Modification of the lipidic and coagulative pattern in postmenopause women: effect of hormone replacement therapy.

AIM: We evaluated the changes of lipidic and coagulative pattern during menopause and the influence of hormone replacement therapy (HRT) on these parameters. METHODS: We considered 158 patients divided into 2 groups: Group I consisted of 127 women in physiological/surgical menopause and Group II of 31 women with childbearing potential. Subsequently, we considered a group III formed of 34 patients from menopausal women (group I) who underwent three months of HRT. We evaluated total-cholesterol (TC), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), triglycerides (TG), lipoprotein (a) (Lpa), fibrinogen, antithrombin III (ATIII), factor VII (FVII) and tissue factor pathway inhibitor (TFPI). RESULTS: We found a worse lipid profile in the post-menopausal group compared to controls (TC 243.8+/-29.7 vs 217.9+/-32.7 mg%, P=0.002; TG 121.5+/-68.4 vs 88.6+/-53.0 mg%, P=0.039; LDL-C 163.0+/-27.9 vs 136.2+/-29.6 mg%, P=0.004; HDL-C 60.9+/-14.9 vs 64.1+/-14.6 mg%, P=ns). With regard to the coagulative pattern, fibrinogen was significantly higher in the post-menopausal group (fibrinogen: 273.3+/-67.4 vs 243.8+/-39.5 mg%, P=0.013; ATIII 112.2+/-11.7 vs 117.5+/-12.7% %, P=0.059; FVII 121.6+/-11.3 vs 117.6+/-10.8 mg%, P=ns; TFPI activity 2.5+/-2.3 vs 2.1+/-1.1 U/mL, P=ns; TFPI antigen 120+/-38 vs 127+/-39 U/mL, P=ns). Comparing the same parameters, before and after three months of HRT, in patients of Group III we observed a significant improvement of TC and TG levels (TC from 232.3+/-42.7 to 215.2+/-37.6 mg%, P=0.0001; TG from 103.7+/-56.8 to 95.0+/-44.3 mg%, P=0.059; HDL-C from 62.3+/-12.9 to 63.6+/-12.6 mg%, P=ns; LDL-C from 149.3+/-38.7 to 132.6+/-34.5 mg%, P=0.0001). The following changes were observed with regard to coagulative parameters: fibrinogen from 270.9+/-69.4 to 253.2+/-56.2 mg%, P=0.07; ATIII from 113.5+/-11.4 to 110.8+/-13.2 mg%, P=0.198; FVII from 108.6+/-18.0 to 104.4+/-17.5 mg%, 0.014. TFPI activity from 2.6+/-2.3 to 2.3+/-1.4 U/ml, P=ns; TFPI antigen from 68+/-13 to 87+/-22 U/mL, P=0.001. CONCLUSION: Our data confirm the presence of an alteration in lipidic and coagulative pattern in post menopausal women and positive changes after HRT.

Pediatric Milliman and Robertson length-of-stay criteria: are they realistic?

OBJECTIVE: Guidelines for inpatient length of stay (LOS) have been developed by several groups; among the most widely applied are those published by Milliman and Robertson (M&R). Few published reports have examined the relationship of actual practice to such guidelines, none in pediatric populations. This study was designed to compare pediatric practice in a large and defined population to M&R LOS criteria. METHODS: Administrative data from New York State in 1995 were used to examine LOS for discharges corresponding to 16 selected pediatric diagnoses for which M&R publishes guidelines. Outliers, defined as the 2% of discharges with the longest LOS, were eliminated. The distribution of LOS for each diagnosis was compared with M&R LOS guidelines. RESULTS: In New York State during 1995, pediatric LOS was markedly divergent from M&R guidelines. In general, the percentage of discharges in excess of the criterion LOS was less for nonmandatory admissions (croup: 23%, gastroenteritis: 44%, and pneumonia: 48%) than for those requiring surgery (uncomplicated appendectomy: 67%, pyloromyotomy: 62%, and major but noncritical burns: 64%) or prolonged treatment with antibiotics (bacterial meningitis: 91% and osteomyelitis: 86%). CONCLUSIONS: In New York State during 1995, LOS for selected pediatric conditions was generally in excess of published M&R guidelines. This raises concern about the potential effects of such guidelines on both patients and the hospitals caring for them. While endorsing the need for cost-effective practice, we call attention to the methods used to develop and validate guidelines.length of stay, pediatrics, managed health care, administrative data, practice guidelines.

