Determinación de la adherencia a los tratamientos prescritos de calcio/vitamina D mediante receta electrónica / Determining adherence to prescribed calcium/vitamin D treatments through electronic prescriptions

INTRODUCCIÓN: el calcio y la vitamina D son nutrientes vinculados a una buena salud ósea y a la prevención de fracturas. En el paciente anciano y en mujeres postmenopáusicas debe considerarse un aporte extra para alcanzar niveles recomendados (25-OHD<50 nmol/L).OBJETIVO: determinar el grado de adherencia a los suplementos de calcio y vitamina D, e indagar en las causas de incumplimiento.MATERIAL Y MÉTODOS: estudio mixto cuali-cuantitativo descriptivo, transversal y retrospectivo, desarrollado en una farmacia comunitaria .Para la determinación del cumplimiento terapéutico (CT) se utilizó una aplicación del programa RELE de la comunidad balear donde se calcula mediante porcentajes la adherencia anual en función de las dosis recogidas y las dosis prescritas. El paciente se considera cumplidor en porcentajes superiores al 80%.La evaluación de las causas motivadoras de incumplimiento se recogieron de una breve entrevista guiada en mostrador.RESULTADOS: se analizaron 15 prescripciones de Vitamina D en ampollas, de las cuales 2 eran en hombres y 13 en mujeres. La edad media se situó en 66.20 años. En 5 prescripciones el paciente fue cumplidor, lo que supone que el incumplimiento terapéutico se sitúa en torno al 66.66 %. El porcentaje medio de adherencia fue 59.63 %.La principal causa de no cumplimiento es el olvido, seguido de desconocimiento de indicación y de considerarse paciente sobremedicado. Se registraron 23 mujeres con prescripción de calcio con vitamina D y 4 varones. Con una edad media de 74.62 años. Los pacientes cumplidores fueron 6, por lo que la tasa de cumplimiento se sitúa en 22.22%. La tasa de adherencia total media resultante fue del 48.60 %. (AU)

An investigation into the health-related quality of life of individuals living with HIV who are receiving HAART.

The health authorities have recently accepted the routine provision of highly active antiretroviral therapy to persons living with AIDS in South Africa. There is a need to investigate the impact of HAART on the health-related quality of life of people living with HIV/AIDS (PLWHA) in a resource-poor environment, as this will have an influence on compliance and treatment outcome. The aim of this study was to explore whether HAART is efficacious in improving the self-reported health-related quality of life (HRQoL) in a group of PWLA in WHO Stages 3 and 4 living in a resource-poor community. A quasi-experimental, prospective repeated measures design was used to monitor the HRQoL over time in participants recruited to an existing HAART programme. The HRQoL of 117 participants was determined through the use of the Xhosa version of the EQ-5D and measurements were taken at baseline, one, six and 12 months. At the time of the 12-month questionnaire, 95 participants had been on HAART for 12 months. Not all participants attended all follow-up visits, but only two participants had withdrawn from the HAART programme, after two or three months. At baseline, the rank order of problems reported in all domains of the EQ-5D was significantly greater than at 12 months. The mean score on the global rating of health status increased significantly (p < 0.001) from a mean of 61.7 (SD = 22.7) at baseline to 76.1 at 12 months (SD = 18.5) It is concluded that, even in a resource-poor environment, HRQoL can be greatly improved by HAART, and that the possible side effects of the drugs seem to have a negligible impact on the wellbeing of the subjects. This bodes well for the anticipated roll-out of HAART within the public health sector in South Africa.

Exhaled nitric oxide in asthmatic and non-asthmatic children: influence of type of allergen sensitization and exposure to tobacco smoke.

