Antiretroviral therapy prescribing in hospitalized HIV clinic patients.

OBJECTIVES: Antiretroviral therapy (ART) medication prescribing errors in hospitalized patients still remain common. This study aimed to examine the initial prescribing of antiretroviral drug regimens for HIV clinic patients admitted to an urban academic teaching hospital. METHODS: A retrospective chart review of all patients with a discharge diagnosis of HIV or AIDS was performed. Only patients actively managed by the hospital out-patient HIV clinic at the time of discharge were included in the final analysis. We compared the ART initially prescribed during hospitalization with the clinic records. Medication errors were separated by type and the prescriber's area of specialty was noted. RESULTS: From 1 January 2009 to 31 December 2009, 90 admissions in 62 patients were included in the final analysis. In 47 of those admissions, the patient had an initial regimen considered to be incorrectly prescribed; in 17 of these 47 admissions, the patient was not prescribed any ART, and in the remainder the errors were related to drug omissions, incorrect frequency/dose, and prescription of the wrong drug. The majority of admissions were by an internal medicine or non-infectious disease (ID) specialist. Average time to ART initiation was comparable among all prescribers. No statistically significant correlation was found between the number of admissions per patient or the prescriber's area of specialty and the percentage of incorrect regimens ordered. CONCLUSION: Hospital HIV medication management still remains an area of focus because of the complexity of regimens, poor medication reconciliation and limited non-HIV/ID specialist knowledge.

Sulfate could mediate the therapeutic effect of glucosamine sulfate.

Glucosamine sulfate is a controversial osteoarthritis remedy that is presumed to stimulate articular cartilage glycosaminoglycan synthesis by increasing glucosamine concentrations in the joint space. However, this is not plausible because even large oral doses of the product have no effect on serum glucosamine concentrations. We propose instead that sulfate could mediate the clinical benefit attributed to this treatment. Sulfate is required for glycosaminoglycan synthesis, and unlike glucosamine, its serum level can be modified by dietary and other factors. In this study, we tested whether oral glucosamine sulfate increases serum sulfate concentrations and whether the sulfate concentration in the synovial fluid reflects that in the serum. The serum sulfate concentration of 7 normal subjects was 331 +/- 21 micromol/L before ingestion of 1.0 g glucosamine sulfate and 375 +/- 17 micromol/L 3 hours after (P <.05). Serum sulfate concentrations decreased from 325 +/- 19 to 290 +/- 19 micromol/L when the same dose of glucosamine sulfate was ingested with 1.0 g of the analgesic drug acetaminophen, which is largely metabolized by sulfation (P <.05). Unlike glucosamine sulfate, oral sodium sulfate did not significantly increase the serum sulfate concentration. Synovial fluid and serum sulfate concentrations were closely similar when measured in 15 patients undergoing diagnostic needle aspiration of a knee effusion (r =.99, slope =.97, P <.0001). These results do not prove that glucosamine sulfate improves osteoarthritis, but considered with other data, they do provide a plausible biochemical mechanism for its reported beneficial effects. This hypothesis is clinically relevant because it predicts that nonsulfate salts of glucosamine will be ineffective and that renal function, diet, and concurrent acetaminophen therapy could confound clinical trials of this therapy.

Advance directives for HIV-positive patients.

The authors surveyed HIV-positive patients to determine their knowledge of and interest in advance directives and their preferences for end-of-life care. The results of this study make clear the need to institute a program of education for those desiring to know more about advance directives.

Information technologies in public health management: a database on biocides to improve quality of life.

BACKGROUND: Biocides for prolonging the shelf life of a large variety of materials have been extensively used over the last decades. It has estimated that the worldwide biocide consumption to be about 12.4 billion dollars in 2011, and is expected to increase in 2012. As biocides are substances we get in contact with in our everyday lives, access to this type of information is of paramount importance in order to ensure an appropriate living environment. Consequently, a database where information may be quickly processed, sorted, and easily accessed, according to different search criteria, is the most desirable solution. The main aim of this work was to design and implement a relational database with complete information about biocides used in public health management to improve the quality of life. METHODS: Design and implementation of a relational database for biocides, by using the software "phpMyAdmin". RESULTS: A database, which allows for an efficient collection, storage, and management of information including chemical properties and applications of a large quantity of biocides, as well as its adequate dissemination into the public health environment. CONCLUSION: The information contained in the database herein presented promotes an adequate use of biocides, by means of information technologies, which in consequence may help achieve important improvement in our quality of life.

Study of the antifungal capacity by means of the contact test.

The antifungal activity of econazole nitrate (Pevaryl) can be demonstrated by means of a new test -- called contact test -- developed by the authors. This method of assessing the fungicidal activity was tested in nine patients and found to be satisfactory.

Double-blind comparison of the efficacy, toleration and safety of tioconazole base 1% and econazole nitrate 1% creams in the treatment of patients with fungal infections of the skin or erythrasma.

A total of 61 patients with proven fungal infection of the skin or with erythrasma took part in a double-blind comparison of the efficacy, toleration and safety of tioconazole base 1% w/w and econazole nitrate 1% creams applied twice daily. Some patients had more than one site of infection and some were infected with more than one fungal/bacterial species. The mean duration of treatment in the tioconazole group of patients was 40 days (range: 12-68) and in the econazole group 38 days (range: 17-101). Clinical and mycologic cure was achieved in 27 of 29 (93.1%) tioconazole-treated and 29 of 31 (93.5%) econazole-treated patients. All but 1 of the cured patients in each treatment group were seen some 6 weeks after the end of treatment; all remained clinically and mycologically cured. Both creams were found to be generally acceptable in terms of ease of application. Some staining was reported in both treatment groups. One side effect of mild intermittent pruritus was reported in an econazole-treated patient. The minimum inhibitory concentrations were determined.