Nurses' preferences regarding MenACWY conjugate vaccines attributes: a discrete choice experiment in Spain.

OBJECTIVES: Immunisation against preventable diseases as meningitis is crucial from a public health perspective to face challenges posed by these infections. Nurses hold a great responsibility for these programs, which highlights the importance of understanding their preferences and needs to improve the success of campaigns. This study aimed to investigate nurses' preferences regarding Meningococcus A, C, W, and Y (MenACWY) conjugate vaccines commercialised in Spain. STUDY DESIGN: A national-level discrete choice experiment (DCE) was conducted. METHODS: A literature review and a focus group informed the DCE design. Six attributes were included: pharmaceutical form, coadministration evidence, shelf-life, package contents, single-doses per package, and package volume. Conditional logit models quantified preferences and relative importance (RI). RESULTS: Thirty experienced primary care nurses participated in this study. Evidence of coadministration with other vaccines was the most important attribute (RI = 43.78%), followed by package size (RI = 22.17%), pharmaceutical form (RI = 19.07%), and package content (RI = 11.80%). There was a preference for evidence of coadministration with routine vaccines (odds ratio [OR] = 2.579, 95% confidence interval [95%CI] = 2.210-3.002), smaller volumes (OR = 1.494, 95%CI = 1.264-1.767), liquid formulations (OR = 1.283, 95%CI = 1.108-1.486) and package contents including only vial/s (OR = 1.283, 95%CI = 1.108-1.486). No statistical evidence was found for the remaining attributes. CONCLUSIONS: Evidence of coadministration with routine vaccines, easy-to-store packages, and fully liquid formulations were drivers of nurses' preferences regarding MenACWY conjugate vaccines. These findings provide valuable insights for decision-makers to optimize current campaigns.

Influence of temperature on decay, mycelium development and sporodochia production caused by Monilinia fructicola and M. laxa on stone fruits.

Brown rot on peaches and nectarines caused by Monilinia spp. results in significant economic losses in Europe. Experiments were conducted to study the effects of temperature (0-33 °C) on the temporal dynamics of decay and mycelium development and the subsequent sporulation on peaches and nectarine fruit infected by M. laxa and M. fructicola. The rates of decay and mycelium development increased with temperature from 0 °C to 25 °C for both Monilinia species. At 0 °C, decay was faster for M. laxa (0.20 cm2 days-1) than for M. fructicola (0.07 cm2 days-1); indeed, M. laxa was able to develop mycelia and sporodochia, but M. fructicola was not. At 4 and 20 °C, there were no differences in decay and mycelia development between the two Monilinia species. When temperature increased from 25 to 33 °C, the rates of fungal decay and mycelium development decreased. At 30 and 33 °C, M. fructicola decayed faster (0.94 and 1.2 cm2 days-1, respectively) than M. laxa (0.78 and 0.74 cm2 days-1, respectively) and could develop mycelia and produce sporodochia, whereas M. laxa failed at 33 °C. These results indicated that M. fructicola is better adapted to high temperatures, whereas M. laxa is better adapted to low temperatures. These results can be used to predict the relative importance of the two species during the season at a given site and to improve management strategies for brown rot in areas where both species are present.

[Early treatment of idiopathic vasculitis, aneurysms and neuroretinitis (IRVAN). A case report]. / Tratamiento precoz de vasculitis idiopática, aneurismas y retinitis (IRVAN). A propósito de un caso.

CASE REPORT: A 55 year old woman presented with retinal vasculitis, multiple aneurysms, macular exudation and widespread retinal nonperfusion and was diagnosed with IRVAN. She was treated with panretinal laser photocoagulation. After 3 years of follow up visual acuity remains stable and there are no complications due to ischaemic sequelae. DISCUSSION: IRVAN syndrome with neovascularisation can progress rapidly despite laser treatment. Panretinal laser photocoagulation has to be considered in the early stages as it is effective in stopping the progression of ischaemia.

Usefulness of bone turnover markers as predictors of mortality risk, disease progression and skeletal-related events appearance in patients with prostate cancer with bone metastases following treatment with zoledronic acid: TUGAMO study.

