Prospective study of urinary tract infection surveillance after kidney transplantation

Background  

Urinary tract infection (UTI) remains one of the main complications after kidney transplantation and it has serious consequences.     

A phase II study of 5‐day intravenous azacitidine in patients with myelodysplastic syndromes

The approved 7‐day schedule of subcutaneous azacitidine for myelodysplastic syndrome is associated with injection site reactions and bruising and may be inconvenient because of the need for weekend doses. Although pharmacokinetic data with IV azacitidine suggests equivalence, there are no efficacy data published. Patients with all myelodysplastic syndromes (MDS) FAB subtypes were enrolled and received 75 mg/m²/d of azacitidine by 20‐min intravenous infusion for 5 days in every 28 days. Global methylation studies were performed at baseline and prior to Cycle 3. Twenty‐five patients were enrolled and 22 were evaluable. Median age was 69.5 years; 9 (41%) patients had lower‐risk disease (IPSS Low or Int‐1) and 13 (59%) had higher‐risk disease (IPSS Int‐2 or High). Twenty‐seven percent of patients responded (5 CRs and 1 PR). The median time to response was 108 days. The median PFS was 339 days (11.3 months), the median OS was 444 days (14.8 months) and the median duration of response (DOR) was 450 days (15.0 months). Global methylation studies suggest a greater degree of demethylation in responders. This regimen appeared to offer a PR + CR rate and median DOR somewhat similar to what has been reported with the 7‐day subcutaneous regimen; however, OS was shorter. Am. J. Hematol. 2009. © 2009 Wiley‐Liss, Inc.     

A Year's Experience in an Intermediate Respiratory Care Unit

BackgroundThe aim of this study was to describe the characteristics and results of patients admitted to an intermediate respiratory care unit (IRCU).Patients and methodsWe performed a 12-month prospective observational study of all the patients admitted to our IRCU during the study period. We analysed sociodemographic and clinical variables, the APACHE-II score, blood gas parameters, hospital stay duration, mortality, and hospital readmission.ResultsWe evaluated 190 patients (64.2% men), with a mean age of 69.4 years. A score of greater than 2 on the Charlson index was recorded in 43.2% of patients. The mean APACHE-II score was 16.3 in the accident and emergency department and 14.3 on entering the IRCU. Fifty percent of the patients were admitted to receive ventilation and, of these, only 6 (5.7%) were admitted to be disconnected from the ventilator. The mean duration of stay in the IRCU was 3.7 days. The readmission rate was 12.7%. Mortality was 12.6% during hospitalisation and 11.6% 90 days after discharge.ConclusionsThe patients admitted to our IRCU were elderly, with considerable comorbidity and high mortality, both during hospitalisation and 90 days after being discharged from hospital. The results revealed no statistically significant differences (mean length of stay, readmission, mortality) according to the type of care administered to the patients (ventilation compared to monitoring).     

Management of acute appendicitis: an imaging strategy in children

The pre-operative diagnosis of acute appendicitis (AA) has markedly changed during the last couple of decades due to the advent of modern imaging technology. Nowadays, the use of imaging has dramatically changed the way we approach children admitted to emergency room for abdominal pain with suspected AA. This change is mainly manifested in our diagnostic strategy.     

Rapacuronium for modified rapid sequence induction in elective caesarean section: neuromuscular blocking effects and safety compared with succinylcholine, and placental transfer

We have compared rapacuronium 2.5 mg kg-1 (n = 20) with succinylcholine 1.5 mg kg-1 (n = 22) in a multicentre, blinded, randomized study in full-term parturients undergoing elective Caesarean section under general anaesthesia. Thiopental 5 mg kg-1 was given i.v. followed by the neuromuscular blocking agent. Sixty seconds later intubation was performed. Intubating conditions, evaluated as excellent, good or poor, were good to excellent in 95% and 91% in the intent-to-treat patients after rapacuronium and succinylcholine, respectively (ns). Mean onset times at the adductor pollicis muscle for rapacuronium and succinylcholine were 80.4 (SEM 14.4) s and 63.9 (5.6) s (ns) while maximum block was 96 (1.9)% and 99 (0.4)%, respectively (ns). Rate of recovery was significantly longer after rapacuronium; times for return of T1 to 25% were 16.9 (1.5) min and 9.6 (1.1) min for rapacuronium and succinylcholine, respectively (P = 0.0004). Maternal side effects included more tachycardia and skin erythema with rapacuronium; no maternal mortality or morbidity, including bronchospasm, occurred in either group. There were no neonatal adverse effects in either group based on: Apgar scores at 1 and 5 min; times to sustained respiration; neuroadaptive capacity scores at 15 min, 2 h and 24 h; and umbilical venous and arterial blood-gas values and acid-base status. At delivery (17.7 (3.2) min), mean maternal plasma concentrations of rapacuronium were 9041.4 (1259.1) ng ml-1 and 506.4 (24.9) ng ml-1 for Org 9488 (the main metabolite). Corresponding values for umbilical venous plasma were 808.0 (92.1) ng ml-1 and 59.1 (6.5) ng ml-1, and for umbilical arterial plasma, 361.4 (56.4) ng ml-1 and 29.7 (4.6) ng ml-1, respectively. Umbilical venous to maternal venous ratios for rapacuronium and Org 9488 were 8.8% (1.3)% and 10.2 (1.7)%, respectively.      

Brain endogenous insulin effects on neurite growth within fetal rat neuron cell cultures.

We have previously described insulin to be synthesized "de novo" within the fetal rat brain and that brain endogenous insulin [I(n)] promoted neurofilament distribution within fetal neurons. In this study, we investigated the role of I(n) in neuron axonal growth. Rat fetal brain stem cells from 16-day gestational age were cultured in an IFDM and treated with an insulin antibody. In addition, the cell cultures were also treated in defined medium with the addition of: 5 ng, 20 ng or 100 ng/ml of insulin or 100 ng/ml insulin-like growth factor 1 (IGF-1). The neuron cell cultures were studied at 1 and 3 days of incubation. The presence of preproinsulin mRNA and insulin immunoreaction confirmed the "de novo" synthesis of insulin by the fetal neuron cell cultures. Axonal growth was similar by day 1 of the study in all the media, but in insulin medium containing 100 ng/ml of insulin the axonal length was significantly longer. By day 3 of incubation I(n) promoted axonal growth. Treating the neurons with an insulin antibody confirmed these findings, with a significant decrease in axonal length (p<0.05). The treatment with different concentrations of exogenous insulin did not promote axonal growth beyond I(n) by day 3 of incubation. IGF-1 did not promote axonal growth by day 3 of incubation. In summary, I(n) may promote axonal growth during brain development.