Asthmatic bronchial inflammation is associated with increased nitric oxide concentrations in exhaled air (eNO). Recent data suggest that this effect arises from atopy. Our aim in this study was to find out whether atopy and sensitization to particular allergens influences eNO levels. A total of 213 subjects (41 asthmatics and 172 controls) (96 boys and 117 girls, 7.3-14 years of age) were studied. Parents completed a questionnaire that sought information on their children's respiratory symptoms and exposure to tobacco smoke. Subjects underwent skin-prick tests for the following common allergens: Dermatophagoides pteronyssinus (Dpt), cat fur, Aspergillus fumigatus, Alternaria tenuis, mixed grass, mixed tree pollen, Parietaria officinalis, egg, and cow's milk. eNO was collected in 1-l mylar bags (exhaled pressure 10 cmH2O, flow 58 ml/s) and analyzed by using chemiluminescence. Atopic and non-atopic children without a history of chronic respiratory symptoms had a similar geometric mean eNO (atopics, n = 28, 11.2 p.p.b.; non-atopics, n = 96, 10.0 p.p.b.; mean ratio 1.1, 95% confidence interval [CI]: 0.7-1.6). Conversely, atopic asthmatic subjects had significantly higher eNO values than non-atopic asthmatic subjects (atopics, n = 25, 24.8 p.p.b.; non-atopics, n = 16, 11.4 p.p.b.; mean ratio 2.2, 95% CI: 1.2-3.9, p= 0.000). In children with rhinitis alone (n = 15) and those with lower respiratory symptoms other than asthma (n = 33), eNO increased slightly, but not significantly, with atopy. eNO levels correlated significantly with Dpt wheal size (r = 0.51) as well with the wheal size for cat, mixed grass, and Parietaria officinalis (r = 0.30-0.29), and with the sum of all wheals (r = 0.47) (p= 0.000). Subjects sensitized only for Dpt (but not those subjects sensitized only for grass pollen or other allergens) showed significantly higher eNO levels than non-atopic subjects (16.4 p.p.b. vs. 10.2 p.p.b., mean ratio 1.6, 95% CI: 1.1-2.3, p= 0.002). In asthmatic subjects, Dpt sensitization markedly increased eNO levels (Dpt-sensitized subjects: 28.0 p.p.b.; Dpt-unsensitized subjects: 12.2 p.p.b.; mean ratio 2.3, 95% CI: 1.5-3.5, p= 0.000). Non-asthmatic Dpt-sensitized subjects also had significantly higher eNO values than non-asthmatic, non-Dpt-sensitized subjects (14.2 p.p.b. vs. 10.1 p.p.b.; mean ratio 1.4, 95% CI: 1.1-1.9, p= 0.008). No difference was found between eNO levels in asthmatic subjects and control subjects exposed or unexposed to tobacco smoke. In conclusion, eNO concentrations are high in atopic asthmatic children and particularly high in atopic asthmatics who are sensitized to house-dust mite allergen.

Off-line exhaled nitric oxide measurements in children.

The concentration of exhaled nitric oxide (eNO) is a useful marker of asthmatic bronchial inflammation. eNO can now be measured away from the laboratory (off-line), even in children. Short exhalation maneuvers (8 sec) and small samples (1 L) of exhaled gas are probably sufficient in children, but more information is needed about the effect of different measurement conditions. As a preliminary step before conducting epidemiological studies in schoolchildren, we investigated the effects of expiratory flow, dead space, and expiratory time on eNO concentrations collected in 1-L mylar collection bags. We studied 101 cooperative subjects (62 males) aged 5-18 years (30 healthy volunteers, 51 asthmatics, and 20 children with various other respiratory diseases) in our pulmonary function laboratory. On-line and off-line eNO were compared in a single session, and analyzed with a Sievers NOA 280 nitric oxide analyzer. For both methods of collecting expired gas, subjects did a single exhalation without breath-holding against an expiratory pressure 10 cm H(2)O. We investigated the effects of expiratory flow, dead space, and exhalation time on eNO; we also compared on-line and off-line eNO measurements, and the repeatability of both techniques at a given flow rate. Expiratory flows of 58 mL/sec provided more reproducible data than lower flows (coefficient of repeatability 1.1 ppb for 58 mL/sec vs. 2.8 for 27 mL/sec vs. 5.7 for 18 mL/sec). eNO concentrations were about 25% higher in off-line than in on-line recordings if the initial 250 mL of exhaled gas were not eliminated, and 37% higher if exhalation lasted longer (16 sec vs. 8 sec). Eliminating 250 mL of dead space and shortening the filling time to 8 sec yielded off-line eNO values close to those on-line (geometric mean off-line eNO 14.4 ppb, 95% confidence interval: 12.2-17.0) vs. on-line eNO 13.8 ppb (95% confidence interval: 11.6-16.5). On-line and off-line results were highly correlated (r = 0.996, P = 0.000) and had similar coefficients of variation (on-line eNO 2.6%, off-line 2.8%). Neither agreement nor repeatability of eNO measurements were affected by disease status or baseline FEV(1) (% predicted values). Once standardized, the off-line eNO technique using 1-L gas collection bags will provide results similar to those recorded on-line.

