Relationship between adherence to oral antidiabetic drugs and control of type 2 diabetes mellitus.

INTRODUCTION AND OBJECTIVES: Poor adherence to oral antidiabetic drugs (Adh-OAD) is a risk factor for poor control of type 2 diabetes mellitus (T2DM). Therefore, it is necessary to quantify the Adh-OAD. This quantification is possible through electronic dispensing records from the community pharmacy. The objective was to evaluate the influence of the Adh-OAD on the control of T2DM and the percentage of glycosylated hemoglobin (%HbA1c) in the patient. MATERIALS AND METHODS: A cross-sectional descriptive observational study was conducted in 8 community pharmacies in Granada (Spain). Patients older than 18 years with T2DM and on oral antidiabetic drugs (OADs) for at least 6 months were included. The main study variables were the control of T2DM, %HbA1c, and the Adh-OAD considering three cut-off points (≥80%, ≥70%, ≥60%). This relationship was studied using multivariate binary logistic regression and multivariate linear regression, respectively. RESULTS: A total of 107 patients were included. The mean age was 70.5 years (SD: 9.7), and 54.2% were men. Eighty-five patients (79.4%) had well-controlled T2DM (mean %HbA1c: 6.5%; SD=0.6). Considering Adh-OAD≥80%, 13.1% (n=14) had a poor adherence and was related to the %HbA1c (ß=0.742; p=0.007) and the control of T2DM (OR: 7.327; 95% CI: 1.302-41.241). Poor adherence was found in 9.3% (n=10) considering Adh-OAD≥70% and in 3.7% (n=4) considering Adh-OAD≥60%. In both cases, a statistically significant relationship was found between Adh-OAD and the %HbA1c and between Adh-OAD and the control of T2DM. CONCLUSIONS: Adh-OAD influenced the %HbA1c in patients with T2DM and the control of their disease.

Assessing the effect of organic amendments on the degradation of profoxydim in paddy soils: Kinetic modeling and identification of degradation products.

The fate and behavior of herbicides can be altered in an unpredictable way when organic amendments are added to soil as a beneficial management tool. The objective of this work was to investigate the effect exerted by the addition of two different organic amendments (alperujo compost and biochar) to soil in the degradation of one of the most relevant new generation rice herbicides, profoxydim. In unamended soils, the degradation of profoxydim was quite fast and was governed by both chemical (DT50steril soil = from 1.52 to 9.21 days) and microbial (DT50nonsterile soil = from 0.47 to 0.53 days) processes. Alperujo- and biochar-amended soils significantly increased the persistence of the herbicide in both soils, especially in the presence of biochar, due to the high capacity absorption of this amendment, increasing DT90 from 1.92 to 3.54 days for DT90unamended to 41.02-48.41 days for DT90biochar amended. Different kinetics models applied to fit the observed dissipation datasets showed that a HS biphasic model fits well with the dissipation of profoxydim in amended and unamended soils. For the first time, five degradation products (DPs) were identified by HPLC-QTOF-MS/MS in soil and a degradation pathway was described. Main DP was generated via oxidation of the sulfur atom to give rise to the corresponding sulfoxide derivative, with this DP being more persistent than the active substance. These outcomes can be very useful for the assessment of the environmental risk associated with the use of profoxydim in rice crops and the application of organic amendments as potential measures for minimizing the risk of contamination of natural water resources.

Evaluation of the safety, tolerance and efficacy of 1-year consumption of infant formula supplemented with Lactobacillus fermentum CECT5716 Lc40 or Bifidobacterium breve CECT7263: a randomized controlled trial.

