Poland syndrome: a new classification system based on a retrospective analysis of 74 cases.

LEVEL OF EVIDENCE: III.

Seymour fracture: Better do not underestimate it.

OBJECTIVES: This study aims to analyze the functional results, management, and complications of acute Seymour fracture treatment and to generalize the understanding of Seymour fractures, as well as awareness about its controversial treatment and critical sequelae. PATIENTS AND METHODS: Between January 1994 and December 2019, a total of 29 patients (20 males, 9 females; mean age: 7.9±3.9 years; range, 1 to 15 years) who presented within the first 24 h of injury and were diagnosed with Seymour fractures and treated in the emergency setting were retrospectively analyzed. Clinical and radiological data were collected from medical records at the time of diagnosis and during follow-up, within a week after the treatment and in the visits required until fracture healing, and no sequelae were observed. In the event of complications, a minimum of one year of follow-up was carried out. Radiographs were taken of the anteroposterior and lateral views during each visit. RESULTS: The mean follow-up was 10.8±8.6 (range, 2 to 36) months. Surgical treatment in the operating room was performed in 24 (82.7%) patients using a single longitudinal Kirschner wire (K-wire) fixation through the distal phalanx and the distal interphalangeal joint in 21 patients. Non-operative treatment based on closed reduction and splinting was performed in five (17.3%) patients. There was no statistically significant difference in the final passive range of motion and physeal growth arrest in relation to the use or non-use of K-wires. The use of antibiotics in any of the three possible administrations (intravenous antibiotic regimen, intravenous and later oral antibiotic at-home or oral antibiotics), in relation to the non-use of antibiotics seemed to be a protective factor against infections (odds ratio=0.04; 95% confidence interval: 0.006-0.2; p=0.001). CONCLUSION: The identification of Seymour fractures is crucial for applying the correct treatment and reducing the risk of complications, such as osteomyelitis and physeal alterations. Based on our study results, we can suggest that the use of an antibiotic regimen causes a lower risk of infections in acute Seymour fractures. The prompt identification of these fractures with a standardized protocol covering irrigation, debridement, reduction, fixation, and prophylactic antibiotics is needed to avoid complications.

Endogenous Neurostimulation and Physiotherapy in Cluster Headache: A Clinical Case.

OBJECTIVE: The aim of this paper is to describe the progressive changes of chronic cluster headaches (CHs) in a patient who is being treated by a multimodal approach, using pharmacology, neurostimulation and physiotherapy. SUBJECT: A male patient, 42 years of age was diagnosed with left-sided refractory chronic CH by a neurologist in November 2009. In June 2014, the patient underwent a surgical intervention in which a bilateral occipital nerve neurostimulator was implanted as a treatment for headache. METHODS: Case report. RESULTS: Primary findings included a decreased frequency of CH which lasted up to 2 months and sometimes even without pain. Besides this, there were decreased levels of anxiety, helplessness (PCS subscale) and a decreased impact of headache (HIT-6 scale). Bilateral pressure pain thresholds (PPTs) were improved along with an increase in strength and motor control of the neck muscles. These improvements were present at the conclusion of the treatment and maintained up to 4 months after the treatment. CONCLUSIONS: A multimodal approach, including pharmacology, neurostimulation and physiotherapy may be beneficial for patients with chronic CHs. Further studies such as case series and clinical trials are needed to confirm these results.

Radial Polydactyly. What's New?

BACKGROUND: Thumb duplication, also called radial or preaxial polydactyly, is classified as an alteration of the radio-ulnar axis in the formation and differentiation of the hand plate, according to the Oberg, Manske and Tonkin classification. OBJECTIVE: Radial polydactyly is a common upper limb malformation. This paper is a comprehensive analysis of radial polydactyly, its genetic explanation, classification, surgical techniques, functional results, as well as present and future scientific evidence on this congenital pathology. CONCLUSIONS: Radial polydactyly occurs most frequently as an isolated defect, but it may also occur in association with other abnormalities, or as part of a syndrome. The Wassel classification is the universal classification for thumb duplication. One of the limitations of it is the misclassification of the immature epiphysis. The Wassel classification not only refers to the pathoanatomy of the polydactyly but also guides the selection of various surgical techniques. Three well-defined surgical objectives should be ensured: thumb alignment, stability, and an acceptable final esthetic appearance. Tada score is a validated functional scale that takes into account the most common and limiting complications, namely clinodactyly and instability. Based on some recent strong research evidence, the JSSH assessment system provides the most reliable outcome of scores. More studies are required to provide evidence-based conclusions regarding the treatment of radial polydactyly.

