Increase of plasmatic beta-endorphin immunoreactive material in children in the perioperative period: the influence of the site of surgery.

BACKGROUND: The primary aim of the study was to confirm the increase of plasmatic IR beta-endorphin material during the perioperative period in children. The second was to search for the factors responsible for this increment. METHODS: Seventy-two consecutive children undergoing a surgical procedure were recruited. Pre-anaesthesia and anaesthesia were standardised. Plasmatic IR beta-endorphin material was measured at three timepoints: at baseline (t (0)), before induction (t (1)), and at the end of anaesthesia (t (2)). Two general linear models were set up to analyse the influence of demographics and clinics on the IR beta-endorphin variation between t (0) and t (1). A third model was established to process the possible surgical factors contributing to the IR beta-endorphin variation between t (1) and t (2). RESULTS: ANOVA showed that IR beta-endorphin concentrations increased significantly across the three timepoints (p < 0.0001). Wilcoxon test proved that the difference was significant both for t (0) vs. t (1) and for t (1) vs. t (2). None of the factors taken into account in the pre-operative period influenced the increase in IR beta-endorphin between t (0) and t (1). Of the factors taken into account in the surgical period, only the type of procedure was significant (p = 0.005). The t-test showed that IR beta-endorphin significantly increased during spermatic and epigastric anastomosis (p = 0.000), orchidopexy (p = 0.02), Van der Meulen urethroplasty (p = 0.004), and Duckett urethroplasty (p = 0.003). CONCLUSION: Plasmatic beta-endorphin increases during the perioperative period in children. The site of surgery is responsible for this increment during intervention.

Trends in young adult mortality in three European cities: Barcelona, Bologna and Munich, 1986-1995.

OBJECTIVE: In recent decades, in most European countries young adult mortality has risen, or at best has remained stable. The aim of this study was to describe trends in mortality attributable to the principal causes of death: AIDS, drug overdose, suicide and motor vehicle traffic accidents, among adults aged between 15 and 34 years in three European cities (Barcelona, Bologna and Munich), over the period 1986 to 1995. METHODS: The population studied consisted of all deaths that occurred between 1986 and 1995 among residents of Barcelona, Bologna and Munich aged from 15 to 34 years. Information about deaths was obtained from mortality registers. The study variables were sex, age, the underlying cause of death and year of death. Causes of death studied were: drug overdose, AIDS, suicide and motor vehicle traffic accidents. Age standardised mortality rates (direct adjustment) were obtained in all three cities for the age range 15-34. To investigate trends in mortality over the study period Poisson regression models were fitted, obtaining the average relative risk (RR) associated with a one year increment. RESULTS: Young adult mortality increased among men in Barcelona and Bologna (RR per year: 1.04, 95% confidence intervals (95%CI): 1.03, 1.06 in Barcelona and RR:1.03, 95%CI:1.01, 1.06 in Bologna) and among women in Barcelona (RR:1.02, 95%CI: 1.01, 1.04), with a change in the pattern of the main causes of death attributable to the increase in AIDS and drug overdose mortality. In Munich, the pattern did not change as much, suicides being the main cause of death during the 10 years studied, although they have been decreasing since 1988 (RR:0.92, 95%CI:0.88, 0.96 for men and 0.81, 95%CI: 0.75-0.87 for women). CONCLUSION: The increase in AIDS mortality observed in the three European cities in the mid-80s and mid-90s has yielded substantial changes in the pattern of the main causes of death at young ages in Barcelona and Bologna. Munich presented a more stable pattern, with suicide as the main cause of death.

Dietary habits as risk factors for inflammatory bowel disease.

OBJECTIVE: To examine the influence of dietary factors in Italian patients with ulcerative colitis and Crohn's disease. DESIGN: We studied dietary habits immediately prior to the onset of disease in 104 patients enrolled in a prospective, epidemiological study of the incidence of inflammatory bowel disease in Italy. METHODS: Each patient was interviewed using a recall questionnaire to provide information on the daily intake of nutrients. The differences in diet between patients and healthy subjects matched for age, sex and city of residence were determined. RESULTS: Our data confirm that patients with Crohn's disease and ulcerative colitis have a high intake of total carbohydrate, starch and refined sugar. This resulted in a significantly higher relative risk (P < 0.001) in both ulcerative colitis and Crohn's disease patients. Total protein intake was significantly higher in ulcerative colitis, but not in Crohn's disease patients, than in controls. Fibre consumption did not differ between patients and controls. CONCLUSIONS: Our results confirm that carbohydrate consumption is significantly higher in IBD patients than in healthy controls. Ulcerative colitis patients also consumed more total protein than controls. The pathogenetic significance of these findings, however, remains unclear.

Niaprazine in the treatment of autistic disorder.

Niaprazine is a histamine H1-receptor antagonist with marked sedative properties. It has been employed in subjects with behavior and sleep disorders. No data concerning the use of niaprazine in subjects with autistic disorder are reported in the literature. The authors performed an open study to assess niaprazine efficacy in a sample of 25 subjects with autistic disorder and associated behavior and sleep disorders. Niaprazine was administered at 1 mg/kg/day for 60 days. A positive effect was found in 52% of patients, particularly on hyperkinesia, unstable attention, resistance to change and frustration, mild anxiety signs, heteroaggressiveness, and sleep disorders. Statistical comparison between responders and nonresponders showed no influence on niaprazine effect by age over or under 12 years, presence of neurologic signs, epilepsy, or abnormalities seen on brain imaging. Niaprazine was more efficacious in subjects with a mild or moderate degree of mental retardation. No side effects were observed. Because of its sedative effects and good tolerability, niaprazine can be used as a first-choice drug to improve behavior and sleep disorders in patients with autistic disorder.

