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Abstract Background This study was designed to evaluate the psychiatrists' level of recognition of somatic symptoms associated to a major depressive episode (MDE) (DSM-IV-TR criteria) and the impact of those somatic symptoms on the treatment effectiveness. Methods This non-interventional study was conducted in 25 medical offices in Puerto Rico from February to December 2003. It had 2 visits separated by 8 weeks. The level of recognition was determined by: the correlation between the physician clinical evaluation and their patients' self-evaluations through different validated instruments using kappa statistics. Chi-square test was used to evaluate the impact of somatic symptoms on treatment antidepressants' effectiveness. Results All the 145 recruited patients reported the presence of at least one somatic symptom associated with their current MDE. In the two visits covered by the study, a fair agreement between the psychiatrists' and the patients' reports was noted for headache, abdominal pain and upper limb pains (0.4003 ≤ κ ≥ 0.6594). For other painful symptoms and painless somatic symptoms, the Kappa values obtained were non-significant. Slight but significant reductions in depression and painful symptoms severity were observed after 8 weeks of treatment. A proportional relationship between the pain and depression severity was observed (p < 0.0001). Conclusion The study results show that somatic symptoms: are very common in depressed Puerto Rican patients; are significant under-reported by psychiatrists; and have a significant impact on the antidepressant effectiveness.

Methicillin-resistant Staphylococcus aureus (MRSA) is a strain of S. aureus that shows resistance to multiple antibiotics. Up to 30% of S. aureus strains isolated from nosocomial infections are MRSA, and it has become a growing problem for public health. The cost of MRSA infection is also having a huge impact financially and results in considerable resource utilization. Puerto Rico’s Legislature passed Law # 298 on October 19, 2012 for the control and prevention of MRSA infections in medical installations in Puerto Rico. In order to comply with the law we conducted a pilot study to identify possible setbacks of the implementation of the MRSA decolonization protocol as standard of care therapy in our institution while contributing to the process of quality improvement and patient safety. Nasal swabs were taken at the Pre-admission Department and processed through a PCR-based MRSA detection assay. A protocol of decolonization in patients with positive results was implemented. The study showed that patients without apparent risk factors could be colonized either with MRSA or Methicillin-sensitive S. aureus (MSSA). The time between pre- admission and surgery was less than the indicated for a proper decolonization procedure. Therefore, 50% of the scheduled surgeries could have been postponed in case of positive MRSA or MSSA. In our experience patient’s education was crucial to guarantee compliance and adherence to treatment. In order to decrease risk of wound infection we recommend that both, screening process and decolonization if required, be performed before the preadmission appointment for elective surgery. This study provided a framework for MRSA pre-admission screening and decolonization in our Institution.

Introduction: Adverse drug effects (ADEs) are the reason for 0.86% to 38.2% of hospital emergency admissions, and a large percentage of them are avoidable. Rational prescription and pharmacotherapy monitoring decrease the appearance of such health problems., Method: Study performed in a tertiary hospital emergency unit with patients selected using a two-phase random sample. The information was obtained from a validated questionnaire and from the clinical history. The data were grouped according to the following cause-effect schema: 1-Potential risk factors for an ADE. 2-Effects likely to be caused by drugs. 3-Consequences of ADEs. 4-Potential confounding factors. The information obtained was evaluated by four independent evaluators using the Dader method., Results: 840 patients were included in the study, and 33% of them came to the emergency unit due to an ADE. ADEs were more frequently observed in female patients, those with higher drug consumption, older patients, those with an underlying illness and in those from underprivileged backgrounds. The factors determining risk of an ADE are the quantity of drugs consumed, sex and the health practices index., Discussion: One third of hospital emergency admissions were due to ADEs, and these were associated with the same factors found in other studies (number of drugs consumed, female sex, age and social background). In addition, we observed that ADEs are predominant in patients with low values on the health practices index, and in those with underlying illnesses., (Copyright © 2009 SEFH. Published by Elsevier Espana. All rights reserved.)

