Curing Chronic Hepatitis C: A Cost Comparison of the Combination Simeprevir Plus Sofosbuvir vs. Protease-Inhibitor-Based Triple Therapy

ABSTRACT Introduction. Interferon-free, multi-direct acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection is highly effective and well tolerated, but costly. To gain perspective on the evolving economics of HCV therapy, we compared the cost per cure of a multi-DAA regimen with the prior standard of triple therapy. Material and methods. Patients infected with HCV genotype 1 who were treated through the University of Colorado Hepatology Clinic between May 2011 and December 2014 comprised the study population. The multi-DAA regimen of simeprevir plus sofosbuvir (SMV/SOF) was compared to the triple therapy regimen consisting of peginterferon and ribavirin, with either boceprevir or telaprevir (TT). Sustained-virologic response (SVR) rates, total costs per treatment and adverse events were recorded. Total cost per SVR were compared for the two treatments, controlling for patient demographics and clinical characteristics. Results. One hundred eighty-three patients received SMV/SOF (n = 70) or TT (n = 113). Patients receiving SMV/SOF were older, more treatment experienced, and had a higher stage of fibrosis. SVRs were 86% and 59%, average total costs per patient were $152,775 and $95,943, and average total costs per SVR were $178,237 vs. $161,813.49 for SMV/SOF and TT groups, respectively. Medication costs accounted for 98% of SMV/SOF and 85% of TT treatment costs. Conclusion. The high cure rate of multi-DAA treatment of HCV is offset by the high costs of the DAAs, such that the cost per cure from TT to multi-DAA therapy has been relatively constant. In order to cure more patients, either additional financial resources will need to be allocated to the treatment of HCV or drug costs will need to be reduced.

Ansiedade em situações de prova: evidências de validade de duas escalas / Anxiety in examination contexts: validity evidence of two scales / Ansiedad en situaciones de prueba: evidencias de validez de dos escalas

A competição, a cobrança social e pessoal e a possibilidade de fracasso são alguns dos fatores que podem tornar a situação de prova um evento estressante e gerador de ansiedade. Nesse contexto, este estudo objetivou disponibilizar para o Brasil dois instrumentos de avaliação da ansiedade em situações de testagem e demonstrar evidências de validade dessas escalas. Participaram do estudo 1.878 estudantes do ensino médio de escolas públicas e particulares de Brasília. Dois instrumentos de ansiedade foram desenvolvidos: um que busca medir quatro dimensões de ansiedade, o Inventário de Ansiedade frente a Provas (IAP), e o Inventário de Ansiedade Internamente e Externamente Causada (IAIEC). Verificou-se que os instrumentos têm adequadas estruturas fatoriais e boa consistência interna. Ademais, análises de correlação com outros instrumentos de ansiedade indicaram evidências de validade convergente adequada com correlações entre 0,31 e 0,72. As implicações do estudo são notáveis no âmbito clínico, social e acadêmico...

Competition, social and personal demands, and the possibility of failure are all factors that might turn examination situations into stressful and anxiety-inducing events. The purpose of the present study was to provide two Brazilian assessment instruments of anxiety in examination contexts and to demonstrate evidence of their validity. A sample of 1,878 high school students from public and private schools in Brasilia participated in this study. Two instruments of anxiety were developed: the Testing Anxiety Inventory (IAP) measuring four anxiety dimensions, and the IAIEC assessing internally and externally caused anxiety. The findings indicate that both instruments have an adequate factor structure and a good internal consistency. Moreover, correlational analysis with other instruments of anxiety suggests evidence of an adequate convergent validity with correlations varying between .31 and .72. The implications of the present study are noteworthy in clinical, social and academic contexts...

La competencia, presión social y personal, así como la posibilidad de fracaso son algunos de los factores que pueden hacer de la realización de una prueba un momento de estrés que genera ansiedad. En ese contexto, este estudio buscó ofrecer dos instrumentos de medida de la ansiedad en situación de prueba y demostrar las evidencias de validez de esas escalas para uso en Brasil. Participaron 1.878 estudiantes de enseñanza media de escuelas públicas y particulares de Brasilia. Dos instrumentos de ansiedad fueron desarrollados: uno que busca medir cuatro dimensiones de ansiedad, el Inventario de Ansiedad frente a Pruebas (IAP), y el Inventario de Ansiedad Interna y Externamente Causada (IAIEC). Se verificó que los instrumentos tienen estructuras factoriales adecuadas y buena consistencia interna. Además, los análisis de correlación con otros instrumentos de ansiedad indicaron evidencias de validez convergente adecuadas con correlaciones entre 0,31 y 0,72. Las implicaciones de esta investigación son importantes para el ámbito clínico, social y académico...

