Evaluation of antisecretory activity of misoprostol in duodenal ulcer patients using long-term intragastric pH monitoring

The effect of the new synthetic prostaglandin E ₁ analog, misoprostol, on intragastric acidity was evaluated by means of 24-hr intraluminal pH monitoring of 16 duodenal ulcer patients. They were randomly allocated into two groups: eight received no medication and misoprostol 400 g bid and eight received ranitidine 150 mg and misoprostol 400 g bid not less than one week apart. The comparison of the 24-hr areas under the curve related to the median pH values showed that no difference existed between misoprostol and untreated patients in the first group, while ranitidine was significantly more effective (P= 0.00003) than misoprostol in the second group. The analysis of arithmetic differences between the 24-hr median pH values showed that misoprostol increased pH values by at least one unit compared to the untreated subgroup for about 3.5 hr, while the antisecretory action of ranitidine was far superior to that of misoprostol throughout the whole 24-hr period. It can be concluded that the effect of twice daily doses of misoprostol 400 g on 24-hr intragastric pH is small and not at all comparable to that of the well-known potent H ₂ blocker ranitidine.     

The Agita S?o Paulo Program as a model for using physical activity to promote health.

The "Agita S?o Paulo" Program applies a multilevel intervention approach to promoting physical activity among the 37 million inhabitants of the state of S?o Paulo, Brazil. The verb "agita" means to move the body, but the term also suggests changing the way of thinking and becoming a more active citizen. Since being launched in 1996, the Program has been widely copied throughout Brazil and in other countries of Latin America, and the World Health Organization has characterized it as a model for other developing countries. The Program aims to disseminate a clear and simple message to the community as well as establish partnerships with governmental and nongovernmental organizations and other entities. The Agita S?o Paulo message encourages people to adopt an active lifestyle by accumulating at least 30 minutes of moderate physical activity per day, on most days of the week. The Program has three main target groups: students, workers, and the elderly. The Program organizes "mega-events" that simultaneously reach and involve large numbers of people, and it also conducts ongoing activities with institutions that become partners of the Program. Intervention studies that the Program has carried out on specific, small groups have found both changes in behavior and an increasing awareness of the Program's name and message. In addition, surveys have found that a growing number of persons in the state of S?o Paulo have become aware of the Program and its message and have changed their physical activity level. A number of the special features of and lessons learned from the Agita S?o Paulo Program may have contributed to its success, including: a multisectorial approach; broad use of partnerships; the inclusion principle (avoiding messages or attitudes that might exclude any social group); the scientific basis for all the Program activities; the extensive free media coverage that the Program has received; a "two-hats" approach, using either governmental or nongovernmental methodologies to promote physical activity, depending on the circumstances; cultural adaptation (using local culture to disseminate the message and make its assimilation easier); encouraging activities that are pleasurable; the clear, simple, feasible message of promoting physical activity; and evaluation of the various Program efforts. These distinctive characteristics help make the Agita S?o Paulo Program a model that could be used in other countries as an effective way to promote health through physical activity.     

What worries the oncology patient's caretaker?

The authors describe and evaluate the main worries which are manifested by those who care for terminal phase oncology patients during the time a patient receives care in a palliative unit. By means of a semi-structured interview, the authors have analyzed the main worries expressed by 50 caretakers who attend to their respective terminal phase cancer patients. The results of this study show that those worries which have a psychosocial character receive a higher degree of worry by caretakers while those which are based on physical symptoms due to the illness are more important for the patients. On the other hand, these worries decrease significantly as the moment of death approaches. Knowing these concrete caretaker worries has made it possible to intervene at opportune moments, which has led to an increase in patients' wellbeing. This research project was carried out, in part, due to the help granted by the General Administration for Scientific and Technical Investigation of the Education and Culture Ministry (PB97-0212).     

Continuous 24 hour intragastric pH monitoring: focus on reproducibility in duodenal ulcer patients. A preliminary report

Continuous 24 h intragastric pH monitoring is increasingly recommended for deciding which is the most appropriate regimen and dosage of new gastric antisecretory drugs. In order to assess its reproducibility, we have repeated the test twice on consecutive days in six patients with endoscopically proven duodenal ulcers because this type of patient seems to be the most suitable for studies on the efficacy of the above mentioned therapy. No patient received medication during the two examination days. Our data showed there was no significant difference (t = 0.31, p = 0.76) between the 24 h areas under the curve of pH profiles of the first day compared with those of the second (mean +/- SD : 3.152 +/- 681 vs 3.073 +/- 1,122). The lack of significant difference (p = 0.20) between the mean times elapsed at the various pH levels during the first and second days was further proof of the reproducibility of the method. As wells these results suggest that day-to-day reproducibility of the technique is good in duodenal ulcer patients. Therefore, its repeated use on the same patient to investigate the effects of various drugs and their different dosages on gastric acidity appears to be reliable.     

