Impact of clinical practice guidelines on priorisation for intensive care beds allocation in high-risk acute coronary syndrome patients: does age play a role?

QUESTION UNDER STUDY: To assess which high-risk acute coronary syndrome (ACS) patient characteristics played a role in prioritising access to intensive care unit (ICU), and whether introducing clinical practice guidelines (CPG) explicitly stating ICU admission criteria altered this practice. PATIENTS AND METHODS: All consecutive patients with ACS admitted to our medical emergency centre over 3 months before and after CPG implementation were prospectively assessed. The impact of demographic and clinical characteristics (age, gender, cardiovascular risk factors, and clinical parameters upon admission) on ICU hospitalisation of high-risk patients (defined as retrosternal pain of prolonged duration with ECG changes and/or positive troponin blood level) was studied by logistic regression. RESULTS: Before and after CPG implementation, 328 and 364 patients, respectively, were assessed for suspicion of ACS. Before CPG implementation, 36 of the 81 high-risk patients (44.4%) were admitted to ICU. After CPG implementation, 35 of the 90 high-risk patients (38.9%) were admitted to ICU. Male patients were more frequently admitted to ICU before CPG implementation (OR=7.45, 95% CI 2.10-26.44), but not after (OR=0.73, 95% CI 0.20-2.66). Age played a significant role in both periods (OR=1.57, 95% CI 1.24-1.99), both young and advanced ages significantly reducing ICU admission, but to a lesser extent after CPG implementation. CONCLUSION: Prioritisation of access to ICU for high-risk ACS patients was age-dependent, but focused on the cardiovascular risk factor profile. CPG implementation explicitly stating ICU admission criteria decreased discrimination against women, but other factors are likely to play a role in bed allocation.

Dukes B colorectal cancer: distinct genetic categories and clinical outcome based on proximal or distal tumor location.

PURPOSE: The aim of this study was to determine whether tumor location proximal or distal to the splenic flexure is associated with distinct molecular patterns and can predict clinical outcome in a homogeneous group of patients with Dukes B (T3-T4, N0, M0) colorectal cancer. It has been hypothesized that proximal and distal colorectal cancer may arise through different pathogenetic mechanisms. Although p53 and Ki-ras gene mutations occur frequently in distal tumors, another form of genomic instability associated with defective DNA mismatch repair has been predominantly identified in the proximal colon. To date, however, the clinical usefulness of these molecular characteristics remains unproven. METHODS: A total of 126 patients with a lymph node-negative sporadic colon or rectum adenocarcinoma were prospectively assessed with the endpoint of death by cancer. No patient received either radiotherapy or chemotherapy. p53 protein was studied by immunohistochemistry using DO-7 monoclonal antibody, and p53 and Ki-ras gene mutations were detected by single strand conformation polymorphism assay. RESULTS: During a mean follow-up of 67 months, the overall five-year survival was 70 percent. Nuclear p53 staining was found in 57 tumors (47 percent), and was more frequent in distal than in proximal tumors (55 vs. 21 percent; chi-squared test, P < 0.001). For the whole group, p53 protein expression correlated with poor survival in univariate and multivariate analysis (log-rank test, P = 0.01; hazard ratio = 2.16; 95 percent confidence interval = 1.12-4.11, P = 0.02). Distal colon tumors and rectal tumors exhibited similar molecular patterns and showed no difference in clinical outcome. In comparison with distal colorectal cancer, proximal tumors were found to be statistically significantly different on the following factors: mucinous content (P = 0.008), degree of histologic differentiation (P = 0.012), p53 protein expression, and gene mutation (P = 0.001 and 0.01 respectively). Finally, patients with proximal tumors had a marginally better survival than those with distal colon or rectal cancers (log-rank test, P = 0.045). CONCLUSION: In this series of Dukes B colorectal cancers, p53 protein expression was an independent factor for survival, which also correlated with tumor location. Eighty-six percent of p53-positive tumors were located in the distal colon and rectum. Distal colon and rectum tumors had similar molecular and clinical characteristics. In contrast, proximal neoplasms seem to represent a distinct entity, with specific histopathologic characteristics, molecular patterns, and clinical outcome. Location of the neoplasm in reference to the splenic flexure should be considered before group stratification in future trials of adjuvant chemotherapy in patients with Dukes B tumors.

