Pharmaceutical Marketing: Implications for Medical Residency Training

An educational intervention was developed to improve family practice residents' ability to obtain useful information from pharmaceutical representatives. The curriculum is based on the traditional one-on-one drug detail. The objectives are to develop residents' skills in controlling the interview, promote skills for critically analyzing drug-promotional material, and discuss ethical issues. The contents include an assessment tool, suggested readings, and interview questions with rationale. After 5 years, residents' confidence in all areas of the curriculum improved significantly.     

Antibiotic prophylaxis with sulbactam/ampicillin in colon surgery

We evaluated the effectiveness of sulbactam/ampicillin (S/A) as a perioperative prophylaxis regimen in elective colic surgery (procedures lasting less than 4 hours). We studied 18 patients (11 males, 7 females; mean age 46 yrs, range 21-72), by an open, non-comparative trial: S/A was given soon before anesthesia (1 g + 2 g) and the same dose was repeated every 6 hours, up to 5 doses. The drug was well tolerated, and there were no side effects requiring the interruption of the prophylaxis. Infection rate was low (only one case of evident suppuration of the wound).     

Intestinal microvillous atrophy in a patient with Down syndrome and aganglionic megacolon

Intestinal microvillous disorders are an uncommon cause of severe diarrhea, with very poor prognosis. The authors report the case of a female infant with Down syndrome, aganglionic megacolon, severe diarrhea, and jejunal biopsy with ultrastructural changes consistent with microvillous atrophy. The patient condition improved after a colostomy performed in the setting of the treatment of Hirschprung disease.     

Search for poliovirus long-term excretors among patients affected by agammaglobulinemia

Patients with agammaglobulinemia may excrete enteroviruses, including vaccine-derived poliovirus, for prolonged periods of time. This poses a risk to the patients but it also may pose a risk to the population after eradication of poliovirus and the cessation of routine vaccination. To assess this risk, a pilot study was performed to identify potential poliovirus long-term excretors in a cohort of 38 patients with a definite/presumptive diagnosis of X-linked agammaglobulinemia (XLA). Stool samples were analyzed to detect any polio or other enteroviruses replicating in the gut and neutralizing antibodies against polioviruses were measured in the sera. No viruses were isolated from the stool samples and most sera had neutralizing antibody levels against all three poliovirus serotypes considered by the WHO to be protective in immunocompetent individuals. This suggests that long-term excretion of enteroviruses in patients with agammaglobulinemia is relatively uncommon.     

Assessment of intrafamilial clinical variability of poikiloderma with neutropenia by a 10-year follow-up of three affected siblings

Clericuzio-type poikiloderma with neutropenia is a well-defined nosological entity, but despite a remarkable number of clinical reports, no long term follow-up data has been presented to date regarding patients with this rare condition.Here we describe the results of clinical follow-up of three siblings, one male (Patient 1) and two females (Patients 2 and 3), subsequent to their first clinical and then molecular diagnosis of Clericuzio-type poikiloderma with neutropenia syndrome due to mutation of USB1gene. Patient 1 always expressed the most severe phenotype, while patients 2 and 3 showed an intermediate and mild phenotype, respectively, as observed since their first clinical evaluation. None of the patients developed skin cancer and/or myelodysplastic disorders considering the peripheral haematological findings. Lens opacity, never reported before, was found in two of the three patients.The long term follow-up observations confirm the stability over time of the pronounced intra-familial heterogeneity of clinical manifestations observed prior to and upon molecular diagnosis. We conclude that prolonged follow-up is an adjunct tool to monitor intra-familial variability of PN clinical spectrum which may favour surveillance of more serious complications of the disease among siblings, when a patient-specific clinical expressivity is present.     

Weighted expectation maximization reconstruction algorithms with application to gated megavoltage tomography

We propose and investigate weighted expectation maximization (EM) algorithms for image reconstruction in x-ray tomography. The development of the algorithms is motivated by the respiratory-gated megavoltage tomography problem, in which the acquired asymmetric cone-beam projections are limited in number and unevenly sampled over view angle. In these cases, images reconstructed by use of the conventional EM algorithm can contain ring- and streak-like artefacts that are attributable to a combination of data inconsistencies and truncation of the projection data. By use of computer-simulated and clinical gated fan-beam megavoltage projection data, we demonstrate that the proposed weighted EM algorithms effectively mitigate such image artefacts.     

