Intraocular penetration of penciclovir after oral administration of famciclovir: a population pharmacokinetic model.

OBJECTIVES: We developed a population model that describes the ocular penetration and pharmacokinetics of penciclovir in human aqueous humour and plasma after oral administration of famciclovir. METHODS: Fifty-three patients undergoing cataract surgery received a single oral dose of 500 mg of famciclovir prior to surgery. Concentrations of penciclovir in both plasma and aqueous humour were measured by HPLC with fluorescence detection. Concentrations in plasma and aqueous humour were fitted using a two-compartment model (NONMEM software). Inter-individual and intra-individual variabilities were quantified and the influence of demographics and physiopathological and environmental variables on penciclovir pharmacokinetics was explored. RESULTS: Drug concentrations were fitted using a two-compartment, open model with first-order transfer rates between plasma and aqueous humour compartments. Among tested covariates, creatinine clearance, co-intake of angiotensin-converting enzyme inhibitors and body weight significantly influenced penciclovir pharmacokinetics. Plasma clearance was 22.8 ± 9.1 L/h and clearance from the aqueous humour was 8.2 × 10(-5) L/h. AUCs were 25.4 ± 10.2 and 6.6 ± 1.8 μg · h/mL in plasma and aqueous humour, respectively, yielding a penetration ratio of 0.28 ± 0.06. Simulated concentrations in the aqueous humour after administration of 500 mg of famciclovir three times daily were in the range of values required for 50% growth inhibition of non-resistant strains of the herpes zoster virus family. CONCLUSIONS: Plasma and aqueous penciclovir concentrations showed significant variability that could only be partially explained by renal function, body weight and comedication. Concentrations in the aqueous humour were much lower than in plasma, suggesting that factors in the blood-aqueous humour barrier might prevent its ocular penetration or that redistribution occurs in other ocular compartments.

O desenvolvimento da Capacidade de Expressão Oral na Aula de Língua Portuguesa: Um estudo na Escola Secundária Abílio Duarte

O trabalho ora a ser realizado tem como tema “O desenvolvimento da Capacidade de Expressão Oral na Aula de Língua Portuguesa: Um estudo na Escola Secundária Abílio Duarte”. Pensamos que no contexto sala de aula muitas vezes a expressão oral carece de ser mais desenvolvida, provavelmente, porque a maior parte dos alunos habitualmente não se expressam em português, mas em crioulo o que acaba por interferir no seu desenvolvimento. É neste sentido que propomos trabalhar o tema já referido onde no desenrolar do nosso trabalho vamos abordar vários aspectos que fazem parte da expressão oral. Talvez haja necessidade de dotar os professores de um conjunto de estratégias que possibilitem o desenvolvimento da expressão oral na língua portuguesa. Isto porque, parece também que as actividades que os professores realizam, muitas vezes não contribuem ou não motivam os alunos a exercitarem a prática da oralidade na mesma.

A Single High Dose of Oral Vitamin D3 Is Not Enough to Correct Insufficiency and Deficiency in a Rheumatologic Population

