Clozapine treatment in patients living in the community

OBJECTIVE: The aim of this study was to assess clozapine treatment in the local community with respect to patient monitoring during dispensing, patient compliance through prescription refills, presence of any other existing co-morbidities and presence of potential drug-drug interactions. METHOD: An audit on whether pharmacy personnel check patients’ white blood cell count and absolute neutrophil count prior to dispensing was performed. A total of 100 audits were carried out. A computer programme entitled ‘Pharmacy Dispensing System’ was used to assess patient compliance through prescription refills over a 3-month period. Another computer programme entitled ‘Schedule V’ was used to determine any other comorbidities. After determining the list of all the chronic medications, analysis of the presence of any potential drugdrug interactions was undertaken. The ‘Drug Interaction Checker’, a drug interaction database provided by RxList, was used. This database classified potential drug-drug interactions into 3 categories namely minor, significant and serious. KEY FINDINGS: The white blood cell count and absolute neutrophil count were checked in all instances (N=100), however this intervention was not documented. Over a 3-month period, 78 out of 90 patients were compliant. Diabetes was the most common co-morbidity (n=15) and 76 patients receiving clozapine may be exposed to a potential drug-drug interaction. A total of 363 possible drug interactions were present in this group of patients. The most common type of potential drug-drug interaction fell in the ‘significant drug-drug interactions’ category (n=289). CONCLUSION: Patient monitoring was carried out, however documentation processes need to be elaborated. Identification of drug interactions is of utmost importance since certain interactions can be dangerous. Apart from detecting drug interactions, discussion with other healthcare professionals should be undertaken to assess the possibility of replacing such interacting drugs with alternative options. This measure should be carried out to promote patient safety.peer-reviewe

Polyxenid millipede (Diplopoda, Polyxenida) associated with empty snail shells

A polyxenid millipede found singly and in groups of up to nine individuals or their exuviae in dead empty snail shells from Qrejten Point, northeastern coast of Malta, was identified as Polyxenus macedonicus Verhoeff, 1952. Other organisms were also collected from the same shells, but there was no evidence to suggest a parasitic or predatory relationship of any of these with the millipedes. We conclude that the polyxenids were exploiting the shells as shelters with a relatively benign microclimate in an otherwise arid environment.peer-reviewe

Nicotine dependence and the International Association for the Study of Pain neuropathic pain grade in patients with chronic low back pain and radicular pain : is there an association?

Background: This study investigated whether current smoking and a higher nicotine dependency were associated with chronic low back pain (LBP), lumbar related leg pain (sciatica) and/or radicular neuropathic pain.Methods: A cross-sectional study was conducted on 150 patients (mean age, 60.1 ± 13.1 yr). Demographic data, the International Association for the Study of Pain (IASP) neuropathic pain grade, STarT Back tool, and the Fagerström test were com- pleted. A control group (n = 50) was recruited.Results: There was a significant difference between current smokers and non- smokers in the chronic LBP group in the mean pain score (P = 0.025), total STarT Back score (P = 0.015), worst pain location (P = 0.020), most distal pain radiation (P = 0.042), and in the IASP neuropathic pain grade (P = 0.026). There was a significant difference in the mean Fagerström score between the four IASP neuropathic pain grades (P = 0.005). Current smoking yielded an odds ratio (OR) of 3.071 (P = 0.011) for developing chronic LBP and sciatica, and an OR of 4.028 (P = 0.002) for obtaining an IASP “definite/probable” neuropathic pain grade, for both cohorts. The likelihood for chronic LBP and sciatica increased by 40.9% (P = 0.007), while the likelihood for an IASP neuropathic grade of “definite/probable” increased by 50.8% (P = 0.002), for both cohorts, for every one unit increase in the Fagerström score.Conclusions: A current smoking status and higher nicotine dependence increase the odds for chronic LBP, sciatica and radicular neuropathic pain.peer-reviewe

Low temperature carburised austenitic stainless steel for metal-on-metal tribological contact

S-phase layers formed on biomedical grade austenitic stainless steels have demonstrated significantly enhanced in-vitro wear and corrosion behaviour. To date, most of these tribo-corrosion studies on S-phase treated alloys were conducted using a polycrystalline alumina or cemented tungsten carbide ball as the counterface material. Testing S-phase against S-phase is both scientifically interesting and technologically important in view of their potential applications for the articulating surfaces of metal-on-metal joint prostheses. In this work, biomedical grade 316LVM discs together with AISI 316 balls were low temperature carburised. In-vitro corrosion-wear testing using an S-phase engineered ball against an S-phase engineered disc was performed. Such testing was also complemented with electrochemical impedance spectroscopy, potentiodynamic and cytotoxicity tests. The results have shown that the carburised 316LVM alloy was found to have good in-vitro cytocompatibility and an augmented corrosion and corrosion-wear resistance when compared with the untreated alloy.peer-reviewe