Análisis morfométrico de la extremidad anterior en Carnivora

Durante los cuatro años de disfrute de la beca (2006 – 2009) se ha consolidado una base de datos de medidas osteológicas del esqueleto apendicular de numerosas especies del O. Carnivora. Concretamente, se han medido 364 individuos de 126 especies. Los ejemplares pertenecían a las colecciones del Phyletisches Museum (Jena, Alemania), el Museum für Naturkunde (Berlín, Alemania), el Museu de Ciències Naturals de la Ciutadella (Barcelona, España), el Múseum National d'Histoire Naturelle (París, Francia), y el Museo Nacional de Ciencias Naturales (Madrid, España). Asimismo, con estos datos se han estado preparando tres artículos sobre la morfología de ciertos elementos del esqueleto apendicular en carnívoros, dos de los cuales se encuentran actualmente en estado de revisión para su publicación científica. Dos de ellos, "Scapula, habitat and locomotion in Carnivora" y "Size and shape in the carnivore scapula", relacionan la morfología escapular con factores como el tamaño del animal, el tipo de locomoción que presenta y el hábitat en el que se encuentra; el primero mediante metodología multivariante (análisis funcional) y el segundo bajo las nuevas técnicas de morfometría geométrica. El tercer artículo, "Scaling and mechanics in the carnivore calcaneus: A comparison of natural and artificial selection", evalúa el efecto de diferentes tipos de selección, natural frente a artificial, sobre la morfología del calcáneo y su influencia en la biomecánica de este hueso. Finalmente, también se ha desarrollado un estudio experimental sobre la búsqueda de estabilidad durante la locomoción arbórea, cuyos resultados han dado lugar al artículo "The search for stability on narrow supports: An experimental study in cats and dogs", que también se halla bajo revisión actualmente.

Walking activity measured by accelerometry during respiratory rehabilitation.

PURPOSE: Activity monitoring is considered a highly relevant outcome measure of respiratory rehabilitation. This study aimed to assess the usefulness of a new accelerometric method for characterization of walking activity during a 3-week inpatient rehabilitation program. METHODS: After individual calibration of the accelerometer at different walking speeds, whole-day physical activity was recorded for 15 patients with chronic obstructive pulmonary disease on the first and the last days of the program, and for 10 healthy subjects. Data were expressed as percentage of time spent in inactivity, low level activity, and medium level activity, with the latter corresponding to usual walking speed. RESULTS: The patients spent more time being inactive and less time walking than healthy subjects. At the end of the rehabilitation program, medium level activity had increased from 4% to 7% of total recording time. However, the change was not significant after periods of imposed exercise training were excluded. Walking activity increased to a greater degree among the patients with preserved limb muscle strength at entry to the program. Although health status scores improved, the changes did not correlate with the changes in walking activity. CONCLUSION: The findings lead to the conclusion that this new accelerometric method provides detailed analysis of walking activity during respiratory rehabilitation and may represent an additional useful measure of outcome.

Identification of a differentially expressed mRNA in axenic Leishmania panamensis amastigotes

Differential display technique was applied in order to identify transcripts which are present in axenic amastigotes but not in promastigotes of the Leishmania panamensis parasites. One of them was cloned and the sequence reveals an open reading frame of 364 amino acids (aprox. 40 kDa). The deduced protein is homologous to the serine/threonine protein kinases and specially to the mitogen activates protein kinases from eukaryotic species. Southern blot analysis suggest that this transcript, named lpmkh, is present in the genome of the parasite as a single copy gene. These results could imply that lpmkh could be involved in the differentiation process or the preservation of amastigotes in axenic conditions.

