Histopathological Review of Childhood and Adolescent Cancers in Northern Ghana.

BACKGROUND: Published data on childhood and adolescent cancers in northern Ghana is scanty. The aim of this retrospective histopathological study was to identify and describe the relative proportions of childhood and adolescent cancers and the associated clinico-pathological features at the Tamale Teaching Hospital. MATERIALS AND METHODS: The cancers were classified according to the International Classification for Cancer in Children. Data was collected on the demographics and the clinico-pathological characteristics of the various types of cancers, from 1st January 2012 to 31st December, 2021, a 10-year period. The data was analysed using SPSS software (Version 26, Chicago). RESULTS: A total of 196 childhood and adolescent cancers were reviewed, with a mean age of 9.5± 5.5 years. Approximately, 51.5% were female, with a younger mean age (years) of 8.4±5.3, compared to 10.6±5.6 for males. Majority (74.0%), were within the 0-14 years age group, (P<0.0001). All the patients presented with swellings and mostly after 6 months of disease onset. The common cancers for the study population were: soft tissue sarcoma (24.2%), primary bone cancer (21.1%), retinoblastoma (17.5%), lymphoma (13.3%), and germ cell tumours (6.7%). For females these were: soft tissue sarcoma (21.0%), retinoblastoma (20.0%), primary bone cancer (19.0%), nephroblastoma (13.0%), and ovarian tumours (12.0%). For males, these were: soft tissue sarcoma (27.7%), bone cancer (23.4%), lymphoma (19.1%), retinoblastoma (14.9%) and head and neck cancer (6.4%). The common soft tissue cancers were: rhabdomyosarcoma (46.8%), and spindle cell sarcoma (NOS) (17.0%). Osteosarcoma (70.7%), and Ewing's sarcoma 6 (14.6%) were the common primary bone cancers. Many (46.4%) of the retinoblastomas were of a high pathological TNM stage III. The optic nerve was involved in 70.6%, with 26.5% margin involvements. CONCLUSION: Childhood and adolescent cancers were common in pediatric age group with late stage at presentation. The common histological subtypes were: soft tissue sarcoma, primary bone cancer and retinoblastoma. There is the need for detection, diagnosis, and prompt oncology care.

CONTEXTE: Les données publiées sur les cancers de l'enfant et de l'adolescent dans le nord du Ghana sont rares. Le but de cette étude histopathologique rétrospective était d'identifier et de décrire les proportions relatives des cancers de l'enfant et de l'adolescent et les caractéristiques clinico-pathologiques associées à l'hôpital universitaire de Tamale. MATÉRIEL ET MÉTHODES: Les cancers ont été classés selon la Classification internationale du cancer chez l'enfant. Des données ont été recueillies sur les caractéristiques démographiques et clinicopathologiques des différents types de cancers. Les données ont été analysées à l'aide du logiciel SPSS (version 26, Chicago). RÉSULTATS: Un total de 196 cancers d'enfants et d'adolescents ont été examinés, avec un âge moyen de 9,5± 5,5 ans. Environ 51,5 % étaient des femmes, avec un âge moyen plus jeune (ans) de 8,4±5,3, contre 10,6±5,6 pour les hommes. La majorité des patients (74,0 %) étaient âgés de 0 à 14 ans (P<0,0001). Tous les patients présentaient des gonflements, le plus souvent après 6 mois d'apparition de la maladie. Les cancers les plus fréquents dans la population étudiée étaient les suivants : sarcome des tissus mous (24,2%), cancer osseux primaire (21,1%), rétinoblastome (17,5%), lymphome (13,3%) et tumeurs germinales (6,7%). Pour les femmes, il s'agissait de sarcomes des tissus mous (21,0 %), de rétinoblastomes (20,0 %), de cancers osseux primaires (19,0 %), de néphroblastomes (13,0 %) et de tumeurs ovariennes (12,0 %). Chez les hommes, il s'agissait de : sarcome des tissus mous (27,7%), cancer des os (23,4%), lymphome (19,1%), rétinoblastome (14,9%) et cancer de la tête et du cou (6,4%). Les cancers des tissus mous les plus fréquents étaient : le rhabdomyosarcome (46,8%) et le sarcome à cellules fusiformes (NOS) (17,0%). Les cancers osseux primaires les plus fréquents étaient l'ostéosarcome (70,7 %) et le sarcome d'Ewing (14,6 %). Un grand nombre (46,4 %) des rétinoblastomes étaient d'un stade pathologique élevé (TNM III). Le nerf optique était impliqué dans 70,6 % des cas, avec 26,5 % d'implication des marges. CONCLUSION: Les cancers de l'enfant et de l'adolescent étaient fréquents dans le groupe d'âge pédiatrique avec un stade tardif à la présentation. Les sous-types histologiques les plus fréquents étaient : le sarcome des tissus mous, le cancer primaire des os et le rétinoblastome. Il est nécessaire de détecter, de diagnostiquer et de fournir des soins oncologiques rapides. Mots clés: Enfance, Adolescence, Cancer, Ghana du Nord.

