Price differentials of oral triptans in eight European Union countries

Triptans are presently a milestone in the treatment of migraine patients. Because of their effectiveness and safety, they have radically improved migraine treatment but their use has meant a substantial increase in spending for medicines. We thus compared retail prices of triptans in eight European Union member states to establish the existence and the amount of price differentials. We found wide price differentials between countries (from 83% to 140%) and within countries, where they attained 191% in Belgium. The least and most expensive products differed from country to country. These differentials mean that the most cost-effective triptans differ from country to country and this can be an important source of variation in the treatment of migraineurs. A better-harmonised European system of pricing could limit these unethical variations.     

Hemoperitoneum identified by focused assessment with sonography for trauma following cardiopulmonary resuscitation

It is generally recognized that lives are saved by administering high-quality cardiopulmonary resuscitation (CPR) to patients in cardiac arrest. A focused assessment with sonography for trauma (FAST) examination is an effective and non–invasive method for detecting rare complications of CPR, such as hemorrhage from abdominal visceral injury. We report the case of a 56-year-old female suffering from intra-abdominal hemorrhage caused by a liver laceration following CPR. The hemoperitoneum was diagnosed by a FAST examination. Although severe complications of CPR are rare, they can be easily detected with the use of a FAST examination. A FAST examination should be considered as a post-resuscitation approach to assess for life-threatening complications in all patients following cardiopulmonary resuscitation.     

Can we objectively measure the human cost of disease?

Economic evaluation of health care programs or technologies requires distinguishing three types of costs: direct, indirect and human. The first two types do not imply peculiar methodological issues to quantify them, even though all researchers do not accept the use of a market prices system. Excluding such different views to calculate in monetary terms these items, evaluation of direct and indirect costs is quite objective. Discussing human costs expressed in quantitative and qualitative terms, we note that they have to be meant as subjective costs. Nevertheless, researchers created health indicators such as QALYs and DALYs, often used in health care studies. Their subjective characteristics require more theoretical discussions about some issues such as the meaning of “quality of life” and “utility”. The lack of a general acceptance of these indicators does not permit their use in health care policy decisions.     

Defective Expression of IL-2 Receptors on Peripheral Blood Lymphocytes from Patients with Cluster Headache

In a previous study we demonstrated that cluster headache (CH) patients present an increased Natural Cytotoxic response after incubation of their peripheral blood lymphocytes (PBL) with Interleukin-2 (IL-2). This phenomenon led to an investigation of the phenotypic expression of PBL before and after IL-2 incubation, and of the IL-2 lymphocyte receptor. IL-2 receptor is expressed on T-lymphocytes activated with an high-affinity binding site. The analysis of the function of human IL-2 receptor was facilitated by the production of a specific monoclonal antibody (MAb). This MAb identifies the IL-2 receptors by blocking the binding of radiolabelled IL-2 to T-cells. In addition, we studied the expression of Leu-4, specific for T-cells; of Leu-11b, specific for FC receptor on NK cells; and the Transferrin Receptor, specific for lymphoblasts and monocytes. Twenty-three episodic CH patients were selected for this study. Ten sex and age-matched healthy volunteers were used as the control group. We evaluated the PBL phenotypic expression of cells subsets before incubation with IL-2 (1,000 I.U./ml) and after 72 hours. The following Becton Dickinson MAbs have been used: anti-Leu-4 (CD3), anti-IL-2 receptors (CD25), anti-Transferrin receptor (TFR) and anti-Leu-11b (CD16). Indirect fluorescence with a Becton Dickinson FACS-420 flow cytometer was used to analyze the cells.(ABSTRACT TRUNCATED AT 250 WORDS)     