BACKGROUND: The microorganism present in breast milk, added to other factors, determine the colonization of infants. The objective of the present study is to evaluate the safety, tolerance and effects of the consumption of a milk formula during the first year of life that is supplemented with L. fermentum CECT5716 or Bifidobacterium breve CECT7263, two strains originally isolated from breast milk. METHODS: A randomized, double blind, controlled, parallel group study including healthy, formula-fed infants was conducted. Two hundred and thirty-six 1-month-old infants were selected and randomly divided into three study groups according to a randomization list. Infants in the control group received a standard powdered infant formula until 12 months of age. Infants in the probiotic groups received the same infant formula but supplemented with L. fermentum CECT5716 Lc40 or B. breve CECT7263. Main outcome was weigh-gain of infants as safety marker. RESULTS: One hundred and eighty-nine infants completed the eleven months of intervention (61 in control group, 65 in Lf group and 63 in Bb group). The growth of infants in the three groups was consistent with standards. No significant differences were observed in the main outcome, weight-gain (Control group: 5.77 Kg ± 0.95, Lf group: 5.77 Kg ± 1.31, Bb group: 5.58 Kg ± 1.10; p = 0.527). The three milk formulae were well tolerated, and no adverse effects were related to the consumption of any of the formula. Infants receiving B. breve CECT7263 had a 1.7 times lower risk of crying than the control group (OR = 0.569, CI 95% 0.568-0.571; p = 0.001). On the other hand, the incidence of diarrhoea in infants receiving the formula supplemented with L. fermentum CECT5716 was a 44% lower than in infants receiving the control formula (p = 0.014). The consumption of this Lactobacillus strain also reduced the duration of diarrhoea by 2.5 days versus control group (p = 0.044). CONCLUSIONS: The addition of L. fermentum CECT5716 Lc40 or B. breve CECT7263, two probiotic strains naturally found in breast milk, to infant formulae is safe and induces beneficial effects on the health of infants. TRIAL REGISTRATION: The trial was retrospectively registered in the US Library of Medicine ( www.clinicaltrial.gov ) with the number NCT03204630 . Registered 11 August 2016.

[Primary myeloid sarcoma of uterine cervix and prevention of fertility. Report of a case]. / Traitement d'un sarcome myéloïde isolé du col utérin et préservation de la fertilité : à propos d'un cas.

The isolated myeloid sarcomas of the cervix are tumors whose forecast was dark for a long time. However, an effective but invasive treatment associating chemotherapy and radiotherapy allows for local remission. This treatment generally causes an ovarian failure and especially infertility. We report the case of a 29-year-old woman suffering from a myeloid sarcoma isolated from the uterine cervix and wishing a pregnancy. A prevention of the deficit ovarian was carried out. This patient presented normal menstrual cycles and a biochemical pregnancy three years after the beginning of the treatment.

Influence of avian reproduction ecotoxicological endpoints in the assessment of plant protection products.

The aim of this paper is to examine the statistical relevance of bird species on the endpoints of avian long-term toxicity studies (eggs laid, eggs set, eggs hatching, embryo survivor, 14-day old survivors and eggshell thickness). Data from 561 animals of three different species (Colinus virginianus, Anas platyrynchos and Coturnix coturnix japonica) tested with five different pesticides were analyzed in this study. The substances considered were: Thiamethoxam (EZ-3-(2-chloro-1,3-thiazol-5-ylmethyl)-5-methyl-1,3,5-oxadiazinan-4-ylidene(nitro)amine), Thiacloprid ((Z)-3-(6-chloro-3-pyridylmethyl)-1,3-thiazolidin-2-ylidenecyanamide), Acetamiprid ((E)-N(1)-[(6-chloro-3-pyridyl)methyl]-N(2)-cyano-N(1)-methylacetamidine), Phosmet (O,O-dimethyl S-phthalimidomethyl phosphorodithioate) and Dicofol (2,2,2-trichloro-1,1-bis(4-chlorophenyl)ethanol). Several general lineal mixed models were conducted to evaluate the factors affecting variables used in long-term reproductive toxicity tests. Test significance was p < 0.01 in all models tested. Model R(2) value was high (0.80) for all variables except for eggs laid (R(2) = 0.42) for the three species studied. Tukey studentized range test showed significant differences among species and pesticides. For pre-hatching period the differences were significant for eggs laid and eggs set among species. C. japonica showed statistical differences for egg hatching. With respect to embryo survivor and 14 days old survival, significant different were found for C.virginianus and A. platyrynchos, respectively. These results indicate that the selected species have an influence in the endpoints to be used for risk assessment.

In vivo efficacy of a bioartificial liver in improving spontaneous recovery from fulminant hepatic failure: a controlled study in pigs.

BACKGROUND: Bioartificial liver may be useful as a bridge to liver transplantation but there are no data of its efficacy in successfully bridging to spontaneous recovery in fulminant hepatic failure. The aim of our study was to evaluate the efficacy of a bioartificial liver in increasing the spontaneous recovery of pigs with hepatic failure. METHODS: The bioartificial liver consisted in a semipermeable dialyzer with 0.6 x 10(9) cryopreserved allogenic hepatocytes. Hepatic failure was induced by portacaval shunt plus 70% hepatectomy and 1 hour occlusion of the hepatic artery. Forty-one pigs were distributed 24 hr after liver failure induction to a group treated with the bioartificial liver (4 hr daily) until recovery or death (n=16), or to a control group (n=25). Intracranial pressure was monitored in 18 additional pigs, before and 4 hr after treatment with the bioartificial liver with (n=12) or without hepatocytes (n=6). RESULTS: Fifteen days after induction of hepatic failure, 44% of the treated animals had survived and recovered from liver failure versus 22% controls (P=0.030). Intracranial pressure decreased from 13.13+/-5.1 to 7.19+/-2.06 mmHg (P=0.02) in treated animals, and remained unchanged in sham-treated animals (14.08+/-1.92 to 12.54+/-3.82, ns). CONCLUSIONS: Bioartificial liver increases survival and allows spontaneous recovery in pigs with fulminant hepatic failure.

