Involvement of Fusarium spp. in fungal keratitis

Members of the filamentous fungal genus Fusarium are among the agents most frequently causing keratomycosis in humans. Fusarium keratitis is most common among agricultural workers in geographical regions with hot, humid, tropical or semi-tropical climates, but can occur more rarely in countries with temperate climates, such as Hungary. Keratitis is usually treated with a topical antifungal agent, sometimes in combination with sub-conjunctival injections and/or antimycotic agents, but therapeutic keratoplasty may be needed for patients whose corneal infection does not resolve. Early and accurate diagnosis, coupled with appropriate antifungal therapy, is crucial for improving the chances of complete recovery.     

Risk of thromboembolism in relation to an in-vitro fertilization programme: three case reports

Severe thrombotic events following ovarian stimulation for in-vitrofertilization (IVF) procedures in three women are reported.None of these patients presented any concomitant clinical signof ovarian hyperstimulation syndrome. Coagulation inhibitorswere in the normal range but cardiovascular risk factors werepresent. It is postulated that early thrombosis could be favouredby high endogenous plasma oestrogen concentrations subsequentto ovarian stimulation when associated with another risk factor.Our data are discussed in relation to previous publications.It is suggested that risk factors must be considered individuallybefore each IVF attempt. In patients at high risk, clinicalmanagement of the post-transfer period is recommended.     

肝癌索拉非尼敏感性预测模型的构建及临床意义

目的：基于生物信息学方法构建并验证肝细胞癌(以下简称肝癌)对索拉非尼敏感性相关基因的预后风险模型,探究该模型对肝癌患者预后和对索拉非尼敏感性的预测能力。 方法：本研究对GSE109211数据集、TCGA-LIHC队列、ICGC-LIRI队列进行差异基因分析,通过交集筛选出肝癌索拉非尼敏感性相关基因。利用单因素Cox分析和LASSO回归构建预后风险模型并进行验证。通过GDSC数据库分析索拉非尼的IC50值并探索其与风险评分的关系。 结果：筛选出365个与索拉非尼敏感性相关的基因,富集分析显示存在与药物代谢相关的信号通路。单因素Cox回归分析出221个与预后相关的基因,通过LASSO回归构建了一个包含7个关键基因的预后风险模型,与低风险组相比,高风险组具有较短的生存时间。多因素Cox回归分析显示风险评分是独立的预后因素。通过对比高、低风险组患者的索拉非尼IC50值,发现高风险组的索拉非尼IC50值较低,提示高风险组对索拉非尼的治疗可能更敏感。 结论：基于索拉非尼敏感性相关基因构建的预后风险模型对肝癌患者预后具有良好的预测价值,并为评估肝癌患者的索拉非尼敏感性提供理论依据。     

脑血管病危险因素在海口城乡对比的调查

目的 通过脑血管病危险因素在海口城乡对比的调查,了解脑血管病发病的相关因素。方法 以整群随机抽样法,从超过４０岁人群中取城市１９２人,农村２３１人进行测定血糖、血甭胆固醇、苷油三酯、高密度脂蛋白、低密度脂蛋白、极低密度脂蛋白。结果 经统计学处理,发现胆固醇、苷油三酯高、低密度脂蛋白、极低密度脂蛋白、极低密度脂蛋白城乡比较均有显著差异（Ｐ〈０．０１）,脑血管病发病率、死亡率,城市明显高于乡村（Ｐ〈０     

Risk infection factors in the total hip replacement

Infection is a complication that occurs in a considerable percentage of hip prostheses replacements, being in many cases necessary to retire them, which generates important health and economical problems. Objectives: To know the distribution of infection and its risk factors in total hip replacement. Material and methods: A four year prospective study was developed in the rehabilitation and orthopedic center of La Paz Hospital. A total of 873 patients were included. Patients were controlled by means of active epidemiological surveillance until the day of discharge, listing up their characteristics at admission and risk factors during their stay. A multivariant study was carried out to determine risk factors. Results: Patients, average age was 63 years, 3.4% of them suffered from diabetes and there were no inmunocompromised patients. The percentage of wound infection during the four years was 6%, being reduced to 1.2% in the last year. The risk factors found in the multivariant study were: incorrect prophylaxis (OR: 3.85), wrong scaring (OR: 14.06), suffering more than one intervention (OR: 7.31) and a hospitalization period longer than 30 days (OR: 2.84). Conclusion: We think that special attention in the care of the surgical wound, as well as the correct use of prophylaxis, can significantly collaborate to the reduction of infection.     