Self-Reported Speech Problems in Adolescents and Young Adults with 22q11.2 Deletion Syndrome: A Cross-Sectional Cohort Study

BACKGROUND: Speech problems are a common clinical feature of the 22q11.2 deletion syndrome. The objectives of this study were to inventory the speech history and current self-reported speech rating of adolescents and young adults, and examine the possible variables influencing the current speech ratings, including cleft palate, surgery, speech and language therapy, intelligence quotient, and age at assessment. METHODS: In this cross-sectional cohort study, 50 adolescents and young adults with the 22q11.2 deletion syndrome (ages, 12-26 years, 67% female) filled out questionnaires. A neuropsychologist administered an age-appropriate intelligence quotient test. The demographics, histories, and intelligence of patients with normal speech (speech rating=1) were compared to those of patients with different speech (speech rating>1). RESULTS: Of the 50 patients, a minority (26%) had a cleft palate, nearly half (46%) underwent a pharyngoplasty, and all (100%) had speech and language therapy. Poorer speech ratings were correlated with more years of speech and language therapy (Spearman's correlation= 0.418, P=0.004; 95% confidence interval, 0.145-0.632). Only 34% had normal speech ratings. The groups with normal and different speech were not significantly different with respect to the demographic variables; a history of cleft palate, surgery, or speech and language therapy; and the intelligence quotient. CONCLUSIONS: All adolescents and young adults with the 22q11.2 deletion syndrome had undergone speech and language therapy, and nearly half of them underwent pharyngoplasty. Only 34% attained normal speech ratings. Those with poorer speech ratings had speech and language therapy for more years.

Fatores que afetam o desempenho na prova de matemática do SEAB: um estudo multinível / Factors that affect the performance on the SAEB mathematics test: a multilevel study

No presente estudo objetivou-se identificar quais características de alunos e escolas são associadas ao desempenho em Matemática. Foram analisados os dados de 35.929 alunos da 3ª série do Ensino Médio, distribuídos em 1.661 escolas brasileiras que fizeram o teste de Matemática do SAEB em 2001. Análise multinível mostrou uma correlação intraclasse (ICC) bruta de 0,43 e uma ICC corrigida pelas variáveis relacionadas com a composição e seletividade da escola de 0,15. Depois da entrada das variáveis de controle, sete indicadores no nível do aluno e cinco indicadores no nível da escola foram identificados como tendo efeito na proficiência em Matemática. No modelo final pelo menos 84,9 por cento da variância total no nível da escola e 19,8 por cento da variância total no nível do aluno foram explicadas. Os resultados do presente estudo corroboram outros estudos brasileiros com o uso de análise multinível sobre os fatores que afetam o desempenho em Matemática.

The main purpose of this study was to identify variables that affect proficiency in Mathematics of Brazilian students of the third grade of secondary school. To attain this goal we analyzed the data of 35,929 students of 1,715 schools who took the Mathematics test of the SAEB in 2001. Multilevel analysis showed a raw intraclass correlation (ICC) of .43 and an ICC corrected for variables related to the composition and selectivity of the school of .15. After the entry of the control variables seven indicators on student level and five indicators on school level were identified that affect achievement in Mathematics. The final model of this study explains at least 84.9 percent of the total variance on school level and 19.8 percent of the total variance on student level. The results of the present study confirm the results of other Brazilian studies related to factors affecting proficiency in Mathematics using multilevel analysis.

