Reduction in Antibiotic Usage Following an Educational Programme

The past decade has seen a steady increase in the consumptionof antibiotics in Sweden, most of which are prescribed for respiratorytract infections. Trends in the prescribing of antibiotics forrespiratory tract infections at the community health centrein Höör, southern Sweden, analysed before and afteran educational programme, showed a significant reduction inthe use of antibiotics, 67.6% of patients (n=216) having beenprescribed antibiotics before the programme in contrast to 43.9%(n=212) afterwards. The reduction was particularly marked withregard to erythromycin and broad-spectrum antibiotics, and incases of rhinitis/rhinopharyngitis, pharyngitis and bronchitis.On an annual basis, the reduction was equivalent to 2.5 defineddaily doses per 1000 inhabitants per day. The study has shownthat a reduction in antibiotic usage for respiratory tract infectionscan be achieved without changing the indications for antibiotictreatment.     

Electrocardiographic and Clinical Predictors of Torsades de Pointes Induced by Almokalant Infusion in Patients with Chronic Atrial Fibrillation or Flutter: A Prospective Study

The aim of this study was to identify predictors of torsades de pointes (TdP) in patients with atrial fibrillation (AF) or flutter exposed to the Class III antiarrhythmic drug almokalant. TdP can be caused by drugs that prolong myocardial repolarization. One hundred patients received almokalant infusion during AF (infusion 1) and 62 of the patients during sinus rhythm (SR) on the following day (infusion 2). Thirty-two patients converted to SR. Six patients developed TdP. During AF, T wave alternans was more common prior to infusion (baseline) in patients developing TdP (50% vs 4%, P < 0.01). After 30 minutes of infusion 1, the TdP patients exhibited a longer QT interval (493 ± 114 vs 443 ± 54 ms [mean ± SD], P < 0.01), a larger precordial QT dispersion (50 ± 74 vs 27 ± 26 ms, P < 0.05), and a lower T wave amplitude (0.12 ± 0.22 vs 0.24 ± 0.16 mV. P < 0.01). After 30 minutes of infusion 2, they exhibited a longer QT interval (672 ± 26 vs 489 ± 74 ms, P < 0.001), a larger QT dispersion in precordial (82 ± 7 vs 54 ± 52 ms, P < 0.01) and extremity leads (163 ± 0 vs 40 ± 34 ms, P < 0.001), and T wave alternans was more common (100% vs 0%, P < 0.001). Risk factors for development of TdP were at baseline: female gender, ventricular extrasystoles, and treatment with diuretics; and, after 30 minutes of infusion: sequential bilateral bundle branch block, ventricular extrasystoles in bigeminy, and a biphasic T wave. Patients developing TdP exhibited early during almokalant infusion a pronounced QT prolongation, increased QT dispersion, and marked morphological T wave changes.     

Asymmetrical effects of increases in hydrostatic pressure on macromolecular movement across the airway mucosa. A study in guinea-pig tracheal tube preparations

This study employed isolated guinea-pig tracheal tube preparations in order to examine effects of increases in hydrostatic pressure on the movement of macromolecular solutes (fluorescein isothiocyanate-conjugated dextran; FITC-D, MW 70 kD; kept either in serosal or mucosal bathing fluids) across the mucosa. An asymmetry of the mucosal barrier was demonstrated by the finding that under baseline zero-pressure difference conditions luminal entry of serosal FITC-D was greater than serosal entry of luminal FITC-D. Furthermore, an increased serosal pressure (5 cm H2O) moved significant amounts of serosal FITC-D into the lumen, whereas a corresponding pressure applied on the luminal side only marginally increased mucosal crossing of luminal FITC-D. By raising the luminal pressure to 10 and 20 cm H2O (which may be used as positive end-expiratory pressures (PEEP) in vivo in patients) mucosal penetration of luminal FITC-D was as marked as that induced in the opposite direction by the low (5 cm H2O) serosal pressure increase. Another aspect of the asymmetry of the airway mucosal barrier was evident from experiments examining the effect of a serosal pressure increase on mucosal penetration of luminal FITC-D. Neither during nor after the period of sustained serosal pressure increase was luminal FITC-D crossing the mucosa to a greater extent than under baseline zero-pressure conditions. This finding agrees with in-vivo data demonstrating that plasma exudation into the airway lumen may not be associated with an increased absorption of luminal solutes.(ABSTRACT TRUNCATED AT 250 WORDS)     

