RESUMEN
BACKGROUND: Needle-related distress is a common yet poorly recognised and managed problem among haemodialysis (HD) patients. The aim of this pilot study is to test the feasibility and acceptability of the INJECT Intervention-an innovative psychology-based intervention to empower patients to self-manage needle distress with the support of dialysis nurses. METHODS: This investigator-initiated, single-arm, non-randomised feasibility study will take place in a large dialysis service in Adelaide, Australia. Participants will include patients aged ≥ 18 years, commencing or already receiving maintenance HD, recruited through dialysis physicians and nursing staff as individuals believed to be at risk of needle distress. They will be screened for inclusion using the Dialysis Fear of Injection Questionnaire (DFIQ) and enrolled into the study if the score is ≥ 2. The multi-pronged intervention encompasses (i) psychologist review, (ii) patient self-management program and (iii) nursing education program. The primary aim is to evaluate feasibility and acceptability of the intervention from patient and dialysis nurse perspectives, including recruitment, retention, engagement with the intervention and completion. Secondary exploratory outcomes will assess suitability of various tools for measuring needle distress, evaluate acceptability of the nursing education program and measure cannulation-related trauma and vascular access outcomes. CONCLUSION: The results will inform the protocol for larger trials addressing needle distress in HD patients. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000229875, approved 4 April 2021, https://www.anzctr.org.au/ .
RESUMEN
Here we report a new low temperature dry ice carbonation approach for the synthesis of carbonate-based nano- and micro-particulate materials, which enables the preparation of monodispersed calcium carbonate nanoparticles and microspheres with very high purity phases.
Asunto(s)
Fibrosis Quística/microbiología , Descontaminación/métodos , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Micobacterias no Tuberculosas/aislamiento & purificación , Esputo/microbiología , Adulto , Burkholderia cepacia/efectos de los fármacos , Burkholderia cepacia/aislamiento & purificación , Femenino , Humanos , Masculino , Infecciones por Mycobacterium no Tuberculosas/epidemiología , Micobacterias no Tuberculosas/efectos de los fármacos , Irlanda del Norte/epidemiología , Ácido Oxálico , Pseudomonas aeruginosa/efectos de los fármacos , Pseudomonas aeruginosa/aislamiento & purificación , Hidróxido de Sodio , Población BlancaRESUMEN
While patients with cystic fibrosis (CF) have had dramatic improvement in their survival rates, this has been accompanied by the emergence of more virulent pathogens such as Pseudomonas aeruginosa and Burkholderia cepacia complex organisms. In addition, there has been emergence of organisms of increasing clinical significance such as the nontuberculous mycobacterial (NTM). Although TB infection in patients with CF is extremely uncommon, there is growing concern with regard to atypical Mycobacterium spp, in particular Mycobacterium abscessus. Many methods of decontamination of sputum, which have been adapted from TB methodologies, are ineffective; as shown by the overgrowth of P. aeruginosa, it is essential that decontamination methods are optimized to overcome this. Establishing optimal methods of isolation and determining accurate levels of prevalence is of importance as, although NTM may be isolated relatively infrequently in CF populations, their clinical status in pulmonary disease is now beginning to emerge.
Asunto(s)
Técnicas Bacteriológicas , Fibrosis Quística/microbiología , Infecciones por Mycobacterium no Tuberculosas/microbiología , Micobacterias no Tuberculosas/aislamiento & purificación , Humanos , Infecciones por Mycobacterium no Tuberculosas/epidemiología , Micobacterias no Tuberculosas/genética , Reacción en Cadena de la Polimerasa , PrevalenciaRESUMEN
BACKGROUND: The efficacy, onset and duration of action and safety of cetirizine 10 mg o.d., fexofenadine 120 mg o.d., and placebo were compared in this investigator-blinded, crossover study involving the use of the Vienna Challenge Chamber. METHODS: 40 volunteers with seasonal allergic rhinitis were exposed to a controlled grass pollen concentration for 6 h on 2 consecutive days. Subjective symptoms and objective measurements were recorded during the allergen exposure periods. RESULTS: Both active medications were significantly more effective than placebo and had a comparable onset of action in alleviating the symptoms of seasonal allergic rhinitis. The efficacy of both active drugs was comparable for the first 4 h after administration of the drugs on day 1 and day 2. However from 22 to 24 h after the first dose cetirizine was significantly superior to fexofenadine for the major symptom complex score and for sneezing. Concerning the total symptom complex score at day 2 fexofenadine could not reach superiority to placebo. No serious adverse events were reported. CONCLUSIONS: Cetirizine and fexofenadine were significantly better than placebo, also in reducing the symptom of nasal congestion. However cetirizine appears to have a longer duration of action than fexofenadine.