BACKGROUND: Owing to the limited validity of clinical data on the treatment of prostate cancer (PCa) and bone metastases, biochemical markers are a promising tool for predicting survival, disease progression and skeletal-related events (SREs) in these patients. The aim of this study was to evaluate the predictive capacity of biochemical markers of bone turnover for mortality risk, disease progression and SREs in patients with PCa and bone metastases undergoing treatment with zoledronic acid (ZA). METHODS: This was an observational, prospective and multicenter study in which ninety-eight patients were included. Patients were treated with ZA (4 mg every 4 weeks for 18 months). Data were collected at baseline and 3, 6, 9, 12, 15 and 18 months after the beginning of treatment. Serum levels of bone alkaline phosphtase (BALP), aminoterminal propeptide of procollagen type I (P1NP) and beta-isomer of carboxiterminal telopeptide of collagen I (ß-CTX) were analysed at all points in the study. Data on disease progression, SREs development and survival were recorded. RESULTS: Cox regression models with clinical data and bone markers showed that the levels of the three markers studied were predictive of survival time, with ß-CTX being especially powerful, in which a lack of normalisation in visit 1 (3 months after the beginning of treatment) showed a 6.3-times more risk for death than in normalised patients. Levels of these markers were also predictive for SREs, although in this case BALP and P1NP proved to be better predictors. We did not find any relationship between bone markers and disease progression. CONCLUSION: In patients with PCa and bone metastases treated with ZA, ß-CTX and P1NP can be considered suitable predictors for mortality risk, while BALP and P1NP are appropriate for SREs. The levels of these biomarkers 3 months after the beginning of treatment are especially important.

Biochemical markers of bone turnover and clinical outcome in patients with renal cell and bladder carcinoma with bone metastases following treatment with zoledronic acid: The TUGAMO study.

BACKGROUND: Levels of bone turnover markers (BTM) might be correlated with outcome in terms of skeletal-related events (SRE), disease progression, and death in patients with bladder cancer (BC) and renal cell carcinoma (RCC) with bone metastases (BM). We try to evaluate this possible correlation in patients who receive treatment with zoledronic acid (ZOL). METHODS: This observational, prospective, and multicenter study analysed BTM and clinical outcome in these patients. Serum levels of bone alkaline phosphatase (BALP), procollagen type I amino-terminal propeptide (PINP), and beta-isomer of carboxy-terminal telopeptide of type I collagen (ß-CTX) were analysed. RESULTS: Patients with RCC who died or progressed had higher baseline ß-CTX levels and those who experienced SRE during follow-up showed high baseline BALP levels. In BC, a poor rate of survival was related with high baseline ß-CTX and BALP levels, and new SRE with increased PINP levels. Cox univariate analysis showed that ß-CTX levels were associated with higher mortality and disease progression in RCC and higher mortality in BC. Bone alkaline phosphatase was associated with increased risk of premature SRE appearance in RCC and death in BC. CONCLUSION: Beta-isomer of carboxy-terminal telopeptide of type I collagen and BALP can be considered a complementary tool for prediction of clinical outcomes in patients with BC and RCC with BM treated with ZOL.

Primary Inoculum Sources of Monilinia spp. in Spanish Peach Orchards and Their Relative Importance in Brown Rot.

Immediately following the identification of Monilinia fructicola in a Spanish peach orchard in the Ebro Valley in 2006, this orchard and two other orchards in the same valley were intensively sampled for potential tree and ground sources of primary Monilinia inoculum before and during three growing seasons between 2006 and 2008. Overwintered Monilinia spp. produced inoculum from only mycelium, and no apothecia were found in any of the three orchards over the three growing seasons. Mummies on trees were the main source of primary inoculum. More than 90% of Monilinia isolates on all fruit mummies were M. laxa. Positive relationships were found between (i) the number of mummified fruit and the incidence of postharvest brown rot (P = 0.05, r = 0.75, n = 8), and (ii) the number of mummified fruit and nonabscised aborted fruit in the trees and the number of conidia on the fruit surface (P = 0.04, r = 0.71; P = 0.01, r = 0.94, respectively, n = 8) and the incidence of latent infection (P = 0.03, r = 0.75; P = 0.001, r = 0.99; respectively, n = 8). In addition, the numbers of mummified fruit and pruned branches on the orchard floor were correlated with the number of airborne conidia in the orchard. Based on the results of these surveys, the control of brown rot in stone fruit orchards is discussed.

