Prospective economic evaluation of lead poisoning prevention programs

This paper illustrates an economic methodology for the prospective evaluation of individual lead poisoning screening and prevention programs. A method is presented for prospectively estimating the prevalence and expected health consequences of lead poisoning in an urban population. The economic costs of these consequences are calculated and cost-benefit analysis is used to complete the evaluation. A case study is developed to illustrate the potential utility of the model as a framework for the prospective evaluation of programs under funding consideration.     

The structural and functional status of the liver in tropical sprue

Summary Liver biopsy and function tests were performed on 8 patients with tropical sprue. Although mild hepatic siderosis and lipofuscin deposition were revealed in addition to some minimal abnormalities in liver function tests, no evidence of significant hepatic injury was found.     

In vivo lysogenic conversion of Tox(-) Streptococcus pyogenes to Tox(+) with Lysogenic Streptococci or free phage

Temperate bacteriophage can transfer toxin-encoding genes between bacteria, often resulting in acquired pathogenicity. However, little is known regarding the effects of the eukaryotic host on the phage-pathogen interaction. Using Streptococcus pyogenes as a model, we demonstrate, both in vitro and in vivo, that the eukaryote mediates the efficient induction of toxin-encoding temperate phage and the resultant conversion of Tox(-) flora to Tox(+). Furthermore, we show that both phage induction and subsequent conversion need not happen in the same mammalian host, as host-to-host phage transmission can result in toxigenic conversion within the secondary host. Ultimately, our findings demonstrate that the eukaryotic host serves as an essential component in the phage-mediated evolution of virulence within the microbial population.     

Proximal row carpectomy: clinical evaluation

Proximal row carpectomy as a treatment of disorders of the radiocarpal joint remains controversial despite numerous reports documenting clinically successful outcomes. Criticism includes postoperative loss of grip strength, unsatisfactory range of motion, prolonged rehabilitation time, and the potential for progressive painful arthritis. Twenty-seven patients were studied to address these concerns. The average length of follow-up was 4 years. Postoperative pain relief was achieved in 26 patients, allowing 24 of the 27 patients to return to their previous activity status within an average of 4.5 months after surgery. In all cases, range of motion matched or surpassed preoperative values. Grip strength improved to an average of 80% of the contralateral side. A detailed radiographic analysis of the radii of curvature of the lunate fossa and the capitate showed that the radius of curvature of the capitate is approximately two thirds of the corresponding value of the lunate. Motion between the capitate and the radius is translational with a moving center of motion, which may dissipate load on the radius and explain the relative success of the procedure.     

Cytogenetic evidence for involvement of B lymphocytes in acquired idiopathic sideroblastic anemias

We studied the cellular distribution of an unusual chromosomal abnormality, an interstitial deletion of the long arm of chromosome 13, in the peripheral blood lymphocytes of two patients with acquired idiopathic sideroblastic anemia (AISA). We found no metaphases containing the 13q- abnormality in preparations of phytohemagglutinin (PHA)-stimulated lymphocytes from either patient. In both cases, however, some metaphases from Epstein-Barr virus (EBV)-transformed lymphoblastoid cell lines contained the clonal karyotypic abnormality. These observations indicate that B lymphocytes but not T cells are expressed as members of the clonal cohort of cells. Our results strongly suggest that the initial pathogenetic events that led to expansion of the 13q- clone occurred in a progenitor cell capable of giving rise to both hematopoietic and B lymphoid cells.     

An integrated surveillance network for antimicrobial resistance,India

ObjectiveTo assess the preparedness of veterinary laboratories in India to participate in an integrated antimicrobial resistance surveillance network and to address gaps in provision identified.MethodsThe Indian Council of Medical Research and the Indian Council of Agricultural Research collaborated: (i) to select eight nationally representative veterinary microbiology laboratories whose capacity for participating in an integrated antimicrobial resistance surveillance network would be assessed using a standardized tool; (ii) to identify gaps in provision from the assessment findings; and (iii) to develop a plan, and take the necessary steps to address these gaps in consultation with participating organizations.FindingsThe main gaps in provision identified were: (i) a lack of dedicated funding for antimicrobial resistance surveillance; (ii) the absence of standard guidelines for antimicrobial susceptibility testing; (iii) a shortage of reference strains for testing and quality assurance; and (iv) the absence of mechanisms for sharing data. We addressed these gaps by creating a veterinary standard operating procedure for antimicrobial susceptibility testing, by carrying out a validation exercise to identify problems with implementing the procedure and by conducting capacity-building workshops for veterinary laboratories.ConclusionAntimicrobial resistance surveillance networks depend on the availability of accurate, quality-controlled testing. The challenges identified in creating an integrated surveillance network for India can be overcome by developing a comprehensive plan for improving laboratory capacity in human, veterinary and environmental sectors that is supported by the necessary funds. The study’s findings may provide guidance for other low- and middle-income countries planning to develop a similar network.     

Beneficial effects of the calcium antagonist PN 200-110 in patients with congestive heart failure

We studied the acute hemodynamic effects of PN 200-110, a newly available calcium antagonist, in 12 patients with severe congestive heart failure. Measurements of cardiac performance were obtained by a right heart catheter before and after administration of 5 and 15 mg of PN. Peak drug effects occurred 1-2 h following the administration of PN 200-110 and were dose related. The 15-mg dose reduced mean arterial pressure (MAP) from 90 +/- 11 to 75 +/- 6 mm Hg (mean +/- SD) (p less than 0.001) and decreased systemic vascular resistance (SVR) from 1,740 +/- 500 to 995 +/- 300 dynes X s X cm-5 (p less than 0.01). Stroke volume index (SVI) increased from 26 +/- 7 to 36 +/- 10 ml/m2 (p less than 0.001), and cardiac index (CI) rose from 2.1 +/- .3 to 2.8 +/- .6 L/m2 (p less than 0.01). Pulmonary arterial wedge pressure (PAW) changed insignificantly. Seven patients performed graded supine exercise at identical workloads before and after treatment. When peak exercise values were compared, the addition of PN 200-110 further reduced SVR from 1,282 +/- 461 to 936 +/- 356 dynes X s X cm-5 (p less than 0.01) and increased CI from 3.3 +/- 1.1 to 4.3 +/- 1.3 L/m2 (p less than 0.01). Only minor, self-limiting side effects were noticed during acute administration. Of the seven patients discharged on PN 200-110 and followed for at least 6 months, six reported substantial relief of symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)