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Antialérgicos/uso terapéutico , Cetirizina/uso terapéutico , Rinitis Alérgica Estacional/tratamiento farmacológico , Terfenadina/análogos & derivados , Terfenadina/uso terapéutico , Adulto , Pruebas de Provocación Bronquial , Estudios Cruzados , Método Doble Ciego , Femenino , Humanos , Cinética , Masculino , Poaceae , Polen , Estornudo/efectos de los fármacosRESUMEN
PURPOSE: To investigate the effects of the phytotherapeutic agent, Permixon(R), on primary cultures of fibroblast and epithelial cells from the prostate, epididymis, testes, kidney, skin and breast and to determine the selectivity and specificity of the action of the drug. MATERIALS AND METHODS: All primary cultures were examined by electron microscopy before and following treatment with Permixon(R) (10 microg./ml.). In addition the apoptotic index was assessed by flow cytometry employing propidium iodide as a fluorophore. The impact of the drug on 5alpha-reductase (5alphaR) isoenzymes was also tested utilizing a pH specific assay. RESULTS: There were changes in the morphology of prostate cells after treatment including accumulation of lipid in the cytoplasm and damage to the nuclear and mitochondrial membranes; no similar changes were observed in other cells. Permixon(R) increased the apoptotic index for prostate epithelial cells by 35% and 12% in the prostate stromal/fibroblast. A lesser apoptotic effect was demonstrated in skin fibroblast (3%) whereas none of the other primary cultures showed any increase in apoptosis when compared with the controls. Permixon(R) was also an effective inhibitor of both 5alphaR type I and II isoenzymes in prostate cells, but other cells showed no inhibition of 5alphaR activity following treatment with the plant extract. CONCLUSIONS: This investigation demonstrated the selectivity of the action of Permixon(R) for prostate cells. The morphological changes in the prostate are accompanied by an increase in the apoptotic index along with an inhibition in the activity of the nuclear membrane bound 5alphaR isoenzymes. No similar changes were observed in any of the other cells under investigation.
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Antagonistas de Andrógenos/farmacología , Extractos Vegetales/farmacología , Próstata/efectos de los fármacos , 3-Oxo-5-alfa-Esteroide 4-Deshidrogenasa/efectos de los fármacos , Apoptosis/efectos de los fármacos , Mama/efectos de los fármacos , Células Cultivadas , Colorantes , Técnicas de Cultivo , Citoplasma/efectos de los fármacos , Epidídimo/efectos de los fármacos , Células Epiteliales/efectos de los fármacos , Femenino , Fibroblastos/efectos de los fármacos , Citometría de Flujo , Humanos , Isoenzimas/efectos de los fármacos , Riñón/efectos de los fármacos , Metabolismo de los Lípidos , Masculino , Microscopía Electrónica , Mitocondrias/efectos de los fármacos , Membrana Nuclear/efectos de los fármacos , Propidio , Serenoa , Piel/efectos de los fármacos , Testículo/efectos de los fármacosRESUMEN
The SF-36 Health Status Questionnaire is a generic quality of life questionnaire based on 36 questions selected to represent nine health concepts. Perennial allergic rhinitis is a disease which causes variable restrictions on the physical, psychological and social aspects of patients' lives. According to the SF-36 questionnaire assessment, quality of life is impaired in these patients. Cetirizine, a potent, reliable histamine H1-receptor antagonist, has already been found to induce significant improvement in the quality of life of patients with chronic rhinitis, as assessed by the same SF-36 questionnaire after 1 and 6 weeks of treatment. This paper further investigates the extent to which cetirizine continues to improve quality of life after a long-term treatment (6 weeks) compared to a shorter treatment (1 week). The analyses show that, despite the significant improvement found after 1 week of treatment with cetirizine compared to placebo, a further 5-week course of therapy not only maintains this improvement but continues to enhance quality of life significantly above and beyond this.