Community ecology of the metazoan parasites of pink cusk-eel, Genypterus brasiliensis (Osteichthyes: Ophidiidae), from the coastal zone of the State of Rio de Janeiro, Brazil

Fifty-five specimens of pink cusk-eel, Genypterus brasiliensis Regan, 1903 (Osteichthyes: Ophidiidae) collected from the coastal zone of the State of Rio de Janeiro, Brazil (approx. 21-23°S, 41-45°W), from September 2000 to January 2001, were necropsied to study their parasites. All fish were parasitized by one or more metazoan. Fourteen species of parasites were collected. G. brasiliensis is a new host record for nine parasite species. The larval stages of cestodes and the nematodes were the majority of the parasite specimens collected, with 38.4% and 36.5%, respectively. Cucullanus genypteri was the dominant species with highest prevalence and/or abundance. The parasites of G. brasiliensis showed the typical overdispersed pattern of distribution. Six parasite species showed correlation between the host's total body length and prevalence and abundance. Host sex did not influence prevalence and parasite abundance of any parasite species. The mean diversity in the infracommunities of G. brasiliensis was H= 0.364 ± 0.103, with correlation with the host's total length and without differences in relation to sex of the host. One pair of adult endoparasites (C. genypteri and A. brasiliensis) showed positive covariations between their abundances. Negative association or covariation was not found. Differences between the qualitative and quantitative aspects of the parasite community of G. brasiliensis from Rio de Janeiro and Argentina suggest the existence of two population stocks of pink cusk-eel in the South America Atlantic Ocean.

SLÃÅN 2007: Dietary Habits of the Irish Population

SLÃÂÅN 2007: Dietary Habits of the Irish Population The third national Survey of Lifestyle, Attitudes and Nutrition (SLÃÂÅN) was conducted in 2007, following previous surveys in 1998 and 2002. The 2007 SLÃÂÅN survey involved a nationally representative sample of 10,364 respondents (62% response rate), of whom 9,223 (89%) completed a standard Willett Food Frequency Questionnaire adapted for use in the Irish population. Click here to download PDF 4mb

Isoenzimatic analysis of four Anopheles (Kerteszia) cruzii (Diptera: Culicidae) populations of Brazil

Anopheles cruzii is a small sylvatic mosquito and primary human Plasmodium vector in Southern Brazil. The distribution of this bromeliad-breeding mosquito follows the Atlantic forest coastal distribution, where bromeliads are abundant. Morphological, genetic, and molecular polymorphisms among different populations have been reported and it has recently been suggested that An. cruzii is a complex of cryptic species. The aim of this work is to analyze the gene flow between different populations of An. cruzii collected in four localities within the geographic distribution range of the species, and to examine if An. cruzii is a complex of cryptic species. The genetic distances show that populations of the states of Santa Catarina, São Paulo, and Rio de Janeiro are genetically closer (0.032 to 0.083) than populations of Bahia (0.364 to 0.853) based on profiles from 10 distinct isoenzyme loci. The Fst was lower (0.077) when the Bahia population was excluded than when it was included (0.300) in the analyses. The inferred number of migrants per generation was 2.99 individuals among populations from the states of Santa Catarina, São Paulo, and Rio de Janeiro and 0.58 migrants per generation among all populations. Results suggest that An. cruzii is a complex of species and that the specimes of state of Bahia can be considered as belonging to a species that is distinct from other three closely-related populations studied.