Frequency drift in MR spectroscopy at 3T

Purpose: Heating of gradient coils and passive shim components is a common cause of instability in the B-0 field, especially when gradient intensive sequences are used. The aim of the study was to set a benchmark for typical drift encountered during MR spectroscopy (MRS) to assess the need for real-time field-frequency locking on MRI scanners by comparing field drift data from a large number of sites.Method: A standardized protocol was developed for 80 participating sites using 99 3T MR scanners from 3 major vendors. Phantom water signals were acquired before and after an EPI sequence. The protocol consisted of: minimal preparatory imaging; a short pre-fMRI PRESS; a ten-minute fMRI acquisition; and a long post-fMRI PRESS acquisition. Both pre- and post-fMRI PRESS were non-water suppressed. Real-time frequency stabilization/adjustment was switched off when appropriate. Sixty scanners repeated the protocol for a second dataset. In addition, a three-hour post-fMRI MRS acquisition was performed at one site to observe change of gradient temperature and drift rate. Spectral analysis was performed using MATLAB. Frequency drift in pre-fMRI PRESS data were compared with the first 5:20 minutes and the full 30:00 minutes of data after fMRI. Median (interquartile range) drifts were measured and showed in violin plot. Paired t-tests were performed to compare frequency drift pre- and post-fMRI. A simulated in vivo spectrum was generated using FID-A to visualize the effect of the observed frequency drifts. The simulated spectrum was convolved with the frequency trace for the most extreme cases. Impacts of frequency drifts on NAA and GABA were also simulated as a function of linear drift. Data from the repeated protocol were compared with the corresponding first dataset using Pearson's and intraclass correlation coefficients (ICC).Results: Of the data collected from 99 scanners, 4 were excluded due to various reasons. Thus, data from 95 scanners were ultimately analyzed. For the first 5:20 min (64 transients), median (interquartile range) drift was 0.44 (1.29) Hz before fMRI and 0.83 (1.29) Hz after. This increased to 3.15 (4.02) Hz for the full 30 min (360 transients) run. Average drift rates were 0.29 Hz/min before fMRI and 0.43 Hz/min after. Paired t-tests indicated that drift increased after fMRI, as expected (p &lt; 0.05). Simulated spectra convolved with the frequency drift showed that the intensity of the NAA singlet was reduced by up to 26%, 44 % and 18% for GE, Philips and Siemens scanners after fMRI, respectively. ICCs indicated good agreement between datasets acquired on separate days. The single site long acquisition showed drift rate was reduced to 0.03 Hz/min approximately three hours after fMRI.Discussion: This study analyzed frequency drift data from 95 3T MRI scanners. Median levels of drift were relatively low (5-min average under 1 Hz), but the most extreme cases suffered from higher levels of drift. The extent of drift varied across scanners which both linear and nonlinear drifts were observed.</p

Long swings in the Canadian dollar

This paper uses daily, monthly, and quarterly observations for the Canadian dollar - US dollar nominal exchange rate over the recent flexible exchange rate period (from 2 January 1973 to 11 June 2004), and a new statistical model of exchange rate dynamics, developed by Engel and Hamilton to test the null hypothesis that the value of the Canadian dollar is characterized by long swings (i.e. it moves in one direction for long periods of time). Results indicate that only with quarterly data does the segmented trends model outperfom the random walk model. In fact, the performance of the segmented trends model declines as the frequency of the data increases, suggesting that at higher frequencies the segmented trends model has a more difficult time in distinguishing trends.

