Fitoplancton del mar peruano en la primavera austral 2002

El Crucero de Evaluación de Recursos Pelágicos 0209-11 de los BIC’s Humboldt, Olaya y SNP-2 abarcó de Paita a IIo; se colectó 158 muestras de fitoplancton, 126 para análisis semi cuantitativo y 32 para análisis cuantitativos. El promedio de biomasa planctónica fue 1,01 mL.m-3, con núcleos de alta concentración al norte (5–6 y 7-8°S) dentro de las 30 mn. El fitoplancton fue predominante en el 37% del área evaluada con dominancia de Coscinodiscus perforatus, C. excentricus, Actinocyclus sp., Thalassiosira rotula, Pseudonitzschia pungens, Detonula confervacea, Pleurosigma sp. y Ditylum brightwellii, asociadas a especies de fase temprana en sucesión (Chaetoceros spp.). Las mayores concentraciones celulares (500x103 cel.L-1) se localizaron en los perfiles de Atico con abundancia de fitoflagelados y en Paita de diatomeas. Ceratium breve, indicador de AES se localizó al norte de los 8°S y por fuera de las 100 mn; y un pequeño núcleo frente a Huacho y Chancay por el desplazamiento de esa masa de agua. Ceratium praelongum, indicador de ASS presentó un ligero acercamiento en Callao a 30 mn y en San Juan a 60 mn. Protoperidinium obtusum, indicador de ACF amplió su distribución debido a la intensificación de los afloramientos.

The alkaline intraplate volcanism of the Antalya nappes (Turkey): a Late Triassic remnant of the Neotethys

Late Triassic submarine alkali basalts and hawaiites were collected from two superimposed tectonic slices belonging to the Kara Dere - Sayrun unit of the Middle Antalya nappes, southwestern Turkey. New determinations on conodont faunas allow to date this sequence to the Lower Carnian (Julian). The volcanic rocks show rather homogeneous compositions, with high TiO2 and relatively low MgO and Ni contents which suggest olivine fractionation. Their primitive mantle-normalised multi-elements plots show Nb and Ta enrichments relative to La, Pb negative anomalies and heavy rare earth element and Y depletions typical of intraplate ocean island basalts. These characteristics are consistent with the major and trace element compositions of their primary clinopyroxene phenocrysts, which do not show any feature ascribable to crustal contamination. The studied lavas display a restricted range of epsilon Nd (+4.6 to +5.2) which falls within the range of ocean island basalts. Their initial (Nd-143/Nd-144)i ratios are too low to be explained by a simple mixing line between depleted MORB mantle (DMM) and HIMU components. Their Pb and Nd isotopic compositions plot along a mixing line between HIMU component and an enriched mantle, the composition of which could be the result of the addition of about 5 to 8% of an EM2 component (recycled marine sediments) to DMM. The lack of evidence for any continental crustal component. in their genesis could be consistent with their emplacement in an intra-oceanic setting.

Traité de blason et recueil d'armoiries, composés par Noel LE BOUCQ, de Valenciennes.

Armoiries de différentes provinces d'Espagne (fol. 58), — des Pays-Bas (fol. 62), — « princes du Pays-Bas (fol. 66 v°), — électeurs et princes d'Alemaigne (fol. 70), — les Lorrains (fol. 76), — duché de Barre (fol. 77 v°), — duché de Savoy (fol. 78), — roy de Franche et nobles d'icelluy » par provinces (fol. 79), — « XII pères de Franche (fol. 88 v°), — duché de Bourgoigne (fol. 90 v°), — Bretons », etc. (fol. 94 v°), — « roy d'Angleterre » et nobles dudit pays (fol. 117), — « les noef Preux (fol. 124 v°), — cités et villes marchandes par toutte renommée (fol. 126 v°), — royaulme de Bohemie (fol. 129), — les Poullennois (Polonais) (fol. 130), — empereurs, royx et princes de estranges pays (fol. 130 v°), — royaulme de Castille (fol. 133), — royaulme d'Arragon (fol. 134 v°), — les Navarrois (fol. 137 v°), — villes de Brabant (fol. 139), — de Flandres (fol. 143 v°), — comté d'Alost (fol. 151 v°), — comté de Hollande (fol. 158), — les Namurois (fol. 160), — comté d'Artoys (fol. 165), — comté de Hainault (fol. 174 v°), — chevaliers bannerés (fol. 180 v°), — officiers de Hainault, etc. (fol. 183 v°), — ville et bourgeois de Valenciennes » (fol. 201). Ce traité de blason commence par une dédicace, datée de 1542, et se termine par la mention : « Faict et achevé, le XXIXe jour du mois de mars l'an mil cincq cens quarante trois. 1543. » — Nombreux blasons peints. L'auteur de ce traité et de ce recueil d'armoiries est peut-être Noel Le Boucq, de Valenciennes. Il a été, en tout cas, fait par ses soins et probablement pour son fils Jacques, car ses armes sont peintes dans la lettre initiale de la préface (fol. 3) ; et elles se retrouvent, avec celles de sa première femme, Anne Le Prince, au fol. 3 v°, et celles de sa seconde femme, Marguerite Vivien, au fol. 4. On lit, en outre, au fol. 1 : « Ce présent livre appertient à Jacques Le Boucq, fils de Noé, demorant en Valenciennes, sur la Croix, au Noef Boucq, à l'enseigne de la Petit Nostre Damme. 1543. »

