A strategy for the management of hospitalized children with acute lower respiratory infections

OBJECTIVES: To improve the quality of care provided to hospitalized children having acute lower respiratory infections (ALRI), to increase the knowledge on this health condition, and to broaden the utilization of health care resources through a program called "Winter Plan". METHODS: The program comprised the use of guidelines for diagnosis and treatment, disease-oriented hospitalizations to provide an increased level of care, management of health care resources and implementation of computerized medical records. Systematic investigation of viral etiology was performed in order to rationalize the use of medications and reduce nosocomial infections. RESULTS: During program implementation (19/V-19/IX/99), 3,317 children were admitted; 1,347 (40.61%) had ALRI, of which 1,096 (81%) were included in the study. Of them, 71% aged less than 1 year. Most ALRI were viral (68%). Admission criteria were: oxygen saturation <95%, tachypnea, retractions or pleural effusion (92.4% of the children). The demand magnitude prevented compliance with isolation guidelines in all cases. Treatment guidelines were followed in a high percentage of cases: 73% of children having bronchiolitis and 72% of those with viral pneumonia received no antibiotics and 96% of children with bacterial pneumonia were put on antibiotics as recommended; use of bronchodilators and corticosteroids was reduced. Medication costs were reduced especially in the corticosteroid group, which meant a greater impact on hospitalization costs. CONCLUSIONS: To decrease ALRI morbidity and mortality there is a need to continue improving the quality of health care during hospitalization and to reinforce health promotion actions and preventive programs at the primary level.     

Deep white matter infarction: correlation of MR imaging and histopathologic findings

Focal and confluent areas of periventricular hyperintensity have been reported on magnetic resonance (MR) images in 30% of patients over 60 years of age. In order to better understand the pathologic basis of these lesions, the authors studied 14 formalin-fixed brains with MR imaging. Multiple focal areas of hyperintensity were identified in the periventricular white matter in three of the 14 brains studied (21%). Subsequent gross and microscopic pathologic examination of both hyperintense and normal-intensity areas was performed on 87 tissue sections. The larger lesions were characterized centrally by necrosis, axonal loss, and demyelination and therefore represent true infarcts. Reactive astrocytes oriented along the degenerated axons were identified at distances of up to several centimeters from the central infarct. This is called isomorphic gliosis and is associated with increased intensity on T2-weighted images that increases the apparent size of the central lesion.     

Dietary phytoestrogens are not associated with risk of overall breast cancer but diets rich in coumestrol are inversely associated with risk of estrogen receptor and progesterone receptor negative breast tumors in Swedish women

Results from epidemiological and experimental studies indicate that phytoestrogens may protect against breast cancer. Because one of the biological effects of phytoestrogens is probably estrogenic, it's possible that the preventive effect on breast cancer differs by estrogen receptor (ER) or progesterone receptor (PR) status of the tumor. We evaluated the associations between dietary phytoestrogen (isoflavonoids, lignans, and coumestrol) intake and risk of breast cancer and whether the ER/PR statuses of the tumor influence this relationship. In 1991-2 a prospective population-based cohort study among Swedish pre- and postmenopausal women was performed, making questionnaire data available for 45,448 women. A total of 1014 invasive breast cancers were diagnosed until December 2004. Cox proportional hazards models were performed to estimate multivariate risk ratios, 95% CI for associations with risk of breast cancer. Intakes of lignan, isoflavonoid, or coumestrol were not associated with breast cancer risk overall or before or after 50 y of age. The effects of lignans or isoflavonoids were independent of receptor status. However, intake of coumestrol was associated with decreased risk of receptor negative tumors (ER-PR-) but not positive tumors. The risk of ER-PR- tumors was significantly lower (50%) in women with intermediate coumestrol intake compared with those who did not consume any. In conclusion, we found no association between intake of isoflavonoids or lignans and breast cancer risk. Our results of a decreased risk of ER-PR- tumors in women with intermediate intake of coumestrol could be due to chance because of the low intake. The results should be confirmed in other studies.     

Is depression more likely following childbirth? A population-based study

Archives of Women's Mental Health - Postpartum depression (PPD) is characterized as a depressive episode conditional on childbirth. We examined whether the risk of depression is higher...     

海南粗榧新碱衍生物HH07A的抗肿瘤作用

用细胞生长曲线测定法及软琼脂集落形成分析法研究了HH07A对几种肿瘤及正常细胞生长的影响。结果表明,1.5ug·ml^-1及3μg·ml^-1HH07A能分别明显抑制L1210和HL-60细胞的生长。3种肿瘤细胞对HH07A的敏感性依次为L1210>KB>HL-60,而正常小鼠粒系祖细胞GM-CPC对药物的敏感性则低于前三者,且HH07A3.5μg·ml^-1对HL-60细胞无分化诱导作用。HH07A对腹水型L1210白血病小鼠、S180小鼠均有较明显的治疗作用,使L1210荷瘤小鼠、S180荷瘤小鼠存活时间延长。也能抑制S180实体瘤的生长。     

A study of temporal artery biopsy for the diagnosis of giant cell arteritis

Clinical Rheumatology - This large, retrospective, multicenter study examines the Mayo Clinic experience with temporal artery biopsies over an 11-year period to help form guidelines that would lead...