Expression of NOS–2, COX–2 and Th1/Th2 cytokines in migraine

Nitric oxide (NO) probably plays an important role in the pathogenesis of migraine without aura (MWA). As the activation of NO–ergic cascade has been shown to be closely linked to cyclooxygenase pathway and to cause some differences in peripheral blood lymphocyte populations, we investigated if the Th1/Th2 balance in peripheral blood of MWA patients was affected in comparison to controls. Twenty–six MWA patients and 10 healthy controls (C) were enrolled in this study. Blood samples were taken at baseline (T0) and during an induced migraine attack (T1). Total RNA from human peripheral blood lymphocytes (PBLs) was isolated and reverse–transcribed to prepare complementary DNA. COX–2, NOS–2 and β–actin were amplified using PCR. PBLs from patients and controls were stimulated with phorbol 12–myristate 13–acetate plus ionomycin in the presence of brefeldin A. Cells were surface–stained with fluorochrome–conjugated anti–CD3 and anti–CD8 monoclonal antibodies (mAbs) and intracellularly stained with fluorochrome– conjugated anti–IFN–γ or anti–IL–4 mAbs. The level of cytokine expression was analyzed by gating on the CD4+ lymphocyte subset. Th1 and Th2 type cytokines (IFN–γ, IL–2, IL–4) were directly assayed in serum by ELISA. Preliminary results indicate that NOS–2 was upregulated in MWA patients at basal time if compared to controls, whereas after NOD administration NOS–2 was significantly decreased. COX–2 was upregulated in MWA patients at basal time and it had an opposite trend after NOD administration. The homeostatic Th1/Th2 balance defined by the IFN–γ or IL–4 cytokine expression was unchanged in MWA patients in comparison to controls, and NOD administration did not affect that pattern. The cell activation machinery was not altered after mitogenic activation, as shown by CD69 expression level. Cytokine serum levels showed no significant changes in all studied situations. This study confirms the relevance of the NOS/COX system in MWA but, in contrast with previous studies, excludes their effect and activation on peripheral cytokine production. More sophisticated experimental models are needed to investigate the ability of NOS/COX to activate migraine pain.     

Leukoedema in addicts to coca leaves in Humahuaca, Argentina

ABSTRACT The oral mucosa of 301 subjects of both sexes, aged 30 to 87 years and living in Humahuaca, in the province of Jujuy, nothern Argentina, was studied for leukoedema and leukoplakia. One hundred and fifty of these persons were addicted to chewing coca leaves. One hundred and fifty-one non-addicts served as controls. Prevalences of 61.3 % for leukoedema and 21.3 % for leukoplakia were reported in the study group. In the control group the prevalences were 9.2 % and 3.9 % for leukoedema and leukoplakia, respectively. The localization of lesions in the study group always coincided with where the coca leaf bolus is habitually kept. In general, the histopathologic pictures were compatible with leukoedema. This confirms previous findings about the effects on the oral mucosa of chewing coca leaves and also the benign character of leukoedema provoked by this irritant.     

Lymphokine-Activated Killer (LAK) Cell Phenomenon in Cluster Headache. "In Vitro" Activation by Recombinant Interleukin-2

Previous studies showed that the Natural Killer (NK) activity of peripheral blood lymphocytes (PBL) from cluster headache (CH) patients is lower than that of controls. This decreased activity seems to be independent of the cluster period. beta-interferon has been shown to be more effective in increasing NK activity when incubated with PBL from CH patients, than with PBL from control donors. Lymphokine-Activated Killer (LAK) cells can be generated by incubation of human PBL in recombinant Interleukin-2 (rIL-2). This phenomenon was studied in 10 CH patients and 8 healthy volunteers. PBL were activated to LAK cells by "in vitro" incubation for 72 hours in Control Medium containing rIL-2 (1000 I.U./ml). A four hour Chromium 51 release was used to measure LAK Cell Killing of K562 target cells. The released radioactivity was measured in a gamma scintillation counter. The CH patients showed a marked increase of LAK generation compared to control subjects. This effect seems to be augmented during the cluster period.     

Expectant fathers' experience during labor with or without epidural analgesia

BACKGROUND: For men the worst aspect of childbirth is witnessing their partner in pain. The aim of this study was to investigate fathers' attitudes towards labor and delivery with and without epidural analgesia. METHOD: The study was performed using a questionnaire that included yes/no, multiple choice or 6-point ordinal scale answers. Expectant fathers whose partners were nullipara between 36 and 38 weeks of gestation were recruited and the questionnaires were administered on the day after the birth. To investigate paternal anxiety during labor, the State part of the State-Trait Anxiety Inventory was used. RESULTS: The questionnaire was completed by 243 fathers. Sixty percent (145) of the parturients received epidural analgesia and 40% (98) did not. Paternal characteristics were comparable. Fathers whose partners did not receive epidural analgesia felt their presence as troublesome and unnecessary (P<0.001). The presence of maternal epidural analgesia increased threefold paternal feelings of helpfulness and was associated with a greater involvement (P<0.001) and less anxiety and stress (P<0.001). Median (range) State-Trait Anxiety Inventory score was respectively 75 (50-80) and 30 (20-60) in fathers whose partners did not or did receive epidural analgesia (P<0.0001). Maternal analgesia greatly increased paternal satisfaction (P<0.0001). CONCLUSION: Epidural analgesia reduces paternal anxiety and stress and increases paternal involvement, participation and satisfaction with the experience of childbirth.