Disproportional impact of the revised AIDS surveillance definition on the AIDS incidence among drug users compared to homosexual men

The impact of changes in 1993 of the old 1987 WHO/CDC AIDS casedefinition was studied in a cohort of 153 HIV-infected injectiondrug users (IDUs) and 502 HIV-infected homosexual men in Amsterdam.It appeared that the extension in Europe of the old AIDS definitionto also include recurrent pneumonia, pulmonary tuberculosisand invasive cervical neoplasia, strongly increases the numberof persons diagnosed with AIDS among IDUs, but will hardly influencethe AIDS incidence among homosexual men. As recurrent pneumoniaand pulmonary tuberculosis are present among drug users withhigh CD4 cell counts, the incidence of these diseases may partlybe determined by environmental factors. The extension of theold 1987 AIDS definition in the USA with CD4 count <200 cells/mm³In addition to the 3 above-mentioned diseases, will also havea larger impact on drug users than on homosexual men.     

Modifications of the urethral rest and stress profiles after different types of surgery for urinary stress incontinence

Summary. Full urodynamic assessment, including urethral profiles at rest and under stress, using microtransducers, was made before and at least 6 months after surgery for urinary stress incontinence in 86 patients. Cure was assessed objectively. Procedures compared were Burch colposus-pension, Pereyra urethrovesical suspension and anterior colporrhaphy. The Burch colposuspension increased the pressure transmission ratio more efficiently than the vaginal operations and the cure rate was 91%. Only 50% of Pereyra operations were successful and success was related to an increase in the functional urethral length and in the pressure transmission ratio. The success rate for anterior colporrhaphy was 57% and was associated with a significant decrease in the maximal urethral closure pressure and the continence area. The prognostic value of the urethral profiles at rest and under stress and the therapeutic implications are discussed.     

Ventricular Arrhythmias in Apparently Healthy Subjects

While it is assumed that the normal heart does not predispose to serious arrhyilimias, several conditions are now being recognized as being associated with short-lasting ventricular arrhythmias. It also becomes clear that idiopathic VT (or repetitive monomorphic VT) sometimes exists on the background of a compromised heart. Whether this dysfunction is due to the arrhythmia or vice versa is not evident. Finally, VF occurs in patients who, at a first glance, have no apparent heart disease, and it is then called idiopathic VF. These complex electrical abnormalities probably reflect disorders, which often are genetically determined. Recognition of these syndromes, often characterized by abnormal repolarization or a disturbed autonomic function is possible if appropriate techniques are used.     

Farm labour in Zimbabwe: a comparative study in health status

Health indicators and factors affecting health status were surveyedin 4 areas of Mashonaland, Zimbabwe, in order to compare thehealth status of different occupational groups, in particularfarm labourers, mineworkers and peri-urban workers. The surveysincluded nutritional anthropometry of the under 5s, data ondemographic patterns and interviews to assess factors such asincome, diet, environmental conditions and access to healthservices. It was found that the health status of children waspoorest in the commercial farm areas. Poor health status wasassociated with other unfavourable factors including overcrowding,poor housing, poor access to water supplies and insanitary conditions.Income per household, relative to a poverty datum line computedfor each area, was very much lower in the commercial farm areasthan in the urban and mine areas. Farm labourers, who are shown by this study to be disadvantagedin many ways when compared to other occupational groups, arealso in the most unfavourable position as regards trying tochange the situation in which they find themselves, having neithera strong union nor representation on local councils. Legislationregulating both environmental and working conditions providesless protection to farm labourers than it does to the otherlabouring groups considered. It is concluded that the poor healthstatus of disadvantaged groups in Zimbabwe will not be substantiallyimproved while the national wealth remains in private hands.Policies to address ill health at its source will only be possiblewhen there is public control of the national wealth.     

Triggering Pulmonary Veins: A Paradoxical Predictor for Atrial Fibrillation Recurrence After PV Isolation

Triggering Pulmonary Veins and Recurrence After Ablation . Purpose: To identify procedural parameters predicting recurrence of atrial fibrillation (AF) after a first circumferential pulmonary vein isolation (CPVI). Methods: One hundred seventy‐one patients undergoing CARTO‐guided CPVI for recurrent AF with a left atrial (LA) diameter <45 mm were studied. Follow‐up (symptoms and 7‐day Holter) was performed at 1 and 3 months and every 3 months thereafter. Clinical and procedural characteristics between successful patients and patients undergoing repeat ablation were compared. In addition, procedural parameters of the first procedure were compared with parameters during repeat ablation. Results: After first CPVI, 80% of patients were free of AF without antiarrhythmic drugs after a follow‐up (FU) of 28 ± 11 months (N = 136). Thirty‐five patients (20%) had recurrence of AF of which 25 underwent repeat ablation (N = 25). Clinical characteristics did not differ between the successful and repeat group. A triggering vein during the index procedure was significantly more observed in the repeat group (56% vs 11%, P < 0.001). At repeat ablation, 2.6 ± 1.2 veins per patient were reconnected. Whereas there was no preferential reconnecting PV, all PVs triggering at index were reconnected (100%). Conclusions: (1) In patients with symptomatic recurrent AF, the presence of a triggering pulmonary vein during ablation is a paradoxical predictor for AF recurrence after PV isolation. (2) The consistent finding of reconnection of the triggering PV at repeat ablation, suggests that, in these patients, the triggering PV is the culprit vein and that reconnection invariably results in clinical AF recurrence. (3) The present study advocates a strategy of even more stringent PV isolation in case of a triggering PV. (J Cardiovasc Electrophysiol, Vol. 21, pp. 381–388, April 2010)     

DOUBLE-BLIND RANDOMIZED MULTICENTRE TRIAL OF ACAMPROSATE IN MAINTAINING ABSTINENCE FROM ALCOHOL

A prospective placebo-controlled, randomized double-blind studyof Acamprosate at two dose levels in alcohol-dependent patientsfollowed up for 12 months was performed. After detoxification,each of the 538 patients included was randomly assigned to oneof three groups: 177 patients received placebo, 188 receivedAcamprosate at 1.3 g/day (low dose group) and 173 received 2.0g/day(high dose group) for 12 months. This was followed by a singleblind 6 month period on placebo. The patients' mean age was43.2 ± 8.6 years. Their mean daily alcohol intake washigh (nearly 200g/day) and of long duration (9.5 ± 7.1years). Abstinence figures followed the order high dose>lowdose>placebo. The difference was significant at 6 months(P     

A factor analytic study of branching patient management problems

This study was undertaken to determine the factor analytic structure of patient management problems (PMPs) and to determine whether such factors are stable for different groups taking the same examination and for the same group over time. Two examinations were administered to a group of medical students, the first during their junior year and the second during their senior year. The second examination was also administered to a second class of students during their junior year. Factor analyses results indicated there are two components to medical problem-solving as measured by PMPs-data gathering and management. Both factors were stable over groups and over time.