[Perineal prostatectomy]. / Prostatectomie périnéale.

There is a lack of prospective randomised trials comparing the efficacy of the different techniques for treating localised prostate cancer. Consequently, selecting one rather than the other appears very difficult. Even radical prostatectomy is controversial regarding its best approach--perineal, retropubic or laparoscopic. The perineal route was the first to be undertaken, and it was dropped out due to the need of performing obturator lymphadenectomy by a separate approach. Widespread use of prostate-specific antigen as a screening method has enabled to diagnose prostate cancer at its early stages, when the potential for lymphatic dissemination is low, which enables to obviate Lymphadenectomy in most patients. This was a promoting circumstance to use the perineal route in radical prostatectomies. In this article we discuss the perineal radical prostatectomy surgical technique, its indications, and its advantages and disadvantages as compared to other approaches.

Nephron-sparing surgery for renal tumor: a choice of treatment in an allograft kidney.

The incidence of de novo malignancies is an accepted complication of organ transplantation. Renal cell carcinoma (RCC) was 4.6% of cancers occurring de novo in organ allograft recipients compared with 3% in the general population. Less than 10% of these renal cancers affected the renal allograft. Among patients developing a renal tumor in the kidney allograft, transplant nephrectomy reduced the quality of life. For these patients for whom preservation of renal function is a relevant clinical consideration, partial nephrectomy may be considered the choice for treatment. Fifteen cases have been reported regarding conservative surgery on kidney transplant tumors. Herein we have reported three cases of renal masses in well-functioning kidney transplants that were successfully treated with nephon-sparing surgery. Our experience demonstrated that in selected patients, nephron-sparing surgery on a renal allograft represents a feasible approach for tumor removal with preservation of graft function.

[What we should know and how we should act when avian flu strikes]. / Qué debemos saber y cómo debemos actuar. Frente a la gripe aviaria.

The author presents an updated review on the flu and the ever more commented bird flu. The most highlighted aspects of this article deal with what composes flu and how one should act given the current circumstances.

Stable Polymorphisms in a Two-Locus Gene-for-Gene System.

ABSTRACT A two-locus gene-for-gene model is presented to analyze coevolutionary dynamics in interactions between host plants and their pathogens. Using both analytical and simulation approximations, we show that the behavior of the model is very simple with one locus. In the reciprocal genetic feedback version, there is a smooth outward spiral toward the boundaries. In the delayed feedback version, there is an infinite family of closed curves corresponding to different initial conditions. Both versions of the model are stabilized by the addition of recurrent mutation. Either a stable interior equilibrium or a stable limit cycle appears. But with the two-locus model, different coevolutionary outcomes are predicted according to the parameter values. For a wide range of small and medium values of virulence and resistance costs, complex fluctuations arise. The number of virulence alleles per isolate and the number of resistance alleles per plant cycle indefinitely. If the costs of both virulence and resistance are above a threshold, the final state of the coevolutionary dynamics is a stable single-resistance static polymorphism in the host and avirulence in the parasite. An equivalent threshold to maintain a disease-free host population was obtained analytically for a multilocus system. These expressions can be used to determine the number of single-resistance host genotypes that would have to be present in a mixture to prevent the spread of any virulent race of pathogen. The model demonstrates that it is preferable to use mixtures of single-resistant genotypes rather than using multiple resistance alleles in the same cultivar.

[Living donor nephrectomy for kidney transplantation. Experience in the first two years]. / Nefrectomía laparoscópica de donante vivo para trasplante renal. Los dos primeros años de experiencia.