The Prognostic Significance of the Size of Primary Malignant Breast Tumour in Ghanaian Women: A Retrospective Histopathological Review (2001-2014) in the Department of Pathology, Korle-Bu Teaching Hospital (KBTH).

BACKGROUND: Previous studies on breast cancer (BC) in Ghanaian women found the disease to be common in young women who present late with large palpable tumours. The aim of this study was to determine how the size of a primary malignant breast tumour influences the prognosis of BC in Ghanaian women. MATERIAL AND METHODS: A retrospective review of BCs diagnosed in mastectomy and wide local excision biopsy specimens with axillary clearance were conducted. Primary malignant breast tumours were categorised based on the size (cm) into: tumour d" 2.0cm (T1), tumour >2.0 d" 5.0 cm (T2) and tumour > 5.0 cm (T3). Data were analysed using SPSS version 23 (Chicago). Associations between tumour variables were determined by Spearman's correlation coefficient and Fisher's exact test (GraphPad prism version 5). RESULTS: The mean size of primary malignant breast tumours was large (5.8±3.8cm). Approximately half were T3 tumours. The mean ages of women diagnosed with T1, T2 and T3 tumours were: 51.5 ±2.0, 52.8±12.4 and 51.2 ±12.7 years, respectively. High grade BCs (II and III combined), involvement of 4 or more positive lymph nodes by malignant cells, high TNM stage and increased prevalence of positive malignant tumour margins were all significantly high in T3 tumours (P<0.0001) compared to T1 and T2 tumours. There were significant associations between T2 tumours and the histological subtype (p- = 0.011) and nodal involvement (p = 0.044) by malignant cells. Similarly, T3 tumours showed significant positive association with the histological subtype (p = 0.019) and nodal involvement (p = 0.018). CONCLUSION: The study found large primary tumour size (T3) to show significant positive association with the histological subtype and lymph nodes involvement by tumour. T3 tumours also showed increased prevalence of positive tumour margins.

CONTEXTE: Les études antérieures sur le cancer du sein (CS) chez les femmes ghanéennes ghanéennes, la maladie est fréquente chez les jeunes femmes qui se présentent tardivement avec de grosses tumeurs palpables.. Le but de cette étude était de déterminer l'influence de la taille d'une tumeur maligne primaire du sein sur le pronostic du cancer du sein au Ghana. MATÉRIEL ET MÉTHODES: Une revue rétrospective de cancer du sein diagnostiqués dans des spécimens de mastectomie et de biopsie d'excision locale large avec dégagement axillaire. Les tumeurs malignes primaires du sein Les tumeurs malignes primaires du sein ont été classées en fonction de leur taille (cm) en : tumeur d'" 2,0 cm (T1), tumeur >2,0 d" 5,0 cm (T2) et tumeur > 5,0 cm (T3). Les données ont été analysées en utilisant la version 23 du SPPS (Chicago). Les associations entre variables tumorales ont été déterminées par le coefficient de corrélation de Spearman et le test exact de Fisher (GraphPad prism version 5). RÉSULTATS: La taille moyenne des tumeurs malignes primaires du sein était grande (5,8±3,8cm). Environ la moitié étaient des tumeurs T3. L'âge moyen L'âge moyen des femmes diagnostiquées avec des tumeurs T1, T2 et T3 était de : 51.5±2,0, 52,8±12,4 et 51,2±12,7 ans, respectivement. Les cancer du sein de haut grade (II et III combinés), l'implication de 4 ganglions lymphatiques positifs ou plus par des cellules malignes, un stade TNM élevé et une prévalence accrue de marges tumorales malignes positives. et la prévalence accrue de marges tumorales malignes positives étaient toutes significativement élevées dans les tumeurs T3 (P<0,0001) par rapport aux tumeurs T1 et T2. Il existait Il y avait des associations significatives entre les tumeurs T2 et le sous-type histologique (p- = 0,0001). histologique (p- = 0,011) et l'atteinte ganglionnaire (p = 0,044) par les cellules malignes. cellules malignes. De même, les tumeurs T3 ont montré une association positive significative avec le sous-type histologique (p = 0,019) et la présence de ganglions (p = 0,018). CONCLUSION: L'étude a montré que la taille importante de la tumeur primaire (T3) à montrer une association positive significative avec le sous-type histologique et l'implication des ganglions lymphatiques par la tumeur. Les tumeurs T3 ont également montré prévalence accrue de marges tumorales positives. Mots clés: Taille de la tumeur primaire, variables tumorales, pronostic, femmes ghanéennes.

