Determinants of condom use among intravenous drug users in Spain

Attitudes to and perception of health care delivery are consideredto be important factors for patient compliance in diabetes.To Investigate insulin-treated diabetic patients' use of, experienceof and attitudes to diabetes care a questionnaire was sent to561 patients, 20–50 years old, living in northern Sweden.Four hundred and eighty-eight patients (87%) participated inthe study. Data were analysed against social, medical and geographicalbackground factors. Female patients more often than men hadseen an ophthalmologist (93 versus 87%, p<0.05), a diabetesnurse specialist (74 versus 64%, p<0.05) and a chiropodist(49 versus 30%, p<0.001) at least once during the courseof their diabetes. Women also used the services of a medicalsocial worker (17 versus 10%, p-0.05) or a psychologist (14versus 8%, p<0.01) more often. More men than women were satisfiedwith the health care they had at the onset (65 versus 38%, p<0.001),but no gender difference in attitude to their present care wasfound. Diabetic patients with chronic complications comparedto those without were less satisfied both with the care theyreceived at the onset of diabetes (40 versus 61%, p<0.001)and at the time they answered the questionnaire (59 versus 72%,p<0.01). Patients in the most sparsely populated health districtwere more seldom able to be seen by the same physician (70 versus93% and 94%, p<0.001) and patient-physician continuity waspoorer over a 3 year period (48 versus 80%, p<0.001). Basedon results of this study, we conclude that use of, experienceof and attitudes to diabetes care are primarily related to genderand sickness factors. Living in sparsely populated areas probablyaffects the use and continuity of hearth care depending on themeans available. The differences demonstrated might be an argumentfor planning more individualized care for diabetic patientsin the future.     

CRYOGLOBULINEMIA AND CUTANEOUS LEUKOCYTOCLASTIC VASCULITIS WITH HEPATITIS C VIRUS INFECTION

Background. Mixed cryoglobulinemia (MC) is a systemic disorder, characterized by a typical clinical triad: purpura, weakness, and arthralgias, with visceral complications such as liver and renal involvement. The objective was to study the association between hepatitis C virus (HCV) infection and essential mixed cryoglobulinemia (EMC). Patients and Methods. Markers of HCV infection in 11 patients with cryoglobulinemia were examined and hepatitis C virus (HCV) was detected in eight of them. These patients were included in a clinical and histologic study. Anti-HCV antibodies were determined by a second-generation enzyme-linked immunosorbent assay (ELISA-2) in sera and cryoprecipitates. Studies on HCV-RNA were performed by a two-stage polymerase chain reaction (PCR) in the serum. A control group, consisting of 28 patients with other cutaneous disorders, was studied for HCV infection using ELISA-2 and PCR. Results. All patients had liver dysfunction, arthralgias, and purpura. Three patients had involvement of the peripheral nervous system, two had renal involvement, and one patient had Sjögren's syndrome. Cryocrits ranged from 3% to 20%. Six patients had type III cryoglobulinemia and the remaining two had type II. Markers for hepatitis B virus (HBV) were negative in all serum samples. Anti-HCV antibodies and HCV-RNA were positive in the serum of all the cases with MC. Anti-HCV antibodies were positive in all cases except for one of the cryoprecipitates tested. Four patients received recombinant interferon alfa. In two of them, serum aminotransferases became normal and cryoglobulins disappeared. Conclusions. The results strongly suggest that HCV infection is responsible for the cryoglobulinemia and vasculitis in patients with MC and that treatment with interferon alfa is presently the treatment of choice for such patients.     

PROGNOSTIC FEATURES OF TERATOMAS WITH MALIGNANT TRANSFORMATION: A CLINICOPATHOLOGICAL STUDY OF 21 CASES

Purpose

Teratomas with malignant transformation comprise up to 6% of metastatic teratomas. The prognosis of patients with these tumors can vary considerably. We delineate factors that may be related to prognosis in a cohort of men with teratoma with malignant transformation.

Materials and Methods

We analyzed pathological features, treatment, response, recurrence, time to recurrence, subsequent followup and survival for 21 patients (median age 28 years) diagnosed with teratoma with malignant transformation during a 7-year period at our institution.

Results

Malignant nongerm cell elements were present in the primary tumor in 11 cases (52%). Of 18 patients with testicular primaries 17 (94%) presented with metastatic disease. Despite aggressive treatment with surgery and chemotherapy 17 of 21 cases (81%) recurred (median time 6 months). Overall, 5 patients (24%) died of disease (median survival 23 months), 5 (24%) are alive with metastases (median followup 41 months) and 11 (52%) have no evidence of disease (median followup 50 months). Progression/recurrence was substantially greater for 2 of 2 cases with a mediastinal origin, 3 of 4 with rhabdomyosarcomatous differentiation and 5 of 6 with neural differentiation compared with the remainder of the cohort (p <0.05).

Conclusions

Teratomas with malignant transformation are usually metastatic at presentation, have a high recurrence rate and are more aggressive than teratomas without malignant transformation. Prognosis is especially poor for mediastinal teratomas with malignant transformation and for those with neural or rhabdomyosarcomatous differentiation. Complete surgical resection of residual or recurrent disease appears to offer the best chance for prolonged survival.     