Background and Objectives: Cocaine is directly related to the occurrence of acute coronary syndromes (ACS). We analyzed the differential characteristics of consumers who suffer an ACS in our environment., Material and Methods: A retrospective study of 914 patients with ACS who entered consecutively to our hospital., Results: Thirty four patients were consumers (3.7%, CI95%: 2.7-5.2), with an average age of 40.1+/-9.1 years, significantly lower than non-consumers (63.6+/-12.15 years, P<.001). The prevalence increased progressively in younger groups. Most were men (82.4%), with higher consumption of tobacco (88.2% vs. 34.2%, P<.001) and other illegal drugs (35.3% vs 0.9%, P<.001). By contrast, they had less frequently hypertension (26.5 vs. 60.5%, P<.001) or diabetes (11.7 vs. 39.8%, P<.001). There was single vessel disease in 44.1%, and a coronary angiography without significant lesions in 20.6% cases., Conclusions: The typical patient with ACS who consumes cocaine is usually a young man, who often takes other drugs and with a lower prevalence of classic risk factors. These data have to be taken into account when considering preventive and therapeutic manoeuvres.

Calorimetric titrations have been performed on the binding of ethidium and propidium to calf thymus DNA at temperatures in the 15-60 degrees C range. Enthalpy changes (delta HB) derived from these experiments performed with the new Omega reaction calorimeter have a precision of +/- 0.10 kcal/mol or less at all temperatures. For ethidium (a monocation), delta HB varies little with temperature, and the heat capacity change (delta CP) for the binding reaction derived from these parameters is 10 cal/deg/mol. In contrast, delta HB changes from -6.5 to -8.1 kcal/mol for DNA binding of propidium (a dication due to a charged amine group at the end of an alkyl chain attached to the phenanthridine ring nitrogen), and delta CP is -57 cal/deg/mol. At 21 degrees C a plot of delta HB vs mole ratio is curved downward for propidium in the 0.08-0.25 range, whereas the same plot at 45 degrees C is a straight line from 0.05 to 0.15 and sharply downward thereafter. Similar plots for ethidium follow the latter pattern between 25 and 50 degrees C. These observations and our analyses of delta HB and delta SB are consistent with the hypothesis that the location in the DNA complex and the rotational motion of the alkylamine chain change substantially over the temperature range in this study. Only near 50 degrees C is delta HB equal for the binding of these two cations to DNA, and caution must be used in analyses of enthalpic effects when the temperature dependence for delta HB is not available.

Differential scanning calorimetry (DSC) has been employed to determine the effect of five commonly employed extrinsic potential-sensitive probes on phase transitions of multilamellar suspensions of L-alpha-dimyristoylphosphatidylcholine (DMPC). At mol% values of less than five, the effect of these probes on the excess heat capacity curve in the vicinity of the gel to liquid crystal phase transition can be described by an equation based on the formation of ideal solutions in both phases. Even at up to 4 mol%, these dyes only moderately reduce the enthalpy change associated with this transition, but cause a marked decrease in the size of the cooperative unit parameter. The excess heat capacity profile for diS-C3-(5) is represented by the ideal solution equation, even at 12 mol%, whereas the suspensions with the other probes present at this level have profiles covering large temperature ranges. Multiple peaks appear at the higher levels for the negatively charged oxonols V and VI, and merocyanine 540, a result consistent with the presence of well-defined microdomains or even phase separation. The enthalpy change associated with the transition near 15 degrees C involving packing in the headgroup region is decreased significantly, indicating that the probes probably affect the lipid headgroup conformation, even at low levels. The cyanine probe diS-C3-(5) causes the heat capacity profile of small unilamellar vesicles to be transformed very rapidly into one similar to that of the vortexed lipid preparations, presumably by a dye-mediated vesicle fusion process, enhanced by the surface location of this probe. All our results are consistent with diS-C3-(5) being located on the surface of the bilayer in both phases, but a penetration of the other probes into the hydrocarbon region, at least in the liquid crystal phase.