Surgical Healthcare Workers Knowledge and Attitude on Infection Prevention and Control: A Case of Tamale Teaching Hospital, Ghana.

BACKGROUND: Most morbidities and mortalities related to clinical, diagnostic, and therapeutic procedures are related to infection and the solution to this is good infection prevention and control (IPC) compliance which is influenced by the right knowledge and positive attitude. AIM: This study aimed to assess infection prevention and control (IPC) knowledge and attitude among healthcare workers at the surgical department of Tamale Teaching Hospital (TTH). METHODS: This study was conducted using a descriptive cross-sectional survey. Data entry and analysis were done using Statistical Package for the Social Sciences (SPSS) version 20 and Graph Pad Prism version 6.05. Tables, frequencies, and percentages were used for descriptive analysis and chi-square analysis for the associations. RESULTS: Of the 156 participants who responded, 22 (14.1%) were doctors, with 107 (68.6%) nurses, 12 (7.7%) certified registered anesthetics (CRA), and 15 (9.6%) orderlies. Approximately, 50.6% of the respondents were knowledgeable with regard to IPC and 55.1% of the respondents had a good attitude towards IPC. Factors associated with knowledge level were educational level (p ≤ 0.001), occupation (p ≤ 0.001), marital status (p=0.030), and age (p=0.030). The occupation was the only factor associated with the attitude level (p=0.048). CONCLUSION: More than half of the healthcare providers reported good knowledge and attitude towards IPC. Proportionally, more nurses had good IPC knowledge and attitude as compared to other professional groups. Firming up and assimilating universal precaution with routine services by providing training, protocol, rules, and regulation are recommended.

Case Report of Three Immature Cystic Teratomas in Northern Ghana.

BACKGROUND: Preoperative diagnosis of immature cystic teratoma can be challenging for clinicians. In this report, we present three cases. METHODS: We describe three women aged 10, 20, and 23 years, respectively, who presented with abdominal masses which were diagnosed by abdominal ultrasound as mature cystic teratomas. All women had emergency laparotomy and oophorectomy. RESULTS: Histopathological examination reported these ovarian tumours to be immature cystic teratomas. This case report also provided a brief summary of the clinicopathological features of all ovarian teratomas diagnosed in two centres during the period of review. CONCLUSION: Immature ovarian teratoma affects primarily younger patients; it is important for clinicians to have a high sense of suspicion whenever the diagnosis of a germ cell tumour is entertained.

A peptide mimic blocks the cross-reaction of anti-DNA antibodies with glomerular antigens.

