Anorexia of aging in long term care: is dronabinol an effective appetite stimulant?--a pilot study.

INTRODUCTION: Anorexia and subsequent weight loss increase the risk of death in long term care (LTC) residents. In patients who fail to respond to nutritional intervention, orexigenic drugs are sometimes prescribed. There is limited data regarding the safety and efficacy of these drugs in older adults. OBJECTIVE: To examine the effect of a 12-week course of dronabinol on LTC residents with anorexia and significant weight loss. DESIGN, SETTING, PARTICIPANTS: Retrospective observational study on residents in five LTC facilities in a major metropolitan area. RESULTS: Twenty-eight subjects (22F, 6M) were involved in the study. Mean age 79.5 +/- 19.8 years (range 46-98 y). Mean body weight, serum albumin and serum prealbumin at baseline were 105.7 +/- 24.7 lbs, 3.39 +/- 0.47 g/dl and 22.15 +/- 7.92 mg/dl respectively. 15 subjects (53.5%) gained weight on dronabinol, of which 10 (67%) gained more than 5 lbs and 6(40%) gained more than 10 lbs. Five (33%) subjects gained less than 5 lbs. Residents who lost weight on dronabinol were younger than those who gained weight (70.9 +/- 5.62 y and 90.8 +/- 7.84 y respectively; p = 0.007) Overall, the mean weight gain on dronabinol was 3 +/- 8.01 lbs (p=0.2). Eleven subjects lost weight (mean loss 3 +/- 2.6 lbs). Of the subjects who lost weight 7 (64%) died compared with 4 (26%) in the subgroup who gained weight. CONCLUSIONS: Dronabinol therapy was well tolerated. Overall, there was a trend toward weight gain in LTC residents treated with 12 weeks of dronabinol. Failure to respond to dronabinol may indicate increased risk of death.

Utilization of standard laboratory methods in the laboratory diagnosis of problem dermatophytes.

The identification of certain dermatophytes may be simplified by using biochemical tests such as urease, nutritional requirements (with commercially available media), and the in-vitro hair penetration test. No study that combines these tests in a diagnostic scheme for identification of the common dermatophytes has been published. one to 20 isolates each of 29 species of dermatophytes (one Epidermophyton floccosum, 10 Microsporum species, and 18 Trichophyton species) were used. They were grown on Christensen's urea agar and the seven nutritional media for the differentiation of the Trichophyton species; the in-vitro hair penetration test was performed in duplicate. Patterns were developed that have been tested and proven to be useful for more than 22 months. In addition, the Microsporum species were all grown on polished rice, and color and sporulation were recorded. All dermatophytes in this study were grown on either Mycosel agar or 2% malt extract agar, and on modified potato dextrose agar and modified Sabouraud agar. Macroscopic and microscopic examinations were made to determine qualitatively the amounts of growth and sporulation on each medium.

Pyrolysis typing of isolates from a recurrence of systemic cryptococcosis.

Cryptococcal meningitis was diagnosed in a 71-year-old male diabetic patient with underlying ischaemic heart disease, asthma and bilateral axillo-femoral vascular grafts. After treatment with fluconazole for 2 months, the patient appeared to be cured. Two years later he presented with an aneurysm of the right graft that was resected and replaced with a new graft segment. Cryptococcus neoformans var. neoformans was grown from post-operative blood cultures and samples of the excised graft. The patient was treated with fluconazole and discharged after 6 weeks. Multiple isolates from both episodes had been preserved, and these, together with isolates from other UK patients, were cultured in duplicate, blind coded and characterised by pyrolysis mass spectrometry (PMS). Duplicate culture and re-isolate sets formed tight clusters, with each patient set clearly distinct. Sets of isolates from the two episodes in this patient formed a single tight cluster and were indistinguishable by PMS. These results support the contention that C. neoformans infection can be reactivated after being dormant for a prolonged period.

Treating malnutrition with megestrol acetate: literature review and review of our experience.