Validación del cuestionario FACT-B+4-MS y exploración de su capacidad predictora en mujeres intervenidas de cáncer de mama / Validation of the FACT-B+4-UL questionnaire and exploration of its predictive value in women submitted to surgery for breast cancer

Introducción y objetivo: La detección precoz de las complicaciones del miembro superior en mujeres intervenidas de cáncer de mama es importante. El cuestionario FACT-B+4-MS, variante del Functional Assessment of Cancer Therapy-Breast (FACT-B) es una escala específica de la función del miembro superior en estas pacientes. Pacientes y métodos: Se valida el FACT-B+4-MS en una cohorte prospectiva de 201 mujeres intervenidas por cáncer de mama (análisis factorial, consistencia interna, fiabilidad test-retest, validez del constructo y sensibilidad al cambio) y se explora mediante regresión logística su capacidad predictora de linfedema y otras complicaciones. Resultados: El FACT-B+4-MS es unifactorial y goza de gran consistencia interna (alfa de Cronbach: 0,87), alta fiabilidad test-retest (coeficiente de correlación intraclase: 0,98), validez de constructo (R de Pearson con el 'Quick DASH': 0,81) y sensibilidad al cambio. En los modelos de regresión, no aparece como variable explicatoria de linfedema, pero sí de otras complicaciones del miembro superior. Conclusiones: El FACT-B+4-MS es útil para medir la discapacidad del miembro superior en mujeres operadas por cáncer de mama. No predice el establecimiento de linfedema, pero sí, aunque débilmente, otras alteraciones (AU)

Introduction and objective: The early detection of upper limb complications is important in women operated on for breast cancer. The 'FACT-B+4-UL' questionnaire, a specific variant of the Functional Assessment of Cancer Therapy-Breast (FACT-B) is available among others to measure the upper limb function. Patients and methods: The Spanish version of the upper limb subscale of the FACT-B+4 was validated in a prospective cohort of 201 women operated on for breast cancer (factor analysis, internal consistency, test-retest reliability, construct validity and sensitivity to change were determined). Its predictive capacity of subsequent lymphoedema and other complications in the upper limb was explored using logistic regression. Results: This subscale is unifactorial and has a great internal consistency (Cronbach's alpha: 0.87), its test-retest reliability and construct validity are strong (intraclass correlation coefficient: 0.986; Pearson's R with 'Quick DASH': 0.81) as is its sensitivity to change. It didn’t predict the onset of lymphedema. Its predictive capacity for other upper limb complications is low. Conclusions: FACT-B+4-UL is useful in measuring upper limb disability in women surgically treated for breast cancer; but it does not predict the onset of lymphoedema and its predictive capacity for others complications in the upper limb is low (AU)

Validation of the FACT-B+4-UL questionnaire and exploration of its predictive value in women submitted to surgery for breast cancer. / Validación del cuestionario FACT-B+4-MS y exploración de su capacidad predictora en mujeres intervenidas de cáncer de mama.

INTRODUCTION AND OBJETIVE: The early detection of upper limb complications is important in women operated on for breast cancer. The "FACT-B+4-UL" questionnaire, a specific variant of the Functional Assessment of Cancer Therapy-Breast (FACT-B) is available among others to measure the upper limb function. PATIENTS AND METHODS: The Spanish version of the upper limb subscale of the FACT-B+4 was validated in a prospective cohort of 201 women operated on for breast cancer (factor analysis, internal consistency, test-retest reliability, construct validity and sensitivity to change were determined). Its predictive capacity of subsequent lymphoedema and other complications in the upper limb was explored using logistic regression. RESULTS: This subscale is unifactorial and has a great internal consistency (Cronbach's alpha: 0.87), its test-retest reliability and construct validity are strong (intraclass correlation coefficient: 0.986; Pearson's R with "Quick DASH": 0.81) as is its sensitivity to change. It didn't predict the onset of lymphedema. Its predictive capacity for other upper limb complications is low. CONCLUSIONS: FACT-B+4-UL is useful in measuring upper limb disability in women surgically treated for breast cancer; but it does not predict the onset of lymphoedema and its predictive capacity for others complications in the upper limb is low.