Anti-DNA antibodies play a pivotal role in the pathogenesis of lupus nephritis by cross-reacting with renal antigens. Previously, we demonstrated that the binding affinity of anti-DNA antibodies to self-antigens is isotype-dependent. Furthermore, significant variability in renal pathogenicity was seen among a panel of anti-DNA isotypes [derived from a single murine immunoglobulin (Ig)G3 monoclonal antibody, PL9-11] that share identical variable regions. In this study, we sought to select peptide mimics that effectively inhibit the binding of all murine and human anti-DNA IgG isotypes to glomerular antigens. The PL9-11 panel of IgG anti-DNA antibodies (IgG1, IgG2a, IgG2b and IgG3) was used for screening a 12-mer phage display library. Binding affinity was determined by surface plasmon resonance. Enzyme-linked immunosorbent assay (ELISA), flow cytometry and glomerular binding assays were used for the assessment of peptide inhibition of antibody binding to nuclear and kidney antigens. We identified a 12 amino acid peptide (ALWPPNLHAWVP, or 'ALW') which binds to all PL9-11 IgG isotypes. Preincubation with the ALW peptide reduced the binding of the PL9-11 anti-DNA antibodies to DNA, laminin, mesangial cells and isolated glomeruli significantly. Furthermore, we confirmed the specificity of the amino acid sequence in the binding of ALW to anti-DNA antibodies by alanine scanning. Finally, ALW inhibited the binding of murine and human lupus sera to dsDNA and glomeruli significantly. In conclusion, by inhibiting the binding of polyclonal anti-DNA antibodies to autoantigens in vivo, the ALW peptide (or its derivatives) may potentially be a useful approach to block anti-DNA antibody binding to renal tissue.

Serum drug concentrations of INH and RMP predict 2-month sputum culture results in tuberculosis patients.

BACKGROUND: In Alberta provincial tuberculosis (TB) clinics, serum drug concentrations (SDCs) are measured in patients with human immunodeficiency virus, diabetes mellitus or at extremes of weight, or showing slow clinical response to treatment, to guide treatment. DESIGN: A retrospective review was performed of TB cases in Northern Alberta with SDCs measured from 1998 to 2013. Adequacy of SDC was based on the maximum concentration (Cmax) achieved in serum, with rifampicin (RMP) values <8 µg/ml and isoniazid (INH) values <3 µg/ml for daily dosing and <9 µg/ml for intermittent dosing considered inadequate. Clinical variables and microbiological outcomes were then compared between the adequate and inadequate groups. RESULTS: Of 134 pulmonary TB cases with SDCs for INH and/or RMP, we found a significant increase in 2-month sputum culture positivity in the cohort with inadequate concentrations of INH compared to those with adequate INH concentrations (42.5% vs. 18.3%, P = 0.0084). A similar trend was seen in the cohort with inadequate concentrations of RMP (39% vs. 21%, P = 0.0725). CONCLUSIONS: Among our study population, low SDCs of INH and, to a lesser extent, RMP, appear to be associated with reduced sputum culture conversion after 2 months of treatment.

Triple-negative breast cancer among ghanaian women seen at Korle-Bu teaching hospital

Background. Women with African ancestry in the United States and in continental Africa have been found to have exceptionally increased frequencies of triple-negative breast cancer (TNBC); prompting speculation that this risk may have an inherited basis and may at least partially explain breast cancer outcome disparities related to racial/ethnic identity. Our goal was to evaluate the breast cancers diagnosed in one of the largest health care facilities in western Africa; and to compare the frequencies as well as risk factors for TNBC versus non-TNBC. Methods. We reviewed all breast cancer cases that had immunohistochemistry (Novolink Detection system); in 2010. Results. The overall study population of 223 breast cancer cases was relatively young (median age 52.4?y); and most had palpable tumors larger than five centimeters in diameter. More than half were TNBC (130 cases; 58.3%). We observed similar frequencies of young age at diagnosis; stage at diagnosis; and tumor grade among cases of TNBC compared to cases of non-TNBC. Conclusion. Ghanaian breast cancer patients tend to have an advanced stage distribution and relatively young age at diagnosis. The triple-negative molecular marker pattern is the most common seen among these women; regardless of age; tumor grade; and stage of diagnosis. Additional research is necessary regarding the causes of TNBC; so that we can elucidate the reasons for its increased prevalence among women with African ancestry

Positive tumor margins in wide local excision of breast cancer: a 10-year retrospective study

