Overall symptom severity as a patient-reported outcome measure for chronic rhinosinusitis: what it reflects and how to measure it.

BACKGROUND: The objective of this study was to identify how - and to what extent - overall symptom severity (OSS) score reflects individual chronic rhinosinusitis (CRS) symptoms and whether it can be measured using alternatives to the standard visual analog scale (VAS). METHODS: CRS patients from four sites across three continents rated their OSS scores, severities of nasal obstruction, nasal drainage, decreased sense of smell, facial pain/pressure and sleep disturbance using a standard VAS, VAS with labeled tick marks at every 1 centimeter, and by writing down their OSS on a scale of 0 - 100 (which was divided by 10), all of which lead to severity scores ranging from 0 - 10 in 0.1 intervals. Quality of life was measured using the SNOT-22 and EQ-5D VAS. RESULTS: In 311 CRS patients, OSS score was significantly correlated with SNOT-22 and EQ-5D VAS. OSS score was most greatly associated with the mean of all individual symptom severity scores. From individual CRS symptoms, OSS was most greatly associated with nasal obstruction followed by nasal drainage and facial pain/pressure severities. These results held true for participants with and without nasal polyps. Measurement of OSS and individual symptom severity scores using a standard VAS, tick-marked VAS, and write-in option had near-perfect consistency. CONCLUSIONS: We demonstrate for the first time that OSS largely reflects the mean of individual CRS symptom severities, although OSS is=== most weighted by nasal obstruction severity. OSS and individual symptom severity scores can be measured using a standard VAS, tick-marked VAS or write-in prompt with near-perfect consistency.

Genetic consequences of interglacial isolation in a steppe bird.

In response to climate changes that have occurred during Pleistocene glacial cycles, taxa associated to steppe vegetation might have followed a pattern of historical evolution in which isolation and fragmentation of populations occurred during the short interglacials and expansion events occurred during the long glacial periods, in contrast to the pattern described for temperate species. Here, we use molecular genetic data to evaluate this idea in a steppe bird with Palaearctic distribution, the little bustard (Tetrax tetrax). Overall, extremely low genetic diversity and differentiation was observed among eight little bustard populations distributed in Spain and France. Mismatch distribution analyses showed that most little bustard populations expanded during cooling periods previous to, and just after, the last interglacial period (127,000-111,000 years before present), when steppe habitats were widespread across Europe. Coalescent-based methods suggested that glacial expansions have resulted in substantial admixture in Western Europe due to the existence of different interglacial refugia. Our results are consistent with a model of evolution and genetic consequences of Pleistocene cycles with low between-population genetic differentiation as a result of short-term isolation periods during interglacials and long-term exchange during glacial periods.

A linear mixed-effects statistical model for in-vivo evaluation of recombinant human growth hormone implants in hypophysectomized rats.

We have used a linear mixed-effects statistical model to evaluate previously published results of body weight evolution in hypophysectomized (Hpx) rats after administration of two different controlled-release formulations of recombinant human growth hormone (rhGH). Using the linear mixed-effects model, it was possible to distinguish between maximal pharmacological response with time in different subjects and relate it to the structure of the different formulations, the release of the hormone from them and the time necessary to obtain a quantitative result as a consequence of the hormone activity, contrary to the multivariate variance analysis model (MANOVA) used in our earlier work. These results confirmed that the maximum body weight gain obtained with the controlled-release implants is similar to that with subcutaneous rhGH, but with the advantage that laminar biodegradable implants need to be administered only once every 2 weeks.

A mathematical model for interpreting in vitro rhGH release from laminar implants.

Recombinant human growth hormone (rhGH), used mainly for the treatment of growth hormone deficiency in children, requires daily subcutaneous injections. The use of controlled release formulations with appropriate rhGH release kinetics reduces the frequency of medication, improving patient compliance and quality of life. Biodegradable implants are a valid alternative, offering the feasibility of a regular release rate after administering a single dose, though it exists the slight disadvantage of a very minor surgical operation. Three laminar implant formulations (F(1), F(2) and F(3)) were produced by different manufacture procedures using solvent-casting techniques with the same copoly(D,L-lactic) glycolic acid (PLGA) polymer (Mw=48 kDa). A correlation in vitro between polymer matrix degradation and drug release rate from these formulations was found and a mathematical model was developed to interpret this. This model was applied to each formulation. The obtained results where explained in terms of manufacture parameters with the aim of elucidate whether drug release only occurs by diffusion or erosion, or by a combination of both mechanisms. Controlling the manufacture method and the resultant changes in polymer structure facilitates a suitable rhGH release profile for different rhGH deficiency treatments.

Lesbian, gay, and bisexual homeless youth: an eight-city public health perspective.