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Antialérgicos/uso terapéutico , Cetirizina/uso terapéutico , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Rinitis Alérgica Perenne/tratamiento farmacológico , Adolescente , Adulto , Anciano , Antialérgicos/administración & dosificación , Cetirizina/administración & dosificación , Método Doble Ciego , Esquema de Medicación , Femenino , Antagonistas de los Receptores Histamínicos H1/administración & dosificación , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Calidad de Vida , Rinitis Alérgica Perenne/psicología , Encuestas y CuestionariosRESUMEN
An accurate evaluation of the functions of the human brain during the administration of drugs is one of the most complex tasks in medical science. In the case of H1 antihistamines, there are many biases that can explain why the interpretation of pharmacological data and those from clinical studies can be very difficult. First of all, the allergic disease itself may modify central nervous system (CNS) functioning and effective medical treatment may accordingly influence the self-reported CNS sensations of patients. Moreover, the carefully selected populations that are enrolled both in pharmacological and clinical studies do not reflect the profile of patients who are treated with such drugs on an everyday basis. Finally, studies of performance impairment and those relying on self-reported sensations may give different and indeed conflicting results. It may be concluded that the various pronouncements on the CNS properties of H1 antihistamines must be treated with some caution.
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Encéfalo/efectos de los fármacos , Antagonistas de los Receptores Histamínicos H1/efectos adversos , Animales , Humanos , Desempeño Psicomotor/efectos de los fármacosRESUMEN
BACKGROUND: The aim of this study was to determine the effect of the phytotherapeutic agent, Permixon, on a novel coculture model of benign prostatic hyperplasia (BPH) in an effort to better understand the mode of action of the drug in vivo. METHODS: The effect of Permixon, at the calculated therapeutic concentration, on the activity of 5alpha-reductase isoenzymes was evaluated utilizing a pH-specific assay. Prostate-specific antigen (PSA) secretions into the medium were measured in the presence and absence of Permixon and quantified by an ELISA assay. The morphological patterns before and following Permixon treatment were also examined by electron microscopy. All results were compared to controls. RESULTS: Permixon at a concentration of 10 micrograms/ml (calculated plasma concentration in patient receiving recommended therapeutic dosage) was shown to be an effective inhibitor of both 5alpha-reductase types I and II isoenzymes without influencing the secretion of PSA by the epithelial cells, even after stimulation with testosterone. The morphology of Permixon-treated cells was found to be markedly different from that of untreated controls. Cells which had been treated with the drug demonstrated extensive accumulation of lipids in the cytoplasm and widespread damage of intracellular membranes, including mitochondrial and nuclear membranes. CONCLUSIONS: Permixon is an effective dual inhibitor of 5alpha-reductase isoenzyme activities in the prostate. Unlike other 5alpha-reductase inhibitors, Permixon induces this effect without interfering with the cells' capacity to secrete PSA, thus permitting the continued use of PSA measurements for prostate cancer screening.