Background. The safety of wide local excision as a standard surgical option for early stage breast cancer management in Ghana has not been evaluated. The aim of this study was to use retrospective histopathological descriptive study to evaluate the prevalence of positive tumor margins in wide local excision specimens and offer recommendations. Study design. We reviewed 147 breast lumps; following wide local excision; which were received in the Department of Pathology; for positive tumor margins. The data was analyzed using SPSS software (version 16). Results. A total of 2;751 female breast cancers were diagnosed during the study period; of which 147 (5.3%) were from wide local excisions (lumpectomies). Thirty-one (21.0%) had positive tumor margins. The mean age of women with positive margins was 53.4 (SD = 17.1) years. The mean size of primary tumor was 4.0 (SD = 2.1) cm; the majority (53.0%) of which were greater than 2.0?cm; but less than or equal to 5.0?cm (T2). A total of 26 (83.4%) of these tumors were invasive ductal carcinomas (NOS); 24 (92.3%) of the cases had combined Bloom-Richardson grading; and many; 10 (41.7%); were grade 1. Conclusion. Our study shows that 21.0% of all wide local excision biopsies had positive tumor margins; a figure that is comparable to those of other studies. Tumors with positive margins in this study were large; 4.0?cm (T2); and common in relatively young women. Treatment failure is therefore likely to occur in these patients

Pregnancy related causes of deaths in Ghana: a 5-year retrospective study.

OBJECTIVE: Data on maternal mortality varies by region and data source. Accurate local-level data are essential to appreciate its burden. This study uses autopsy results to assess maternal mortality causes in southern Ghana. METHODS: Autopsy log books of the Department of Pathology, Korle-Bu Teaching Hospital Mortuary were reviewed from 2004 through 2008 for pregnancy related deaths. Data were entered into a database and analyzed using SPSS statistical software (Version 19). RESULTS: Of 5,247 deaths among women aged 15-49, 12.1% (634) were pregnancy-related. Eighty one percent of pregnancy-related deaths (517) occurred in the community or within 24 hours of admission to a health facility and 18.5% (117) occurred in a health facility. Out of 634 pregnancy-related deaths, 79.5% (504) resulted from direct obstetric causes, including: haemorrhage (21.8%), abortion (20.8%), hypertensive disorders (19.4%), ectopic gestation (8.7%), uterine rupture (4.3%) and genital tract sepsis (2.5%). The remaining 20.5% (130) resulted from indirect obstetric causes, including: infections outside the genital tract, (9.2%), anemia (2.8%), sickle cell disease (2.7%), pulmonary embolism (1.9%) and disseminated intravascular coagulation (1.3%). The top five causes of maternal death were: haemorrhage (21.8%), abortion (20.7%), hypertensive disorders (19.4%), infections (9.1%) and ectopic gestation (8.7%). CONCLUSION: Ghana continues to have persistently high levels of preventable causes of maternal deaths. Community based studies, on maternal mortality are urgently needed in Ghana, since our autopsy studies indicates that 81% of deaths recorded in this study occurred in the community or within 24 hours of admission to a health facility.

NAAG peptidase inhibitors block cognitive deficit induced by MK-801 and motor activation induced by d-amphetamine in animal models of schizophrenia.

The most widely validated animal models of the positive, negative and cognitive symptoms of schizophrenia involve administration of d-amphetamine or the open channel NMDA receptor blockers, dizocilpine (MK-801), phencyclidine (PCP) and ketamine. The drug ZJ43 potently inhibits glutamate carboxypeptidase II (GCPII), an enzyme that inactivates the peptide transmitter N-acetylaspartylglutamate (NAAG) and reduces positive and negative behaviors induced by PCP in several of these models. NAAG is an agonist at the metabotropic glutamate receptor 3 (mGluR3). Polymorphisms in this receptor have been associated with expression of schizophrenia. This study aimed to determine whether two different NAAG peptidase inhibitors are effective in dopamine models, whether their efficacy was eliminated in GCPII knockout mice and whether the efficacy of these inhibitors extended to MK-801-induced cognitive deficits as assessed using the novel object recognition test. ZJ43 blocked motor activation when given before or after d-amphetamine treatment. (R,S)-2-phosphono-methylpentanedioic acid (2-PMPA), another potent NAAG peptidase inhibitor, also reduced motor activation induced by PCP or d-amphetamine. 2-PMPA was not effective in GCPII knockout mice. ZJ43 and 2-PMPA also blocked MK-801-induced deficits in novel object recognition when given before, but not after, the acquisition trial. The group II mGluR antagonist LY341495 blocked the effects of NAAG peptidase inhibition in these studies. 2-PMPA was more potent than ZJ43 in a test of NAAG peptidase inhibition in vivo. By bridging the dopamine and glutamate theories of schizophrenia with two structurally different NAAG peptidase inhibitors and demonstrating their efficacy in blocking MK-801-induced memory deficits, these data advance the concept that NAAG peptidase inhibition represents a potentially novel antipsychotic therapy.

