Nosocomial infections in the rehabilitation department.

AIM: The patients of a Rehabilitation Department are at high risk of nosocomial infections because they generally have a long term hospitalisation and more and more frequently immune-compromised subjects, like old patients or with chronic illness, are admitted to rehabilitation programs. However, to evaluate the real infectious risk of a Rehabilitation Unit, it is important to consider also that a high number of patients are transferred from other hospitals after a specific therapy of the acute phase of their medical or surgical pathology and so many nosocomial microrganisms previously acquired may spread to a Rehabilitation Unit. METHODS: From January to December 2003 we have performed a screening of the bacteruria among the patients at admittance to the Rehabilitation Unit of S. Orsola Fatebenefratelli Hospital of Brescia (Italy). RESULTS: A significant bacteruria (>100000 cfu/mL) in 28.9% of 114 patients coming from home and in 41.9% of 179 patients transferred from other hospitals without antibacterial treatment has been documented. CONCLUSIONS: These findings confirm the presence of an high number of patients colonized or infected by nosocomial bacteria previously acquired in hospital and underline the need, in addition to specific skill, of wide infectious knowledge among the medical staff of a Rehabilitation Unit. A specific approach to the infectious problem in the Rehabilitation Department in order to reduce the risk of nosocomial infections may be suggested.

Value of the dorsal cutaneous guinea pig model in selecting topical antiviral formulations for the treatment of recurrent herpes simplex type 1 disease.

Recurrent herpes simplex labialis represents a disease still difficult to treat, despite the availability of many established antiviral drugs used in clinical research since 30 years ago. Although differences between the human disease and that obtained in experimental animal suggest caution in predicting an effective clinical response from the experimental results, some of the animal models seem to be useful in optimising the topical formulation of single antiviral drugs. In the present work the dorsal cutaneous guinea pig model was used to compare 5 different topical antiviral formulations with clinical promise (active molecule: 5% w/w micronized aciclovir, CAS 59277-89-3), using both roll-on and lipstick application systems. The aim being to evaluate which vehicle (water, oil, low melting and high melting fatty base) and application system (roll-on, lipstick) enhances the skin penetration and the antiviral activity of the drug, after an experimental intradermal infection with Herpes simplex virus type 1 (HSV-1). As reference, a commercial formulation (5% aciclovir ointment) was used. The cumulative results of this study showed that the formulation A, containing 5% aciclovir in an aqueous base in a roll-on application system, has the better antiviral efficacy in reducing the severity of cutaneous lesions and the viral titer; among the lipsticks preparations, the formulation D, containing 5% aciclovir in a low melting fatty base, demonstrates a very strong antiviral activity, though slightly less than formulation A. This experimental work confirms the validity of the dorsal cutaneous guinea pig model as a rapid and efficient method to compare the antiviral efficacy of new formulations, with clinical promise, to optimise the topical formulation of the active antiviral drugs.

Nasal formulations of ketorolac tromethamine: technological evaluation--bioavailability and tolerability in rabbits.

This paper describes the development of a novel formulation of the powerful non narcotic analgesic ketorolac tromethamine. This drug is given orally three to four times/day to deliver a total of 30 to 60 mg of drug. Higher doses cannot be given orally because of gastrointestinal side effects and intramuscular injections, three times/day must then be used. The need for injections limits the drug to a clinical setting. Nasal delivery offers a method of achieving the high blood levels of repeated intramuscular injections in a formulation that can be easily applied by the patients. Four formulations were evaluated in "in vitro" and "in vivo" rabbit tests. The best formulation consisted of a 5% solution of ketorolac tromethamine containing 0.3% sodium glycocolate as a known mucosal drug absorption enhancer. Ketorolac applied in this way had a bioavailability greater than 80%. The controlled release nature of nasal delivery also doubled the drug's apparent half life. The drug formulation was stable in three-months stability tests and produced minimal nasal irritation.

[Neurological changes in aged patients with fractures of the femur: prevalence and clinical aspects]. / Le alterazioni neurologiche nel paziente anziano con frattura di femore: prevalenza e aspetti clinici.

This study evaluates the prevalence and clinical significance of the main neurological diseases in 246 hospitalized elderly patients with hip fracture, who have to undergo rehabilitative treatment. Eighty-three patients already had clinically noticeable neurological diseases before fracture; they were compared to other components the survey. As for the type of fracture and surgical treatment, differences have not been found. Medical conditions have proved worse among neurological disease bearers; the same patients also had to run into more complications. What results from the study, considering the high prevalence of neurological diseases in patients with hip fractures, suggests that these neurological diseases are important risk factors for accidental falls and it's necessary to provide these patients with careful, continuous hospital assistance.