Notes et extraits de Pierre-François CHIFFLET, concernant principalement la Franche-Comté et la Bourgogne.

On remarque : « Ex Glossario pervetusto » (f. 3) ; — « Ex chartis ecclesiae de Caritate » (f. 10) ; — « Ex veteri membrana et ex antiquo circulo depicto propè altare Maurimonasterii in Alsatia » (f. 10) ; — « Ex chartis R. P. Stephani Voyrin » (f. 11) ; — « Episcopi Metenses, ex ms. codice Sancti Arnulfi Metensis » (f. 12 v°) ; — Lettre de Hugues Métel à Gerland (f. 14) ; — « Ex variis catalogis sanctorum » (f. 14) ; — « Ex archivio ecclesiae Beatae Magdalenae [Bisuntinae] » (f. 17) ; — « Ex archivio Sancti Vincentii Bisont[ini] » (f. 18) ; — « Ex archivio monasterii Bellaevallis » [Bisuntinae dioecesis] (f. 20) ; — « Ex veteri necrologio Sancti Stephani [Bisuntini], quod est ad margines Martyrologii Bedae perantiqui, ad ejusdem ecclesiae usum accommodati » [cf. ms. de Besançon 712] (f. 23 v°) ; — « Inter martyrologium et regulam, seu librum primum concilii Aquisgranensis, habetur haec sententia absolutionis » (f. 25) ; — « Ante veterem Ordinem Romanum, qui est Liber Pontificalis, habentur sequentes formulae praestandae obedientiae archiepiscopis et ecclesiae Bisuntinae » (f. 25 v°) ; — « Alia ex archivo archiepiscopi [Bisuntini] » (f. 26 v°) ; — « Ex archivio Balernensi » (f. 27 v°) ; — « Ex variis sanctorum historiis manuscriptis » (f. 30) ; — « Extraits concernant Tournus » (f. 34 v°), — notamment : « Ex codice manuscripto Trenorchiensi, membraneo, quod vocare possis Registrum Trenorchiense, incipiens ab anno 1222 et desinens in 1296 ; inscribitur : Feoda ecclesiae Trenorchiensis » (f. 37) ; — « Ex notis R. P. Voyrini » [cf. supra, f. 11] (f. 49) ; — « Inscriptio vetus Luxoviensis » (f. 50 v°) ; — Notes historiques, concernant principalement des abbayes comtoises (f. 51) ; — « Scriptores rerum Burgundicarum » (f. 52) ; — « Ex parvo chartulari Sancti Benigni [Divionensis] » (f. 52 v°) ; — « Ex libro anniversariorum Sancti Benigni [Divionensis] », 1579-1629 (f. 52 v°) ; — « Ex chartulari Sancti Symphoriani Augustodunensis » (f. 53) ; — « Ex chartulari Sancti Marcelli Cabilonensis » (f. 53 v°) ; — « Ex chartulari S. Sequani » [Lingonensis dioecesis] (f. 54 v°) ; — « Ex chartulari Sanctae Capellae Divionensis » (f. 55) ; — « Ex chartulari cathedralis Augustodunensis » (f. 55 v°) ; — « Ex tomo priore chartularis Sancti Stephani Divionensis » (f. 56) ; — « Ex chartulari Cluniacensi » (f. 57) ; — « Ex apographo chartularis Matisconensis, cujus autographum vetus dicebatur Liber catenatus » (f. 57 v°) ; — « Ex chartulari Patriciaci, qui est prioratus dependens a Floriacensi abbatia, situs in comitatu Kadrellensi, dioecesi Augustodunensi » (f. 58 v°) ; — Extraits concernant Autun et les comtes d'Autun (f. 