Use of the QuantiFERON-TB Gold test to confirm latent tuberculosis infection in a Canadian tuberculosis clinic.

SETTING: Capital Health Tuberculosis (TB) Clinic, Edmonton, Alberta, Canada. OBJECTIVE: To analyze the QuantiFERON-TB Gold In-Tube test (QFT) results after implementation as a routine test for tuberculin skin test (TST) positive patients. DESIGN: From November 2004 until January 2007, patients who were TST-positive and were eligible for preventive treatment based on Canadian guidelines, were offered a QFT. RESULTS: Of 1446 TST-positive patients, only 566 (39.6%) were QFT-positive. Categorized by reason for TST testing, 43.1% of 304 contacts, 32.8% of 348 employment screens and 24.2% of 298 post secondary school screens were QFT-positive. In contrast, 59.7% of 290 immigration screens were QFT-positive. A multivariate analysis found that QFT positivity was associated with older age, larger TST size, high-incidence TB region of birth, history of TB and chest X-ray findings suggestive of previous TB. CONCLUSION: Implementation of the QFT as a secondary test for latent TB infection (LTBI) can significantly reduce the number of patients given LTBI treatment in a low-incidence country such as Canada.

'Pseudo' treatment failure of pulmonary tuberculosis in association with a tuberculoma.

Failure of tuberculosis patients to respond to treatment is usually explained by one or more of five mechanisms: improper drug prescription; patient nonadherence to prescribed therapy; primary or acquired drug resistance; drug malabsorption; and rarely, exogenous reinfection with a drug-resistant isolate. Response to treatment is best measured bacteriologically; two different smear and one culture criteria for failure are widely used. Patients meeting either smear, but not culture, criteria for treatment failure may be said to have 'pseudo' treatment failure. Whether a patient can meet both smear criteria for failure, and not have a mechanism for treatment failure nor meet culture criteria, is unknown. A case of 'pseudo' treatment failure is reported in which both smear criteria for failure were met, but no mechanism for failure was proven to be operative.

Prevention of hospitalizations for heart failure with an interactive home monitoring program.

Congestive heart failure is the most common cause of hospitalization for the older population. A previous study demonstrated that rehospitalizations, undertaken by 30% to 50% of elderly patients, can be prevented with intensive multidisciplinary intervention. A pilot study was designed to determine whether a less intensive program with patient education materials, automated reminders for medication compliance, self-monitoring of daily weights and vital signs, and facilitated telephone communication with a nurse-monitor could reduce hospitalizations and whether this benefit could be extended to younger outpatients. Twenty-seven male patients (mean age 62 years) with New York Heart Association class II to IV congestive heart failure caused by dilated cardiomyopathy underwent follow-up with an independent service, which provided the primary cardiologist with information concerning changes in vital signs or symptoms. The number of hospitalizations and hospital days during the mean value of 8.5 months in the program was compared patient by patient with the number during the equivalent period before entrance in the program. The number of hospitalizations for cardiovascular diagnoses and hospital days was reduced from 0.6 to 0.2 (p = 0.09) per patient year of follow-up and 7.8 to 0.7 days per patient per year (p < 0.05). Hospitalizations for all causes fell from 0.8 to 0.4 per patient per year (p = not significant) and 9.5 to 0.8 days per patient per year (p < 0.05). The greatest absolute and relative benefit was observed among patients with more severe congestive heart failure. The most frequent indication for intervention was an increase in weight, which was managed with adjustment of diuretic dosages. This preliminary experience suggests that close telephone monitoring by personnel from an independent service can prevent hospitalizations for heart failure among both recently discharged patients and ambulatory outpatients and among both elderly and middle-aged persons.