Indicações da validade convergente do teste Não-Verbal de Inteligência Son-R 2½-7[A] / Indications of the convergent validaty of the Non-verbal Tes of Intelligence Son-R 2½-7[A]

O objetivo deste estudo foi avaliar a validade convergente do teste não-verbal de inteligência SON-R 2½-7[a] no Brasil. O teste em questão é a versão abreviada do SON-R 2½-7 que foi publicado na Holanda em 1998 e que foi normatizado e validado em vários países de Europa. A versão abreviada foi administrada no Brasil em 120 crianças com idade variando entre 5 e 7 anos junto com as Matrizes Progressivas Coloridas (MPC) do Raven e com a Escala de Maturidade Mental Colúmbia (EMMC). A correlação, corrigida para atenuação, do SON-R 2½-7[a] com estes dois testes foi respectivamente, 0,77, e 0,62. Foi observada uma relação particularmente forte entre o MPC e a escala de execução do SON-R 2½-7[a], e entre o EMMC e a escala de raciocínio do SON-R 2½-7[a]. Os resultados do presente estudo indicam uma boa validade convergente do teste para a faixa de idade investigada.

This study aimed to investigate the convergent validity of the nonverbal test of intelligence SON-R 2½-7[a] in Brazil. This test is the abridged edition of the SON-R 2½-7 nonverbal test of intelligence that was published in 1998 in The Netherlands with normatization and validation studies realized in various European countries. The abridged edition was administered in Brazil to 120 children with ages varying between 5 and 7 years together with Raven’s Colored Progressive Matrices (CPM) and the Columbia Mental Maturity Scale (EMMC). The correlation, corrected for attenuation, of the SON-R 2½-7[a] with these two tests was .77 and .62, respectively. A particularly strong relationship was observed between the CPM and the performance scale of the SON-R 2½-7[a], and between the EMMC and the SON-R reasoning scale. The results of this study indicate a fair convergent validity of the SON-R 2½-7[a] for the investigated age group.

Avaliação de programas sociais: comparando estratégias de análise de dados / Social programs evaluation: a comparison of data analysis strategies

Este artigo apresenta uma discussão sobre questões metodológicas em relação à avaliação de programas sociais, tomando como exemplo o caso do Plano Nacional de Qualificação do Trabalhador - PLANFOR. O delineamento da pesquisa foi de um estudo quase-experimental, com três grupos: dois experimentais e um controle. A pesquisa foi realizada durante os anos de 2001 a 2004, com coleta de dados antes e depois do programa, englobando 360 instituições, sendo uma por município, cobrindo todas as regiões brasileiras. Para a coleta de dados, utilizou-se um instrumento com indicadores quantitativos (sociais e econômicos). Foram comparadas quatro estratégias de análise de dados: análise de variância (ANOVA) de mensurações repetidas (pré e pós-teste), ANOVA com escores de ganho, ANOVA com categorização dos sujeitos no pré-teste (blocking) e análise de covariância (ANCOVA). Foram ainda consideradas interpretações alternativas para os efeitos encontrados. Por fim, discutiu-se a adequação de tais estratégias para a avaliação de programas sociais.

This article presents a discussion about methodological questions related to social programs evaluation, taking as an example the case of the National Worker Qualification Plan - PLANFOR. The present study used a quasi-experimental design containing three groups: two experimental groups and one control group. The research was realized from 2001 to 2004, with data collection before and after the program, and comprising 360 organizations, one per city, from all Brazilian regions. For data collection, it was used an instrument with quantitative indicators (social and economic). Four data analysis strategies were compared: analysis of variance (ANOVA) of repeated measurement (pre- and post-test scores), ANOVA with gain scores, ANOVA after subjects' categorization on their pre-test (blocking), and analysis of covariance (ANCOVA). Alternative explanations of the observed effects were considered. Finally, the suitability of these strategies to the evaluation of social programs was discussed.

SOME ASPECTS OF THE BIOLOGY OF Macrobrachium dux (LENZ, 1910) (CRUSTACEA:DECAPODA:NATANTIA) IN RIVER OROGODO, NIGER DELTA, NIGERIA / Algunos aspectos de la biología de Macrobrachium dux (Lenz, 1910) (Crustacea:Decapoda:Natantia) en el río Orogodo, delta del Niger, Nigeria

