Allopurinol desensitization with A 2 weeks modified protocol in an elderly patients with multiple comorbidities: a case report

BACKGROUND: Allopurinol is an effective urate-lowering drug that is well tolerated by the majority of patients. Patients with chronic renal insufficiency have an increased risk of hypersensitivity reactions with allopurinol. CASE PRESENTATION: 75 year old male patient with gout, renal insufficiency, history of metastatic colorectal carcinoma status post-resection was referred to Allergy clinic for a maculopapular eruption that developed 1 week after initiating therapy with allopurinol. The rash resolved with discontinuation of allopurinol. However, his serum urate level rose to 19.9 mg/dl. We initially proposed a slow 4 week oral allopurinol desensitization. The treating nephrologist felt it was critical to lower urate more rapidly. As a result, we modified the dose and standard 4 week protocol down to 2 weeks. A suspension of allopurinol was prepared by the allergy nurse practitioner with a 300 mg allopurinol tablet. The sensitization protocol was modified as a starting dose of 0.3 mg escalating to a final dose of 300 mg/day in 2 weeks. There was no reaction during or after the desensitization. The patient’s urate level normalized (6.3 mg/dl) and has continued on 300 mg allopurinol daily without reaction. CONCLUSION: A 2 week modified allopurinol desensitization protocol is a safe alternative for elderly patients with multiple comorbidities

Identifying physiological measures of lifetime welfare status in pigs: exploring the usefulness of haptoglobin, C-reactive protein and hair cortisol sampled at the time of slaughter

Background: Physiological measures indicative of the welfare status of animals during rearing could form part of an abattoir-based animal health and welfare assessment tool. A total of 66 pigs were used in this study, the aim of which was to assess how serum concentrations of haptoglobin (Hp) and C-reactive protein (CRP) (assessed in 51 pigs), and hair concentrations of cortisol (assessed in 65 pigs), measured at or close to slaughter, reflected welfare-related indicators recorded from the animal during its lifetime. These indicators were recorded at intervals between 7 and 21 weeks of age and included assigning scores for levels of tail and skin lesions, recording the presence or absence of certain health issues, and conducting qualitative behavioural assessments (QBA). Results: Pigs recorded as having tail lesions during their lifetime had higher hair cortisol levels than those with no tail lesions (tail lesions: 47.87 ± 3.34 pg/mg, no tail lesions: 42.20 ± 3.29 pg/mg, P = 0.023), and pigs recorded as having moderate or severe tail lesions had higher Hp levels than those with no or mild tail lesions (moderate/severe: 1.711 mg/ml ± 0.74, none/mild: 0.731 mg/ml ±0.10, P = 0.010). Pigs recorded as being lame during their lifetime tended to have higher hair cortisol levels than non-lame pigs (lame: 52.72 pg/mg ± 3.83, not lame: 43.07 pg/mg ± 2.69, P = 0.062). QBA scores were not associated with any of the physiological measures (P > 0.05). Receiver Operator Curve (ROC) analysis was also carried out to get a better understanding of the usefulness of the physiological measures in discriminating animals that had had welfare-related issues recorded during their lifetime from those that had not. Hair cortisol was determined as having ‘moderate’ accuracy in discriminating pigs that were tail bitten on-farm from unbitten pigs (AUC: 0.748) while Hp and CRP were determined to have no meaningful discriminatory ability (AUC < 0.600). Conclusion: This research should be repeated on a larger scale, but the results suggest that hair cortisol measured at slaughter could provide insight into the welfare status of pigs during their lifetime. Hp may be a useful indicator of tail lesions in pigs. However, further research utilising a greater proportion of severely bitten pigs is required before conclusions can be drawn

Abnormal Vaginal Flora in Low-Risk Pregnant Women Cared for by a Public Health Service: prevalence and Association with Symptoms and Findings from Gynecological Exams