OBJECTIVES: Laparoscopic surgery offers potential advantages in terms of diminishment of postoperative pain, shorter hospital stay, faster convalescence, and better cosmetic results. These advantages may increase kidney donation, making donation be accepted by more candidates. We report our first 2 years' experience with laparoscopic donor nephrectomy METHODS: Between March 2002 and February 2004 we performed 38 laparoscopic living donor nephrectomies for kidney transplantation. The technique of choice was the transperitoneal laparoscopic approach with four trocars, usually three of them from the start of the procedure--two 10-12 mm and one 5 mm--, and a 6.5 cm perumbilical midline incision for kidney retrieval at the end of the procedure. RESULTS: Receptor and donor survivals were 100%. Graft survival was 97.6%. There was not any case of delayed graft function. Donor: Mean operative time was 161 minutes (115-260). Mean estimated blood loss was 270 ml (100-1200). Three patients required blood transfusions, 2 units of packed red blood cells each. Mean hospital stay was 5.1 days (3-11). Mean warm ischemia time was 3.2 min. (2-10). Conversion to open surgery was necessary in four cases. Receptor: there have been three significant complications requiring surgical repair: one case of low arterial flow, one vesico ureteral leak, and one midurethra stenosis. Initial renal function: mean serum creatinine at one month was 147mmol/l, with a trend to improve to 126 mmol/l at one year, which is considered optimum. First postoperative day mean serum creatinine was 192mmol/l and the nadir was on second postoperative day with a value of 152mmol/l. CONCLUSIONS: We believe laparoscopic living donor nephrectomy is a real alternative to open surgery because it offers better recovery to the donor with the same capacity to preserve renal function in the receptor.

Cavernositis following intracavernous injection of vasoactive drugs.

Intracavernous injection is one of the most common treatments of erectile dysfunction. Infectious complications are rare, but hazardous. We report the case of a 44-year-old to stress the importance of patient supervision and drug prescription.

Hasson's laparoscopic trocar in percutaneous bladder stone lithotripsy.

Bladder calculi are a common problem traditionally treated with open cystolithotomy or transurethral cystolithalopaxy. Percutaneous cystolithotomy via an Amplatz sheath is a recent approach that keeps urethral instrumentation to a minimum. We describe a percutaneous approach to bladder stones using a Hasson's trocar. With this approach, one or more watertight approaches to the bladder can be created, allowing any kind of endoscopic surgical material to be introduced, thus opening new possibilities in the design of percutaneous bladder surgery techniques.

Epidemic dynamics and patterns of plant diseases.

ABSTRACT The general Kermack and McKendrick epidemic model (K&M) is derived with an appropriate terminology for plant diseases. The epidemic dynamics and patterns of special cases of the K&M model, such as the Vanderplank differential-delay equation; the compartmental healthy (H), latent (L), infectious (S), and postinfectious (R) model; and the K&M model with a delay-gamma-distributed sporulation curve were compared. The characteristics of the disease cycle are summarized by the basic reproductive number, R(0), and the normalized sporulation curve, i(tau). We show how R(0) and the normalized sporulation curve can be calculated from data in the literature. There are equivalences in the values of the basic reproductive number, R(0), the epidemic threshold, and the final disease level across the different models.However, they differ in expressions for the initial disease rate, r, and the initial infection, Q, because the values depend on the sporulation curve. Expressions for r and Q were obtained for each model and can be used to approximate the epidemic curve by the logistic equation.

Topical verapamil lowers outflow facility in the rabbit eye.

Results of studies examining the mechanism of the ocular hypotensive effect of topical calcium channel blockers are controversial. Whereas evidence obtained in perfused human eyes indicates that these drugs lower intraocular pressure by increasing the aqueous humor outflow, tonographic studies in rabbits have revealed that they reduce both the aqueous humor outflow and inflow. In order to clarify such a discrepancy, the aim of this study was to assess whether the effect of topical verapamil on the facility of aqueous humor outflow in the rabbit eye was dose-related. Total outflow facility was determined by two-level constant pressure perfusion in anesthetized rabbits. The effect of 5 different concentrations on aqueous humor outflow at 60 minutes postdrug was studied in groups of 10 rabbits each. Baseline outflow facility was also determined in a group of 15 rabbits. In order to check the reliability of the method for detecting drug-induced changes in aqueous outflow, the effect of pilocarpine was also tested. Topical verapamil was shown to lower outflow facility in the rabbit eye in a dose-related fashion. On the contrary, topical pilocarpine was found to significantly increase outflow facility. Our data indicate that topical verapamil reduces outflow facility in the rabbit eye.