This article reports on results of a one-day public health survey conducted in six states by homeless youth providers to measure and compare risk factors between lesbian, gay, and bisexual (LGB) homeless youth and non-LGB homeless youth. This article intends to inform the child welfare field on existing gaps in services and areas where more training and technical support is necessary in providing services to homeless LGB youth. The findings point to substantial differences within the homeless youth sample and demonstrate that in addition to the public health risks young people face merely by being homeless, the risks are exacerbated for those who self-identify as lesbian, gay, or bisexual. The article informs child welfare providers and policymakers about the substantial vulnerability of LGB youth beyond that of non-LGB homeless youth and the need to fund programming, training, technical assistance and further research to specifically respond to the complex needs of this population.

Transient myocardial injury after elective electrical cardioversion.

A patient with recent myocardial infarction underwent elective direct current countershock because of atrial fibrillation. After several shocks, the ST segments were strikingly raised throughout the precordial leads, which disappeared with the administration of a perfusion of nitroglycerin. This case is evidence that electrical cardioversion can cause myocardial damage.

Two-year follow-up study of elderly residents in S. Paulo, Brazil: methodology and preliminary results.

INTRODUCTION: Previous cross-sectional studies have shown a high prevalence of chronic disease and disability among the elderly. Given Brazil's rapid aging process and the obvious consequences of the growing number of old people with chronic diseases and associated disabilities for the provision of health services, a need was felt for a study that would overcome the limitations of cross-sectional data and shed some light on the main factors determining whether a person will live longer and free of disabling diseases, the so-called successful aging. The methodology of the first follow-up study of elderly residents in Brazil is presented. METHOD: The profile of the initial cohort is compared with previous cross-sectional data and an in-depth analysis of nonresponse is carried out in order to assess the validity of future longitudinal analysis. The EPIDOSO ('Epidemiologia do Idoso') Study conducted a two-year follow-up of 1,667 elderly people (65+), living in S. Paulo. The study consisted of two waves, each consisting of household, clinical, and biochemical surveys. RESULTS AND CONCLUSIONS: In general, the initial cohort showed a similar profile to previous cross-sectional samples in S. Paulo. There was a majority of women, mostly widows, living in multigenerational households, and a high prevalence of chronic illnesses, psychiatric disturbances, and physical disabilities. Despite all the difficulties inherent in follow-up studies, there was a fairly low rate of nonresponse to the household survey after two years, which did not actually affect the representation of the cohort at the final household assessment, making unbiased longitudinal analysis possible. Concerning the clinical and blood sampling surveys, the respondents tended to be younger and less disabled than the nonrespondents, limiting the use of the clinical and laboratory data to longitudinal analysis aimed at a healthier cohort. It is worth mentioning that gender, education, family support, and socioeconomic status were not important determinants of nonresponse, as is often the case.

[The impact of AIDS in Portugal]. / O impacto da SIDA em Portugal.

An outline of the AIDS epidemiological situation in Portugal is given. Its mortality is compared with that of other diseases connected with the behaviour of individuals. The weight of AIDS on mass media is discussed. Prevention strategies adopted in Portugal are mentioned and its impact on the Portuguese society is reflected upon. The interference of AIDS in questions concerning ethics and deontology is commented on. Reference is made to aspects of the impact of AIDS upon health research worldwide: a brief discussion is presented on the repercussion that AIDS might have on research in Portugal.

Comparative degradation study of biodegradable microspheres of poly(DL-lactide-co-glycolide) with poly(ethyleneglycol) derivates.

The biodegradable polymers of poly(DL-lactide-co-glycolide) (PLGA) and poly(ethyleneglycol) (PEG) have come into use in the last few years for the control of the release of drugs. The incorporation of units of PEG produce an increased in vivo half life of the microparticles. The methoxylation of the PEG allows a control of the microparticles. The methoxylation of the PEG allows a control of the polymerization reaction by blocking one of the reactive terminals. An important aspect to be studied is the degradation of these polymers. The objective was centred on comparing the degradation that microspheres made of PLGA and PLGA-PEG (also with derivate methoxylated PEG). Degradation of the microspheres was studied at 37 degrees C and neutral pH. Samples were taken at different times to determine the size distributions, the mean diameter, the molecular weight and the structural composition of the polymer. The fastest decrease in Mw is observed in the case of PLGA microspheres. The PLGA-PEG microspheres show a significant size increase (from 24.6 to 90 microns) due to a swelling process. Any appreciable changes in Tg values were observed during the assay (30 days).

[Myelocytic leukaemia with atypical evolution (author's transl)]. / Leucosis mieloide de evolución atípica

A case of myelocytic leukaemia appeared in a four year old boy. The surprisingly benign evolution until now, leds to a speculation on the possible influence exerced by chickenpox virus as a immunologic stimulant.