Introduction: Vitamin D plays a major role in bone metabolism and neuromuscular function. Supplementation with vitamin D is effective to reduce the risk of fall and of fracture. However adherence to oral daily vitamin D supplementation is low. Screening and correcting vitamin D insufficiency in a general rheumatologic population could improve both morbidity and quality of life in these patients with chronic painful disorders and at high risk of osteoporosis. After determining the prevalence of vitamin D deficiency in this population, we evaluated if supplementation with a single high dose of oral 25-OH vitamin D3 was sufficient to correct this abnormality. Methods: During one month (November 2009), levels of 25-OH vitamin D were systematically determined in our rheumatology outpatient clinic and classified into three groups: vitamin D deficiency (<10 μg/l), vitamin D insufficiency (10 to 30 μg/l) or normal vitamin D (>30 μg/l). Patients with insufficiency or deficiency received respectively a single high dose of 300000 IU or 600000 IU oral vitamin D3. In addition, all patients with osteoporosis were prescribed daily supplement of calcium (1 g) and vitamin D (800 IU). 25-OH vitamin D levels were reevaluated after 3 months. Results: Vitamin D levels were initially determined in 292 patients (mean age 53, 211 women, 87% Caucasian). 77% had inflammatory rheumatologic disease (IRD), 20% osteoporosis (OP) and 12% degenerative disease (DD). Vitamin D deficiency was present in 20 (6.8%), while 225 (77.1%) had insufficiency. Of the 245 patients with levels <30 μg/l, a new determination of vitamin D level was available in 173 (71%) at 3 months. Conclusion: Vitamin D insufficiency is highly prevalent in our rheumatologic population (84%), and is not adequately corrected by a single high dose of oral vitamin D3 in more than half of the patients with IRD and DD. In patients with OP, despite association of a single high dose with daily oral vitamin D supplementation, 40% of patients are still deficient when reevaluated at 3 months.

Cançons de tradició oral de la Terra Alta

 Treball de recerca realitzat per un alumne d’ensenyament secundari i guardonat amb un Premi CIRIT per fomentar l'esperit científic del Jovent l’any 2010. El treball neix amb una manifesta voluntat de servei a la comunitat. La canviant naturalesa de tota societat i la necessitat d'adaptació als continus canvis que experimenta cada grup humà porten aparellada la ineludible desaparició de les manifestacions culturals que deixen d'adequar-se a la nova realitat. Així que el primer objectiu d'aquesta recerca és intentar salvaguardar tot un patrimoni cultural que, atenent l'estructura socioeconòmica i demogràfica de la Terra Alta, està destinat irremeiablement a perdre's en els pròxims deu o quinze anys i, en molts casos, abans i tot. En una primera fase, s’han consultat arxius especialitzats per a determinar l'estat de la qüestió pel que fa als cançoners, i s’ha realitzat una revisió bibliogràfica. Posteriorment, s'ha iniciat el treball de camp sobre el terreny. Pel que fa a aspectes de teoria etnogràfica lligats estrictament a les músiques de les cançons, la investigació ens ha proporcionat una nova llum sobre alguns punts interessants la concepció apriorística que en teníem -ara ho sabem- hem hagut de canviar i rebutjar. Contràriament al pensament comunament arrelat, el treball ha demostrat que les cançons de tradició oral no són tan antigues ni tenen tampoc un origen tan inveterat com se'ls sol suposar. I, això, sense comptar que amb aquest investigació s'omple un buït de coneixement sobre la Terra Alta.

Dietary vitamin D and cancers of the oral cavity and esophagus.

BACKGROUND: Data on the association between vitamin D and upper digestive tract neoplasms are limited. METHODS: In two case-control studies in Italy, we examined the relation between dietary vitamin D intake and squamous cell carcinoma of the esophagus (SCCE; 304 cases) and oral/pharyngeal cancer (804 cases). Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by multiple logistic regression. RESULTS: Adjusted ORs for SCCE and oral/pharyngeal cancer were 0.58 (95% CI 0.39-0.86) and 0.76 (95% CI 0.60-0.94), respectively, for the highest tertile of vitamin D intake. Using a reference group of those in the highest tertile of vitamin D who were never/former smokers, ORs were 8.7 (95% CI 4.1-18.7) for SCCE and 10.4 (95% CI 6.9-15.5) for oral/pharyngeal cancer among heavy smokers in the lowest vitamin D tertile; similarly, compared with those in the highest tertile of vitamin D who drank <3 alcoholic drinks/day, corresponding ORs were 41.9 (95% CI 13.7-128.6) for SCCE and 8.5 (95% CI 5.7-12.5) for oral/pharyngeal cancer, among heavy alcohol drinkers in the lowest vitamin D tertile. CONCLUSION: We observed inverse associations between dietary vitamin D intake and risk of SCCE and, perhaps, oral/pharyngeal cancer, which were most pronounced among heavy current smokers and heavy consumers of alcohol.