Biosensors based on membrane-bound enzymes immobilized in a 5-(octyldithio)-2-nitrobenzoic acid layer on gold electrodes.

Gold electrodes were modified through chemisorption of 5-(octyldithio)-2-nitrobenzoic acid (ODTNB). ODTNB includes a long chain in a short-length thio acid, providing a heterogeneous-like alkanethiol layer after adsorption on gold electrodes. Membrane-bound enzymes, in particular D-fructose dehydrogenase (FDH), D-gluconate dehydrogenase (GADH), and L-lactic dehydrogenase (cytochrome b2) (Cyb2), were immobilized onto ODTNB-modified gold electrodes simply by adsorption. The short-length thio acid may provide electrostatic interactions with enzyme surface charges, while the alkanethiolate enables hydrophobic interaction with the largely lipophilic, membrane-bound enzymes. The immobilization of FDH, GADH, and Cyb2 onto ODTNB-modified gold surfaces has been studied with the quartz crystal microbalance (QCM). Spectrophotometric and electrochemical assays indicate that the immobilized enzyme retains its enzymatic activity after immobilization onto the ODTNB-modified gold surface. The amount of immobilized (and active) enzyme was estimated from QCM to be of the order of 2.5 x 10(-12)-5.3 x 10(-12) mol x cm(-2). A fructose biosensor was developed, making use of a gold surface modified with ODTNB and fructose dehydrogenase, employing hydroxymethylferrocene as a mediator in solution. Calibration curves exhibited a linear relation between the biosensor response and the substrate concentration up to 0.7 mM. Statistical analysis gave an excellent linear correlation (r = 0.9993) and a sensitivity of 6.1 mM(-1) fructose. The biosensor shows a significant stable catalytic current for at least 25 days.

Dithiobissuccinimidyl propionate as an anchor for assembling peroxidases at electrodes surfaces and its application in a H2O2 biosensor.

Exposure of gold surfaces to solutions of dithiobis N-succinimidyl propionate (DTSP) gives rise to the modification of the surface with N-succinimidyl-3-thiopropionate (NSTP) which can, in turn, react with amino groups allowing for the covalent immobilization of enzymes such as horseradish peroxidase (HRP). The coverage of NSTP has been estimated to be of the order of 1.3 x 10(-10) from the charge consumed during its reductive desorption. The binding reaction of HRP with NSTP modified gold surfaces has been studied with the quartz crystal microbalance, and the results suggest that the immobilization process involves two steps in which the first (faster) appears to correspond to the rapid incorporation of the enzyme whereas the second is likely due to the slow incorporation of additional enzyme and/or reorganization of the immobilized layer. Spectrophotometric and electrochemical assays indicate that the immobilized HRP retains its enzymatic activity after immobilization onto the DTSP modified gold surface. The amount of immobilized (and active) HRP was estimated from QCM and spectrophotometric measurements to be of the order of 1.5 x 10(-11) mol/cm2. A peroxide biosensor was developed making use of a gold surface modified with DTSP and HRP employing Os and Ru complexes of 1,10-phenanthroline 5,6-dione (phen-dione) of the type [M(phendione)x(L)3-x]+2 (where L = 1,10-phenanthroline or 2,2'-bipyridine, x = 1-3) as mediators with the quinone moieties being the active component. The efficiency of the mediators increased with increasing number of phendione ligands.

Pyrethroid resistance in Culex quinquefasciatus from west Africa.

Pyrethroid resistance was investigated in thirty-three samples of Culex quinquefasciatus Say from twenty-five cities in Côte d'Ivoire and Burkina Faso. Permethrin resistance ratios at LC50 ranged from 9.5- to 82-fold in Côte d'Ivoire and from 17- to 49-fold in Burkina Faso. For deltamethrin, resistance ratios were lower and ranged from nine to thirty-eight in both countries. A strain was selected with permethrin to investigate resistance mechanisms. After forty-two generations of selection, permethrin resistance level reached 3750-fold, but deltamethrin resistance remained unexpectedly unchanged. This indicated that a specific mechanism was involved in permethrin resistance. Synergist assays and biochemical tests indicated that resistance was partly due to P450-dependent oxidases. A target site insensitivity (kdr) was also involved, associated with DDT cross resistance and a dramatic loss of permethrin knockdown effect on adults. This resistance should be taken into consideration when planning the use of pyrethroid-impregnated materials in urban areas, as Culex is by far the main source of nuisance. Any failure in nuisance control due to resistance is likely to demotivate people in using impregnated materials.

