Effect of Rehabilitation Program on Endocrinological Parameters in Patients with COPD and in Healthy Subjects

Background: Skeletal muscle wasting commonly occurs in patients with chronic obstructive pulmonary disease (COPD) and has been associated with the presence of systemic inflammation and endocrinological disturbance. The aim of this study is to analyze the effect of rehabilitation program on the balance of anabolic versus catabolic hormone in patients with COPD and in healthy subjects. Methods: Nineteen patients with COPD and 16 age-matched healthy subjects undertooked exercise training 3 days/week for 8 weeks. Before and after the training program the concentration of growth hormone (GH), Insulin-Like Growth Factor-1 (IGF-1), Insulin-like Growth Factor-Binding Protein 3 (IGF-BP3), testosterone and cortisol in serum were determined. The exercise measurements included a 6-Minute Walking Test (6MWT). Results: After 8 weeks, there was no significant change in lung function in patients with COPD and healthy subjects. Growth hormone, Insulin-like Growth Factor-1 and Insulin-like Growth Factor-Binding Protein 3 increased significantly after rehabilitation training (p < 0.01). The rehabilitation program improves the testosterone/cortisol ratio (T/C ratio) in both groups. There is a significant improvement in the 6-Minute Walking distance (6MWD) in both groups (p < 0.01). Dyspnea and heart rate at rest and at the peak of the 6-Minute Walking Test (6MWT) decreased significantly after training program (p < 0.01). Conclusion: Pulmonary rehabilitation induces an improvement of the anabolic process and reduces proteine distruction by the modifications in endocrinological factors regulating skeletal muscle in patients with COPD.     

Laboratory evaluation of Vectobac as against Aedes aegypti in Monterrey,Nuevo León,Mexico

Intensive use of the organophosphate insecticide malathion against adults and temephos against larvae of Aedes aegypti in Mexico over the past 30 years has led to problems requiring the use of new larvicides. Toward this objective, Bacillus thuringiensis var. israelensis (Bti), a target-specific and environmentally safer control agent, was evaluated. Laboratory bioassays were done to determine the susceptibility of 2nd- and 3rd-stage larvae of Ae. aegypti to Vectobac 12 AS (aqueous suspension, 600 ITU/mg). A median lethal concentration of 0.0104 ppm and a 95% lethal concentration of 0.18 ppm were determined after 24 h of exposure to the agent. The values obtained were adjusted for field application and were further tested in the field by the State of Nuevo León, Mexico Vector Control Program. Suspensions of Bti were poured into pipe-water trucks and transferred to domestic 200-gal metal water drums. Larval populations were reduced during a 2-week study period. However, residents complained about a fine dusty film on the water surface. Nevertheless, these results are promising for future Bti field applications.     

Breast cancer in the elderly: the role of adjuvant radiation therapy

PURPOSE: To evaluate available data on breast conserving surgery (BCS) with or without radiation therapy (RT), and alternative options (e.g. Tamoxifen alone) (Tam), focusing specifically on the older patients. METHODS AND MATERIALS: The MEDLINE was searched for the terms elderly, BCS, adjuvant/postoperative RT, Tamoxifen, and randomized trials from 1992 to 2002. RESULTS: Authors reviewed papers of general interest on the elderly and breast cancer (BC), meta-analysis, randomized trials on BCS+/-RT and Tam+/-surgery without RT, retrospective non-randomized trials, and reported on prognostic factors for local recurrence in BCS alone, including biomarkers, attempts made to define a low-risk group, and methods of modification of the current, protracted standard adjuvant RT course. CONCLUSIONS: Postoperative RT after BCS has a firm rationale; in current clinical practice, if the BCS+RT is medically appropriate and the patient shares the choice, after a full information of the available options and their implications, it is clinically sound to propose this approach. However, there is controversy whether a subgroup of elderly patients could be safely spared: in this setting a randomized trial is clearly warranted.     

Preventing disability from occupational musculoskeletal injuries in an urban, acute and tertiary care hospital: results from a prevention and early active return-to-work safely program

OBJECTIVE: Healthcare workers are at high risk for musculoskeletal injuries. A program was developed to decrease the incidence of musculoskeletal injuries and the duration of associated time loss. METHODS: A program combining primary prevention and on-site early intervention was implemented at a large, urban hospital. Incidence rates were compared using Poisson regression. Cox regression was used to analyze the time to return to regular duties. RESULTS: Although there was no reduction in incidence, the program was effective in returning injured employees to work more promptly for registered nurses and health science professionals (therapists, technicians), although not for facility support staff. CONCLUSIONS: Overall savings in time loss and compensation payments were realized. However, better integration of prevention and follow-up efforts are needed, and greater attention to the sociopolitical environment is required to improve outcomes for facility support staff.     

Intrapartum prediction of macrosomia: accuracy of abdominal circumference estimation

OBJECTIVE: To evaluate the accuracy of abdominal circumference (AC) estimation of macrosomia early in labor and whether a cutoff value could be detected. DESIGN: A prospective clinical trial. SETTING: The Department of Obstetrics and Gynecology, Cairo University. PARTICIPANTS: One hundred pregnant females presenting in early labor with clinical impression of macrosomia were examined by ultrasound, and those babies with abdominal circumference more or equal to 35 cm were recruited for the study. INTERVENTIONS: Every woman was considered as her own control, and fetal weight was calculated using the formula of Shepard et al. The accuracy of abdominal circumference in prediction of macrosomia was evaluated using the Receiver operating characteristic curve. RESULTS: A cutoff value of AC > or =37 cm was found to have a sensitivity of 77%, a specificity of 75%, a positive likelihood ratio of 3.1 and a negative likelihood ratio of 0.3. CONCLUSION: Intrapartum ultrasonographic evaluation of abdominal circumference for suspected macrosomic babies in early labor is an easy, practical method that should be adopted in decision making.