Surgical Techniques for Displaced Radial Neck Fractures: Predictive Factors of Functional Results.

BACKGROUND: Fractures of the radial neck represent about 1% of all childhood fractures and 5% to 10% of childhood traumatic lesions involving the elbow. Management of these fractures in children is still controversial. Intramedullary percutaneous nail reduction (Métaizeau technique) is considered the most effective surgical technique because of its excellent results and easy learning curve. Complications may arise, however, especially in Böhler technique, in which a percutaneous pin is placed over the radial head. When this technique does not provide correct reduction, open reduction must be performed. Because open reduction is traditionally associated with a high risk of complications, however, its use is restricted to severely displaced fractures and only when the percutaneous techniques have failed or their application contraindicated because of associated injuries to the distal radius. METHODS: In this retrospective study, we evaluated 51 children between the ages of 6 and 15 years who presented to our institution from 1996 to 2012 with Métaizeau-modified Judet grades 3, 4a, and 4b radial head fractures. The surgical techniques used were closed reduction and casting under general anesthesia (n=7), closed reduction and intramedullary nailing using Métaizeau technique (n=27), and Métaizeau technique and open reduction with intramedullary nailing (n=17). Functional results of the 3 surgical techniques were evaluated using the Mayo Elbow Performance Score (MEPS) and compared by modified Judet classification using χ analysis. RESULTS: No statistic significant association was found between type of surgery and final MEPS was observed (P=0.110). However, a significant association was found between initial modified Judet grade and final MEPS. CONCLUSIONS: In the present study, final functional outcome seems to be not affected by open reduction but was significantly associated with initial modified Judet grade. LEVEL OF EVIDENCE: Level III-retrospective study comparing closed and open reduction techniques, performed at the same institution.

A Cross-Sectional Study of Human Papillomavirus Vaccine Utilization Among University Women: The Role of Ethnicity, Race, and Risk Factors.

OBJECTIVE: We estimated the prevalence of human papillomavirus (HPV) vaccination by ethnicity and race and compared vaccination use by known risk factors. MATERIALS AND METHODS: We applied a cross-sectional design using an anonymous, online survey distributed in 2011 to female undergraduates (n = 284) between the ages of 18 and 26 years. The study was approved by the University of Arizona Institutional Review Board. RESULTS: Overall, 55% of women reported receiving the HPV vaccine. Within racial and ethnic groups, HPV vaccination was highest among American Indian/Alaska Native women with 71%, followed by Hispanic women with 68%, black/African American women with 58%, white women with 51%, and Asian/Pacific Island women with 31%. Moreover, Hispanic women were twice as likely to be vaccinated compared with white women (OR = 2.08; 95% CI = 1.14-3.78). Among unvaccinated women, 55% had discussed HPV with a provider and 56% had reported no concerns about the vaccine and/or had high levels of HPV knowledge. CONCLUSIONS: Human papillomavirus vaccine is highly acceptable among college women, particularly among Hispanic women. Efforts to vaccinate should include time of college enrollment. Such efforts are critical for the large scale prevention of cervical cancer and its precursor lesions and ultimately for preventable cervical cancer mortality.

Microwave diathermy for treating nonspecific chronic neck pain: a randomized controlled trial.

BACKGROUND CONTEXT: Although the use of deep heat therapy is widespread, there is scant literature available on its effectiveness in treating back or neck pain. PURPOSE: The purpose of this study was to determine the efficacy of microwave diathermy to treat nonspecific chronic neck pain. DESIGN: The study was designed as a double-blind, randomized controlled trial. PATIENT SAMPLE: The patient sample consisted of 149 patients with nonspecific chronic neck pain in a hospital of the Andalusian Public Health Care System, Spain OUTCOME MEASURES: The study outcome measures are as follows: at baseline, pain intensity (using a visual analogue scale), disability (Neck Disability Index), and health-related quality of life (36-item short form health survey [SF-36]); at 3 weeks, baseline measures and patients' perceived overall outcome and satisfaction with the treatment; and at 6 months, 3-week measures, therapeutic co-interventions, and adherence to exercises. METHODS: Patients were allocated randomly to three groups. The first group received continuous microwave diathermy, the second group was administered pulsed microwaves, and the third group (the control group) received unplugged microwaves. All three groups received the same general treatment: range of motion, isometric exercises, and transcutaneous electrical nerve stimulation. RESULTS: The three groups had reduced pain and disability, and improvement was seen in some dimensions of the SF-36. However, there were no differences found in any of the parameters measured among the three therapeutic groups. CONCLUSIONS: Microwave diathermy does not provide additional benefit to a treatment regimen of chronic neck pain that already involves other treatment approaches.

