A role for the primary care physician in counseling young African-American men about homicide prevention

Homicide is the leading cause of death in African-American men aged 15–34 years, yet physicians rarely discuss homicide prevention with patients. The authors propose that physicians have a role in preventing homicide similar to their role in other preventive medicine issues. This study evaluated patients’ responsiveness to a physician’s counseling about firearms and homicide. While being treated for unrelated problems at a walk-in ambulatory clinic, 53 African-American men patients received brief counseling by the physician about six preventive medicine topics, including firearms. A postvisit interview demonstrated that the discussion of firearms was well received and recalled more than any other preventive medicine issue discussed.     

High-Strength Tretinoin for Rapid Retinization of Photoaged Facial Skin

Background. Emollient creams of 0.02% and 0.05% tretinoin are currently used for improving the appearance of photoaged skin. At these concentrations, using this vehicle, the clinical results take many months.
Objective. The objective was to formulate and test a higher strength tretinoin that enhances penetration of the active molecule through the stratum corneum so that the clinical result is achieved after 1 month of treatment.
Methods. Thirty-two female subjects underwent treatment with 0.25% tretinoin solution applied nightly for 1 month. Subjects were evaluated clinically at baseline and 1, 2, and 4 weeks. Clinical grading was performed by comparing digital photographs before and after treatment.
Results. Almost all subjects improved on all measures of clinical grading (fine lines, mottled pigmentation, surface texture/roughness) by the end of the study.
Conclusion. Tretinoin solution at a concentration of 0.25% is an effective and tolerable treatment for photodamaged facial skin and greatly shortens the time required for clinical response.     

FK506 in combination with methotrexate for the prevention of graft- versus-host disease after marrow transplantation from matched unrelated donors

The safety and potential efficacy of FK506 in combination with a short course of methotrexate (MTX) for the prevention of acute graft-versus- host disease (GVHD) after marrow transplantation from HLA-matched unrelated donors was evaluated in a single-arm Phase II study conducted at two centers. Forty-three patients, 15 to 54 (median 41) years of age, were transplanted for hematologic malignancies. Thirty-seven of 43 evaluable patients had evidence of sustained marrow engraftment. Five patients died before day 17 after transplantation. The median time to an absolute neutrophil count of > 0.5 x 10(5)/L was 21 (range, 14 to 30) days. Nephrotoxicity (serum creatinine concentration > 2 mg/dL or doubling of baseline) occurred in 32 patients (74% cumulative incidence during the first 100 days after transplant). Other adverse effects included hypertension (n = 27), hyperglycemia (n = 27), neurotoxicity (n = 9) and thrombotic thrombocytopenic purpura (n = 2). Severe veno- occlusive disease of the liver occurred in 9 (21%) of the 43 patients. Eighteen patients (42%) developed grades II to IV acute GVHD and five (12%) developed grades III to IV acute GVHD. Twelve of 25 evaluable patients developed extensive chronic GVHD within 1 year of marrow transplantation resulting in an estimate of the probability of developing this complication of 48%. The cumulative incidence of transplant-related mortality during the first 100 days was 37%. Kaplan- Meier estimates of disease-free survival at 2 years for good-risk, poor- risk, and all patients were 65%, 4%, and 32%, respectively. FK506 in combination with a short course of MTX appears active in preventing acute GVHD after marrow transplantation from unrelated donors. Further studies comparing the combination of FK506 and MTX with cyclosporine and MTX for the prevention of acute GVHD are warranted.     

Membrane abnormality in red blood cells with weak type B expression

The mechanisms of unusually weak blood group (A and B) expressions are not yet well understood. We examined properties of blood group galactosyltransferase (B-enzyme) and characteristics of red cell membrane components obtained from family members with A2Bm character. B- enzyme activity of the A1Bm plasma is in normal range, and kinetic properties (i.e., Km for UDP-Gal, Km for 2'-fucosyllactose, and pH optima) of B-enzyme from the A1Bm subjects are identical to that of normal B-enzyme. When A1Bm red cell were incubated with UDP-Gal and B- enzyme, the cells became strongly agglutinable with anti-B. When A1Bm membranes were incubated with B-enzyme or A-enzyme (i.e., blood group N- acetylgalactosaminyltransferase) and the appropriately labeled nucleotide sugar (UDP-Gal3H for B-enzyme and UDP-GalNAc3H for A- enzyme), significant incorporation of the sugar was observed. The amounts of the sugar incorporated into A1Bm membranes were about 40%- 50% of that incorporated into O membranes at saturation, indicating that about one-half of H-sites remained unglycosylated in A1Bm red cells. Examination of radioactive components by isoelectric focussing revealed that the labeled components of A1Bm membranes were distinctively different from that of O membranes. Therefore, one can conclude that the weak B expression is not due to direct mutation of ABO locus, but due to a secondary consequence of genetic abnormality of a membrane component (or components) associated with blood group substances.     

Factors associated with inadequate prenatal care in Ecuadorian women

Background

Although inadequate prenatal care has been associated with adverse perinatal outcomes, reports on the factors associated with poor prenatal care in developing Latin American countries are scarce.

Objective

To determine factors associated with inadequate prenatal care among women from low socioeconomic circumstances.

Method

Women delivered after a pregnancy duration of more than 20 weeks at the Enrique C. Sotomayor Obstetrics and Gynecology Hospital, Guayaquil, Ecuador, were surveyed. The questionnaire collected sociodemographic data and reasons for having inadequate prenatal care. Adequacy of prenatal care was measured with the Kessner index and correlated to the sociodemographic data.

Results

During the study period, 1016 pregnant women were surveyed. Among them, there were adolescents (23.7%), primigravidas (30.8%), and women with a high-risk pregnancy (29.3%). According to the Kessner index, prenatal care was considered adequate or inadequate in 24.5% and 75.5% of cases, respectively. Knowledge regarding the importance of adequate prenatal care and the effects of poor prenatal care was lower among women who had received inadequate prenatal care. The women that were considered to have had adequate prenatal care had at least one visit, and they were more often cared for by a specialist than women who considered having inadequate prenatal care. The three most important reasons associated to inadequate prenatal care in this series (n=767), were economic difficulties having to care for a small child, and transportation difficulties. Logistic regression analysis determined that women with undesired pregnancies who resided in rural areas and were para 5 or higher had an increased risk of inadequate prenatal care. On the other hand, an adverse outcome to a prior pregnancy (abortion, intrauterine fetal demise, or ectopic pregnancy) decreased this risk. Marital status and educational level were confounding factors.

Conclusions

Although prenatal care at our institution is free, adequacy was thought to be low. The main factors associated with poor prenatal care were mostly conditions related to poverty.