Asunto(s)
Inhibidores de 5-alfa-Reductasa , Antagonistas de Andrógenos/farmacología , Extractos Vegetales/farmacología , Próstata/efectos de los fármacos , Hiperplasia Prostática/tratamiento farmacológico , Antagonistas de Andrógenos/uso terapéutico , Anticuerpos Monoclonales , División Celular/efectos de los fármacos , Técnicas de Cocultivo , Células Epiteliales/efectos de los fármacos , Células Epiteliales/ultraestructura , Fibroblastos/efectos de los fármacos , Fibroblastos/ultraestructura , Formazáns/química , Humanos , Concentración de Iones de Hidrógeno , Inmunohistoquímica , Isoenzimas , Masculino , Microscopía Electrónica , Extractos Vegetales/uso terapéutico , Próstata/patología , Antígeno Prostático Específico/análisis , Antígeno Prostático Específico/metabolismo , Hiperplasia Prostática/patología , Serenoa , Células del Estroma/efectos de los fármacos , Sales de Tetrazolio/químicaRESUMEN
Alcohol and drug knowledge of inner-city mothers was evaluated following an educational mailing, and the relationship between knowledge and alcohol and illicit drug use during pregnancy was tested. Eighty-four postpartum African-American mothers with known alcohol and drug use during pregnancy received a U.S. Department of Education publication, Growing Up Drug Free: A Parent's Guide to Prevention. Results of a phone-administered quiz from this booklet were compiled, and alcohol and drug use subgroups were compared. The average score was 50%. Half of the women did not know that alcohol is the most commonly used drug in the United States. Few identified alcohol, tobacco, and marijuana as the three drugs most commonly used by children. Lack of teenage substance use experience was perceived to increase the risk of chemical dependency. Drinkers and drug users were fourfold more likely to answer at least six questions correctly (p=.03 each, logistic regression). Parental knowledge of substance use, particularly of alcohol, remains inadequate. We suggest that appropriate parental education tools are still needed for optimal primary prevention of substance use by inner-city children.
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Alcoholismo/prevención & control , Negro o Afroamericano , Conocimientos, Actitudes y Práctica en Salud , Madres , Trastornos Relacionados con Sustancias/prevención & control , Población Urbana , Adolescente , Adulto , Negro o Afroamericano/estadística & datos numéricos , Alcoholismo/psicología , Trastornos Relacionados con Cocaína/psicología , Recolección de Datos , Femenino , Humanos , Drogas Ilícitas , Madres/estadística & datos numéricos , Periodo Posparto , Embarazo , Fumar/psicología , Trastornos Relacionados con Sustancias/psicología , Población Urbana/estadística & datos numéricosRESUMEN
Paracrine interactions between primary cultured prostate epithelial cells and stromal fibroblasts were investigated in relation to morphology, growth, androgen sensitivity and secretory activities using co-cultures in which the two populations were separated by a microporous membrane. In this new model system, both cell types maintained several aspects of the differentiated phenotype including the capacity to express 5alpha-reductase iso-enzymes and androgen receptors, to respond to androgens and to secrete prostate-specific antigen by the epithelial cells. Morphological studies demonstrated that the cells grown in co-culture exhibited round nuclei, tonofibrils and microvilli in epithelial cells and elongated nuclei, large amounts of Golgi apparatus and cilia in the fibroblasts, all indicative of the differentiated state. The co-culture system highlights the importance of the metabolic co-operation between prostate fibroblast and epithelial cells for preserving the phenotypic characteristics associated with the human prostate in vivo.
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Técnicas de Cocultivo , Próstata/citología , Hiperplasia Prostática/patología , Comunicación Celular , División Celular , Colestenona 5 alfa-Reductasa , Medios de Cultivo Condicionados/farmacología , Dihidrotestosterona/farmacología , Células Epiteliales/citología , Células Epiteliales/efectos de los fármacos , Células Epiteliales/metabolismo , Células Epiteliales/ultraestructura , Fibroblastos/citología , Fibroblastos/efectos de los fármacos , Fibroblastos/metabolismo , Fibroblastos/ultraestructura , Humanos , Concentración de Iones de Hidrógeno , Técnicas para Inmunoenzimas , Queratinas/metabolismo , Masculino , Microscopía Electrónica , Oxidorreductasas/metabolismo , Fenotipo , Próstata/efectos de los fármacos , Próstata/metabolismo , Próstata/ultraestructura , Antígeno Prostático Específico/metabolismo , Hiperplasia Prostática/metabolismo , Testosterona/farmacologíaAsunto(s)
Antialérgicos/uso terapéutico , Cetirizina/uso terapéutico , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Loratadina/uso terapéutico , Rinitis Alérgica Estacional/tratamiento farmacológico , Terfenadina/uso terapéutico , Urticaria/tratamiento farmacológico , Humanos , Cómputos MatemáticosRESUMEN
We have developed a coculture system for primary fibroblast and epithelial cells derived from benign prostatic hyperplasia (BPH) that retained many of the characteristics of the intact human prostate. In contrast to separately cultured prostate fibroblast and epithelial cells, cocultures of fibroblasts and epithelial cells maintained messenger ribonucleic acid expression and functional activity for both isoenzymes of 5 alpha-reductase (type I and type II) as well as maintained expression of androgen receptors and prostate-specific antigen. Furthermore, levels of prostate-specific antigen secreted by cocultured epithelial cells were increased by treatment with androgens, mimicking the situation in the human gland. This contrasted with conventionally cultured fibroblasts or epithelial cells, which failed to express 50 alpha-reductase type II and rapidly lost expression of androgen receptors and androgen sensitivity upon being placed into culture. Electron microscopy demonstrated intracellular structures indicative of the differentiated state of the cocultured cell types, including round nuclei, tonofibrils, and microvilli in epithelial cells and elongated nuclei; large amounts of Golgi and cilia; along with immature collagen fibers in fibroblasts. The present study demonstrates that the coculture model reflects more closely the in vivo system for human BPH and is thus a far more suitable model for investigating the molecular and cellular events that underlie BPH than current in vitro systems.