Fluconazole prophylaxis prevents intra-abdominal candidiasis in high-risk surgical patients.

OBJECTIVE: To evaluate the efficacy and safety of intravenous fluconazole for the prevention of intra-abdominal Candida infections in high-risk surgical patients. DESIGN: Randomized, prospective, double-blind, placebo-controlled study. SETTING: Two university-affiliated hospitals in Switzerland. PATIENTS: Forty-nine surgical patients with recurrent gastrointestinal perforations or anastomotic leakages. INTERVENTIONS: Prophylaxis with intravenous fluconazole (400 mg per day) or placebo continued until resolution of the underlying surgical condition. MEASUREMENTS AND MAIN RESULTS: Patients were evaluated daily, and specimens for culture were obtained three times per week during prophylaxis. The primary study end points were the frequency of and the time to intra-abdominal Candida infections. Secondary end points were the frequency of candidiasis (intra-abdominal and extra-abdominal) and the emergence or persistence of Candida colonization. Among patients who were not colonized at study entry, Candida was isolated from surveillance cultures during prophylaxis in 15% of the patients in the fluconazole group and in 62% of the patients in the placebo group (relative risk, 0.25; 95% confidence interval, 0.07 to 0.96; p = .04). Candida peritonitis occurred in one of 23 patients (4%) who received fluconazole and in seven of 20 patients (35%) who received placebo (relative risk, 0.12; 95% confidence interval, 0.02 to 0.93; p = .02). In addition, one catheter-related Candida albicans sepsis occurred in a fluconazole-treated patient. Thus, overall, candidiasis developed in two fluconazole patients and seven placebo patients (relative risk, 0.25; 95% confidence interval, 0.06 to 1.06; p = .06). C. albicans accounted for 87% of the Candida species isolated before or during prophylaxis, and all C. albicans strains were susceptible to fluconazole. Fluconazole was well tolerated, and adverse events occurred at similar frequencies in both treatment groups. CONCLUSIONS: Fluconazole prophylaxis prevents colonization and invasive intra-abdominal Candida infections in high-risk surgical patients.

Thermogenic response to an oral glucose load in man: comparison between young and elderly subjects.

To investigate the effect of age and change in body composition on the increase in energy expenditure consecutive to the ingestion of a 75-g glucose load, respiratory exchange measurements were performed on 24 subjects, 12 elderly (mean +/- SEM, 73 +/- 1 yr) and 12 young (25 +/- 1 yr). The body weight was comparable, 62 +/- 2 kg in the elderly group vs 61 +/- 3 in the young, but the body fat content of the elderly group was significantly greater than that of the young (29 +/- 2% vs 19 +/- 2%, p less than 0.001). The elderly group presented a slight glucose intolerance according to the World Health Organization (WHO) criteria, with a 120-min plasma glucose of 149 +/- 9 mg/dl (p less than 0.005 vs young). The postabsorptive resting energy expenditure (REE) was 0.83 +/- 0.03 kcal/min in the elderly group vs 0.98 +/- 0.04 in the young (p less than 0.02); this decrease of 15% was mainly related to the decrease in fat free mass (FFM) in the elderly group, which averaged 14%. The difference was not significant when REE was expressed per kg FFM. The glucose-induced thermogenesis (GIT) expressed as percent of energy content of the load was 6.2 +/- 0.6% in the elderly group and 8.9 +/- 0.9% in the young (p less than 0.05). It is concluded that the glucose-induced thermogenesis is decreased in elderly subjects. However, when expressed per kg FFM, the increment in energy expenditure (EE), in response to the glucose load, is not different in elderly subjects, suggesting that the decrease of thermogenesis may be attributed to the age-related decrease in FFM.