Aeromonas hydrophila and its relation with drinking water indicators of microbiological quality in Argentine.

In Argentine, water municipal supplies disinfection is carried out by chlorine. We have isolated Aeromonas hydrophila from a chlorinated water supply in Buenos Aires that fulfilled Argentinean microbiological quality standards. It is an aquatic organism that could produce cytotoxins and enterotoxins associated with acute gastroenteritis and wound infections in human and hemorrhagic septicaemia of fish, reptiles and amphibians. The isolated strain produced protein bands at isoelectric point in the range of 4.6-5.3 lightly labile at 56 degrees C and heat labile at 100 degrees C non cholera antitoxin reactive in electrofocusing assay (IEF) and showed hemolytic activity thermolabile at 56 degrees C and 100 degrees C in 5% rabbit erythrocytes in phosphate buffered saline. A cytotoxic effect thermolabile at 56 degrees C and 100 degrees C and a cytotonic activity were demonstrated in Vero cell cultures. Survival assay of A. hydrophila and indicator organisms would show no correlation between their contamination sources. Biofilms production could explain the persistence of this gram negative pathogen organism in chlorinated tap water. A water system supply maintenance program and pasteurisation may be performed in spite of water chlorination.

Fathering pregnancies: marking health-risk behaviors in urban adolescents.

PURPOSE: To establish self-reported rates and associated correlates of fathering pregnancies in urban teen males, and to explore the possibility of using their pregnancy history as a marker for other health-risk behaviors. METHODS: A blinded, self-administered questionnaire was given to the predominantly African-American patients of an inner-city adolescent outpatient clinic. Urine was also collected in a blinded, anonymous fashion, matched to the questionnaires, and tested for five drugs of abuse. Males were classified as having or not having a pregnancy history (PH) according to a questionnaire response item. PH and non-PH participants were compared for eight risk factors using univariate and multivariate methods. RESULTS: A total of 24.2% reported a PH. These males were about 14 times more likely to report three or more sex partners in the last year, more than five times as likely to report a sexually transmitted disease history, more than three times as likely to test positive for drugs, and more than 2.5 times as likely to be inconsistent or nonusers of condoms as compared to males without a pregnancy history. An association between violent behavior and PH is unsupported. CONCLUSIONS: Pregnancy history can be a valuable marker for other risk factors among inner-city African-American males. With some patients, it may be easier for clinicians to discuss pregnancy history or fatherhood as opposed to drug abuse and other more sensitive risk factors. The topic can then be used as a gateway for discussion of other risk factors.

PIP: Findings are presented from a study conducted to establish self-reported rates and associated correlates of fathering pregnancies among urban male teenagers, and to explore the possibility of using their pregnancy history (PH) as a marker for other health risk behaviors. A blinded, self-administered questionnaire was given to a convenience sample of 399 young, nonvirgin men aged 12-19 years old, of mean age 16.3, recruited from April 1994 through March 1996 at an inner-city adolescent outpatient clinic. 93.8% of the subjects were African-American and 24.2% reported causing a PH. A urine sample was collected from 73.5% of the study participants and tested for 5 drugs of abuse. 27.7% of these men had traces of drugs in their urine, of whom more than 97% were positive for cannabinoids. Compared to the young men with no pregnancy history, those with a PH were 13.8 times more likely to report 3 or more lifetime sex partners, 5.4 times more likely to report a history of STDs, 3.1 times more likely to test positive for consuming drugs, and more 2.7 times more likely to be inconsistent or nonusers of condoms. No support was found for an association between violent behavior and PH.

[Streptokinase: correlation between different methods of biological evaluation]. / Estreptoquinasa: correlación entre diferentes métodos de valoración biológica.