[Potential antibiotic pharmaceutical cost reduction in an operative unit of infectious diseases. Projects for making savings and improvements]. / Riduzione della spesa farmaceutica per antibiotici in una Unit Operativa di Malattie Infettive. Progetti di risparmio e miglioramento.

The authors intend to evaluate the results obtained from a pharmaco-economic project included in the 1999 and 2000 budgets. The objectives of the study are: 1) to establish whether there has been a saving in expenses for antibiotic therapy (T.A.) during the first half-year of 1999 and during the first half-year of 2000 and to ascertain the reasons for any positive result; 2) to evaluate the average hospital stay in the first half-year of 2000 and to observe how many times patients were been discharged early with shift therapy. Of the 286 patients (1999) and 309 (2000) considered, we focused attention on 187 (1999) and 190 patients (2000) who were treated with antibiotic therapy. A substantial cost saving was found in antibiotic use (-31%) in the first half-year of 2000 due to the early discharge and the continuation of home therapy for a fair number of patients and due to increased attention in the choice of medicine for less serious diseases. The second objective was not achieved with the reduction of average hospital stay even if the average length of antibiotic therapies (D.M.T.) fell from 13.1 days at 1st September to 9.8 days in the first half-year of 2000 (P:NS). These results suggest that projects designed to achieve financial savings and improvements require more cooperation between clinical U.O. and services that enable hospital stay to be shortened.

[Not Available]. / Tubercolosi ed infezioni da HIV 1-2 in Guinea Bissau. Aggiornamento Epidemiologico e stima delle sopravvivenze in una Coorte di Pazienti Tubercolotici con infezione da HIV-2.

The authors briefly report the epidemiological status of HIV-1 and HIV-2 infections among patients affected by tuberculosis in Guinea Bissau and evaluate the therapeutic follow up in 177 patients contemporarily affected by TBC and HIV-2 infection. The evaluation of the surviving times has been done according to the Kaplan-Meier curve by considering the following determinants: 1) sex; 2) sputum positive for acid-fast bacilli; 3) age range: A) 10-30 years - B) 31-45 years - C) more than 45 years. The total number days/person was 1417. The drop out was moderate. The serum prevalence for HIV-2 in patients affected by tuberculosis in Guinea Bissau is about 20% but in the last two years HIV-1 infection is increasing. There is no significant difference in the surviving curves due to the sex. Tbc-HIV-2+ patients have a longer survival than tbc-HIV-1+ patients reported by European and North America epidemiological data. The present epidemiological data were obtained in an African environment and, due to the low financial support, it was not possible to correlate them with the immunological and microbiological ones.

[Pharmaco-economic evaluation of antibiotic therapy in a ward for infections diseases] / Alcune valutazioni di farmacoeconomia sull'antibioticoterapia in un reparto di malattie infettive.

For all hospitalized patients admitted in the first six months of 1999, we recorded the data relative to antibiotic therapy (TA) administered, establishing the period of treatment in days and the dosage, including any variations during the period in question. We calculated the prescribed daily dose (PDD) and were thus able to establish the expense incurred in antibiotic therapy, comparing the real overall cost per product used. For all patients, the discharge diagnosis was reported, and the whole case-study was aggregated into homogeneous groups. PDD was compared with DDD (defined daily doses). The Pareto curve was used to highlight the antibiotics with higher overall cost. Besides cotrimoxazole, ceftriaxone and ciprofloxacin were the antibiotics most frequently prescribed, while ceftriaxone, imipenem-cilastatine and vancomycin were the antibiotics incurring the greatest expense. With reference to the average duration of the treatment cycle, ceftriaxone (9.75 dd) and ciprofloxacin tbl (6.75 dd) were the only antibiotics (in monotherapy) used for less than 10 treatment days. Special attention was paid to analysing the TA costs in treating pneumonia, which accounted for the highest percentage of cases (50 cases). Ceftriaxone, especially pulmonary infections, was the most commonly used drug. In hospitalized subjects treated who show good therapeutic response, we recommend early discharge and continuation of the therapy at home (switch therapy). This strategy will allow the patient to return to his/her family in good time, also thereby reducing hospital management costs.

Practical evaluation of standard-based low-cost video conferencing in telemedicine and epidemiological applications.

The results of the evaluation of use of low-cost video conferencing systems (VCSs) in telemedicine is presented. Applications sharing, a new feature of these systems, recently has allowed high-quality computer-supported collaborative work (CSCW). The video conferencing (VCing) equipment used was Intel ProShare 200 v2.0a. It is representative of other low-cost VCSs. The areas of application are epidemiology and telemedicine (orthopaedics and radiology). Potential end users filled out 58 evaluation questionnaires concerning user profiles, contents and benefits of the sessions, organizational aspects, user friendliness, user acceptance, cost effectiveness, technical and multipoint related aspects. Although the end users had a lot of computer experience, their knowledge in VCSs was rather limited. The users assessed the system capable of being integrated into routine work, despite a high organizational impact. The VCS is user friendly, application sharing being used in almost every session. Audio quality was not always sufficient. The remote video was sufficient, as was the quality of medical images such as CT, MRI or X-ray. The user acceptance of the system was high. Multipoint sessions require a structured protocol to be effective. Some technical problems with MCUs (Multipoint Control Units) occurred. The use of low-cost standard VCSs in telemedicine is advisable and is a good substitute for real meetings.