The effect of topical diltiazem on ocular hypertension induced by water loading in rabbits.

The aim of this work was to assess the effect of topical diltiazem on the ocular hypertension induced by water loading in rabbits. The effect of three different concentrations of diltiazem on the intraocular pressure rise produced by oral administration of tap water (60 ml/kg) was tested in groups of nine or ten rabbits each. When applied at the lowest concentration studied, topical diltiazem was found to enhance the intraocular pressure rise after water loading. In contrast, when applied at the highest concentration, diltiazem counteracted the ocular hypertension caused by water loading. Although diltiazem, and probably other calcium channel blockers, may be useful in the management of ocular hypertension, the data obtained suggest that these drugs may have complex actions on aqueous humor dynamics; therefore further studies in animal models for glaucoma should be carried out before their clinical evaluation in humans.

The effect of topical diltiazem on the intraocular pressure in betamethasone-induced ocular hypertensive rabbits.

The effect of calcium channel blockers (CCBs) on intraocular pressure (IOP) remains still controversial, although some preliminary reports suggest that these drugs may be effective in the management of ocular hypertension and low-tension glaucoma. The aim of the present work was to assess the effect of topical diltiazem on IOP in an animal model for glaucoma, the betamethasone-induced ocular hypertension in rabbits. IOP was measured with a manometrically calibrated applanation pneumatonograph. Ocular hypertension was produced in 120 rabbits by weekly subconjunctival injection of a betamethasone suspension into the left eye. The experiments examining the ocular actions of diltiazem were carried out in two stages. In the first one, the ability of topical diltiazem to prevent the rise in IOP induced by betamethasone was studied. In a second phase, the effect of topical diltiazem on IOP in betamethasone-induced ocular hypertensive rabbits was assessed. Diltiazem was topically applied once daily for 5 days a week into the left eye. The effect of five different concentrations of diltiazem was evaluated to obtain dose-response curves. Topical diltiazem was found to prevent in a dose-related fashion the betamethasone-induced IOP rise as well as to reduce IOP in rabbits made ocular hypertensive by weekly subconjunctival injection of betamethasone. Unilateral topical administration did not produce a clear effect on IOP in the untreated eye. This is the first report describing the ocular hypotensive action CCBs in animal model for glaucoma. These findings are in agreement with preliminary evidence suggesting that CCBs may have a beneficial effect in human ocular hypertension.

The effect of topical dihydroergocristine on the intraocular pressure in alpha-chymotrypsin-induced ocular hypertensive rabbits.

Having previously reported that topical dihydroergocristine dose-dependently reduces intraocular pressure in ocular normotensive rabbits with a maximum response and potency higher than those of timolol and pilocarpine, the aim of the present work was to assess the effect of this drug in alpha-chymotrypsin-induced ocular hypertensive rabbits. Intraocular pressure was measured with a pneumatonometer. The experiments examining the effects of dihydroergocristine on intraocular pressure were conducted in 10 albino rabbits in which ocular hypertension was induced by intracameral injection of alpha-chymotrypsin. Intraocular pressure responses to drug vehicle and 5 different doses of topical dihydroergocristine were studied in order to obtain a dose-response curve. Tonographies were also performed in ocular hypertensive rabbits 2 h after vehicle and dihydroergocristine instillation to ascertain the actions of this drug on aqueous humor dynamics. Topical dihydroergocristine was found to lower intraocular pressure in alpha-chymotrypsin-induced ocular hypertensive rabbits in a dose-related manner, with the ED50 of the concentration-response curve very similar to that previously obtained in ocular normotensive rabbits. Data from tonographic studies indicate that dihydroergocristine reduces intraocular pressure in this animal model for glaucoma by decreasing the aqueous humor inflow. Our findings suggest that topical dihydroergocristine may be useful in the treatment of ocular hypertension.