60 v°) ; — « Ex autographis Sancti Benigni Divionensis » (f. 61) ; — « Iterum ex chartulari Sancti Stephani Divionensis » (f. 61) ; — « Ex autographis monasterii puellarum Tartensis » (f. 62) ; — « Iterum ex tabulario Cluniacensi, adnotatis paginis » (f. 62 v°) ; — « Ex majore tabulario ecclesiae Cabilonensis, quod digessit Johannes Germani, Cabilonensis episcopus » (f. 64 v°) ; — « Ex tabulario abbatiae de Buxeria » (f. 65) ; — « Ex autographis monialium Benedictinarum de Pralon » (f. 66) ; — « Ex autographis prioratus Vallis Beatae Mariae juxta Talant, de Ordine Vallis Scholarium, vulgò Bonvau » (f. 66) ; — « Ex kalendario pervetusto Sancti Benigni Divionensis » (f. 66 v°) ; — « Ex martyrologio proprio Sancti Martini Eduensis » (f. 67) ; — « Ex necrologio Sancti Lazari Aeduensis » (f. 67) ; — « Ex chronico Sancti Petri Vivi Senonensis » (f. 67) ; — « Ex chronico S. Medardi Suessionensis » (f. 68) ; — « Ex brevi chronico Sancti Dionysii ad cyclos paschales » (f. 68) ; — « De Saracenis in Gallia profligatis » (f. 69) ; — « Ex necrologio Sancti Augendi Jurensis » (f. 74) ; — « Ex necrologio Sancti Petri Bisuntini » (f. 74) ; — « Ex necrologio veteri Sancti Stephani [Bisuntini] » (f. 74 v°) ; — « Ex registro Innocentii papae VI, anni IX pontificatus, Christi 1361 » (f. 82) ; — « Ex tabulis capituli Sancti Dionysii de Vergeyo, nunc Nuciacensis » (f. 83) ; — « Ex manuscripto codice donationum 208 Joannis, comitis Burgundiae et domini Salinensis, super puteum Salinarum » (f. 89 v°) ; — « Ex archivo Sancti Anatolii Salinensis ; ex magno necrologio chartaceo eique simili membraneo, composito 1390 » (f. 92) ; — « Ex chartis prioratus de Marthereto prope Vesulium » (f. 94) ; — « Ex archivo Sancti Pauli Bisonticensis » (f. 95) ; — « Ex veteri chartulario Sancti Pauli [Bisonticensis] » (f. 95 v°) ; — « Ex veteri manuscripto codice Sancti Pauli [Bisonticensis] » (f. 96) ; — « Ex antiquioribus libris ecclesiae Sancti Stephani [Bisonticensis], scriptis aut in usum adhibitis tempore Hugonis primi, [archiepiscopi Bisonticensis] » (f. 96 v°) ; — « Ex codice Sancti Stephani [Bisonticensis] pervetusto, qui Bisonticensis ecclesiae sacros ritus continet » (f. 97) ; — « Ex antiquis codicibus Sancti Pauli [Bisonticensis] » (f. 98) ; — « Ex antiquo rituum libro » (f. 98) ; — « Ex antiquis letaniis, tempore Hugonis I, [archiepiscopi Bisuntini], in ecclesia Bisontina cani solitis ; ex manuscriptis Sancti Stephani et Sancti Pauli » (f. 99) ; — « Extraits de plusieurs manuscrits de Saint-Paul de Besançon » (f. 99 v°) ; — « Ex manuscripto codice Sanctae Magdalenae [Bisuntinae] » (f. 101) ; — Inscription trouvée à Saint-Ferjeux, en 1627 (f. 101 v°) ; — « Ex antiquis membranis archivii ecclesiae metropolitanae Bisontinae », extraits