[Renal adenocarcinoma with vena cava invasion: current status of its diagnosis and treatment using total segmentary cavectomy]. / Adenocarcinoma renal con invasión de vena cava: estado actual de su diagnóstico y tratamiento mediante cavectomía total segmentaria.

OBJECTIVES: Renal adenocarcinoma is characterized by marked venotropism; 20-49% show extension into the main renal vein and 4-19% into the vena cava. The present study analyzes the different diagnostic methods to evaluate the vascular involvement by renal carcinoma and presents the results achieved by total segmental cavectomy with ligation of the left renal vein and without vena caval reanastomosis. METHODS: Three patients (two males, one female) underwent total segmental cavectomy with ligation of the left renal vein in our Service over the last 10 years. A bilateral subcostal approach with access to the large vessels was utilized in all three cases. The superior and inferior renal vena cava were exposed and the hepatic veins were ligated at the level of the intrahepatic segment. Incision of the vena cava was performed, the thrombus was removed and the renal vessels were ligated. The proximal and distal segments of the vena cava were ligated after cavectomy. In the third patient, intrahepatic extension of the thrombus required the use of a temporary filter for the proximal segment of the vena cava. RESULTS: The early postoperative course was satisfactory; adequate renal function was maintained and no problems with venous return were observed. Of the diagnostic methods analyzed, MRI was found to be the most useful. A relationship was found between survival and the pathological stage and the presence or absence of lymph node metastasis. CONCLUSIONS: Total segmental cavectomy without reanastomosis and with ligation of the left renal vein appears to be a feasible technique which achieves good results. MRI is the diagnostic method of choice in the evaluation of vascular tumor extension.

Outcome of autoimmune hepatitis after liver transplantation.

BACKGROUND: Recurrence of autoimmune hepatitis after liver transplantation is not rare, but there is little information about its time of onset, risk factors, response to treatment and prognosis. The aim of this study was to evaluate the rate of recurrence and outcome of autoimmune hepatitis after transplantation. METHODS: The records of patients transplanted in eight centers in our country between 1984 and 1996 were retrospectively analyzed. RESULTS: Forty-three of the 2331 (1.8%) recipients fulfilled diagnostic criteria of autoimmune hepatitis at the time of transplantation. Sixteen patients were excluded from evaluation. Nine (33%) of the 27 patients evaluated fulfilled criteria for recurrence of autoimmune hepatitis, with a mean time of recurrence after orthotopic liver transplantation of 2.6+/-1.5 years. Patients with recurrence had a longer follow-up time after transplantation (5.1 vs. 2.5 years, P=0.0012) and were receiving less immunosuppressive treatment. The estimated risk of recurrence of autoimmune hepatitis in the graft increased over time: 8% over the first year and 68% 5 years after transplantation. None of the seven patients with liver-kidney microsomal-positive antibodies recurred (P=0.059). Fifty percent of the patients failed to respond or responded only partially to therapy, although none of the patients have deteriorated clinically after 2.4+/-1.06 years of follow-up after recurrence. CONCLUSIONS: Recurrence of autoimmune hepatitis in the graft is a common event with an incidence that increases over time as immunosuppression is reduced. Although response to treatment is poor, patient and graft survival do not appear to be decreased.

Arterioportal fistula and hemobilia with associated acute cholecystitis: a complication of percutaneous liver biopsy.

Complications attributable to percutaneous liver biopsy, including hemobilia and arterioportal fistula, are uncommon. In this report, we present the case of a patient who underwent percutaneous liver biopsy and, as a consequence of this procedure, developed an arterioportal fistula and hemobilia with associated acute cholecystitis. The diagnosis of hemobilia was possible with abdominal ultrasound and upper endoscopy, but the patient required cholecystectomy. Hepatic angiography was performed, demonstrating the arterioportal fistula and hemobilia. Transcatheter embolization occluded the fistula, resolving the hemobilia. We recommend ultrasound and upper endoscopy as initial diagnostic procedures, but angiography and selective embolization must not be delayed if arterioportal fistula and/or hemobilia is suspected since these measures may help to prevent further complications.