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3-Oxo-5-alfa-Esteroide 4-Deshidrogenasa/análisis , Isoenzimas/análisis , Próstata/enzimología , Hiperplasia Prostática/enzimología , Hiperplasia Prostática/patología , 3-Oxo-5-alfa-Esteroide 4-Deshidrogenasa/biosíntesis , Andrógenos/farmacología , División Celular/efectos de los fármacos , Técnicas de Cocultivo , Cartilla de ADN , Células Epiteliales/enzimología , Células Epiteliales/patología , Células Epiteliales/ultraestructura , Fibroblastos/enzimología , Fibroblastos/patología , Fibroblastos/ultraestructura , Humanos , Isoenzimas/biosíntesis , Masculino , Reacción en Cadena de la Polimerasa , Próstata/patología , Hiperplasia Prostática/cirugía , Receptores Androgénicos/análisis , Receptores Androgénicos/biosíntesisRESUMEN
Forty-five patients with residual or recurrent nasal polyposis after ethmoidectomy were treated with either cetirizine at twice the daily recommended (20 mg) dose or placebo for three months. The number and size of polyps remained unchanged during the study period. Cetirizine was found to reduce nasal sneezing and rhinorrhoea effectively. The drug also had a beneficial effect on nasal obstruction in the latter part of the study. The side effects of 20 mg (double the recommended daily adult dose) of cetirizine were few and comparable to placebo.
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Antialérgicos/uso terapéutico , Cetirizina/uso terapéutico , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Pólipos Nasales/tratamiento farmacológico , Adulto , Anciano , Método Doble Ciego , Esquema de Medicación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mucosa Nasal/efectos de los fármacosRESUMEN
Hilton Head Hospital, a 64-bed acute care hospital in Hilton Head Island, SC, was built in 1975. During its early years, the hospital struggled to meet its payroll. For the last few years, the hospital's operating margin has been so healthy that this small, general hospital is now able to contribute substantially to maintaining its sophisticated services and equipment. As vice-chairman of the hospital's board of trustees, vice-chairman of the hospital's parent corporation, and chairman of the hospital's foundation, Frederick S. Donnelly, Jr., is well aware of the governing boards' decisions that have contributed to Hilton Head Hospital's financial turnaround. He recently talked with Trustee managing editor Karen Gardner about the hospital's finances.
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Administración Financiera de Hospitales/tendencias , Administración Financiera/tendencias , Consejo Directivo , Hospitales con menos de 100 Camas , Renta , South CarolinaRESUMEN
Cercarial transmission of Schistosoma mansoni and S. mattheei was monitored in two small rivers near Durban, South Africa. The seasonal patterns recorded corresponded to those already documented for these parasites. In the case of S. mansoni, however, this was interrupted at the height of the transmission season. The reason for this was believed to be very low oxygen concentrations in the snail habitat due to unusually extensive growth of the plant Ludwigia stolonifera over the water. The failure of the spring rains, which would normally have flushed the system is seen as contributing to this phenomenon. Infection rates in the snail intermediate hosts were low (less than 10%). A preponderance of male worms of both schistosome species was noted.