Oral antineoplastic agents: how do we care about adherence?

AimsOral therapies, including hormone‐based or targeted therapies, have recently taken an increasing place in cancer treatment. In this context, a state of the art of the available studies dealing with the adherence of adult patients to oral anticancer treatment is warranted. The purpose of this review is to address (i) the association between assessment methods and measured adherence, (ii) the putative factors related to adherence and (iii) new ways of improving adherence to oral cancer therapies.MethodsWe conducted a literature‐based narrative review of studies obtained from Pubmed using medical subject heading terms and free‐text terms combining concepts related to oral anticancer medication and adherence.ResultsThe analysis is based on 48 studies published since 1990, mostly assessing hormone‐based therapy in breast cancer and targeted therapies in chronic myeloid leukaemia. Various methods of adherence were reported including self‐report, medication measurement or combinations of methods. Adherence rates were found to vary from 14% to 100%. Beside patient related‐factors, adherence rate discrepancies were found to be dependent on the method used. Furthermore, there was no consensual definition of adherence even regarding the same methods, some of them tolerating a period of interruption during the treatment period. Finally, several studies addressing persistence found a progressive decrease in adherence with time.ConclusionAdherence to novel oral therapies is a major issue and further research is warranted to standardize adherence assessment in clinical studies better and to define better the most appropriate approaches to improve long term adherence in oncology practice.     

Autism: A form of lead and mercury toxicity

AimAutism is a developmental disability characterized by severe deficits in social interaction and communication. The definite cause of autism is still unknown. The aim of this study is to find out the relation between exposure to Lead and/or mercury as heavy metals and autistic symptoms, dealing with the heavy metals with chelating agents can improve the autististic symptoms.MethodBlood and hair samples were obtained from 45 children from Upper Egypt with autism between the ages of 2 and 10 years and 45 children served as controls in the same age range, after taken an informed consent and fill a questionnaire to assess the risk factors. The samples were analyzed blindly for lead and mercury by using atomic absorption and ICP-MS. Data from the two groups were compared, then follow up of the autistic children after treatment with chelating agents were done.ResultsThe results obtained showed significant difference among the two groups, there was high level of mercury and lead among those kids with autism. Significant decline in the blood level of lead and mercury with the use of DMSA as a chelating agent. In addition, there was decline in the autistic symptoms with the decrease in the lead and mercury level in blood.ConclusionLead and mercury considered as one of the main causes of autism. Environmental exposure as well as defect in heavy metal metabolism is responsible for the high level of heavy metals. Detoxification by chelating agents had great role in improvement of those kids.     

Global efforts inconquering lung cancer in China

Lung cancer, the most prevalent and deadly malignancy in the world, poses a particularly critical healthcare challenge to China due to the rapidly increasing new cases and the unique cancer genetics in...     

Initiation of postpartum contraception: A survey among health centre physicians and nurses in Finland

Objective

To examine self-reported professional practices of postpartum contraceptive counselling at Finnish community health centres.

Design

A survey study with self-administered online questionnaires.

Setting

All local municipalities (n = 107) in the Expert Responsibility Area of Tampere University Hospital in Western Finland in 2005.

Subjects

A total of 69 (64% of 107) health centre physicians and 80 (75%) nurses performing postpartum check-ups.

Main outcome measures

Contraceptive method most often initiated or recommended to breastfeeding women at postpartum visit; timing of postpartum initiation of hormonal and intrauterine contraceptive methods in relation to breastfeeding and resumption of menses.

Results

The most common contraceptive method initiated or recommended to breastfeeding women by both physicians (41%) and nurses (45%) was the condom, followed by progestin-only pills and intrauterine contraception. Few professionals recommended breastfeeding (lactational amenorrhea) as the only contraceptive method. Only eight (12%) physicians inserted a copper-releasing intrauterine device and five (7%) a levonorgestrel-releasing intrauterine system typically at the postpartum visit; the majority delayed the insertions until the resumption of menses. Fifty-three (77%) physicians initiated combined oral contraceptives mostly when breastfeeding was terminated and menses had returned. Over half of the municipalities involved in the study did not provide any medical contraceptives free of charge postpartum.

Conclusion

Professionals’ reports indicate that initiation of effective contraceptive methods is delayed after childbirth. In order to promote better postpartum contraception practices, updated evidence-based guidelines are needed.     

Cluster headache

Cluster headache is a stereotypic, primary headache disorder that is marked by repeated short-lasting attacks of severe, unilateral head pain and associated autonomic symptoms. Cluster headache is probably due to an abnormality in the circadian hypothalamic generator with subsequent trigeminovascular activation. We have reviewed the clinical manifestations, pathophysiology, gender differences, and treatment options in cluster headache.     

