Atrial fibrillation in athletes.

Many studies have shown a relationship between long-term endurance sport practice and atrial fibrillation. Inflammation, anatomic remodelling, alterations in the autonomic system and neurohormonal activation are all possible explanations for the increased prevalence of this arrhythmia in athletes. Atrial fibrillation may determine disabling symptoms like palpitations and impaired physical performance, compromising eligibility for competitive activities, but exclusion from sport is not necessary for all athletes. Limited data are available on drug therapy and recently ablation resulted to be a particularly attractive option for young athletes with paroxysmal atrial fibrillation. The purpose of this review is to discuss mechanisms, clinical features, management of atrial fibrillation in competitive athletes, including criteria for eligibility and disqualification in sport practice.

Play-back theatre, theatre laboratory, and role-playing: new tools in investigating the patient-physician relationship in the context of continuing medical education courses.

AIM: The aim of this study was to report on the validation of a role-playing approach, using play-back and theatre laboratory in the context of a continuing medical education (CME) course on predialysis and transplantation, to discuss the patient-physician relationship. METHODS: The course was developed with the help of a theatre director. The role-playing 2-day course was designed to be highly interactive for a small group (15-20 participants), based on a core of case reports (dialysis, transplantation, and return to dialysis after graft failure). Two stages were included: play-back theatre in which experiences told by the participants were mimed by a group of actors, and theatre laboratory in which different aspects of voice and touch were explored. Opinions were gathered by an anonymous semistructured questionnaire completed by all participants. RESULTS: The course obtained a high score from The Ministry of Health (14 credits, 1 per teaching hour). The opinions of the 18 participants were highly positive; all liked the courses. Sixteen of 18 asked to repeat the experience. The strong emotional involvement was an advantage for 15 of 18, sharing emotional aspects of the profession for 10 of 18, and usefulness in clarifying opinions on "dark sides" of our profession for 10 of 18. CONCLUSION: The positive opinions recorded during this experience, the first experiment with a "psycho-theatrical approach" developed in a CME course in our country, suggest the benefit of implementing nonconventional, educational approaches in a multidisciplinary discussion of the patient-physician relationship in transplantation medicine.

CKD patients and erythropoietin: do we need evidence-based informed consent?

BACKGROUND: Consent to therapy is increasingly requested in the form of ''informed consent''. OBJECTIVE: To validate an evidence-based informed consent form for erythropoietin (EPO) therapy and to evaluate patient opinions about the informed consent approach. METHODS: An evidence-based informed consent form was developed as part of the Evidence-Based-Medicine course at the Medical School of Turin, Italy. It was validated by anonymous questionnaires (0-10 analogical scales and open answers) administered to patients at different stages of CKD (19 pre-ESRD, 26 hemodialysis, 12 transplant patients) attending an outpatient unit of the University of Turin, to 8 nurses, and to 26 medical students. RESULTS: All individuals filled in the questionnaire. Interest in a detailed explanation of the therapy was high (median 9), as was comprehension (median 9), with no differences between patients with regard to disease stage (pre-ESRD vs. RRT) or educational level. Prior knowledge of the therapy was affected by the educational level (p=0.013 for the advantages and p=0.004 for the side effects) and the professional role (patients vs caregivers: p=0.009 for the advantages and p<0.001 for side affects); patient knowledge of the advantages (median 6) tended to increase as the disease progressed (p=0.015). The most common response by patients was that informed consent was necessary for all drugs (35.1%); 73.1% of the caregivers considered it necessary only for severe side effects. The preferred modality of consent was discussion with the caregiver during the clinical controls (42% of all cases). CONCLUSIONS: Patient interest in and comprehension of an informed consent form with a detailed explanation of the therapy was high; the caregiver's opinion was still the most valued teaching tool.

Antepartum nonstress test and the postmature pregnancy.

A review of 4320 consecutive term deliveries identified 258 women (6%) delivered at a gestational age of 42 weeks or longer. The group accounted for 30% of all cesarean sections for fetal distress, 30% of all infants with a low five-minute Apgar score, 40% of neonatal intensive care admissions, 60% of neonatal deaths, and 30% of all stillbirths. Nonstress tests were performed on 228 women with a postmature pregnancy. Results were defined as normal (score 7 to 10) in 83.4%, inconclusive (score 5 to 6) in 12.2%, and abnormal (score 1 to 4) in 4.4% of these cases. Monitored patients did significantly better than patients in the nonmonitored group, and so did those with normal nonstress test scores when compared with the abnormal scores. Whereas perinatal mortality in the monitored group was similar to that in the nonpostmature population, the perinatal morbidity was significantly higher.