Prevalence and control of arterial hypertension in the south-east of Spain: A radical but still insufficient improvement

Stroke mortality rates in Spain are one of the highest in all of Europe. At the same time, the Murcia region (south-east Spain) shows, for both genders, the highest age-adjusted stroke mortality rates in all of Spain. The earliest available hypertension figure estimations for this area go back to 1981, when a high prevalence combined with an almost nonexistent control was detected. One decade later, updated prevalence estimations of hypertension are presented jointly with their degree of control and their association with other risk factors based on the results of a prevalence survey in a random population sample (n = 3,091). Arterial blood pressure was measured following the MONICA protocol, maintaining a tight quality control on between and within-observer variability. As hypertensive was considered as any person with systolic blood pressure (SBP) 140 mmHg or with diastolic blood pressure (DBP) 90 mmHg or with antihypertensive pharmacological treatment. Detected prevalence rises to 32.3% (CI 95%: 29.1%–35.5%) among males and to 23.7% (CI 95%: 21.4%– 26%) among females, maintaining its level regarding figures observed back in 1981. However, its control has been increased, especially among hypertensive women [from less than 5% in 1981 to 35% (95% CI: 32%–37.8%) at present]. Hypertension is strongly associated to hipercholesterolemia, overweight, obesity and diabetes (p < 0.01). On the contrary, it shows an opposite association with current smoking, higher educational level and leisure time physical activity (p < 0.01). The highest educational level was associated with better hypertension treatment and control. In summary, while hypertension prevalence is stabilized in our population, its control has improved in a measurable but still insufficient way. These results are in accordance with a decreasing trend in stroke mortality registered in the Murcia Region along the last decade.     

Increasing physician involvement In cholesterol-lowering practices: The role of knowledge,attitudes and perceptions

The study evaluated a multifaceted educational intervention systematically designed to increase physician involvement in cholesterol-lowering practices. We hypothesized that knowledge, perceptions and behaviours would be enhanced in participating physicians, compared with controls. Method: Fifty-one family physicians were assigned randomly to three groups; the two experimental groups attended a training workshop, received physician and patient education materials and ongoing consultant support. One experimental group also received a “cuing” intervention. The control group received no interventions. Outcome measures included knowledge and attitude scores, self-efficacy perceptions, and physician dietary counselling behaviour. Measures were taken at pretest, 6 weeks and 15 months later. Results: Intervention group physicians achieved significantly higher knowledge scores than the control group at the six-week test; the differences disappeared at 15 months. Attitudes, self-reported practices and overall self-efficacy scores were similar across groups. Within group variation was highly significant. Physician dietary counselling scores were significantly higher in the intervention groups (p = 0.0001). Some associations were seen among knowledge, attitude, self-efficacy and dietary counselling scores. Conclusion: Physician behaviour change in cholesterol reduction may not depend entirely upon knowledge, attitudes and perceptions. This revised version was published online in June 2006 with corrections to the Cover Date.     

Aspects of the aetiology of congenital heart disease

A concise overview of current knowledge on the aetiology ofcongenital heart disease is provided. At present, only 10 to20% of the cases occurring in neonates can be attributed toknown risk factors. Recurrence within relatives, chromosomalanomalies, genetic disorders, maternal diseases and teratogenexposure are addressed briefly; contemporary research modelsand methods, e.g. embryology and genetics and molecular biology,are referred to. A major innovation has been the introductionof the concept of common pathogenetic pathways. Thus, differentteratogenic factors or risk-factors may affect normal developmentat an identical stage and cause similar malformations. Also,the importance of timing of an event is stressed. If the timeframe of exposure does not coincide with embryogenesis any teratogeniceffect may be missed. Large-scale epidemiological studies on fetuses and neonateswith congenital heart disease are introduced as a third modeof research on the aetiology, although this approach is notused efficiently at present; cases of intra-uterine death canbe considered a valuable source of information that needs furtherattention. Combined, the above three lines of research may proveproductive, but the design of a comprehensive research projectwould need to be handled carefully. Possibilities for preventionof the occurrence of cardiovascular malformations are reported.Through lack of knowledge of causality, at present, only secondaryprevention may be possible and hence deserves attention. However,there appears to be no provision for thorough pre-natal screeningtests for congenital heart disease in an unselected population.     

Electrocardiological profile and proarrhythmic effects of quinidine,verapamil and their combination: a mapping study

Quinidine and verapamil are widely used as antiarrhythmic agents and their combination is often used in the treatment of supraventricular tachycardia. This study was undertaken to clarify, whether these drugs exert proarrhythmic effects on the ventricles in therapeutic concentrations and whether possible arrhythmogenic effects might be enhanced by combination. Isolated rabbit hearts perfused according to the Langendorff technique were treated with increasing concentrations of quinidine (0.05 to 3.5 M) or verapamil (5 to 50 M) or of their combination (70:1 or 10:1; quinidine:verapamil) corresponding to common low, medium and high free therapeutic concentrations. The epicardial activation process was measured using a computer assisted mapping system for unipolar multichannel recording (256 channels simultaneously).Both substances prolonged the atrioventricular conduction time PQ. This effect was even more pronounced if the 70:1 combination was administered. The activation pattern was altered by both drugs and their combination to the same extent as became obvious from analysis of local activation vectors and of localisation of breakthroughpoints of epicardial activation for heart beats under control conditions and under drug treatment. The epicardial potential durations were prolonged by quinidine and to the same degree by the combinations, but not by verapamil alone. The total activation time was prolonged under the influence of quinidine and if the 70:1 combination was given. Both substances exerted a negative inotropic effect which was enhanced in an additive manner if both drugs were combined. In parallel the coronary flow was diminished.From these results it is concluded that (1) in this therapeutic concentration range quinidine possess a greater proarrhythmic risk than verapamil, (2) that both drugs' PQ prolonging effect can be enhanced by combination, (3) that combination does not enhance the proarrhythmic effects but the negative inotropic effects.