A randomized trial comparing two corticosteroid regimens combined with mycophenolate mofetil and cyclosporine for prevention of acute renal allograft rejection.

INTRODUCTION: The launching of mycophenolate mofetil (MMF) has reduced the incidence of acute rejection episodes. We sought to evaluate the efficacy of decreasing the steroid dose. MATERIALS AND METHODS: This was a quasiexperimental, randomized, prospective trial. We enrolled 150 patients who received de novo renal transplantations from living or cadaveric donors, fulfilling the screening criteria. Patients were randomized to one of the following two arms: (A) MMF at a 2 g/d dose, cyclosporine (CsA) at a dose necessary to achieve target levels, and corticosteroids at the usual doses; (B) MMF at a 2 g/d dose, CsA at a dose necessary to achieve target levels, and corticosteroids at doses 50% lower than those of group A. RESULTS: Group A included 72 (48%) and group B, 78 patients (52%). There were no differences among the variables: leukopenia occurred in 11 patients in group A, and five patients in group B. Complications occurred in 67.4% (56) of group A, but only 32.6% (27) were related to infections. One case of urinary infection occurred in group B, while six occurred in group A. There was one case of acute rejection in group A, and none in group B. One graft loss occurred in group A. There were no differences in the remaining variables under study. DISCUSSION: The results showed an increased complication rate related to receiving usual steroid doses. There was no increase in acute rejection episodes among patients receiving 50% of the usual steroid dose.

Single-dose ciprofloxacin versus 3 days of norfloxacin in uncomplicated urinary tract infections in women.

A double-blind, randomized controlled study to evaluate the efficacy and safety of a single dose of 500 mg of ciprofloxacin versus 3 days 400 mg twice-daily of norfloxacin in uncomplicated urinary tract infection in women was designed. Patients underwent four visits: baseline, and at 3, 7 and 28 days. The main efficacy variables were clinical and microbiological outcome at day 7. Analyses on both valid patients and intention-to-treat populations were performed. Two hundred and twenty-six patients (114 receiving ciprofloxacin and 112 receiving norfloxacin) were considered valid for efficacy evaluation. Bacteriologic cure was 91.2% in the ciprofloxacin group and 91.9% in the norfloxacin group. Clinical resolution was 91.2 and 93.8%, respectively. Both treatments were equally efficacious (P = 0.016).

[Prevalence of cognitive deterioration in a geriatric urban population]. / Prevalencia de deterioro cognitivo en una población urbana en edad geriátrica.

A descriptive study was carried out in Salt (Gerona) to evaluate the prevalence of cognitive impairment in a geriatric urban population and its relation with several variables which might have an influence on it. The cognitive status was evaluated with the score in the Mini-Mental State Examination (MMSE). A representative sample of 392 individuals was obtained out of an overall population of 2,394 registered persons above 65 years of age; 354 of them were interviewed. The overall rate of intellectual deterioration (MMSE less than 24) was 26.5%, and it was 8% for the important deterioration (MMSE less than 18). The presence of cognitive impairment was significantly correlated in multivariate analysis with advanced age, low educational level and limited personal autonomy.

Validez y fiabilidad de la prueba de Kupperman / Validity and reliability of the Kupperman test

Objective: To study the validity and reliability of the Kupperman test (KT), which measures climacteric symptoms. Design: Validation study. Setting: an urban primary care center (Gerona-3 primary care center) in Gerona, Spain. Patients: A randomized sample of women aged between 45 and 60 years old. Sample size for the calculation of intraclass correlation coefficient (ICC): N=256. Measurements: KT was administered on two occasions. At the baseline visit, both KT and the Nottingham Health Profile (NHP) were administered. Results: Twenty-eight patients (11%) refused to participate. Reliability: the ICC for the total KT score was 0.779, and for the diverse fields was between 0.777 (for hot flushes) and 0.531 (for arthralgias). Validity: the correlation between NHP and KT was 0.605 (P<.0005). The KT score for menopausal (159) and non-menopausal women (69) showed no statistically significant differences (12.96 vs 10.51; P=.055). The ICC of the KT revealed that this test was suitable for group use but not for individual use (ICC< 0.9). KT measures quality of life in women between 45 and 60 years old indirectly (through symptoms). The lack of significant differences between menopausal and non-menopausal women could be due to the low power of KT (AU)

Objetivo: Estudiar la validez y la fiabilidad de la prueba de Kupperman (PK), que mide sintomatología climatérica. Diseño: Estudio de validación. Emplazamiento: Zona básica de salud urbana. Pacientes: Muestra aleatoria de mujeres con edades comprendidas entre los 45 y los 60 años. Tamaño muestral para el cálculo del coeficiente de correlación intraclase (CCI), n = 256. Mediciones: Se administró la PK en dos ocasiones, en la primera cita junto con el Nottingham Health Profile (NHP). Resultados: Se negaron a participar 28 (11%) mujeres. Fiabilidad: el CCI para la puntuación total de la PK fue de 0,779 y para los diversos campos CCI oscilaba entre el 0,778 de los sofocos hasta 0,531 de las artralgias. Validez: la correlación entre el NHP y prueba de PK fue de 0,605 (p < 0,0005). La puntuación para la PK entre mujeres menopáusicas (159) y no menopáusicas (69) mostraba diferencias no estadísticamente significativas (12,96 frente a 10,51; p = 0,055) Conclusiones: La PK no presenta unos CCI adecuados para su uso individual (CCI < 0,9), sino para su uso grupal. LA PK mide de modo indirecto (a través de los síntomas) la calidad de vida de las mujeres de 45 a 60 años. La falta de diferencias significativas entre menopáusicas y no menopáusicas puede deberse a poca potencia (AU)