Prostitution and risk of HIV: male partners of female prostitutes.

OBJECTIVE: To describe risk behaviours for infection with HIV in male sexual partners of female prostitutes. DESIGN: A cross sectional study. SETTING: Genitourinary medicine clinic, St Mary's Hospital, London. SUBJECTS: 112 self identified male sexual partners of female prostitutes: 101 who reported commercial sexual relationships only, five who reported non-commercial relationships only, and six who reported both commercial and non-commercial relationships. MAIN OUTCOME MEASURES: Reported risk behaviours for infection with HIV. RESULTS: Of the 40 men who had had previous HIV tests or were tested during the study, two (5%) were infected with HIV. Of the men who would answer the questions, 34/94 reported having sex with other men, 2/105 reported using injected drugs, 8/105 had a history of blood transfusion, 14/108 reported a past history of gonorrhoea, 44/102 reported paying for sex abroad, and 8/92 said that they had also been paid for sex. Of the 55 men who reported paying for vaginal intercourse in the past year, 45 (82%) said that they had always used a condom. In contrast, of the 11 non-paying partners of prostitutes, only two (18%) reported ever using a condom with their partners. CONCLUSIONS: Men who have sex with female prostitutes cannot be assumed to be at risk of infection with HIV only by this route: homosexual contact may place them at greater risk. Despite the heterogeneity among male sexual partners of prostitutes, patterns of use of condoms were uniform when they were considered as a reflection of the type of relationship a man had with a female prostitute rather than a consequence of an individual's level of risk.

PIP: A cross sectional study of prostitutes was complemented by interviewing both paying (clients) and non paying (boyfriends or husbands) partners of female prostitutes to describe known risk factors and different sexual behaviors for infection with HIV. Altogether 112 men participated in the study during 1990-91: 107 were clients of female prostitutes and 11 were non paying members. 75 men had responded to advertisements, 24 were recruited through the genitourinary medicine clinic, and 13 through other methods. 47 interviews were conducted face-to-face and 65 by telephone. 24 men reported having had HIV tests; a further 16 men were tested during the study. The results yielded an overall prevalence of infection with HIV of 5% (2/40). Of the men who replied, 2% reported past use of injected drugs; 8% (8/105) had a history of blood transfusion; 13% (14/108) reported a history of gonorrhea; and 36% (34/94) reported ever having had sex with another man. 15 reported having sex with other men in the past year, and 6 reported taking part in anal intercourse. During their most recent contacts, all 6 men had used condoms, and 1 reported a condom failure. Of the 84 men who reported paying for sex in the past year, 55 had vaginal sex and 45 of these always used a condom. 79 clients reported some use of condoms using sex with prostitutes in the past year, of whom 23 said that 1 or more had failed. Condoms were used in commercial sex primarily to prevent sexually transmitted infections and HIV. Most men always used a condom with a prostitute; most used a condom sometimes with causal, non commercial partners; but few used a condom with regular non commercial partners (wife or steady girlfriend). Among the 11 men who reported noncommercial relationships with prostitutes, 6 who also had paid for sexual intercourse during the past year reported always using a condom in those encounters. In contrast, of the 11 non paying partners, only 2 (18%) reported ever using a condom with their partners.

Cis-trans isomerization of polyunsaturated fatty acid residues in phospholipids catalyzed by thiyl radicals.

Phospholipids containing trans-unsaturated fatty acid residues are the major products of the thiyl radical attack on L-alpha-phosphatidylcholine from soybean lecithin in homogeneous solution or in liposomes (LUVET). Thiyl radicals act as the catalyst for the cis-trans isomerization, and the number of catalytic cycles depends on the reaction conditions. The presence of approximately 0.2 mM oxygen does not influence the reaction outcome but accelerates the efficiency of cis-trans isomerization in homogeneous solution. Under these conditions, the PUFA peroxidation is found to be unimportant. A detailed study of the isomerization of methyl linoleate including product studies indicates the formation of a small amount of conjugated dienes that act as inhibitors. Indeed, all-trans-retinol substantially retarded the isomerization process.