Preliminary investigation into some aspects of the biology of the palaemonid prawn, Macrobrachium dux (Lenz, 1910) in River Orogodo at Abavo, southern Nigeria was carried out between March and August 1995. The freshwater prawns were collected with properly baited cage traps and scooping with hand basket. The study revealed that the prawn species were widespread and abundant in the river. Abundance in terms of number and biomass was more during the wet season with a peak in August. Both adults and juveniles showed a progressive increase from late dry season to midrainy season (August). The malefemale ratio was 1:1.2. The fluctuation in the number and percentage of ovigerous females indicated that the prawn spawned during the midrainy season (JuneAugust). Ovigerous females ranged from 4.6 to 7.5 cm and egg size varied from 1.5 to 1.7 mm. The prawn attained a maximum total length and weight of 7.5 cm and 7.0 g respectively. Its growth pattern was allometric. The mean monthly condition factor (k) ranged from 1.43 to 2.37 and generally showed a monthly fluctuation with a peak in July.

Una investigación preliminar de algunos aspectos de la biología del langostino Macrobrachium dux (Lenz, 1910) fue realizada en el río Orogota en Abavo, sur de Nigeria entre marzo y agosto de 1995. Los langostinos de agua dulce fueron recolectados con trampas y removidos con una canasta de mano. Este estudio reveló que las especies de langostinos se encontraban distribuídas ampliamente y en abundancia en este río. La abundancia en términos de número y biomasa fue mayor en la estación lluviosa con un pico en agosto. Tanto adultos como juveniles mostraron un crecimiento progresivo desde el final de la estación seca hasta la mitad de la estación luuviosa (agosto). La relación machoshembras fue de 1:1,2. La fluctuación entre el número y porcentaje de hembras ovígeras que los langostinos depositan sus huevos durante la mitad de la estación lluviosa. Hembras ovígeras oscilaron entre 4,6 y 7,5 cm y el tamaño de los huevos varió entre 1,5 y 1,7 cm. Los langostinos alcanzaron longitudes y pesos totales de 7,5 cm y 7 g respectivamente. Su patrón de crecimiento fue alométrico. El promedio mensual del factor de condición osciló entre 1,43 y 2,37 y mostró fluctuación mensual con el pico en julio.

Fatores associados ao desempenho escolar: estudo multinível com dados do SAEB/2001 / Factors associated with school performance: a multilevel study with data of SAEB/2001

Esse estudo visou construir um modelo de desempenho escolar utilizando análise multinível, um tipo de regressão múltipla que leva em consideração a estrutura hierárquica dos dados. Foram considerados os dados do SAEB de 2001, especificamente os referentes aos alunos da 3ª série do Ensino Médio. Depois de controlar o efeito das variáveis de seletividade e composição escolar verificou-se uma correlação intraclasse de 0,17. Isso significa que 17 por cento da variância no desempenho escolar podem ser atribuídos ao nível da escola. No modelo multinível final foram incluídas sete variáveis referentes ao aluno e nove variáveis referentes à escola. As variáveis com efeito mais forte concernentes ao aluno foram: atraso escolar e comparação do aluno com os colegas. Quanto à escola foram: recursos culturais agregado e atraso escolar agregado. Espera-se que o modelo final seja utilizado para a elaboração de políticas públicas visando o melhoramento do sistema educacional brasileiro.

The purpose of this study was to construct a model of student performance using multilevel analysis, a type of multiple regression that takes into consideration the hierarchical structure of the data. The study used the data of the third grade students of secondary school who participated in the SAEB 2001 assessment. After controlling the effect of the variables of selectivity and school composition, an intraclass correlation of 0.17 was found, indicating that 17 percent of the variance in student performance can be attributed to the school level. In the final multilevel model seven variables of student level and nine variables of school level were included. The variables with the strongest effect on student level were: school delay and comparison of the student with his colleagues. On school level these variables were: aggregated cultural resources and aggregated school delay. The final model elaborated in this study will hopefully be used to elaborate public policies with a view to improve the Brazilian educational system.