The benefits of in-home pharmacy evaluation for older persons.

OBJECTIVE: To assess the potential benefit of a pharmacist performing in-home medication evaluations on frail older people. DESIGN: Prospective analysis with pre-post comparison. SETTING: A hospital-based home care program at the Sepulveda Veterans Affairs Medical Center. PARTICIPANTS: Male veterans in a home care program who live within 15 miles of the medical center and take three or more prescription medications (N = 20, mean age: 75.1 years). MEASURES: Prescribed medications were documented from the medical records and compared with regimens actually being followed in the home. In addition, the home was inspected, patients were educated, and recommendations were made to the prescribing physicians when necessary. RESULTS: At first visit, patients had a mean of 6.0 prescribed daily medications but were only taking 4.7 of these regularly. Also noted were many potentially unnecessary medications (70% of subjects) and multiple problems with the medication regimen (e.g., incorrect drug frequency or dosage, expired medications, medication omission). Follow-up visit revealed a significant decrease in medication discrepancies and problems (P < or = .05). CONCLUSION: An in-home pharmacy assessment reveals many problems with drug administration not otherwise detected easily. These assessments can lead to potentially useful interventions that can improve medication regimens and compliance. Determination of long-term effects must await controlled trials.

Relation of the nine-minute self-powered treadmill test to maximal exercise capacity and skeletal muscle function in patients with congestive heart failure.

The 9-minute self-powered treadmill test has been employed to evaluate submaximal exercise capacity in heart failure patients, but its relation to maximal exercise capacity and to indexes of skeletal muscle function has not been well defined. Two protocols were utilized. The first evaluated the relation of the peak oxygen uptake (VO2) achieved on the self-powered treadmill to that during a symptom-limited treadmill protocol, and examined the reproducibility of this test. Thirteen patients (aged 62 +/- 2 years, in New York Heart Association class I to III [2.3 +/- 0.1], ejection fraction 23 +/- 2% [means +/- SEM]) and 10 age-matched sedentary controls were studied. The second protocol, which involved 18 patients (aged 65 +/- 2 years, in New York Heart Association class I to IV [2.4 +/- 0.1], ejection fraction 23 +/- 2%) and 10 age-matched controls evaluated the relation of performance on the self-powered treadmill to maximal systemic exercise capacity on a cycle ergometer and to indexes of skeletal muscle function. In the first protocol, the test was found to be highly reproducible. The proportion of self-powered treadmill to maximal treadmill peak VO2 did not differ significantly between patients and controls (95 +/- 5% vs 87 +/- 6%). In the second protocol, patients achieved a lower peak VO2 (15.6 +/- 1.1 vs 25.6 +/- 0.9 ml/kg/min, p < 0.001), walked a shorter distance on the self-powered treadmill (367 +/- 32 vs 667 +/- 28 m, p < 0.001), and exhibited less knee extensor work capacity (1,075 +/- 116 vs 1,390 +/- 110 ft-lbs, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

24-hour efficacy of once-daily diltiazem in essential hypertension.

The safety and effectiveness of a once daily formulation of diltiazem hydrochloride (diltiazem CD) in the treatment of essential hypertension was assessed in a total of 127 patients with supine diastolic blood pressures (DBP) of 95 to 110 mmHg randomized to diltiazem CD (n = 61) or placebo (n = 66). Patients were titrated to doses of 120, 240, or 360 mg to achieve DBP reduction to less than 90 mmHg. At end study diltiazem CD changed trough supine SBP and DBP by -8.4 +/- 1.7 (p = 0.0009) and -8.6 +/- 1.1 mmHg (p = 0.0075), respectively. Heart rate was not significantly changed (-1.3 +/- 1.1 beats/min, p = 0.4362). The average dose of diltiazem CD was 268 mg with 69% achieving a clinical response. A subset of 47 patients underwent ambulatory blood pressure monitoring to assess the consistency of the effect over the full 24-h dosing interval. Diltiazem CD lowered DBP and SBP throughout the dosing interval. The overall side effect profile was similar to placebo. This study provides evidence of 24-h efficacy of this new, once daily formulation of diltiazem.