Megestrol acetate is a semi-synthetic progestational steroid that was originally used as a therapeutic modality for metastatic breast and endometrial cancers. What was originally considered to be it's most frequent side effect, an increase in appetite and in body weight, has gradually become an established treatment of malnutrition in patients with the acquired immuno-deficiency syndrome or with non-hormone responsive cancers. The use of megestrol acetate in treating malnutrition in older persons, in patients on dialysis and in a number of other situations is currently under investigation. The authors review the evidence available to support the use of megestrol acetate in treating malnutrition in these selected groups, and the problems associated with administering megestrol acetate; they also report on their own experience with megestrol acetate in the geriatric population.

Determination of sensitivity to antifungal drugs: evaluation of an API kit.

Evaluation of a commercial kit method for testing sensitivity of yeasts to antifungal drugs was performed employing agar gel dilution as the reference method. For the cidal drugs amphotericin B and flucytosine, results were closely comparable. For the three azole drugs tested, miconazole, econazole and ketoconazole, the discrepant results obtained probably relate to a number of factors affecting the end-point when testing these agents. Although easy to perform, the kit method is relatively expensive and the newer antifungal agents (e.g. fluconazole and itraconazole) are not included. Though showing promise, the kit method has limitations in its present format.

Use effectiveness of the Creighton model ovulation method of natural family planning.

OBJECTIVE: To determine the use effectiveness of the Creighton model ovulation method in avoiding and achieving pregnancy. DESIGN: Prospective, descriptive. SETTING: A natural family planning clinic at a university nursing center. PARTICIPANTS: Records and charts from 242 couples who were taught the Creighton model. The sample represented 1,793 months of use of the model. MAIN OUTCOME MEASURE: Creighton model demographic forms and logbook. RESULTS: At 12 months of use, the Creighton model was 98.8% method effective and 98.0% use effective in avoiding pregnancy. It was 24.4% use effective in achieving pregnancy. The continuation rate for the sample at 12 months of use was 78.0%. CONCLUSION: The Creighton model is an effective method of family planning when used to avoid or achieve pregnancy. However, its effectiveness depends on its being taught by qualified teachers. The effectiveness rate of the Creighton model is based on the assumption that if couples knowingly use the female partner's days of fertility for genital intercourse, they are using the method to achieve pregnancy.

PIP: In Wisconsin, nurse researchers followed 242 couples who had enrolled in the Marquette University Nursing Center's natural family planning program between October 1984 and May 1992 to determine the use effectiveness of the Creighton model ovulation detection method to avoid or achieve pregnancy. The couples were largely college educated (98%), white (93%), and Roman Catholic (80.2%). Natural family planning [NFP] practitioners trained according to the Creighton model use a standard teaching format and language to teach couples how to determine fertility by examining the cervical mucus. The practitioner informs each couple that if they choose to have genital intercourse during the fertile period, they have abandoned the model as a method of pregnancy avoidance and have adopted it as a method of achieving pregnancy. The NFP practitioners followed the couples for 12 months for a cumulative number of 2284 ordinal months, during which the couples used the Creighton model. The use effectiveness rate of avoiding pregnancy at the 12th ordinal month was 98%. The method effectiveness rate of avoiding pregnancy at the 12th ordinal month was 98.8%. The use effectiveness rate of achieving pregnancy at the 12th ordinal month was 24.4%. The cumulative discontinuation rate was 20.2% at the 12th ordinal month. Personal reasons (17.4%) were the major reason for discontinuation. These findings suggest that the Creighton model is effective at avoiding or achieving pregnancy, if it is taught by qualified teachers.

Drug treatment of sexually transmittable diseases.

Sexually transmittable diseases are an important group of conditions which frequently confront the Australian family practitioner. Primary-care health workers need especially to know how to deal with acute urethritis, persistent vaginitis and recurrent genital herpes, and should be aware of the rapidly spreading world-wide epidemic of drug-resistant gonorrhoea. The drug treatment aspects of managing sexually transmitted diseases in Australia are summarised.