Demonstration of antihistamine properties with AST-1: a bioactive extract from garden slugs (Diplosolenodes occidentalis) / Demostración de las propiedades antihestamínicas con ast-1, un extracto bioactivo de las babosas de jardín (diplosolenodes occidentalis)

Parched and ground whole garden slugs are claimed in rural Jamaican folklore practices to have useful effects in the treatment of bronchial asthma. Since this claim may be associated with respiratory dysfunction due to histamine from allergic sensitization, the authors investigated the effects of a semi-pure alcoholic extract (AST-1) on histamine-induced contraction of the guinea pig in vitro tracheal muscle preparation and cutaneous allergic responses in ovalbumin sensitized guinea pigs. Chemical analysis of AST-1 by column chromatography and thin layer chromatography indicated two compounds in the composition, but the molecular structures were not determined Pharmacological evaluation of AST-1 produced a concentration-dependent inhibition of histamine-induced contraction of the guinea pig tracheal muscle preparation. AST-1 also inhibited contraction of the tracheal muscle produced by selective H1 receptor stimulation with HTMT dimaleate. H2 receptors were not involved, as indicated by the absence of contraction with dimaprit hydrochloride, a selective H2 agonist. Also, in ovalbumin sensitized guinea pigs, AST-1 and diphenhydramine, a selective H1 antagonist, inhibited the cutaneous responses due to intradermal injection of histamine and ovalbumin. These results suggest that AST-1 has H1 anti-histamine properties which can inhibit histamine-induced tracheobronchial muscle contraction and cutaneous responses due to allergy.

En el contexto de las prácticas folclóricas de la Jamaica rural, se afirma que las babosas de jardín tostadas y molidas, tienen efectos útiles en el tratamiento del asma bronquial. Como que esta afirmación puede estar asociada con una disfunción respiratoria debida a la histamina de la sensibilización alérgica, los autores se dieron a la tarea de investigar los efectos de un extracto alcohólico semi-puro (AST-1) sobre la contracción inducida por histamina de un preparado in vitro de músculo de tráquea de cobayo, y las respuestas cutáneas alérgicas en cobayos sensibilizados con ovalbúmina. El análisis químico de AST-1 mediante cromatografía en columna y cromatografía en capa fina, indicaron dos compuestos en la composición, pero no se determinaron las estructuras moleculares. La evaluación farmacológica de AST-1 produjo una inhibición ­ dependiente de la concentración ­ de la contracción, inducida por histamina, del preparado de músculo de tráquea de cobayo. El AST-1 también inhibió la contracción del músculo traqueal producida por la estimulación de receptor selectivo H1 con dimaleato de HTMT. No se involucraron receptores H2, como lo indicó la ausencia de contracción con hidrocloruro de dimaprit ­ un agonista selectivo H2. Asimismo, en cobayos sensibilizados con ovalbúmina, el AST-1 y la difenidramina ­ un antagonista selectivo H1 ­ inhibieron las respuestas cutáneas debido a la inyección intradérmica de histamina y ovalbúmina. Estos resultados sugieren que el AST-1 tiene propiedades antihestamínicas H1, las cuales pueden inhibir la contracción muscular traqueobronquial inducida por la histamina y las reacciones cutáneas debido a la alergia

Dietary intake of choline and plasma choline concentrations in pregnant women in Jamaica / La ingestión de colina en la dieta y las concentraciones de colina en plasma en las mujeres embarazadas en Jamaica

Choline is an essential nutrient for humans and its availability during pregnancy is important for optimal fetal development. The Food and Nutrition Board of the Institute of Medicine in the United States of America has set the adequate choline intake during pregnancy at 450 mg/day. There is limited data available on normal plasma choline concentrations in pregnancy. Moreover, there are neither documented studies of choline intake among pregnant women in the Jamaican population nor of free plasma choline concentrations during pregnancy. Sixteen women presenting to the antenatal clinic of the University Hospital of the West Indies (UHWI) at 10-15 weeks of gestation were selected for this pilot study. A food frequency questionnaire was administered to estimate frequency of consumption of foods rich in choline. Fasting blood samples were collected by venepuncture and plasma assayed for choline using liquid chromatography electrospray ionization isotopic dilution mass spectrometry. Most of the women reported consumption of diets that delivered less than the recommended choline intake (mean +/- SEM, 278.5 +/- 28.9 mg). Mean plasma choline concentration was 8.4 +/- 0.4 micromol/L. This falls below the normal concentration (10 micromol/L) reported for individuals that are not pregnant and pregnant (14.5 micromol/L). The results of this study may be an indication that the choline included in the diet of pregnant women in Jamaica may not be adequate to meet both the needs of the mother and fetus and that further studies are warranted to determine clinical implications.