Analytical strategies for amperometric biosensors based on chemically modified electrodes.

Various strategies based on the use of chemically modified electrodes for the development of amperometric biosensors are described. Particular emphasis is placed on materials capable of catalyzing the oxidation of NADH and coupling these with enzymatic activities for biosensor construction. In terms of electrocatalysts, the discussion will centre on electrodeposited films of 3,4-dihydroxy benzaldehyde (3,4-DHB) and related analogs as well as on electrodeposited films of transition metal complexes of 1,10-phenanthroline-5,6-dione (phen-dione). Electrodeposited films of these materials have been coupled to the enzymatic activity of aldehyde dehydrogenase and alcohol dehydrogenase for the development of biosensors for aldehydes and ethanol, respectively.

The effects of prior gravidity on the outcomes of ovum donor and own oocyte cycles.

OBJECTIVE: To determine the effects of prior gravidity on hormonal parameters, medication regimen, oocyte parameters, fertilization, and clinical pregnancy rates (PRs) in donor and own oocyte cycles. DESIGN: A retrospective study of 64 first-attempt ovum donor cycles and 102 first-attempt IVF and ZIFT cycles using own oocytes conducted during a 2.5-year time period. Analyses of covariance and t-tests using gravidity of oocyte source (gravida versus nulligravida) and controlling for sperm parameters were used to assess differences in hormonal, endometrial, medication, and demographic parameters and were performed separately for donor cycles and for own oocyte cycles. SETTING: Private fertility center. PATIENTS: In ovum donation cycles, oocyte parameters, medication administered, and hormonal parameters of 64 oocyte donors between the ages of 21 and 35, 34 of whom were never pregnant, i.e., nulligravida and 30 who had ever been pregnant, regardless of the outcome of that pregnancy, i.e., gravida, were studied. In own oocyte cycles, oocyte parameters, medication administered, and hormonal parameters of 102 women, 54 nulligravida and 48 gravida, between the ages of 23 and 44 were studied. MAIN OUTCOME MEASURE: Medication requirements, hormonal response, seminal parameters, oocyte quality, fertilization, and clinical PRs. RESULTS: For patients using their own oocytes, there were no significant differences in any of the parameters studied. In contrast, compared with their nulligravida counterparts, gravida oocyte donors had fewer poor quality oocytes, had more high quality oocytes that fertilized, had a higher proportion of their oocytes fertilize, and had a higher PR per transfer. CONCLUSION: A prior history of gravidity is an important predictor of clinical pregnancy in donor oocyte cycles but not in cycles in which patients use their own oocytes. Oocyte recipients may wish to consider donor gravidity in selecting their donor.

[Evaluation of the malate dehydrogenase activity in deteriorated sunflower seeds]. / Evaluacíon de la actividad malato deshidrogenasa en semillas deterioradas de girasol.

Malate dehydrogenase (MDH) activity in sunflower (Helianthus annus L. cv. Peredovik) seeds stored at 65 degrees C and 90 degrees C for 1, 3, 5, 7, and 14 days was evaluated. This study was design to discern the usefulness of this viability test for deteriorated seeds. Differences in the resistance to the heat storage were detected between treatments as reflected by changes in the evolution of MDH activity. A decrease of MDH activity in both soluble and mitochondrial fractions was observed, which was more evident in seeds stored at high temperature. These differences are poorly correlated to viability as determined by tetrazolium staining, and should be related to integrity of cellular membranes as evidenced by differential MDH activity in soluble and mitochondrial fractions.

[Apparently critical posterior activity in a non-epileptic subject: variations during wakefulness and sleep (author's transl)]. / Activité postérieure apparemment critique chez un sujet non-épileptique. Variation au cours de la veille et du sommeil.

Sub-clinical critical discharges arising from the posterior temporal or temporo-occipital regions, which were bilateral but independent, were seen at each examination (5) of a 13 year old non-epileptic child over a period of more than a year. The discharges were present during wakefulness and while falling asleep. They were blocked during the deep slom-ware stage and paradoxical phase of sleep. They were not modified by anti-convulsant therapy and there was no previous family history. Their relation to Gibb's "Psychomotor variant discharge" is envisaged.