Stimulated acoustic emission to image a late liver and spleen-specific phase of Levovist in normal volunteers and patients with and without liver disease

Quantitative studies were performed to investigate liver- specific uptake of the microbubble Levovist®, using stimulated acoustic emission (SAE), which can detect microbubbles even when stationary or slow-moving. These comprised studies of biodistribution comparing the liver and kidney in five normal volunteers, reproducibility in 34 patients, comparison between cirrhotics and controls (n = 9 each) and maximal depth of effect at different frequencies (180 measurements in 31 patients). Stimulated acoustic emission lasted beyond 30 min, with strongly liver-specific properties in each volunteer and was highly reproducible. No difference in the amount of SAE in the superficial liver was seen between cirrhotic and normal livers, but attenuation was higher in cirrhotics. This demonstrates a frequency-dependent effect on liver SAE penetration. We conclude that the liver uptake of Levovist® lasts over 30 min, is reproducible, occurs even where diffuse liver disease is present and can be used to assess tissue attenuation in a novel fashion.     

526株临床感染病原菌的耐药性监测分析

目的监测福鼎市医院2005年度临床感染病原菌的耐药状况，为本地区医院感染的流行病学调查及临床合理用药提供依据。方法应用回顾性统计分析2005年度本院各临床标本中分离的病原菌对常用抗生素的耐药情况。结果共分离出病原菌526株，其中革兰阴性杆菌265株，占50．4％；真菌130株，占24．7％；革兰阳性球菌115株，占21．9％。各菌属对常用抗生素的耐药率有差异，大肠杆菌对呋喃妥因的耐药率最低为11％；克雷伯菌属对氧氟沙星的耐药率最低为31％；假单胞菌属对环丙沙星的耐药率最低为40％；不动杆菌属对头孢他啶的耐药率最低为32％；肠杆菌属对呋喃妥因的耐药率最低为29％。未发现耐万古霉素的葡萄球菌，呋喃妥因对葡萄球菌有较好的抗菌活性。结论临床常见病原菌对常用抗菌药物呈高耐药率，且有逐年增高的趋势，医院应重视细菌耐药性监测，合理使用和控制滥用抗生素。     

双氢青蒿素对肿瘤细胞及肿瘤动物模型的抑制作用

目的:观察双氢青蒿素对多种肿瘤细胞和动物移植瘤模型的抑制作用,分析其抗癌作用的特异性.方法:用MTT法、SRB法观察和比较双氢青蒿素对多种肿瘤细胞和正常人体细胞的抑制作用,采用小鼠的B16-BL6、H22和Lewis等肿瘤模型分析双氢青蒿素对肿瘤生长的抑制作用以及铁对双氢青蒿素抗肿瘤效应的药物协同作用.结果:双氢青蒿素对小鼠的B16-BL6、H22和Lewis肿瘤模型的肿瘤生长有较强的抑制作用;提前6 h口服少量硫酸亚铁,可明显增强双氢青蒿素对B16-BL6、H22的抗肿瘤效应;双氢青蒿素对K562、KB、HCT、SGC7901、Hela、HepG、BGC823、KCC853、Bel7402、A549、B16-BL6细胞均有抑制作用.IC50(μg/mL)分别为4.12、10.21、11.02、11.77、13.03、18.36、26.47、28.02、44.55、46.28、54.46.在17.5～35 μg/mL药物浓度作用下,正常细胞(HELF)有3%～5%生长,而肿瘤细胞没有增长,并有部分死亡.结论:双氢青蒿素对多种肿瘤细胞和动物移植瘤模型具有一定的选择性抑制作用,铁剂有抗癌协同作用.     

阿托伐他汀在不稳定性心绞痛患者早期应用中对C反应蛋白影响的研究

目的研究不稳定性心绞痛患者接受阿托伐他汀治疗3d后对血浆高敏-C反应蛋白(hs-CRP)及血脂水平的影响。方法选择2003年5月～2004年5月住院94例不稳定性心绞痛患者为研究对象,随机分为两组,常规治疗组47例,给予抗凝、硝酸酯类、β受体阻滞剂、血管紧张素转换酶抑制剂和钙拮抗剂等药物;阿托伐他汀干预组47例,在常规治疗基础上加用阿托伐他汀(商品名:阿乐)每日20mg,治疗3d,并测定两组治疗前后hs-CRP及血脂水平变化。结果治疗3d后,阿托伐他汀干预组血浆hs-CRP水平较常规治疗组明显降低(P<0.01),但两组治疗前后各血脂成分的变化差异无显著性。结论不稳定心绞痛患者较大剂量阿托伐他汀治疗3d后,可明显降低血浆hs-CRP水平,从而抑制冠心病患者炎性反应,有利于动脉粥样硬化斑块的稳定性,且该作用并不依赖于血脂的变化。