and adherence to therapy.     

Hepatitis and HIV Risk among Drug-Using Men Who Have Sex with Men: Demonstration of Hart's Law of Inverse Access and Application to HIV

Objectives: The first 215 drug-using men who have sex with men (DU-MSM) evaluated for possible participation in a controlled behavioral intervention study were tested for Hart's law of inverse access, which predicts that access to prevention resources varies inversely to need. Methods: Hepatitis B vaccination, mental health, and substance abuse treatment were used to measure health resource use; hepatitis B (HBV) and HIV infections and unsafe sex measured preventive care needs. Socioeconomic status indicators included education, ethnicity, and income. Results: HBV-vaccinated men were more likely to be white and college educated. HBV-infected men were more likely to be black, older, HIV-positive, and have higher rates of substance use with sex. When stratified according to socioeconomic status indicators, levels of HBV vaccination were inverse to the rates of HBV and HIV infection. This relationship was not found for psychosocial treatment utilization. Conclusions: Demonstration of Hart's law among high-risk DU-MSM has important implications for future HIV prevention efforts among high-risk individuals. Combining HIV, hepatitis, and substance abuse prevention in primary care and substance abuse treatment settings is discussed.     

Human complement regulatory proteins protect swine lungs from xenogeneic injury

BACKGROUND: Pulmonary xenotransplantation is not possible because of hyperacute lung injury, the pathogenesis of which is unknown. This study evaluates complement-dependent pathways of pulmonary injury during heterologous perfusion of swine lungs. METHODS: Lungs from unmodified swine and swine expressing human decay-accelerating factor and human CD59 (hDAF/hCD59 swine) were perfused with either human plasma or baboon blood. Pulmonary vascular resistance and static pulmonary compliance were measured serially, and swine lung tissue were examined by light microscopy. Complement activation was assessed by serial measurements of baboon plasma C3a-desArg concentrations. RESULTS: Perfusion of unmodified swine lungs with human plasma and baboon blood resulted in hyperacute lung injury within minutes of perfusion. However, function was preserved in swine lungs expressing human decay-accelerating factor and human CD59. In both study groups, xenogeneic perfusion with baboon blood resulted in at least a sevenfold increase in plasma C3a-desArg levels suggesting transient activation of complement. CONCLUSIONS: Lungs from swine expressing human decay-accelerating factor and human CD59 were resistant to injury during perfusion with human plasma and baboon blood, indicating that complement mediated some of the features of xenogeneic acute lung injury.     

The feasibility of demonstration of GM- and InV-systems in decaying organs

Summary -globulin factors (Gm and InV-systems) were determined in 12 cadavers in blood and various organ exprimates (kidney, liver, spleen and muscle). Also checked was the time interval up to which these factors could still be demonstrated in decaying organs.For this purpose blood and portions of the organs were left to decay in plastic containers at an average temperature of 19.1°C. Examinations were done with the agglutination-inhibition-test. The exprimates were employed in dilutions 1:10 and 1:20. The serum factors Gm (1), (2), (4), (10) and InV (1) could be demonstrated for varying periods of time.In organs they could be demonstrated for between one and eight weeks. Only factors Gm(1) and Gm(2) could be demonstrated beyond this time. As a rule these serum factors were demonstrable in blood for a longer period of time than in organs. Factor Gm(4) proved to be the most stable one, as it could be demonstrated up to 11 weeks in decaying serum.In 2200 individual tests with a dilution 1:20 no false positive results were obtained, with the dilution 1:10, however, 5 false positive tests were found. No explanation can be given for the different periods of time for which these factors can be demonstrated under conditions of decay.

---

Zusammenfassung Bei zwölf Leichen wurden im Blut und in verschiedenen Organpreßsäften (Niere, Leber, Milz und Muskel) die -Globulineigenschaften (Gm- und InV-Systeme) bestimmt und ihre Nachweiszeit bei Fäulnis überprüft. Blut und Organteile wurden hierbei in verschließbaren Plastikgefäßen bei einer mittleren Temperatur von 19,1°C faulen gelassen. Die Untersuchungen erfolgten mit dem Agglutinationshemmtest.Die Preß- bzw. Fäulnissäfte wurden in 1:10 und 1:20 Verdünnungen verwendet. Die Serumfaktoren Gm(1), (2), (4), (10) und Inv(1) konnten über unterschiedlich lange Zeiträume nachgewiesen werden.In den Organen betrug die Nachweiszeit zwischen einer und acht Wochen, wobei nur die Faktoren Gm(1) und Gm(2) über diese Wochen nachweisbar blieben. Die Serumeigenschaften waren im Blut allgemein länger nachweisbar als in den Organen. Am stabilsten erwies sich der Faktor Gm(4), der bis zu elf Wochen im faulenden Serum festgestellt werden konnte.Bei 2200 Einzelbestimmungen wurden mit der 1:20 Verdünnung in keinem Fall falsch positive Ergebnisse erzielt, mit der 1:10 Verdünnung hingegen fünf falsch positive Ergebnisse.Eine Erklärung für die unterschiedlich langen Nachweiszeiten unter Fäulnisbedingungen kann nicht gegeben werden.

     

Inhibition of the antimetamorphic action of prolactin in larval Ambystoma tigrinum by lysine vasopressin,arginine vasotocin,and aldosterone

In an earlier study it was reported that oxytocin was able to block the antimetamorphic action of prolactin (PRL) in larval tiger salamanders, Ambystoma tigrinum (Platt and LiCause, 1980). In this study, we have examined the effects of lysine vasopressin (LVP), arginine vasotocin (AVT), and aldosterone on induced metamorphosis in larval A. tigrinum and on the inhibition of this process by PRL. Both LVP and AVT were found to interfere with the inhibition of gill resorption, tail fin regression, and body weight loss by PRL. An anti-PRL effect of aldosterone was observed but appeared to be limited to the gill. AVT alone had a significant acceleratory effect on body weight loss during metamorphosis. A “water balance” response was observed in only one case. Twenty-four hours after treatment with LVP and PRL, this group of animals did show a significant increase in body weight. These results are discussed with regard to the problem posed by neurohypophysial hormone contamination of PRL preparations and in context with our hypothesis that the antimetamorphic action of PRL is at least partially osmoregulatory in nature.