Improved Growth Response to GH Treatment in Irradiated Children

ABSTRACT. The growth response to two years of GH treatment was studied in fifteen children after radiotherapy for a cranial tumor. The growth response was compared to that of short children (– 2 SD) and that of children with idiopathic growth hormone deficiency (GHD) of similar ages. All children were treated with hGH 0.1 IU/kg/day s.c; which is a higher dose and frequency than previously reported for irradiated children. On this protocol the growth rate increased 5.0 ± 0.5 cm/y (mean ± SEM) the first year and 3.8 ± 0.7 cm/y the second year compared to the growth rate the year before GH-treatment. Although the net gain in growth was higher than previously reported, the first year growth response was significantly reduced ( p < 0.05) compared to that of GHD-children (7.6 ± 0.5 cm/y) but exceeded ( p < 0.05) that of short children (3.4 ± 0.3 cm/y). The median spontaneous 24 h-GH secretion was 209 mU/I in the short children, 52 mU/I in the irradiated children and 16 mU/1 in the idiopathic GHD children. Thus the growth increment varied inversely to the spontaneous GH secretion observed in the three groups.     

A Longitudinal Study on Growth and Spontaneous Growth Hormone (GH) Secretion in Children with Irradiated Brain Tumors

ABSTRACT. Longitudinal growth was studied in 27 children after radiotherapy for a brain tumor. Growth deviation (1 SD) was found in 56% of the children after 2 years and was most profound in prepubertal children aged between 3 and 8 years at the time of irradiation. In this group growth velocity was markedly reduced and no catch up was seen. In all children studied growth hormone (GH) secretion, measured as the spontaneous secretion over 24 hours, was found to be severely disturbed. Our conclusion is that all children with a growth deviation 1 SD after radiotherapy (40 Gy) to the hypothalamo–hypophyseal region should be considered GH deficient. In such children GH treatment can be initiated without further testing.     

EXCRETION OF BILE ACIDS IN ERYTHROBLASTOSIS FOETALIS

The excretion pattern of intramuscularly injected cholic acid-24–¹⁴C was studied for 4 days after the injection in 10 cases of erythro-blastosis (EB). Seven patients with EB and raised serum conjugated bilirubin excreted 3643% of the injected isotope in the urine, whereas the amounts of isotope in the faeces varied greatly. In 3 cases without raised serum conjugated bilirubin less isotope was recovered in the urine and always more than 10% of injected isotope was recovered in the faeces. Cholic acid-24–¹⁴C was excreted essentially unchanged in all cases but in conjugated form. In all cases of EB the urine was found to contain bile acids, chiefly cholic acid. The infants with EB associated with cholestasis excreted 4.8–132.3 μmol of these acids per day; the corresponding values in the absence of cholestasis being 0.4–0.9 μmol per day. In the infants with physiological jaundice the excretion ranged from less than 0.01 to 0.7 μmol per day; the correspondign values in the 2 patients with hyperbilirubinaemia were about 0.2 μmol per day. The infants with EB associataed with cholestasis were found to excrete as large amounts of bile acids in the urine as the infants with intrahepatic cholestasis. These findings strongly suggest that increased serum conjugated bilirubin, irrespective of the patho-genesis of the liver damage, is associated with an impaired bile acid excretion to the intestine. EB without increased serum conjugated bilirubin did not seem to alter the bile acid metabolism, since the urinary excretion of cholic acid and chenodeoxycholic acid in these cases was practically the same as in jaundiced newborn infants.     