Prognostic value of age and Wassel classification in the reconstruction of thumb duplication.

BACKGROUND: Various surgical techniques for thumb duplication have been described. The main goal in thumb reconstruction is to achieve optimal function, stability, and shape. Few publications have quantified the functional results of each surgical option and factors that may affect these outcomes. METHODS: We performed a retrospective review during the period from 1990 to 2011 of 115 surgery patients, 99 of whom had a mean postoperative follow-up of 44.1 months. They were classified according to the Wassel classification. We assessed the surgical technique, functional results, and complications, and evaluated the probable prognostic value of age and Wassel classification. RESULTS: This case series comprised mainly female patients (62 %) and the right hand (74 %), with a mean age at operation of 20 months. The most common group was Wassel type IV (54 %). On the basis of the Tada scoring system, we obtained 91 good results (91 %). Complications occurred in 27 patients (27 %), mainly instability and axis deformation. In a comparison of preoperative factors (age at the time of surgery and Wassel classification) with the final results (Tada score and complications), the association between older age at surgery and complications (p = 0.0001) and Wassel types III and IV and complications (p = 0.0210 and p = 0.0095) was statistically significant. CONCLUSIONS: Following the basic concepts of anatomical reconstruction, we obtained good results in most patients. The main complications were instability and axial deformity. These were most common in patients who underwent operations at an age of more than 12 months, and patients with Wassel types III and IV deformities.

[Opiate dependence type II or antisocial: Cloninger's Psychobiological Model and its usefullness in addictions]. / Dependencia de Opiáceos tipo II o antisocial: utilidad del Modelo Psicobiológico de Cloninger en adicciones.

The aim was to analyze the relationship between Cloninger's dimensions and Personality Disorders (PD) (with DSM-IV criteria) in opiate dependents. The study was Cross-sectional. The sampling of 196 patients with opiate dependence was consecutive. All were receiving treatment in an inpatient detoxification unit. Cloninger's Temperament and Character Inventory (TCI), International Personality Disorders Examination (IPDE) and a Substance Use Questionnaire were used. Character's dimensions as Self-directness and Cooperation were related with PD when scored low. Opposite to Cloninger descriptions, high scores of Self-transcendence were related with presence of PD. Related to temperamental dimensions, cluster A was related with low scores of Reward Dependence (RD) and cluster C with high scores of Harm Avoidance (HA). Otherwise, in cluster B, while Borderline PD had high scores of Novelty Seeking (as high HA), the Antisocial PD only were related to low scores of RD. RD dimension seems useful to differ from presence or absence of Antisocial PD, also when alcohol consumption is considered. Cloninger's Model of Personality is useful in drug dependents for the definition of the different PD, as well as for probable PD's aggregation. This model also helps to create subtypes in opiate dependents as the antisocial or type II.

Dependencia de Opiáceos tipo II o antisocial: utilidad del Modelo Psicobiológico de Cloninger en adicciones / Opiate Dependence Type II or antisocial: Cloninger’s Psychobiological Model and its usefullness in addictions

