Prevention of chemotherapy-induced nausea and vomiting in the real-world setting in Spain.

PURPOSE: Proper monitoring and management of chemotherapy-induced nausea and vomiting (CINV) with antiemetics is crucial for cancer patients. This study aimed to evaluate the use of antiemetics for the treatment of highly emetogenic chemotherapy (HEC) including carboplatin in the real-world setting in Spain. METHODS: A representative panel of cancer specialists was asked to collect information about the antiemetic treatments provided to patients receiving chemotherapy. Records formed part of the Global Oncology Monitor© database (Ipsos Healthcare, London, UK). Chemotherapy data were extrapolated using Ipsos Healthcare's projection methodology. RESULTS: A total of 73 experts were finally included. Data from 9519 patients, estimated to be representative of 202,084 patients, were collected. HEC (and carboplatin-based chemotherapy) was administered to 73,118 (36%) patients, cisplatin-based therapy being the most frequent treatment (n = 34,649, 47.38%). Neurokinin-1 receptor antagonists (NK1RAs) alone or in combination were used as prophylaxis for CINV in 14,762 (20%) patients, while the combination of NK1RA with 5-hydroxytryptamine-3 receptor antagonist (5-HT3RAs) and dexamethasone as recommended by the international guidelines was used in 5849 (8%) patients only. No antiemetic prophylaxis was administered to 8.46% of the patients receiving HEC (n = 6189). Physicians classified cisplatin-, anthracycline-cyclophosphamide (AC-), and carboplatin-based regimens as HEC in 63%, 22% and 4% of the cases, respectively. CONCLUSIONS: The use of NK1RA-containing regimens for CINV prevention in patients treated with HEC was less than expected, suggesting poor adherence to international antiemetic guidelines.

Leprosy in Britain: 50 years experience in Liverpool

BACKGROUND: Leprosy is a chronic infection that presents with varying dermal and neurological symptoms, and which can lead to extensive disability and morbidity, often with accompanying social stigma. AIM: To review the patients presenting to the Liverpool School of Tropical Medicine (LSTM) between 1946 and 2003, looking specifically at country of birth and of infection, details of clinical presentation, diagnosis, management and reactions. DESIGN: Retrospective record review. METHODS: We retrieved all available clinical records for patients seen between 1946 and 2003 (n = 50), consisting of letters, hospital and LSTM casenotes, and some radiographs and photographs. Any history of tuberculosis or diabetes was recorded. RESULTS: Most patients (64%) were born in the Indian subcontinent, and most were thought to have contracted the disease there (62%). Features at presentation included anaesthetic skin lesions in 19 (36%), hypopigmentation in 15 (30%), and peripheral nerve enlargement in 25 (50%). Diagnoses were made by a combination of clinical data and biopsy (60%), and slit skin smears were positive for acid-fast bacilli in 61% of multibacillary patients. Initial presentation was with a leprosy reaction in five cases (10%), and reactions were documented in 42% of all patients. Treatments were varied, progressing from traditional Eastern medicine to the WHO-approved multidrug therapy in use today, with prophylaxis for children and close contacts. DISCUSSION: Leprosy remains an important diagnosis to consider in patients with a history of work or travel in the tropics, and is a diagnosis with far-reaching medical, social and emotional consequences.

Estimated HIV risk among Hispanics in a national sample of drug users.

OBJECTIVE: To estimate and compare the HIV risks among three Hispanic subpopulations. METHODS: Chronic drug users participating in a nationwide intervention study on drug use were interviewed with regard to drug use and sexual behavior. HIV risk was estimated using information about individuals' HIV-relevant behaviors, the social context (i.e., city) in which such behaviors occur, and published estimates of HIV transmission for various risk behaviors. Multiple linear regression analysis was used to investigate differences in estimated HIV risk between Puerto Rican, Mexican-American, and Mexican drug users, accounting for sociodemographic factors, sexual preference, and geographic region. RESULTS: Puerto Ricans had significantly greater estimated overall HIV risk, estimated injection risk, and in general, significantly greater estimated sexual risk than Mexican Americans and Mexicans. No significant differences were found in any estimated risk between Mexican Americans and Mexicans in this sample. No significant differences were found among any of the subgroups for estimated risk from having anal sex while using a condom, or from having receptive anal sex without using a condom. CONCLUSIONS: These findings suggest that Puerto Ricans who use drugs experience a higher risk of HIV infection than other Hispanic drug users. Research is needed to identify which economic, social, and cultural components account for this increased risk.