La colina es un nutriente esencial para los seres humanos y su disponibilidad durante el embarazo es importante para el óptimo desarrollo del feto. La Junta de Alimentos y Nutrición (Food and Nutrition Board) del Instituto de Medicina de los Estados Unidos ha establecido que la ingestión de colina durante el embarazo debe ser 450 mg/día. Los datos disponibles sobre concentraciones de colina en plasma durante el embarazo son limitados. Por otro lado, no existen estudios documentados sobre la ingestión de colina entre las mujeres embarazadas en la población de Jamaica, ni sobre las concentraciones libres de colina en plasma durante el embarazo. Dieciséis mujeres que se presentaron a la clínica de atención prenatal del Hospital Universitario de West Indies entre las 10–15 semanas de gestación, fueron seleccionadas para este estudio piloto. Se aplicó un cuestionario de frecuencia alimentaria a fin de estimar la frecuencia de consumo de alimentos ricos en colina. Se recogieron muestras de sangre en ayunas mediante venopuntura, y se sometió el plasma a análisis en busca de colina, usando la espectrometría de masa de dilución isotópica, ionización por electrospray y cromatografía líquida. La mayoría de las mujeres reportaron consumo de dietas que suministrabanmenos de los niveles de ingestion de colina recomendados (media ± SEM, 278.5 ± 28.9 mg). La concentracion media de colina en plasma fue 8.4 ± 0.4 mmoles/L. Esto se halla por debajo de la concentracion normal (10 mmoles/L) reportado tanto para no embrazadas como para embarazadas (14.5 mmoles/L). Concluimos que los resultados de este estudio pueden ser una indicacion de que los niveles de colina incluidos en la dieta de las mujeres en estado de gestacion en Jamaica no son adecuados para satisfacer las necesidades ni de la madre ni del feto, y que vale la pena la realizacion de estudios ulteriores al objeto de determinar las implicaciones clinicas.

Madame Bovary de Flaubert: un estudio sobre la envidia y la venganza / Flaubert’s Madame Bovary: A study in envy and revenge

Los autores se proponen en este ensayo, pensar en la dinámica inconsciente que guiaba los actos de Emma Bovary, la heroína descripta genialmente por G. Flaubert. Para ellos, la desmedida hostilidad y sentimientosvengativos, tienen su origen en que ´Emma siente inferioridad y envidia´. Sus conductas extravagantes estarían dando cuenta de una venganza dirigida hacia los hombres, en este caso centrada en la figura de su marido,por haberla desflorado. Experiencia ésta vivida como mutilante y de ´violencia sangrienta´ según sus propias fantasías. Señalan los autores, que ´una reacción como la suya debe ser comprendida en términos de la estructura general de la personalidad, el resultado de conflictos originados en la niñez´

Cultural bias in the SON-R test: comparative study of Brazilian and dutch children / Cultural bias in the SON-R test: comparative study of Brazilian and dutch children

No presente estudo, incluindo 83 crianças brasileiras e 51 holandesas, verificou-se a presença de viés cultural nos itens do SON-R 5½-17 que usam objetos e situações concretas. Dois procedimentos foram seguidos para detectar viés do item. No primeiro, perguntou-se às crianças, imediatamente depois de uma resposta errada, se elas reconheceram os desenhos utilizados nos itens. No segundo procedimento, comparou-se a dificuldade dos itens para as crianças brasileiras com a dificuldade dos itens para as crianças holandesas da amostra de normatização do SON-R 5½-17. Identificaram-se quatorze itens com viés, dos quais dez favorecem as crianças holandesas e quatro as crianças brasileiras. A desvantagem cultural para as crianças brasileiras é bastante pequena, levando em consideração o grande número de itens investigado. Este estudo indicou quais itens do SON-R 5½-17 precisam ser melhorados, não só por razões de viés cultural, mas também porque crianças, independentemente do background cultural, encontraram problemas com o reconhecimento de vários desenhos.