Oral Correction in Foreign Language Classrooms

This paper analyses the correction of errors and mistakes made by students in the Foreign Language Teaching classroom. Its goal is to point out typical correction behaviors in Cape Verde in Language Teaching classrooms and raise teachers’ consciousness concerning better correction practice.

A importância da educação para a saúde oral nos adolescentes nas escolas secundárias do conselho de São Vicente

A cárie dentária afecta a população mundial e é o responsável pela dor e perda dos dentes. Prevalece nas crianças que frequentam o pré-escolar, o ensino básico e nos adolescentes do ensino secundário e tem implicações no bem-estar individual e social dos afectados. A pesquisa que desenvolvemos cuja pergunta de partida é: como o enfermeiro pode intervir no sentido de melhorar a saúde oral dos adolescentes? E o título A importância da Educação para a Saúde Oral nos adolescentes nas escolas secundárias do concelho de São Vicente, é de carácter quantitativo, uma vez que recolhemos uma amostra constituída por 80 alunos do 7ºano e 80 alunos do 11ºano das escolas secundárias da ilha de São Vicente, através de um inquérito por questionário fechado, tendo em conta três dimensões: a caracterização do aluno; as questões relacionadas com os hábitos de higiene oral e com os hábitos alimentares, e depois foram realizadas sessões de Educação para a Saúde (EpS), para proporcionar conhecimentos sobre a saúde oral, sensibilizar os alunos sobre os problemas orais e apostar na prevenção. Posteriormente examinamos os dados numericamente, através das estatísticas. Paralelamente o processo de recolha e tratamento de dados remete para um estudo de carácter qualitativo, por termos feito observações dentro e fora das escolas, conversado com os membros do corpo directivo e por causa de toda a reestruturação que foi sendo feita enquanto desenvolvíamos esta pesquisa, Relativamente à análise dos dados, a maioria dos alunos inquiridos, revelaram ter comportamentos e hábitos de saúde oral adequados. Uma minoria, tanto no 7º como no 11º anos afirmou não ter cárie dentária. Porém, a maioria já teve ou tem sangramento durante a escovagem dos dentes e também dores nos dentes. A percentagem desses sintomas não corresponde à percentagem da cárie dentária, o que denuncia discordâncias entre algumas respostas. Neste sentido, alertamos que este indicador deve ser tido em conta em futuros trabalhos de intervenção a serem realizados na comunidade estudantil para que possa ser feita uma observação da cavidade oral e assim clarificá-lo.

Invasive candidiasis as a cause of sepsis in the critically ill patient.

Invasive fungal infections are an increasingly frequent etiology of sepsis in critically ill patients causing substantial morbidity and mortality. Candida species are by far the predominant agent of fungal sepsis accounting for 10% to 15% of health-care associated infections, about 5% of all cases of severe sepsis and septic shock and are the fourth most common bloodstream isolates in the United States. One-third of all episodes of candidemia occur in the intensive care setting. Early diagnosis of invasive candidiasis is critical in order to initiate antifungal agents promptly. Delay in the administration of appropriate therapy increases mortality. Unfortunately, risk factors, clinical and radiological manifestations are quite unspecific and conventional culture methods are suboptimal. Non-culture based methods (such as mannan, anti-mannan, β-d-glucan, and polymerase chain reaction) have emerged but remain investigational or require additional testing in the ICU setting. Few prophylactic or pre-emptive studies have been performed in critically ill patients. They tended to be underpowered and their clinical usefulness remains to be established under most circumstances. The antifungal armamentarium has expanded considerably with the advent of lipid formulations of amphotericin B, the newest triazoles and the echinocandins. Clinical trials have shown that the triazoles and echinocandins are efficacious and well tolerated antifungal therapies. Clinical practice guidelines for the management of invasive candidiasis have been published by the European Society for Clinical Microbiology and Infectious Diseases and the Infectious Diseases Society of North America.