Auditory input modulates sleep: an intra‐cochlear‐implanted human model

To properly demonstrate the effect of auditory input on sleep of intra‐cochlear‐implanted patients, the following approach was developed. Four implanted deaf patients were recorded during four nights: two nights with the implant OFF, with no auditory input, and two nights with the implant ON, that is, with normal auditory input, being only the common night sounds present, without any additional auditory stimuli delivered. The sleep patterns of another five deaf people were used as controls, exhibiting normal sleep organization. Moreover, the four experimental patients with intra‐cochlear devices and the implant OFF also showed normal sleep patterns. On comparison of the night recordings with the implant ON and OFF, a new sleep organization was observed for the recordings with the implant ON, suggesting that brain plasticity may produce changes in the sleep stage percentages while maintaining the ultradian rhythm. During sleep with the implant ON, the analysis of the electroencephalographic delta, theta and alpha bands in the frequency domain, using the Fast Fourier Transform, revealed a diversity of changes in the power originated in the contralateral cortical temporal region. Different power shifts were observed, perhaps related to the exact position of the implant inside the cochlea and the scalp electrode location. In conclusion, this pilot study shows that the auditory input in humans can introduce changes in central nervous system activity leading to shifts in sleep characteristics, as previously demonstrated in guinea pigs. We are postulating that an intra‐cochlear‐implanted deaf patient may have a better recovery if the implant is maintained ON during the night, that is, during sleep.     

Dietary modulation of colonic mucosal urokinase activity in rats

Abstract The amount and type of dietary fibre ingested influences colonic luminal characteristics, especially the concentration of carbohydrate fermentation products such as butyrate. This study aimed to assess whether diets supplemented with fibres of differing fermentability (delivering different amounts of butyrate to the colon) influence mucosal activities of urokinase and brush border hydrolases, and epithelial turnover. Groups of five rats were fed one of four diets containing low (2%), highly fermented (guar 10% or oat bran 10%) or slowly fermented fibre (wheat bran 10%) for 4 weeks. Activities of urokinase, alkaline phosphatase, dipeptidyl peptidase IV and maltase were measured in mucosal homogenates of proximal and distal colon and from rectum. Proliferative kinetics were assessed in distal and proximal colon by the metaphase arrest technique. Hydrolase activities were similar across all four dietary groups but a significant difference was found for urokinase ( P = 0.014). This was due to a reduction in urokinase activities of > 30% at the three sites in the wheat bran group compared with the other groups. Of proliferative indices, only crypt column height differed across the groups ( P = 0.038) and was highest in rats fed wheat bran and lowest in those fed the low fibre diet ( P = 0.047). The proportion of mitoses in the top one-fifth of the crypt also differed across groups ( P = 0.038) due to the high values in the distal colon of the low fibre group. Thus, addition of a slowly fermented (but not highly fermented) fibre to the diet of rats reduces net urokinase activity in large bowel mucosa and increases the life span of colonic epithelial cells without changing activities of brush border hydrolases.     

Interactions of Monoamine Oxidase Inhibitors,N-Acetylenic Analogues of Tryptamine,with Rat Liver Microsomal Cytochrome P450

Abstract— Interactions between some novel and potent monoamine oxidase inhibitors (MAOIs), acetylenic analogues of tryptamine, and rat liver microsomal cytochrome P450 (P450) as evidenced by visible spectra analysis were analysed. Compounds with a secondary aliphatic amine moiety throughout induced type II difference spectra and exhibited the highest affinity for P450, whereas tertiary amines induced type I spectral changes and showed diminished affinity. P450 dependent aniline hydroxylase activity was inhibited by all compounds in an irreversible time-dependent manner. Only tertiary aliphatic amines constituted the substrate for P450-dependent N-demethylase activity, with comparable kinetic parameters. The N-demethylated metabolites were identified by thin-layer chromatography and mass-spectrometric analyses. These findings describe the role of P450-dependent microsomal mono-oxygenase systems in the metabolism of some MAOI acetylenic tryptamine derivatives and the possible hepatic contribution to adverse interactions between MAOIs, endobiotics and sympathomimetic compounds.     

CLINICAL AND EPIDEMIOLOGICAL PROFILE OF ELDERLY PATIENTS WITH CHAGAS DISEASE FOLLOWED BETWEEN 2005-2013 BY PHARMACEUTICAL CARE SERVICE IN CEARá STATE, NORTHEASTERN BRAZIL

By controlling the transmission of Chagas disease, the challenge of providing assistance to millions of infected patients that reach old age arises. In this study, the socioeconomic, demographic and comorbidity records of all elderly chagasic patients followed at the Pharmaceutical Care Service of the Chagas Disease Research Laboratory were assessed. The information related to the clinical form of the disease was obtained from medical records provided by the Walter Cantídio University Hospital. The profile of the studied population was: women (50.5%); mean age of 67 years; retired (54.6%); married (51.6 %); high illiteracy rate (40.2%); and family income equal to the minimum wage (51.5%). The predominant clinical forms of Chagas disease were cardiac (65.3%) and indeterminate (14.7%). The main electrocardiographic changes were the right bundle branch block (41.0%), associated or not with the anterosuperior left bundle branch block (27.4%). The average number of comorbidities per patient was 2.23 ± 1.54, with systemic arterial hypertension being the main one found (67.0%). It was found that the elderly comprise a vulnerable group of patients that associate aging with cardiac and/or digestive disorders resulting from the evolution of Chagas disease and other comorbidities, which requires special attention from health services to ensure more appropriate medical and social care.