Validação cruzada de uma escala de clima organizacional / Cross validation of a scale of organizational climate

A estabilidade da estrutura fatorial de uma escala de clima organizacional com 66 itens foi investigada. A amostra de 61.349 respondentes foi dividida aleatoriamente em duas partes, a primeira para identificação da estrutura fatorial, a segunda para verificação da sua replicabilidade. O critério adotado para identificar o número de fatores resultou na extração de sete fatores. Para obter uma estrutura fatorial satisfatória 23 itens foram eliminados. Uma segunda análise fatorial dos 43 itens restantes indicou sete fatores explicando 63,4 por cento da variância. Uma análise fatorial de segunda ordem revelou um fator geral explicando 55,5 por cento da variância. Para verificar a estabilidade da estrutura fatorial, os mesmos procedimentos e critérios foram empregados na segunda amostra. Os resultados indicam uma grande estabilidade da estrutura fatorial hierárquica da escala de clima organizacional, com sete fatores de primeira ordem e um fator geral de segunda ordem.

Two siblings with Allgrove's syndrome and extrapyramidal features.

We report two siblings with Allgrove's syndrome and extrapyramidal features. Though various neurological abnormalities have been described in this disorder, we report the first patient of Allgrove's syndrome associated with dystonia and chorea.

OSPE in pathology.

Undergraduate medical education is currently undergoing extensive re-evaluation with new core educational objectives being defined. Consequently, new exam systems have also been designed to test the objectives. Objective structured practical examination (OSPE) is one of them. We conducted OSPE in a regular batch of 64 students. The batch was divided into 4 groups, one group taking the conventional practical exam and the other groups OSPE with minor variations. Different aspects were compared and analyzed and we found that OSPE was more objective, measured practical skills better, had a wide discrimination index and eliminated examiner bias. The questionnaire given to the students revealed a high acceptance rate among them.

Papillary cystic tumor of pancreas--report of two cases.

Two cases of Papillary cystic tumor of pancreas--one metastasizing to lymph node and the other non-metastasizing are reported for their rare occurrence. Both occurred in young females and presented with heaviness and pain in the left hypochondrium with palpable mass. On radiological examination, mass was arising from tail of pancreas and had typical gross features. The histological findings seen in metastasizing tumor were capsular invasion, infiltration to surrounding pancreatic tissue and vascular invasion with metastasis to lymph node. Difference in nuclear grade or mitosis was not observed. Adjuvant chemotherapy was given for metastasizing tumor and patient is symptom free after 56 month. Non-metastasizing case is well after 15 months.

Prevalence of primary glaucoma in an urban south Indian population.

Glaucoma is fast emerging as a major cause of blindness in India. In order to estimate the prevalence of primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG) in an urban South Indian population, we examined 972 individuals aged 30-60 years, chosen using a cluster sampling technique from 12 census blocks of Vellore town. They underwent a complete ocular examination, including applanation tonometry and gonioscopy, at the Medical College Hospital. Characteristic field defects on automated perimetry was a diagnostic requisite for POAG. Prevalence (95% CI) of POAG, PACG, and ocular hypertension were 4.1 (0.08-8.1), 43.2 (30.14-56.3), and 30.8 (19.8-41.9) per 1,000, respectively. All the PACG cases detected were of the chronic type. Hitherto unavailable community-based information on primary glaucoma in our study population indicates that PACG is about five times as common as POAG.

Visual outcome and complications of residents learning phacoemulsification.

The increasing popularity of phacoemulsification in our country raises important training issues. We prospectively analyzed the incidence of complications and visual outcomes in the initial 70 phacoemulsifications (70 patients) performed by the first two residents learning phacoemulsification in our training programme. Both were experienced in standard (manual) extracapsular cataract extraction. Postoperative follow up of 6 weeks or longer was available in 59 eyes. The 11 patients (11 eyes) lost to follow up did not have any intra-operative complications. The overall incidence of vitreous loss was 10%, similar to the frequency of this complication (determined retrospectively) in the first 70 standard extracapsular cataract extractions performed by the same residents. Intraocular lenses (IOL) were successfully implanted in 62 eyes, as planned. One IOL dislocated into the vitreous was successfully repositioned. Other complications encountered included superior corneal edema (3 eyes), iris damage inferiorly (7 eyes) and clinical cystoid macular edema (5 eyes). A best corrected visual acuity of 6/12 or better was obtained in 56 (94.8%) of the 59 eyes available for the six week follow up. In the eyes with vitreous loss, 6 out of 7 had visual acuity better than 6/12. No nuclei were lost into the vitreous. The rate of surgical complications for residents learning phacoemulsification in a supervised manner can be acceptably low.