Comparison of indices proposed as criteria for assigning skin notation

OBJECTIVES: Skin notations are used as a hazard identification tool to flag chemicals associated with a potential risk related to transdermal penetration. The transparency and rigorousness of the skin notation assignment process have recently been questioned. We compared different approaches proposed as criteria for these notations as a starting point for improving and systematizing current practice. METHODS: In this study, skin notations, dermal acute lethal dose 50 in mammals (LD(50)s) and two dermal risk indices derived from previously published work were compared using the lists of Swiss maximum allowable concentrations (MACs) and threshold limit values (TLVs) from the American Conference of Governmental Industrial Hygienists (ACGIH). The indices were both based on quantitative structure-activity relationship (QSAR) estimation of transdermal fluxes. One index compared the cumulative dose received through skin given specific exposure surface and duration to that received through lungs following inhalation 8 h at the MAC or TLV. The other index estimated the blood level increase caused by adding skin exposure to the inhalation route at kinetic steady state. Dermal-to-other route ratios of LD(50) were calculated as secondary indices of dermal penetrability. RESULTS: The working data set included 364 substances. Depending on the subdataset, agreement between the Swiss and ACGIH skin notations varied between 82 and 87%. Chemicals with a skin notation were more likely to have higher dermal risk indices and lower dermal LD(50) than chemicals without a notation (probabilities between 60 and 70%). The risk indices, based on cumulative dose and kinetic steady state, respectively, appeared proportional up to a constant independent of chemical-specific properties. They agreed well with dermal LD(50)s (Spearman correlation coefficients -0.42 to -0.43). Dermal-to-other routes LD(50) ratios were moderately associated with QSAR-based transdermal fluxes (Spearman correlation coefficients -0.2 to -0.3). CONCLUSIONS: The plausible but variable relationship between current skin notations and the different approaches tested confirm the need to improve current skin notations. QSAR-based risk indices and dermal toxicity data might be successfully integrated in a systematic alternative to current skin notations for detecting chemicals associated with potential dermal risk in the workplace. [Authors]

Survey of Lifestyle, Attitudes and Nutrition in Ireland. Mental Health and Social Well-being Report

SĹN 2007: Older People, Loneliness and Social Support to Mental HealthSĹN, the national Survey of Lifestyle, Attitudes and Nutrition, shows that most Irish adults have a reasonably high level of positive mental health. It is the largest national survey on positive and negative mental health and social well-being in the Irish adult population.��One finding highlights the significance of loneliness and social support to mental health. Finding reveal that 14% of respondents reported being often lonely in the last four weeks, with women, older people and respondents in lower social class groups reporting high levels of loneliness. The SĹN report indicates that being widowed and not being in paid employment are the strongest overall predictors of loneliness. Respondents who are widowed are about five times more likely to feel lonely than those who are married or cohabiting, while 17% of respondents aged 65 and over report being often lonely.��SLAN 2007 highlights the significance of loneliness and social support to mental health. It proposes community-based interventions, including community development approaches and strategies to promote community involvement as a way to tackle such social and health inequities at local level. The report also highlights the importance of implementing the recommendations of the policy document A Vision for Change. It says that protection and promotion of the future health and well-being of the Irish population requires the implementation of effective cross-sectoral policies that will help create and maintain a mentally healthy society, with consequent health, economic and social benefits for all.����SLAN is commissioned by the Department of Health and Children and involved face-to-face interviews with 10,364 respondents aged 18 years and over.��

Apoyo social a drogodependientes en programa de mantenimiento con metadona en una prisión

Goal: To learn more about the social support available to patients participating in a prison methadone maintenance program (PMM). Methodology: Descriptive, with controls. Setting: A penitentiary in Albolote (Granada) Population Sample: The total prison population was 1,579; 364 patients were included in the PMM; 35 were female and 329 were male. 60 patients, 7 women and 53 men, were used as cases. 30 non-drug dependent prisoners, 3 women and 27 men, were the control group. They had no antecedents of problems with drug addiction. Interventions: Interviews with cases and controls to learn about their addictive antecedents, family structure, socio-economic level, and a hetero-applied MOS questionnaire was completed. Percentages of each social support variable were obtained and compared using the chi-squared technique. Results: The overall support received is low in 38 cases (74.5%) and in 9 controls (30%): p = 0.0001. OR 0.1466, confidence interval at 95% (0.0538-0.3989). Support received is normal in 13 cases (25%) and 21 controls (70%): p = 0.0007. OR 0.69, confidence interval at 95% (0.44-0.93). All of the variables were statistically significant for non-drug addicts, except for emotional support, which was the same for both groups. Conclusion: The perception of inmates participating in the methadone maintenance program was that they received less social support than the non-drug dependent inmates.