Continuous 24-hour intragastric pH monitoring in the evaluation of the effect of a nightly dose of famotidine, ranitidine and placebo on gastric acidity of patients with duodenal ulcer

In 11 duodenal ulcer patients, the antisecretory effects of bedtime famotidine 40 mg were compared to those obtained with ranitidine 300 mg and placebo by means of continuous 24-hour intragastric pH monitoring. The 24-hour areas under the curve of pH profiles of the two H2 blockers were significantly different from those related to placebo (p approximately 0 for ranitidine and p = 0.00001 for famotidine), but not from each other (p = 0.51). Onset and duration of the famotidine action, however, were respectively earlier and longer lasting (12 vs. about 9 h) than those of ranitidine. Famotidine was also significantly superior (p approximately 0) to ranitidine in keeping intragastric pH at high values (especially those comprised between 6 and 8 pH units), although theoretically equipotent doses of the two H2 antagonists were used.     

Low prevalence of hepatitis B markers among Mexican female sex workers

OBJECTIVES: To estimate the prevalence and associated risk factors of hepatitis B virus (HBV) serological markers in female sex workers (FSW) in Mexico City. METHODS: The study population consisted of 1498 FSW who attended a detection centre for human immunodeficiency virus (HIV) in Mexico City, between January and October 1992. Study participants responded to a standardised questionnaire and provided a blood sample for serology of syphilis, HIV, and HBV. RESULTS: A total of 0.2% (95% CI 0.1-0.3) of the population were hepatitis B surface antigen (HBsAg) carriers. The general prevalence of antibodies to hepatitis B core antigen (anti-HBc) was 6.3% (95% CI 5.5-7.1). This marker of previous exposition to HBV, was independently associated by logistic regression multivariate analysis with age, working in the street, and history of blood transfusion (BT) before 1987 (OR 4.8, 95% CI 2.1-11.3). Syphilis prevalence was 7.6% (95% CI 6.2-8.9) and HIV prevalence was 0.1% (95% CI 0-0.3). CONCLUSIONS: The prevalence of HBV infection in this group of Mexican FSW is lower than previously reported in other countries. In addition, the frequency of HBsAg carriers is similar to that in the general Mexican population. The absence of two major risk factors for HBV transmission in this group of FSW--that is, injecting drug use and anal intercourse, could help to explain this finding. However, the positive association between anti-HBc and history of blood transfusion demonstrated here, highlights the need to reinforce strict control of blood supplies in Mexico.     

Isolation and molecular cloning of beta-neurotoxins from the venom of the scorpion Centruroides suffusus suffusus

This communication reports the identification and characterization of two new toxins from the venom of the scorpion Centruroides suffusus suffusus, named: CssVIII and CssIX, according to the original nomenclature of toxins previously described for this scorpion. The isolation was obtained by means of two chromatographic steps, and a cDNA library was used to fully identify their precursors. CssVIII and CssIX contain signal peptides of 19 and 17 amino acid residues, and mature peptides of 66 and 65 residues, respectively. Intracranial injections into mice of both purified toxins showed toxicity results similar to those found for toxins CssII and CssIV. Additionally, they compete with the parent toxin CssIV, in binding and displacement experiments, conducted with brain synaptosomes showing nanomolar affinities. These results strongly support the conclusion that they are new β-neurotoxins and certainly would be of the interest of researchers in the field of venomics for studying sodium channels.     

Identification of a new BRCA2 large genomic deletion associated with high risk male breast cancer

Background

Male breast cancer (MBC) is an uncommon disease that has been the focus of limited research. It is estimated that approximately 10% of men with breast cancer have a genetic predisposition, with BRCA2 being the most prevalent genetic mutation. Here we describe the case of MBC in a 64-year-old man who presented on physical examination a nodule in his left breast and declared to have an extensive family history of cancer.

Methods and results

The patient was firstly diagnosed with an invasive ductal carcinoma (IDC) with histological grade III, nuclear grade 3, pT4N2Mx and positive for hormonal receptors and HER2. Exome sequencing was performed by massive parallel sequencing which had detected a novel BRCA2 germline mutation that is a large genomic deletion of 3,492 nucleotides including BRCA2 exon 14, and this deletion is out of frame and is predicted to lead to a stop codon in exon 15 at codon 2,496.

Conclusion

Large rearrangements in BRCA1 and BRCA2 occur in a small percentage (<1%) of patients tested for hereditary breast and ovarian cancer. This is the first report of the mutation del3492 in BRCA2 exon 14, which leads to a truncated protein and therefore is clinically relevant. Mutation segregation analysis should be further done in the Brazilian population. Herein we highlight the importance of next-generation sequencing in the detection of large genomic deletions.