Need for treatment of gonorrhea to be effective against Chlamydia trachomatis

Men and women with gonorrhea or contact to gonorrhea are frequently co-infected with Chlamydia trachomatis. To assess the importance of using treatment regimens active against both Neisseria gonorrhoeae and C trachomatis, tetracycline 500 mg orally four times daily for five days, with activity against both organisms, was compared with ceftriaxone, 250 mg once intramuscularly, with activity against only N gonorrhoeae. N gonorrhoeae microbiological failure occurred in six of 148 patients (4%) on tetracycline and zero of 85 on ceftriaxone. Microbiological failure for C trachomatis occurred in zero of 27 on tetracycline and 10 of 12 (83%) on ceftriaxone (P<0.001). In addition, 14 others on ceftriaxone had C trachomatis first isolated after treatment. When all types of microbiologialc and clinical failures are included, outcome was significantly better on tetracycline (P<0.001). Optimal treatment of patients with gonorrhea must include regimens with activity against both C trachomatis and N gonorrhoeae.     

Decreased Intrinsic Factor Secretion in AIDS: Relation to Parietal Cell Acid Secretory Capacity and Vitamin B12 Malabsorption

AIDS-associated gastric secretory failure has been characterized by decreased secretion of acid, pepsin, and gastric juice volume. To determine whether decreased intrinsic factor secretion and vitamin B12 malabsorption occur in this entity, we performed prospective measurements of maximal acid output, intrinsic factor output, vitamin B12 absorption, serum vitamin B12, and holotranscobalamin II in 10 consecutive AIDS patients. Four of 10 patients had low maximal acid output, i.e., < or = 1.5 mEq/h (control = 12.8 +/- 9.0, range 2.5-25 mEq/h). Four patients had low intrinsic factor output, i.e., < or = 1.1 microgram/h (control = 8.2 +/- 6.9, range 3.1-19.4 micrograms/h). One patient with low intrinsic factor output had low serum vitamin B12 and a Schilling test consistent with pernicious anemia. A second patient with very low intrinsic factor output (0.16 micrograms/h) had low parts I and II Schilling tests; malabsorption most likely resulted from both low intrinsic factor secretion and ileal disease. One of three vitamin B12 malabsorbing patients, with normal serum vitamin B12, had low holotranscobalamin II, 25 pg/ml (control holotranscobalamin II = 76 +/- 44, range 44-152 pg/ml). Maximal acid output and intrinsic factor output did not correlate in AIDS (r = 0.36, p = 0.30) in contrast to the expected correlation in controls (r = 0.91, p = 0.03). We conclude that low intrinsic factor secretion is common in AIDS and contributes to vitamin B12 malabsorption. Decreased parietal cell secretion of intrinsic factor and acid may occur independently in human immunodeficiency virus-associated gastric secretory failure. Low holotranscobalamin II, an early manifestation of vitamin B12 malabsorption, results in decreased delivery to vitamin B12-dependent tissues prior to depletion of serum vitamin B12. Regular supplementation with vitamin B12 may therefore be warranted in patients with advanced HIV infection.     

Zirconia Phase Transformation,Metal Transfer,and Surface Roughness in Retrieved Ceramic Composite Femoral Heads in Total Hip Arthroplasty

Ceramic femoral heads have had promising results as a bearing surface in total hip arthroplasty. Our objective was to evaluate a series of retrieved alumina-zirconia composite ceramic femoral heads for evidence of the tetragonal to monoclinic zirconia phase transformation, metal transfer and articular surface roughness. Raman spectra showed evidence of the zirconia phase transformation in all retrieved specimens, with distinct monoclinic peaks at 183, 335, 383, and 479 cm^− 1. All components displayed metal transfer. An increase in the zirconia phase transformation was seen with increasing time in vivo. No correlation between extent of zirconia phase transformation and the surface roughness was found. These short-term results suggest that the use of an alumina-zirconia composite ceramic is a viable option for femoral heads in THA.     

Myocardial bridging and sudden death

Myocardial bridging (MB) has been described more than 200 years ago. However it's implications on the genesis of myocardial ischaemia were not studied until recently. Little is known about the real incidence, survival in people with this entity and pathophysiology. Data found in the literature are prone to bias since all studies published are retrospective and the populations studied are limited and very selectioned. Most authors agree that most MB is rather frequent and seldom generates ischaemia. A significant clinical effect of myocardial bridging implies a thick MB with at least 75% coronary systolic obstruction associated with ventricular hypertrophy and/or rapid tachycardia. In the peculiar case of sudden death, we think that to consider MB as a cause of this sudden death we need more than a simple necroptic finding of a MB. A history of clinical and/or electrocardiographic confirmed ischaemia or the presence of histological abnormalities suggesting myocardial ischaemia can be helpful.