This study identifies the prevalence of vaginal flora alterations in low-risk pregnant women and their association with reported symptoms and gynecological exams. This quantitative, descriptive, cross-sectional study was conducted in public primary care service units in Botucatu, SP, Brazil from 2006 to 2008 with 289 pregnant women from a stratified sample obtained by sampling by care unit. Tests of vaginal content were performed using Gram’s method and testing for Trichomonas vaginalis using Diamond’s medium. The prevalence of altered vaginal flora was 49.5%, of which bacterial vaginosis (20.7%), vaginal candidiasis (11.8%) and intermediate flora (11.1%) were the most frequent, not considering associations. Results revealed a high prevalence of vaginal flora alterations with little relation to symptoms, but in agreement with findings from the gynecological exams. Considering undesirable maternal and perinatal outcomes and feasible laboratory practices, the establishment of a routine for diagnosing vaginal flora alterations in low-risk pregnant women is suggested.Se tuvo por objetivo identificar la prevalencia de las alteraciones de flora vaginal en gestantes de bajo riesgo, su asociación a la sintomatología referida y examen ginecológico. Estudio cuantitativo, descriptivo y transversal, desarrollado en el servicio público de atención básica de Botucatu/SP, en el período de 2006 a 2008, con 289 gestantes, el muestreo fue realizado de forma estratificada por unidad. Se realizó examen del contenido vaginal utilizándose coloración por el método de Gram e investigación de Trichomonas vaginalis en medio líquido de Diamond. Desconsiderándose las asociaciones, la prevalencia de flora vaginal alterada fue de 49.5%, siendo las alteraciones más frecuentes: vaginitis bacteriana (20.7%), candidiasis vaginal (11.8%) y flora intermediaria (11.1%). Los datos apuntan elevada prevalencia de las alteraciones de flora vaginal, con poca asociación a la sintomatología, pero con asociación a hallazgos del examen ginecológico. Considerándose las repercusiones maternas y perinatales indeseables y la práctica de laboratorio ejecutable, se sugiere el establecimiento de rutina para diagnóstico de las alteraciones de flora vaginal en gestantes de bajo riesgo.Objetivou-se identificar a prevalência das alterações de flora vaginal em gestantes de baixo risco, sua associação à sintomatologia referida e exame ginecológico. É estudo quantitativo, descritivo e transversal, desenvolvido no serviço público de atenção básica de Botucatu, SP, no período de 2006 a 2008, com 289 gestantes, amostradas de forma estratificada por unidade. Realizou-se exame do conteúdo vaginal, utilizando-se coloração pelo método de Gram e pesquisa de Trichomonas vaginalis em meio líquido de Diamond. Desconsiderando-se as associações, a prevalência de flora vaginal alterada foi de 49,5%, sendo as mais frequentes: vaginose bacteriana (20,7%), candidíase vaginal (11,8%) e flora intermediária (11,1%). Os dados apontam elevada prevalência das alterações de flora vaginal, com pouca associação à sintomatologia, mas associação com achados do exame ginecológico. Considerando-se as repercussões maternas e perinatais indesejáveis e a prática laboratorial exequível, sugere-se o estabelecimento de rotina para diagnóstico das alterações de flora vaginal em gestantes de baixo risco

DYNAMIC CONTROL OF INFEASIBILITY IN EQUALITY CONSTRAINED OPTIMIZATION

This paper describes a new algorithm for solving nonlinear programming problems with equality constraints. The method introduces the idea of using trust cylinders to keep the infeasibility under control. Each time the trust cylinder is violated, a restoration step is called and the infeasibility level is reduced. The radius of the trust cylinder has a nonincreasing update scheme, so eventually a feasible (and optimal) point is obtained. Global and local convergence of the algorithm are analyzed, as well as its numerical performance. The results suggest that the algorithm is promising.1931299132

Nonlinear programming algorithms using trust regions and augmented Lagrangians with nonmonotone penalty parameters

A model algorithm based on the successive quadratic programming method for solving the general nonlinear programming problem is presented. The objective function and the constraints of the problem are only required to be differentiable and their gradients to satisfy a Lipschitz condition. The strategy for obtaining global convergence is based on the trust region approach. The merit function is a type of augmented Lagrangian. A new updating scheme is introduced for the penalty parameter, by means of which monotone increase is not necessary. Global convergence results are proved and numerical experiments are presented.84116120