EXCRETION OF BILE ACIDS IN EXTRAHEPATIC BILIARY ATRESIA AND INTRAHEPATIC CHOLESTASIS OF INFANCY

This series included 24 infants, 16 boys and 8 girls, who were admitted to hospital with the diagnosis of obstructive jaundice. Five of the infants were subsequently found to have extra-hepatic biliary atresia (BA) and the other 19 infants intrahepatic cholestasis of infancy (IHC). The infants were investigated given special attention to: the quantitative urinary excretion of cholic and chenodeoxycholic acids, the isotope excretion after intramuscular injection of cholic acid-24–¹⁴C, the nature of labelled urinary bile acids, the half-life and the pool size of cholic acid. At the first examination of the infants after admission the urinary excretion of cholic and chenodeoxycholic acids varied greatly between the patients. However, on comparing the values obtained in the two groups, it was found that there was virtually no difference between the mean daily values of cholic and chenodeoxycholic acids in urine, and the ratio cholic to chenodeoxycholic acid between the BA group and the IHC group. After the injection of isotopic cholic acid most of the isotope was recovered in the urine in all cases. In the infants with BA the faecal excretion of the isotope was low, being less than 3 per cent of the injected isotope. Out of the 19 infants with IHC the recovery of the injected isotope in faeces was also less than 3% in 11 infants. In 8 infants with IHC the faecal isotope excretion was significantly high to exclude extrahepatic biliary atresia. The first 24 hour urine specimen contained small amounts of unconjugated labelled cholic acid in all cases whereas in no case did the patients excrete unconjugated labelled cholic acid 48 hours after the injection of the isotope. No transformation of cholic acid was observed. There was no difference between the BA group and IHC group with regard to the percentage labelled glycine conjugates of total excreted urinary conjugates. Neither was there any difference between the two groups with regard to half-life and pool size of cholic acid. There was no difference with respect to the bile acid metabolism between infants with congenital CMV infection, decreased serum concentrations of alfal-antitrypsin and the other patients.     

Economic consequences of occupational disorders in women with repetitive industrial work

Background: In a previous study, we found a three to four timesincrease in sick listing and disability pensioning among 269women in industrial repetitive work, as compared to 290 referentwomen in varied work. Methods: Here, by using an economic model,we estimated the costs for society of the work-environment dysfunctionsin the industrial group. Results: The costs for disability pensionsin the exposed group were 38.8 kSEK per person year at riskand for sick-leave 27.2 kSEK per person year, while the directcosts for health care were 2.2 kSEK per person year. Among referents,the sums were much lower: 5.6 kSEK per person year for disabilitypensions and 7.9 kSEK per person year for sick-leave and costsfor health care were 0.9 kSEK per person year. The costs (lossesin production) per person year of employment were 4.7 timeshigher for the exposed women than for the referents. The differencewas 53, 800 SEK (1 ECU = 8.74 SEK), of which disability pensioningwas 62%, sick-leave 35% and healthcare 3%. The actual transfersin the social insurance system corresponded to 45.1 MSEK amongthe exposed workers, as compared to 9.1 MSEK for the referents.Conclusions: Repetitive industrial work results in huge costs.Hence, preventive and other measures are needed.     

Caries and consumption of sweets in 15- and 18-year-olds interviewed with visualization.

Abstract – The aim of this study was first to investigate the relationship at group level between approximal caries, restorations in posterior regions and consumption of sweets during the past 3 yr in 15-yr-old schoolchildren selected for different caries experience. An interview method was used with the sweets on display. Secondly, the aim was to reinterview the subjects as 18-yr-olds using the same method in order to study the correlation between caries incidence and consumption of sweets during the past 3 yr. Seventy-five individuals from three groups, 30 with 0, 25 with 4-6, and 20 with 12-15 approximal DFS, were selected for the first interview. Sixtynine of them were reinterviewed 3 yr later. Caries incidence during the 3-yr period was expressed as a percentage of the number of caries-free approximal surfaces of premolars and molars at the age of 15. The results showed no statistically significant differences in mean number of intakes of sweets per day (2.2, 2.2, and 2.8) between the original DFS groups. The correlation coefficient between caries incidence and number of intakes of sweets in the second part of the study was 0.25 (p<0.05). After correction for the modifying effect of oral hygiene, the coefficient was 0.51 (P<0.01) in the less favorable fraction and 0.11 (P>0.05) in the favorable fraction.