An evaluation of structure-penetration relationships in percutaneous absorption.

Prediction of chemical transport across skin is important both to the optimization of topical and transdermal drug delivery and to the assessment of risk following dermal exposure. To facilitate estimation of percutaneous absorption, a number of model in vitro experimental systems have been developed. However, the predictive applicability of the different approaches (with respect to human skin penetration), and the quantitative aspects of the structure-permeation behavior revealed, have not been critically evaluated. The objectives of this paper are to collect, from the literature, the more systematic investigations pertaining to chemical transport across the skin, to quantify the dependence of permeation on the lipophilicity of the penetrants studied, and to assess the relative utility of model systems for the prediction of percutaneous absorption. The categories of chemicals addressed in the survey include n-alkanols, para-substituted phenols, steroids and non-steroidal anti-inflammatory drugs. The experimental systems, used in the studies considered, involve, primarily, steady-state transport measurements across excised skin taken from either human cadavers or hairless mice. Favorable comparisons of these data to solute flux across simple organic liquid membranes are possible. Overall, general patterns of behavior emerge from the analysis such that qualitative predictions can be made. From a quantitative standpoint, though, it is clear that additional "structure-activity" work is necessary to provide appropriate equations that can relate penetration between different test systems and between different chemical classes.

Social and family integration of hemiplegic elderly patients 1 year after stroke.

We interviewed 120 elderly hemiplegic patients 1 year after their acute stroke to assess cognitive impairment using the Mini-Mental State Examination, functional autonomy using the Barthel Index, mood disorders using the Hamilton Rating Depression Scale, and social integration using the Social Functioning Exam. Of the 76 patients admitted to this study, eight (12.1% of those testable) had significant cognitive impairment, 41 (53.9%) were functionally self-sufficient, 27 (35.5%) showed depressive symptoms, and 44 (57.9%) had problems in social and family integration. We suggest that a complete rehabilitation program aimed at producing a good quality of life for elderly hemiplegic patients should take into account all these aspects of human existence.

Pharmacokinetic considerations in the use of newer transdermal formulations.

This review addresses the pharmacokinetics and pharmacodynamics of transdermally delivered drugs. The systemic input of drugs via the skin has attracted considerable interest over the past 15 years. The early promise of the administration route has, to some extent, been realised with the approval and successful launching of transdermal formulations of hyoscine (scopolamine), glyceryl trinitrate (nitroglycerin), clonidine and oestradiol. The further application of transdermal delivery, however, will require additional effort. While other molecules (e.g. testosterone, fentanyl, nicotine) may ultimately be administered in this way, important questions pertaining to pharmacology (tolerance), toxicity (irritation, sensitisation) and dose sufficiency (penetration enhancement) remain. These problems are illustrated using information which has been published in the literature. Overall, while the enthusiasm for attraction and benefits of transdermal delivery remain evident, it is clear that future successes will demand a heightened level of commitment and skill from the pharmaceutical scientist.

[Microbiological aspects of urinary infections in hospitalized and ambulatory elderly patients]. / Aspetti microbiologici delle infezioni urinarie nell'anziano ospedalizzato ed ambulatoriale.

The authors studied the microorganisms found in urocultures of three groups of elderly patients giving an exact map of the microbiology and epidemiology of the urinary tract infections of elderly patients. They shown also the calibrated loop seeding method as the most efficient to evaluate low bacterial concentration in urines which in these patients are significant.

[Pleural empyema caused by Salmonella cholerae suis in a patient with breast cancer in the stage of metastatic dissemination]. / Empiema pleurico da Salmonella cholerae suis in paziente con carcinoma mammario in fase di disseminazione metastatica.

A pleural localisation of Salmonella cholerae suis infection is described in a patient with breast carcinoma. The evolution of neoplastic disease seems to be more slow after salmonellosis. On the basis of this case the most important mechanisms between immunity and tumors are discussed.

[Usefulness of plasma cell acid phosphatase in the differential diagnosis of monoclonal gammopathies]. / Utilità della fosfatasi acida plasmacellulare nella diagnostica differenziale delle gammopatie monoclonali.

The acid phosphatase activity has been studied cytochemically in bone marrow plasma cells of 12 patients with multiple myeloma and 15 with non-myeloma plasmocytosis. The acid phosphatase activity has been significantly higher in the myeloma group. The utilization and usefulness of this cytochemical reaction for the diagnosis of multiple myeloma are proposed.