El objetivo es relacionar las dimensiones del modelo de Cloninger y los trastornos de personalidad (TP) según criterios DSM-IV en dependientes de opiáceos. Para ello se realizó un estudio transversal, por muestreo consecutivo, en 196 dependientes de opiáceos ingresados en una Unidad de Desintoxicación Hospitalaria. Se usaron un cuestionario de consumo de sustancias, el inventario de temperamento y carácter de Cloninger (Temperament and Character Inventory, TCI) y la entrevista diagnóstica internacional de los trastornos de la personalidad (International Personality Disorders Examination, IPDE). Los resultados mostraron que puntuaciones bajas en las dimensiones caracteriales auto-dirección y cooperación se asocian con la presencia de TP. Al contrario de lo descrito por Cloninger, puntuaciones altas en la dimensión caracterial autotrascendencia se relacionan significativamente con la presencia de TP. Respecto a las dimensiones temperamentales, el clúster A se relaciona con baja dependencia del refuerzo (DR) y el clúster C con alta evitación del daño (ED). No obstante, en el clúster B, si bien el trastorno límite de la personalidad presenta alta Búsqueda de Novedad (además de alta ED), el trastorno antisocial de la personalidad (TAP) sólo se relaciona con bajas puntuaciones en DR. DR diferencia entre la ausencia o presencia de TAP, incluso considerando la influencia de la dependencia de alcohol. Por todo ello, el modelo de personalidad de Cloninger es útil para definirlos diferentes TP en población drogodependiente, permitiendo agrupar el diagnóstico probable de TP, así como para crear subtipos como el antisocial o tipo II en dependientes de opiáceos(AU)

The aim was to analyze the relationship between Cloninger’s dimensions and Personality Disorders (PD) (with DSM-IV criteria) in opiate dependents. The study was Cross-sectional. The sampling of 196 patients with opiate dependence was consecutive. All were receiving treatment in an inpatient detoxification unit. Cloninger’s Temperament and Character Inventory (TCI), International Personality Disorders Examination (IPDE)and a Substance Use Questionnaire were used. Character’s dimensions as Self-directness and Cooperation were related with PD when scored low. Opposite to Cloninger descriptions, high scores of Self-transcendence were related with presence of PD. Related to temperamental dimensions, cluster A was related with low scores of Reward Dependence (RD) and cluster C with high scores of Harm Avoidance (HA). Otherwise, in cluster B, while Borderline PD had high scores of Novelty Seeking (as high HA), the Antisocial PD only were related to low scores of RD. RD dimension seems useful to differ from presence or absence of Antisocial PD, also when alcohol consumption is considered. Cloninger’s Model of Personality is useful in drug dependents for the definition of the different PD, as well as for probable PD’s aggregation. This model also helps to create subtypes in opiate dependents as the antisocial or type II(AU)

Enfermedad de Chagas-Mazza: seroprevalencia, características epidemiológicas y sociales / Chagas-Mazza' disease: seroprevalence, epidemiological and social features / Doença de Chagas-Mazza: soroprevalência, características epidemiológicas e sociais

La enfermedad de Chagas-Mazza es una enfermedad parasitaria causada por un protozoo flagelado, el Trypanosoma cruzi. Es una patología característica de Hispanoamérica y en la actualidad habría en el mundo más de 20 millones de infectados. Los objetivos del trabajo fueron: determinar la seroprevalencia en los pacientes con solicitud de serología para enfermedad de Chagas-Mazza y evaluar la situación epidemiológica y social de la población afectada. El trabajo es de tipo prospectivo, observacional y comprende el período entre julio de 2006 y julio de 2008. Se emplearon como técnicas de diagnóstico sobre muestras de suero: Hemaglutinación indirecta (HAI Chagatest, Wiener lab), enzimoinmunoensayo (Chagatest ELISA v 3.0 Wiener lab), ¡nmunofluorescencia indirecta (IFI con reactivos propios, utilizando antígenos y controles del Instituto Nacional de Parasitología "Dr. Mario Fatala Chabén"). Se consideraron positivas aquellas muestras con las que se obtuvo un resultado positivo en dos de las tres técnicas. Con el fin de optimizar la recolección de datos epidemiológicos se utilizó una estrategia multidisciplinaria que involucró a los médicos que solicitaban el estudio, a la Sala de Epidemiología, al servicio de Asistencia social y al laboratorio. Se obtuvo una seroprevalencia de 11,4% en el período estudiado, con la siguiente distribución por país de nacimiento: 47,8% Argentina, 43,5% Bolivia, 8,3% Paraguay y 0,4% Chile. Es evidente la importancia de los fenómenos migratorios en la región, entendiendo que la enfermedad de Chagas-Mazza representa una forma de movilización social. El 60,4% de los pacientes seropositivos tenían necesidades básicas insatisfechas, sólo el 30% de los entrevistados tenían estudios primarios completos. En cuanto a la percepción de la patología, se observa la aceptación de la enfermedad en referencia a que la padecen sus padres, otros familiares o allegados.

