Effectiveness and safety of colistin for the treatment of multidrug-resistant Pseudomonas aeruginosa infections.

PURPOSE: To describe the clinical and microbiological outcomes of patients infected with multidrug-resistant Pseudomonas aeruginosa (MDRP) treated with colistin (colistimethate sodium) and the adverse events observed with this treatment. METHODS: Retrospective study of MDRP infections treated with colistin from 1997 to 2006. RESULTS: 121 episodes were identified. The median daily intravenous dose was 240 mg/day; 28.9% of patients received intravenous and nebulized colistin. Clinical outcome was favorable in ten cases of bacteremia (62.5%, n = 16), 43 cases of bronchial infection (72.9%, n = 59), 13 cases of pneumonia (65%, n = 20), 11 cases of urinary infection (84.6%, n = 13), eight cases of skin and soft tissues (72.7%, n = 11), and in the one case of arthritis and one case of otitis. Eradication was achieved in 31 (34.8%) of the 89 patients with available bacteriologic data. Factors associated with bacteriological failure were smoking, chronic obstructive pulmonary disease (COPD), and previous infection with P. aeruginosa. Nephrotoxicity occurred in ten cases (8.3%), with the associated factors being previous chronic renal insufficiency, diabetes mellitus, and aminoglycoside use. Crude mortality was 16.5%, and related MDRP was 12.4%, and was higher in patients with pneumonia or bacteremia (36.1%) than in other types of infections (8.2%). CONCLUSIONS: Colistin is a safe option for the treatment of MDRP infections, with acceptable clinical outcomes. However, bacteriological eradication is difficult to achieve, especially in COPD patients.

Quantification of chloroanisoles in cork using headspace solid-phase microextraction and gas chromatography with electron capture detection.

Chloroanisoles can migrate from the cork stopper in wine bottles to the wine and give it a musty taint so it is important to find a method by which they can be determined. The aim of this paper is to develop a method for quantifying 2,4-dichloroanisole, 2,6-dichloroanisole, 2,4,6-trichloroanisole, 2,3,4,6-tetrachloroanisole and 2,3,4,5,6-pentachloroanisole in cork using headspace solid-phase microextraction and gas chromatography with electron capture detection. After we had prepared the cork standards that were so essential to the work we optimised the parameters that most influence headspace solid-phase microextraction: fibre coating, vial volume, cork, kind and volume of solvent to help the extraction, extraction temperature and time, ionic strength and stirring. The method quantifies the total amount of chloroanisoles in cork stoppers (natural, agglomerated, agglomerated with disks and sparkling wine stoppers), at suitable concentrations so that the capacity of these compounds to give wine a musty taint can be evaluated. The quantification limits are: 2,6-dichloroanisole (8.6 ng/g), 2,4,6-trichloroanisole (0.8 ng/g), 2,4-dichloroanisole (3.5 ng/g), 2,3,4,6-tetrachloroanisole (0.6 ng/g), 2,3,4,5,6-pentachloroanisole (0.8 ng/g). The other quality parameters are: recoveries (90.3-105.8%), repeatability (4-13% (RSD expressed)) and intermediate precision (5-14% (RSD expressed)).

Determination of 2,4,6-trichloroanisole in wines by headspace solid-phase microextraction and gas chromatography-electron-capture detection.

One of the most important problems in the wine world, today, is cork taint, which often has been chemically identified as 2,4,6-trichloroanisole (TCA). The perception limit of this compound is very low (close to 10 and 40 ng/l for white and red wines, respectively), so, even at such low concentrations, its presence becomes a problem in wine quality. A method for the analysis of TCA in white and red wines has been developed in our laboratory, using headspace solid-phase microextraction and gas chromatography with electron-capture detection. The method, which has been optimized using an experimental design, involves the use of fibres coated with polydimethylsiloxane (PDMS) and allows the analysis of TCA at very low concentrations (under 500 ng/l) with good accuracy (RSD < or = 10%). The limits of quantification of the method are 5 and 8 ng/l for white and red wines, respectively, while the limit of detection is 1 ng/l for both types of wine.

[Attitudes and knowledge of primary care physicians about community breast cancer screening programs]. / Actitudes y conocimientos de los médicos de atención primaria sobre los programas poblacionales de cribado de cáncer de mama.

OBJECTIVE: To find the view of Primary Care doctors in relation to the need for a community programme of breast cancer screening, its effectiveness and the criteria underlying its application. DESIGN: Crossover study. SETTING: Municipal districts of Ciutat Vella and Sant Martí, Barcelona. PARTICIPANTS: General Practitioners (GPs) in the programme. INTERVENTION: A self-filled questionnaire. The questions sought the level of agreement with 11 statements concerning: importance as health problem, effectiveness of the programmes, target population and role of GP. Results were compared for: year of graduation, sex and type of centre. MEASUREMENTS AND MAIN RESULTS: Of 140 doctors, 110 (78.6%) replied. There was majority agreement with all the statements, especially so in: "Breast cancer is one of the three main causes of death in women in Barcelona"; "screening of 50-64-year old women should be recommended"; and "GPs must recommend screening to their patients". CONCLUSION: The replies to the questionnaire indicated agreement with the programme's basic orientation, except for including 40 to 49-year old women in the programme, which the programme did not propose. Hopefully, this consensus will help Primary Care professionals become involved in the screening programme.