A study was carried out to establish an appropriate method for streptokinase (SK) potency determination (biological assay) in order to fulfil the main function of the Instituto Nacional de Medicamentos respecting products marketed in Argentina. The potency of different commercial samples of SK was determined against the International Standard, and three internationally accepted methods were used for this purpose: fibrin plate, clot lysis and chromogenic method. The analysis of results suggests that the fibrin plate method is the least precise and reproducible. The clot lysis and chromogenic methods demonstrated great precision and reproducibility, giving a correlation coefficient of 0.99. It is concluded that both of these methods are best suited to determine potency of SK commercial products.

Increased drug use among old-for-grade and dropout urban adolescents.

INTRODUCTION: In tracking the epidemic of drug use in our communities, much emphasis has been placed on identifying predictive variables. In this study, we examine the relationship between drug use and school progress among a sample of inner-city adolescents. METHODS: A blinded, anonymous questionnaire covering a variety of health risk behaviors was administered to 1,720 adolescent patients who visited our outpatient clinic. Participants were classified as age-appropriate for last school grade completed, older than normal for grade, or as a dropout. A urine specimen was also collected in a blinded, anonymous fashion from each participant, and tested for five common substances of abuse. RESULTS: Nearly 12% of participants tested positive for drugs. Participants who were old for grade were over 40% more likely to be positive for drugs than grade-appropriate respondents, while school dropouts were more than twice as likely to test positive. CONCLUSIONS: These results demonstrate that being old-for-grade (OFG) and being a dropout in our population are markers for being at higher risk of substance abuse.

The changing pattern of substance abuse in urban adolescents.

OBJECTIVES: To determine the prevalence of specific drug use in adolescents attending an adolescent health clinic and to compare current rates with a similar previous study. DESIGN: Blinded and anonymous urine samples obtained from patients presenting for routine health care were tested for the presence of cannabinoids, phencyclidine (PCP), amphetamines, opiates, and cocaine. SETTING: Adolescent medicine outpatient clinic. PATIENTS: Patients were between 12 and 21 years of age. Specimens from 1313 patients in 1995 to 1996 and 1312 patients in 1989 to 1990 were tested. MAIN OUTCOME MEASURES: Current drug use rates were compared with a similar screening of patients conducted in 1989 to 1990. Comparisons between studies were made on the basis of specific drug, age, and sex. RESULTS: For the most recent patient group, 14% were positive for 1 or more drugs and 13% were positive for cannabinoids. Males were significantly more likely to test positive for drug use than females. The oldest adolescents were more likely to test positive for drug use than younger adolescents. Comparing the 2 study year cohorts, patients tested recently were significantly more likely to have urine tests positive for at least 1 drug and cannabinoids in particular and less likely to have urine tests positive for cocaine. CONCLUSIONS: There has been an increase in positive urine tests in patients seen in our ambulatory clinic, with a strong shift toward cannabinoids and a shift away from cocaine. Practitioners need to be aware that drug use patterns in adolescents can shift relatively abruptly and counseling should be targeted to current drug use patterns.

Tooth crown size differences between age groups: a possible new indicator of stress in skeletal samples.

Juveniles and adults from a prehistoric Amerindian skeletal series from Tennessee are compared for differences in the means and variances of the buccolingual dimensions of their permanent teeth. While there are no significant differences in variance, it is found that juveniles exhibit significantly smaller mandibular canines, first premolars, and first molars. The results are similar to those of a previous examination of an Amerindian skeletal collection from South Dakota. There is evidence to suggest that teeth may fail to develop to their maximum genetic size potential when there is interference from exogenous chronic stressors such as malnutrition or disease. Archaeological and biological evidence demonstrates that both the Tennessee and South Dakota series represent groups that suffered considerably from environmental stressors. It is suggested that those persons who suffered most were more likely to die prematurely, thus explaining why juvenile skeletons tend to have smaller teeth. The conclusion is that the examination of age variation in crown size can be a useful supplement to other osteological indicators of stress in skeletal collections. The factor of sex ratio and the implications of the results for other kinds of dental metric studies are discussed.