Sibt fir-raħal

Ġabra ta’ poeżiji u proża li tinkludi: Hemm xtajta ta’ Ġorġ Borg – Kelma ta’ Paul P. Borg – Inżul ix-xemx fuq il-Guadalquivir ta’ Norbert Bugeja – In-ners ta’ Charles Casha – Tbissima ta’ Carmel G. Cauchi – Qalbi ta’ Sergio Grech – Poeżija waħda ta’ Sergio Grech – Nugrufum ta’ Maria Grech Ganado – Bħal vuċi oħra ġo dil-konfużjoni ta’ Adrian Grima – Funeral ta’ Henry Holland – Ftit weraq mill-gżira ta’ Immanuel Mifsud – Għax xi darba kien hemm il-Palestina ta’ Walid Nabhan – It-tmiem fil-qrib ta’ Patrick Sammut – Biljett miftuħ ta’ Karl Schembri – Statistika ta’ Lillian Sciberras – Meta waqa’ l-ispazju kollu fuqha ta’ Clare Azzopardi – Passju ta’ Stanley Borg – Abdilla l-għaqli u l-kibx il-mitluf ta’ Steve Borg – Qaddis ġdid ta’ Maurice Mifsud Bonnici – Bl-irħis ta’ Vince Vella – Fejn hemm il-beraħ ta’ Trevor Żahra – L-Apostata jew moħħ imħarbat ta’ Albert Camus, traduzzjoni ta’ Toni Aquilina – Il-kantiku tal-ħlejjaq ta’ San Franġisk t’Assisi bi traduzzjoni ta’ Mario Debono – Siltiet minn “Il-Profeta” ta’ Kahlil Gibran, traduzzjoni ta’ Victor Fenech – L-għaxija ta’ jum ta’ festa ta’ Giacomo Leopardi, traduzzjoni ta’ Oliver Friggieri – Is-sibt fir-raħal ta’ Giacomo Leopardi, traduzzjoni ta’ Alfred Palma.peer-reviewe

Interobserver agreement for the ATS/ERS/JRS/ALAT criteria for a UIP pattern on CT.

OBJECTIVES: To establish the level of observer variation for the current ATS/ERS/JRS/ALAT criteria for a diagnosis of usual interstitial pneumonia (UIP) on CT among a large group of thoracic radiologists of varying levels of experience. MATERIALS AND METHODS: 112 observers (96 of whom were thoracic radiologists) categorised CTs of 150 consecutive patients with fibrotic lung disease using the ATS/ERS/JRS/ALAT CT criteria for a UIP pattern (3 categories--UIP, possibly UIP and inconsistent with UIP). The presence of honeycombing, traction bronchiectasis and emphysema was also scored using a 3-point scale (definitely present, possibly present, absent). Observer agreement for the UIP categorisation and for the 3 CT patterns in the entAUe observer group and in subgroups stratified by observer experience, were evaluated. RESULTS: Interobserver agreement across the diagnosis category scores among the 112 observers was moderate, ranging from 0.48 (IQR 0.18) for general radiologists to 0.52 (IQR 0.20) for thoracic radiologists of 10-20 years' experience. A binary score for UIP versus possible or inconsistent with UIP was examined. Observer agreement for this binary score was only moderate. No significant differences in agreement levels were identified when the CTs were stratified according to multidisciplinary team (MDT) diagnosis or patient age or when observers were categorised according to experience. Observer agreement for each of honeycombing, traction bronchiectasis and emphysema were 0.59+/-0.12, 0.42+/-0.15 and 0.43+/-0.18, respectively. CONCLUSIONS: Interobserver agreement for the current ATS/ERS/JRS/ALAT CT criteria for UIP is only moderate among thoracic radiologists, AUrespective of theAU experience, and did not vary with patient age or the MDT diagnosis

Repurposing a neurodegenerative disease drug to treat Gram-negative antibiotic-resistant bacterial sepsis

The emergence of polymyxin resistance in carbapenem-resistant and extended-spectrum beta-lactamase (ESBL)-producing bacteria is a critical threat to human health, and alternative treatment strategies are urgently required. We investigated the ability of the hydroxyquinoline analog ionophore PBT2 to restore antibiotic sensitivity in polymyxin-resistant, ESBL-producing, carbapenem-resistant Gram-negative human pathogens. PBT2 resensitized Klebsiella pneumoniae, Escherichia coil, Acinetobacter baumannii, and Pseudomonas aeruginosa to last-resort polymyxin class antibiotics, including the less toxic next-generation polymyxin derivative FADDI-287, in vitro. We were unable to select for mutants resistant to PBT2 + FADDI-287 in polymyxin-resistant E. coli containing a plasmidborne mcr-1 gene or K. pneumoniae carrying a chromosomal mgrB mutation. Using a highly invasive K. pneumoniae strain engineered for polymyxin resistance through mgrB mutation, we successfully demonstrated the efficacy of PBT2 + polymyxin (colistin or FADDI-287) for the treatment of Gram-negative sepsis in immunocompetent mice. In comparison to polymyxin alone, the combination of PBT2 + polymyxin improved survival and reduced bacterial dissemination to the lungs and spleen of infected mice. These data present a treatment modality to break antibiotic resistance in high-priority polymyxin-resistant Gram-negative pathogens