The Chagas-Mazza' disease is a parasitic disease caused by a flagellate protozoan, Trypanosoma cruzi. It is a pathology characteristic of Latin America and currently have over 20 million people infected all over the world. The objectives of this study were: to state the prevalence in patients with Chagas-Mazza ' disease infection application and to evaluate the epidemiological and social situation of the affected population. The work is prospective, observational, and covers the period July 2006 to July 2008. Were used as diagnostic techniques on serum samples: Indirect Hemagglutination (IHA Chagatest, Wiener lab), enzyme immunoassay (ELISA Chagatest Wiener lab v 3.0), immunofluorescence (IFI with their own reagents, antigens and controls using the National Institute of Parasitology "Dr. Mario Fatala Chabén"). Those samples were considered positive with which a positive result was obtained in two of the three techniques. To optimize the collection of epidemiological data used a multidisciplinary approach, involving physicians who requested the study to the Board of epidemiology, social work service and laboratory. We obtained a seroprevalence of 11.4% over the period studied, with the following distribution by country of birth: 47.8% Argentina, 43.5% Bolivia, 8.3% Paraguay and 0.4% Chile. Highlights the importance of migratory phenomena in the region, understanding that Chagas-Mazza' disease is a form of social mobilization. In 60.4% have unmet basic needs, only 30% of respondents have completed primary education. Regarding the perception of pathology is observed acceptance of the disease in reference to that suffered by their parents, other family members or relatives.

A doença de Chagas-Mazza é uma doença parasitaria causada por um protozoário flagelado, o Trypanosoma cruzi. E uma patologia característica de Hispanoamérica e na atualidade existiriam no mundo mais de 20 milhóes de infectados. Os objetivos do trabalho foram: determinar a soroprevalência nos pacientes com pedido de sorologia para doença de Chagas-Mazza e avaliar a situaçâo epidemiológica e social da populaçâo afetada. O trabalho é de tipo prospectivo, observacional e compreende o período entre julho de 2006 e julho de 2008. Foram utilizadas como técnicas de diagnóstico sobre amostras de soro: Hemaglutinaçâo indireta (HAI Chagatest, Wiener lab), enzimaimunoensaio (Chagatest ELISA v 3.0 Wiener lab), imunofluorescência indireta (IFI com reagentes próprios, utilizando antígenos e controles do Instituto Nacional de Parasitologia "Dr. Mario Fatala Chabén"). Foram consideradas positivas aquelas amostras com as quais foi obtido um resultado positivo em duas das très técnicas. Visando a otimizar a coleta de dados epidemiológicos, foi utilizada uma estratégia multidisciplinar que envolveu os médicos que solicitavam o estudo, a Sala de Epidemiologia, o serviço de Assistência Social e o laboratório. Foi obtida uma soroprevalência de 11,4%, no período estudado, com a seguinte distribuiçâo por país de nascimento: 47,8% Argentina, 43,5% Bolivia, 8,3% Paraguai e 0,4% Chile. E evidente a importancia dos fenómenos migratórios na regiâo, entendendo que a doença de Chagas-Mazza representa uma forma de mobilizaçâo social. 60,4% dos pacientes soropositivos tinham necessidades básicas insatisfeitas, só 30% dos entrevistados tinham finalizado o Primerio Grau. Quanto à percepçâo da patologia, observase a aceitaçâo da doença em referência a que é padecida por seus pais, outros familiares ou conhecidos.

Discovery of novel quaternary ammonium derivatives of (3R)-quinuclidinyl carbamates as potent and long acting muscarinic antagonists.

Novel quaternary ammonium derivatives of N,N-disubstituted (3R)-quinuclidinyl carbamates have been identified as potent M(3) muscarinic antagonists with long duration of action in an in vivo model of bronchoconstriction. These compounds have also presented a high level of metabolic transformation (human liver microsomes). The synthesis, structure-activity relationships and biological evaluation of these compounds are reported.

Discovery of novel quaternary ammonium derivatives of (3R)-quinuclidinol esters as potent and long-acting muscarinic antagonists with potential for minimal systemic exposure after inhaled administration: identification of (3R)-3-{[hydroxy(di-2-thienyl)acetyl]oxy}-1-(3-phenoxypropyl)-1-azoniabicyclo[2.2.2]octane bromide (aclidinium bromide).