de bulles pontificales, etc. (f. 102) ; — « Ex archivio Loci Crescentis seu Trium Regum » (f. 105) ; — Notes empruntées, « ut videtur », à Anselme « de Marenchiis » (f. 106) ; — « Ex actis capituli Bisontini » (f. 106 v°) ; — « Ex obitibus adnotatis ad marginem martyrologii cathedralis Aeduensis » (f. 106 v°) ; — Fragment de chronique, 563-1033, tiré « ex veteri membrana monasterii Sancti Augendi » (f. 107) ; — « Ex alia membrana, post chronicon Engolismense » (f. 107) ; — « Ex archivio abbatiae de Aceyo » (f. 108) ; — « Ex archivio abbatiae de Roseriis » (f. 109) ; — « Extrait d'un tome des recognoissances des fiefs du Charolois » (f. 109 v°) ; — « Ex polypthico Sancti Vincentii Cabilonensis » (f. 114) ; — « Ex Aeneae, Parisiensis episcopi, collectione contra Graecos, Biblioth. Thuan., n. 444 » (f. 114) ; — « Consuetudines Cluniacenses, auctore Wdalrico, monacho Cluniacensi » (f. 115) ; — Inscriptions copiées « in pervetusto manuscripto codice, post Persii satyras », etc. (f. 116) ; — Extraits d'une « Vita metrica sancti Eustachii martyris, cognomine Placidae », contenue « in manuscripto codice Cisterciensi », etc. (f. 116 v°) ; — « De archiepiscopis Bisontinis » (f. 119) ; — « Ex archivio capituli Bisontini » (f. 120 v°) ; — « Notitia nostrorum diplomatum » (f. 124-135 r° , 141 r° , 142 v° et 143 r°) ; — « De comitibus Burgundiae in Sancti Stephani basilica Bisontina sepultis, ex veteri membrana archivi ecclesiae metropolitanae » (f. 135 v°) ; — Lettre autogr. de « Pierre-François Chifflet » [à Baluze], Dijon, 18 mars 1657 (f. 161) ; — Fragment de charte, « extrait du thresor de S. Anatoile de Salins » (f. 162) ; — Lettre autogr. de « [fr.] François Du Chemin » à Chifflet, Cîteaux, 16 mai 1657 (f. 167) ; — « Nova regum Francorum series, a quâ Theodericus II et omnes ejus posteri excluduntur, ex manuscripto codice Fontanetensi » (f. 171) ; — « Vita sancti Theutbaldi, Viennensis archiepiscopi », incomplète [Bibliotheca hagiographica latina, 8044 b] (f. 172 et 172 bis) ; — « Ex chartulario Sancti Germani Autisiodorensis », diplômes carolingiens (f. 174) ; — Fragment d'une lettre [adressée vraisemblablement à Chifflet], Paris, octobre 1670 (f. 177) ; — Extraits « ex vitâ sancti Theutbaldi, Viennensis archiepiscopi..., ex manuscripto codice monasterii Sancti Theuderii, ubi sanctus Theobaldus, Viennensis archiepiscopus, requiescit » [extraits de la vie dont un fragment occupe les feuillets 172 et 172 bis] (f. 178) ; — Lettre autogr. de « P[ierre-] F[rançois] Chifflet » [à Baluze], 10 mars (f. 180) ; — Notes sur saint Théobald, archevêque de Vienne (f. 181). Cf. Ulysse Robert, Catalogue des manuscrits relatifs à la Franche-Comté, qui sont conservés dans les bibliothèques publiques de Paris (1878), p. 161-162.