A frequency and time domain study of the horizontal and vertical vestibuloocular reflex in the pigeon

1. The horizontal and vertical vestibuloocular reflex (HVOR and VVOR, respectively) was studied in four chronically instrumented pigeons. Eye movements were measured using the magnetic search-coil technique and were produced by rotation in the dark. During the rotation paradigms, the pigeons were either pharmacologically aroused (using amphetamine) or drug free (normal). The pigeon HVOR and VVOR were tested using step and sinusoidal rotational stimulation. The range of frequencies (0.03-6.0 Hz) and the magnitude of the sinusoidal stimuli were chosen to match those used in a previous study of the responses of semicircular canal primary afferents (SCPAs) in unanesthetized (i.e., normal) pigeons. 2. The gain of the HVOR and VVOR in both normal and aroused pigeons was independent of stimulus magnitude (6-30 degrees/s) over the frequency range tested. In aroused pigeons, the frequency independent gain (G) of the HVOR (G = 0.6) and VVOR (G = 0.9) was roughly twice that for normal pigeons. Pigeon VOR phase under all combinations of orientation and arousal level was independent of stimulus magnitude except at the lowest frequency tested (0.03 Hz). At this frequency, phase lead decreased as stimulus magnitude increased for the HVOR and VVOR in both normal and aroused pigeons. 3. The step and sinusoidal gains were greater for the VVOR than for the HVOR under the same level of arousal. Neither the gain nor the dominant time constant of the VOR (tau vor) differed for rotation direction (clockwise or counterclockwise) for the HVOR or VVOR in normal or aroused pigeons. 4. The mean value of tau vor was 4.0 +/- 0.5 (SE) s as estimated from frequency response data and 4.3 +/- 0.4 s as estimated from step response data for the HVOR and VVOR in both normal and aroused pigeons. In comparison, the mean value of the dominant or cupular time constant (tau c) of normal pigeon SCPAs was approximately 10 s as estimated from frequency response data. These results indicate that tau vor is shorter than tau c in the pigeon. 5. At higher frequencies, the pigeon HVOR and VVOR exhibit an increasing phase lag unaccompanied by a gain change--characteristics produced by a pure time delay. The value of this time delay was about 7 ms for both the HVOR and VVOR in both normal and aroused pigeons. The HVOR and VVOR in normal and aroused pigeons lacked the higher frequency lead characteristics present in the frequency responses of most pigeon SCPAs.     

Emilin genes are duplicated and dynamically expressed during zebrafish embryonic development.

Emilins are a family of extracellular matrix proteins with common structural organization and containing a characteristic N-terminal cysteine-rich domain. The prototype of this family, Emilin-1, is found in human and murine organs in association with elastic fibers, and other emilins were recently isolated in mammals. To gain insight into these proteins in lower vertebrates, we investigated the expression of emilins in the fish Danio rerio. Using sequence similarity tools, we identified eight members of this family in zebrafish. Each emilin gene has two paralogs in zebrafish, showing conserved structure with the human ortholog. In situ hybridization revealed that expression of zebrafish emilin genes is regulated in a spatiotemporal manner during embryonic development, with overlapping and site-specific patterns mostly including mesenchymal structures. Expression of certain emilin genes in peculiar areas, such as the central nervous system or the posterior notochord, suggests that they may play a role in key morphogenetic processes.     

Female reproductive health in two lamp factories: effects of exposure to inorganic mercury vapour and stress factors

To evaluate the possible influence of mercury vapour on female reproduction, 153 women working in a mercury vapour lamp factory have been compared with 193 women employed in another factory of the same company, where mercury was not used. Both groups of subjects were exposed to stress factors (noise, rhythms of production, and shift work). The production process has been analysed by inspection of the plants and by collective discussions with "homogeneous groups" of workers; a retrospective inquiry into work history and reproductive health events has been subsequently performed by an individual interview. Women exposed to mercury vapour currently not exceeding the time weighted average air concentration of 0.01 mg/m3 declared higher prevalence and incidence rates of menstrual disorders, primary subfecundity, and adverse pregnancy outcome; however, the progression of these problems with the level of exposure to mercury inside the same factory was not always clear. The results of this study neither prove nor exclude the possibility that occupational exposure to this concentration of mercury has a negative effect on female reproduction.