The objective of this work was to discover a novel, long-acting muscarinic M(3) antagonist for the inhaled treatment of chronic obstructive pulmonary disease (COPD), with a potentially improved risk-benefit profile compared with current antimuscarinic agents. A series of novel quaternary ammonium derivatives of (3R)-quinuclidinol esters were synthesized and evaluated. On the basis of its overall profile, (3R)-3-{[hydroxy(di-2-thienyl)acetyl]oxy}-1-(3-phenoxypropyl)-1-azoniabicyclo[2.2.2]octane bromide (aclidinium bromide) emerged as a candidate for once-daily maintenance treatment of COPD. This compound is a potent muscarinic antagonist, with long duration of action in vivo, and was found to have a rapid hydrolysis in human plasma, minimizing the potential to induce class-related systemic side effects. Aclidinium bromide is currently in phase III development for maintenance treatment of patients with COPD.

Understanding barriers to cervical cancer screening among Hispanic women.

OBJECTIVE: We investigated issues affecting Papanicolaou smear screening access, health services utilization, acculturation, social networking, and media venues most conducive to acquiring health information among Hispanics. STUDY DESIGN: Self-identified Hispanics were surveyed. Participants were stratified based on age, time living in the United States, and Papanicolaou screening frequency. RESULTS: Of 318 participants, Hispanics aged 30 years or older and living in the United States less than 5 years prefer speaking Spanish. Women with 5 or more lifetime Papanicolaou smears were 1.610 times more likely to have lived in the United States 5 or more years, 1.706 times more likely to speak a second language, and 1.712 times less likely to need a translator during their health care encounter. CONCLUSION: Age and years living in the United States may be independent risk factors for participation in Papanicolaou screening programs. Social difficulties inherent to acculturation inform health behavior and translate to health disparity among Hispanics. Our results may help design federally funded and community-level programs.

Validation of a procedure for the gas chromatography-mass spectrometry analysis of cocaine and metabolites in pericardial fluid.

A method is described for the simultaneous quantification of cocaine, benzoylecgonine, and cocaethylene in pericardial fluid. Pericardial fluid samples from autopsy casework involving cocaine-related deaths and deaths unrelated to drug abuse were collected. The extraction of cocaine and its metabolites was performed using Bond-Elut Certify columns. Pericardial fluid samples were adjusted to pH 7 and applied to the pre-conditioned cartridges. After the washing steps, compounds were eluted with a mixture of chloroform/isopropanol (80:20) with 2% ammonium hydroxide. The dry extracts were derivatized with pentafluoropropionic anhydride and hexafluoroisopropanol and analyzed by gas chromatography-mass spectrometry using electron impact ionization and selective ion monitoring acquisition. Deuterated internal standards were used. The analytical method developed was linear, sensitive, selective, accurate, and sufficiently precise to be applied routinely in forensic toxicology. In this study, the procedure has been successfully applied to a number of forensic cases involving cocaine intoxication.

Application of pericardial fluid to the analysis of morphine (heroin) and cocaine in forensic toxicology.

In this study opiates (morphine and codeine) and cocaine and its related metabolites (benzoylecgonine and cocaethylene) were analyzed in pericardial fluid by GC/MS. This is the first study reporting levels of drugs of abuse in this body fluid. The analytical method used has been previously validated and then applied to 54 drug-related deaths in the Barcelona area (Spain). Median levels were as follows: morphine 589ng/ml, range 19-8857 (n=49); codeine 26ng/ml, range 15-343 (n=35); cocaine 78ng/ml, range 10-220 (n=14), benzoylecgonine 742ng/ml, range 20-3386 (n=15), and cocaethylene 36ng/ml, range 9-100 (n=13). In addition, a comparative study of the concentration of opiates and cocaine in pericardial fluid by both semi-quantitative EMIT d.a.u. and GC/MS (used as reference) was performed. Fairly good correlations for opiates (r=0.905) and cocaine (r=0.859) were found; however, the consistently low results of EMIT in the analysis of cocaine comparing to GC/MS could be caused by matrix effect. In spite of that, it raises the possibility of using the immunoassay as a preliminary technique in forensic toxicology.