Canakinumab for the treatment of acute flares in difficult-to-treat gouty arthritis: Results of a multicenter, phase II, dose-ranging study.

OBJECTIVE: To assess the efficacy and tolerability of canakinumab, a fully human anti-interleukin-1β monoclonal antibody, for the treatment of acute gouty arthritis. METHODS: In this 8-week, single-blind, double-dummy, dose-ranging study, patients with acute gouty arthritis whose disease was refractory to or who had contraindications to nonsteroidal antiinflammatory drugs and/or colchicine were randomized to receive a single subcutaneous dose of canakinumab (10, 25, 50, 90, or 150 mg; n = 143) or an intramuscular dose of triamcinolone acetonide (40 mg; n = 57). Patients assessed pain using a 100-mm visual analog scale. RESULTS: Seventy-two hours after treatment, a statistically significant dose response was observed for canakinumab. All canakinumab doses were associated with numerically less pain than triamcinolone acetonide; thus, a dose with equivalent efficacy to triamcinolone acetonide 72 hours after treatment could not be determined. The reduction from baseline in pain intensity with canakinumab 150 mg was greater than with triamcinolone acetonide 24, 48, and 72 hours after treatment (differences of -11.5 mm [P = 0.04], -18.2 mm [P = 0.002], and -19.2 mm [P < 0.001], respectively), and 4, 5, and 7 days after treatment (all P < 0.05). Canakinumab significantly reduced the risk of recurrent flares versus triamcinolone acetonide (P ≤ 0.01 for all doses) (relative risk reduction 94% for canakinumab 150 mg versus triamcinolone acetonide). The overall incidence of adverse events was similar for canakinumab (41%) and triamcinolone acetonide (42%); most were mild or moderate in severity. CONCLUSION: Our findings indicate that canakinumab 150 mg provides rapid and sustained pain relief in patients with acute gouty arthritis, and significantly reduces the risk of recurrent flares compared with triamcinolone acetonide.

A pilot assessment of alpha-stat vs pH-stat arterial blood gas analysis after cardiac arrest.

PURPOSE: Resuscitated cardiac arrest (CA) patients typically receive therapeutic hypothermia, but arterial blood gases (ABGs) are often assessed after adjustment to 37°C (alpha-stat) instead of actual body temperature (pH-stat). We sought to compare alpha-stat and pH-stat assessment of Pao2 and Paco2 in such patients. MATERIALS AND METHODS: Using ABG data obtained during the first 24 hours of intensive care unit admission, we determined the impact of measured alpha vs calculated pH-stat on Pao2 and Paco2 on patient classification and outcomes for CA patients. RESULTS: We assessed 1013 ABGs from 120 CA patients with a median age of patients 66 years (interquartile range, 50-76). Median alpha-stat Pao2 changed from 122 (95-156) to 107 (82-143) mm Hg with pH-stat and median Paco2 from 39 (34-46) to 35 (30-41) mm Hg (both P < .001). Using the categories of hyperoxemia, normoxemia, and hypoxemia, pH-stat estimation of Pao2 reclassified approximately 20% of patients. Using the categories of hypercapnia, normocapnia, and hypocapnia, pH stat estimation of Paco2 reclassified approximately 40% of patients. The mortality of patients in different Pao2 and Paco2 categories was similar for pH-stat and alpha-stat. CONCLUSIONS: Using the pH-stat method, fewer resuscitated CA patients admitted to intensive care unit were classified as hyperoxemic or hypercapnic compared with alpha-stat. These findings suggest an impact of ABG assessment methodology on Pao2, Paco2, and patient classification but not on associated outcomes.

CD4(+) T cell count decreases by ethnicity among untreated patients with HIV infection in South Africa and Switzerland.

BACKGROUND: Estimates of the decrease in CD4(+) cell counts in untreated patients with human immunodeficiency virus (HIV) infection are important for patient care and public health. We analyzed CD4(+) cell count decreases in the Cape Town AIDS Cohort and the Swiss HIV Cohort Study. METHODS: We used mixed-effects models and joint models that allowed for the correlation between CD4(+) cell count decreases and survival and stratified analyses by the initial cell count (50-199, 200-349, 350-499, and 500-750 cells/microL). Results are presented as the mean decrease in CD4(+) cell count with 95% confidence intervals (CIs) during the first year after the initial CD4(+) cell count. RESULTS: A total of 784 South African (629 nonwhite) and 2030 Swiss (218 nonwhite) patients with HIV infection contributed 13,388 CD4(+) cell counts. Decreases in CD4(+) cell count were steeper in white patients, patients with higher initial CD4(+) cell counts, and older patients. Decreases ranged from a mean of 38 cells/microL (95% CI, 24-54 cells/microL) in nonwhite patients from the Swiss HIV Cohort Study 15-39 years of age with an initial CD4(+) cell count of 200-349 cells/microL to a mean of 210 cells/microL (95% CI, 143-268 cells/microL) in white patients in the Cape Town AIDS Cohort > or =40 years of age with an initial CD4(+) cell count of 500-750 cells/microL. CONCLUSIONS: Among both patients from Switzerland and patients from South Africa, CD4(+) cell count decreases were greater in white patients with HIV infection than they were in nonwhite patients with HIV infection.