An evaluation of drug injection behaviors and HIV infection. National AIDS Research Consortium.

This paper investigates domains of drug injection behavior and the association of derived factors to HIV serostatus. Two sets of data were randomly selected and matched from a national data set of over 40,000 drug injectors. One set was HIV seropositive and the other HIV seronegative heterosexual injectors. Samples were matched to control for the effects of race/ethnicity, gender, and age on serostatus. Factor analysis was used to investigate relationships among drug injection behaviors. Four independent factors were found. Two factors were found to be statistically related to HIV serostatus in high seroprevalence areas. None of the needle use factors was found to be significantly associated with serostatus in low seroprevalence areas.

[The regulatory mechanisms of glomerular filtration: the tubuloglomerular feedback system, physiological aspects and their participation in the physiopathology of kidney diseases]. / Mecanismos de regulación de la filtración glomerular: sistema retroalimentario tubuloglomerular, aspectos fisiológicos y su participación en la fisiopatología de enfermedades renales.

The tubuloglomerular feedback system (TGF), the main component of the autoregulation mechanism, maintains constant glomerular blood flow and filtration rate. The system is based in the morpho-functional association among the macula densa, the afferent and efferent arterioles, the glomerulus and the extraglomerular mesangial cells. The macula densa cells sense the changes in solute concentrations and osmolarity in the tubular fluid and send vasoconstrictor or vasodilatory signals to the arterioles that modify blood flow and glomerular filtration rate. However, the mechanism by which the macula densa sends signals to the arterioles remains unknown. A chemical mediator such as prostaglandins or adenosine has been postulated. Our studies discarded the participation of prostaglandins as mediators. Further studies from our group with adenosine analogs indicate that this nucleotide participates in the activation of the TGF responses, and suggest alternate activation pathways not previously described. To evaluate the role of TGF feedback in the glomerular hemodynamic changes associated with progression of renal damage, we studied TGF responses in rats with Goldblatt hypertension and partial ablation of the contralateral kidney. Our results suggest that the sensitivity of the system is decreased. This alteration may contribute to glomerular hypertension and progression to renal damage.

Focus on: Thomas Jefferson University Hospital, Department of Biomedical Instrumentation.

Technology management services at Thomas Jefferson University Hospital are provided by two distinct cost centers: The Department of Biomedical Instrumentation and Jefferson Biomedical Shared Services. The in-house division of the Department of Biomedical Instrumentation (BMI) provides clinical engineering services to the hospital, a 717-bed, tertiary care facility. BMI supports traditional patient care instrumentation, as well as dialysis machines, anesthesia machines, lasers, and the neonatal extracorporeal membrane oxygenation (ECMO) systems. In addition, the department supports over 3,000 personal computers and associated peripherals, and provides research, design, database support, device evaluation, incident investigation, and product problem investigation services. Jefferson Biomedical Shared Services, an integral component of the Department of Biomedical Instrumentation, offers a shared services program to local area hospitals. It has a current client list of 11 major healthcare institutions with annual revenues approaching $3,000,000 per year.

Biomedical equipment information management for the next generation.

Recent restructuring of the quality assurance standards of the JCAHO and the benefits to be gained from assurance indicators are requiring clinical engineering support groups to manage their equipment inventories with greater precision. Technological enhancements in the database industry have provided these groups with a mechanism with which they can manage. Assessments of equipment reliability, departmental management, and quality assurance give supervisory staff an important tool for feedback.