The results of this survey highlight the importance of recognizing BP cuffs as potential vectors of pathogenic bacteria among patients and as a source of reinfection when dedicated to a single patient, emphasizing the urgent need for validated procedures for their use and maintenance.
A trial was carried out of prophylaxis of folate deficiency in 105 acutely ill patients immediately following admission to an ICU with evaluation of folate status. These patients were fed either orally or by enteral or parenteral nutrition. Three groups were established regardless of the type of nutrition: - Group 1 received 5 mg/day parenteral folinic acid; - Group 2 received 50 mg/week parenteral folinic acid; - Group 3 received no parenteral folinic acid. Before treatment, 19% of the patients presented very low serum folate levels (less than 2.7 ng/ml). Two of them developed acute folate deficiency with severe hematological disturbances quite reversed with folinic acid. Folate levels were inversely correlated with the severity of the clinical status and were lower in septic and feverish patients. The effect of folinic acid administration was assessed after seven days of treatment: daily administration of 5 mg folinic acid appeared to be the best regimen with normalization of serum folate levels in all cases; results appeared to be better than with 50 mg once weekly. Oral and enteral administration of folate supplies considered to be physiological (300 micrograms/day folic acid) did not appear to be sufficient to normalize in all cases blood folate levels in these acutely ill patients.
The pharmacokinetic values of d,l-leucovorin and l-leucovorin were compared in eight healthy volunteers following oral administration of 25 mg d,l-leucovorin and 12.5 mg l-leucovorin. Serum levels of l-5-formyltetrahydrofolate, l-5-methyltetrahydrofolate, and total reduced folates were measured by an established microbiological method. Pharmacokinetic data for both preparations were consistent with those previously reported for d,l-leucovorin, with essentially complete first pass metabolism to l-5-methyltetrahydrofolate, the active metabolite. No differences were found between the two preparations in serum concentrations of active folate fractions, AUC, or Cmax, or in clearance and volume of distribution estimates. These data suggest that after administration of 25 mg of d,l-leucovorin, the d-diastereoisomer has no significant effect on the standard pharmacokinetic measurements of the active l-folates.
Summary The comparative efficacy of the pure diastereoisomers of leucovorin, the natural (6S) and the unnatural (6R) forms was compared to the racemic form (6RS). A protective effect in methotrexate-treated CCRF-CEM cells was obtained with 6S at concentrations 100-fold higher than those of methotrexate and with 6RS at concentrations 2-fold greater than those of 6S; however, at low concentrations of methotrexate, 6S was more effective than 6RS in preventing the cytotoxicity of methotrexate; on the opposite, 6R exhibited a protective effect at concentrations 104 higher than those of methotrexate. On the same cell line, 6S was shown to enhance the cytotoxic effect of 5 Fluorouracil exactly as 6RS while 6R did not exhibit any enhancing effect on cells exposed to 5 Fluorouracil.
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