Brain Tissue Hypoxia is a Strong Predictor of Outcome after Severe Traumatic Brain Injury Independent from Elevated Intracranial Pressure

Introduction: Low brain tissue oxygen pressure (PbtO2) is associated with worse outcome in patients with severe traumatic brain injury (TBI). However, it is unclear whether brain tissue hypoxia is merely a marker of injury severity or a predictor of prognosis, independent from intracranial pressure (ICP) and injury severity. Hypothesis: We hypothesized that brain tissue hypoxia was an independent predictor of outcome in patients wih severe TBI, irrespective of elevated ICP and of the severity of cerebral and systemic injury. Methods: This observational study was conducted at the Neurological ICU, Hospital of the University of Pennsylvania, an academic level I trauma center. Patients admitted with severe TBI who had PbtO2 and ICP monitoring were included in the study. PbtO2, ICP, mean arterial pressure (MAP) and cerebral perfusion pressure (CPP = MAP-ICP) were monitored continuously and recorded prospectively every 30 min. Using linear interpolation, duration and cumulative dose (area under the curve, AUC) of brain tissue hypoxia (PbtO2 < 15 mm Hg), elevated ICP >20 mm Hg and low CPP <60 mm Hg were calculated, and the association with outcome at hospital discharge, dichotomized as good (Glasgow Outcome Score [GOS] 4-5) vs. poor (GOS 1-3), was analyzed. Results: A total of 103 consecutive patients, monitored for an average of 5 days, was studied. Brain tissue hypoxia was observed in 66 (64%) patients despite ICP was < 20 mm Hg and CPP > 60 mm Hg (72 +/- 39% and 49 +/- 41% of brain hypoxic time, respectively). Compared with patients with good outcome, those with poor outcome had a longer duration of brain hypoxia (1.7 +/- 3.7 vs. 8.3 +/- 15.9 hrs, P<0.01), as well as a longer duration (11.5 +/- 16.5 vs. 21.6 +/- 29.6 hrs, P=0.03) and a greater cumulative dose (56 +/- 93 vs. 143 +/- 218 mm Hg*hrs, P<0.01) of elevated ICP. By multivariable logistic regression, admission Glasgow Coma Scale (OR, 0.83, 95% CI: 0.70-0.99, P=0.04), Marshall CT score (OR 2.42, 95% CI: 1.42-4.11, P<0.01), APACHE II (OR 1.20, 95% CI: 1.03-1.43, P=0.03), and the duration of brain tissue hypoxia (OR 1.13; 95% CI: 1.01-1.27; P=0.04) were all significantly associated with poor outcome. No independent association was found between the AUC for elevated ICP and outcome (OR 1.01, 95% CI 0.97-1.02, P=0.11) in our prospective cohort. Conclusions: In patients with severe TBI, brain tissue hypoxia is frequent, despite normal ICP and CPP, and is associated with poor outcome, independent of intracranial hypertension and the severity of cerebral and systemic injury. Our findings indicate that PbtO2 is a strong physiologic prognostic marker after TBI. Further study is warranted to examine whether PbtO2-directed therapy improves outcome in severely head-injured patients .

Why Objective Monitoring of Compliance is Important in the Management of Hypertension.

Hypertensive patients often experience poor adherence to treatment, a frequent cause of uncontrolled blood pressure. In this study, we have evaluated whether or not the use of electronic monitoring for drug adherence is a useful approach to identify and correct compliance problems in hypertensive patients, which may ultimately enhance the effect of antihypertensive therapy. Sixty-nine treated patients with an office blood pressure greater than 140/90 mm Hg were enrolled in this study. With patient consent, current antihypertensive therapy was dispensed in electronic pillboxes that record the time and date of each opening without changing the drug regimen. The intention was to provide physicians with objective measurements of drug compliance. The monitoring of compliance per se without any other intervention induced a marked decrease of blood pressure in the whole group (from 159/104Â+/-23/12 mm Hg to 143/92Â+/-20/15, meansÂ+/-standard deviation, p less than 0.001). A complete normalization of blood pressure (less than 140/90 mm Hg) was obtained in one third of the patients (group 1, n=23) during the monitoring period. A significant improvement of blood pressure control was found in another third (group 2, n=23), whereas in the remaining patients (group 3, n=23) no change in blood pressure was observed. The distribution of individual compliance values, as well as the mean compliances was comparable in the three subgroups. Conversely, the compliance reports have identified several potentially overtreated patients in group 1, a large number of patients with a poor adherence to the prescribed therapy in all groups, and patients who clearly needed a change in pharmacotherapy mainly in group 3. Thus, our results suggest that electronic monitoring of compliance can considerably enhance the efficacy of antihypertensive therapy in patients with uncontrolled hypertension. This procedure should be used more extensively in clinical practice whenever the blood pressure response to therapy appears insufficient. (c)2000 by Le Jacq Communications, Inc.

[Lettre autographe signée de Giuseppe Verdi adressée à Escudier, Gênes, 21 août 1869]

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Age and adverse drug reactions from psychopharmacological treatment: Data from the AMSP drug surveillance programme in Switzerland.

QUESTION UNDER STUDY: The frequency of severe adverse drug reactions (ADRs) from psychotropic drugs was investigated in hospitalised psychiatric patients in relation to their age. Specifically, the incidence of ADRs in patients up to 60 years was compared to that of patients older than 60 years. METHODS: Prescription rates of psychotropic drugs and reports of severe ADRs were collected in psychiatric hospitals in Switzerland between 2001 and 2010. The data stem from the drug surveillance programme AMSP. RESULTS: A total of 699 patients exhibited severe ADRs: 517 out of 28,282 patients up to 60 years (1.8%); 182 out of 11,446 elderly patients (1.6%, ns). Logistic regression analyses showed a significantly negative relationship between the incidence of ADRs and patients' age in general and in particular for weight gain, extrapyramidal motor system (EPMS) symptoms, increased liver enzymes and galactorrhoea. A significantly negative relationship was observed for age and the dosages of olanzapine, quetiapine, risperidone, valproic acid and lamotrigine. When comparing age groups, frequency of ADRs was lower in general for antipsychotic drugs and anticonvulsants, in particular for valproic acid in the elderly. Weight gain was found to be lower in the elderly for antipsychotic drugs, in particular for olanzapine. For the group of mood-stabilising anticonvulsants (carbamazepine, lamotrigine and valproic acid) the elderly exhibited a lower incidence of reported allergic skin reactions. CONCLUSION: The results suggest that for psychiatric inpatients the incidence of common severe ADRs (e.g., weight gain or EPMS symptoms) arising from psychotropic medication decreases with the age of patients.

Impact of Matrix-Assisted Laser Desorption Ionization Time-of-Flight Mass Spectrometry on the Clinical Management of Patients With Gram-negative Bacteremia: A Prospective Observational Study.

Background. Early identification of pathogens from blood cultures using matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry may optimize the choice of empirical antibiotic therapy in the setting of bloodstream infections. We aimed to assess the impact of this new technology on the use of antibiotic treatment in patients with gram-negative bacteremia. Methods. We conducted a prospective observational study from January to December 2010 to evaluate the sequential and separate impacts of Gram stain reporting and MALDI-TOF bacterial identification performed on blood culture pellets in patients with gram-negative bacteremia. The primary outcome was the impact of MALDI-TOF on empirical antibiotic choice. Results. Among 202 episodes of gram-negative bacteremia, Gram stain reporting had an impact in 42 cases (20.8%). MALDI-TOF identification led to a modification of empirical therapy in 71 of all 202 cases (35.1%), and in 16 of 27 cases (59.3%) of monomicrobial bacteremia caused by AmpC-producing Enterobacteriaceae. The most frequently observed impact was an early appropriate broadening of the antibiotic spectrum in 31 of 71 cases (43.7%). In total, 143 of 165 episodes (86.7%) of monomicrobial bacteremia were correctly identified at genus level by MALDI-TOF. Conclusions. In a low prevalence area for extended spectrum betalactamases (ESBL) and multiresistant gram-negative bacteria, MALDI-TOF performed on blood culture pellets had an impact on the clinical management of 35.1% of all gram-negative bacteremia cases, demonstrating a greater impact than Gram stain reporting. Thus, MALDI-TOF could become a vital second step beside Gram stain in guiding the empirical treatment of patients with bloodstream infection.