Knowledge Regarding Hepatitis C Among Injecting Drug Users

Hepatitis C (HCV) is very prevalent among injecting drug users (IDU). Control of this infection poses a major challenge to harm reduction services. Education of all IDU regarding HCV constitutes part of the harm reduction programme. We sought to assess understanding of HCV among IDU attending an addiction treatment clinic and to identify whether or not those with increased contact with health professionals demonstrated better understanding. A total of 105 IDU were interviewed to assess their knowledge regarding modes of transmission and chronicity of HCV infection. They had first injected an average of 10.0 years previously. Interviewees were more successful at identifying activities which carried a risk of HCV transmission than they were at identifying activities which posed no risk of infection. Over one-third falsely believed that one could contract HCV infection even when injecting 'safely'. Understanding of the long-term nature of HCV infection was also impaired. A group on methadone maintenance for a median period of 1.4 years failed to demonstrate significantly better knowledge than those attending for a 21-day detoxification. Those in frequent contact with a GP performed less well than those without such contact. Understanding of HCV among IDU is inadequate and must improve if primary prevention efforts are to succeed. We question the value of didactic approaches to educating IDU and call for a more experiential teaching style which may be more successful at countering prevalent misconceptions.     

Cellular mechanisms involved in recovery from acute malaria in Gambian children

This paper reports the results of in vitro experiments which attempt to elucidate the mechanisms whereby Gambian children control acute infections of Plasmodium falciparum. It was shown initially that mononuclear cells from children with acute malaria, in the presence of specific antibody, caused a marked reduction in in vitro parasite growth. IgM antibodies appeared to be considerably more effective than IgG. T or B lymphocytes were ineffective in the system; adherent cells alone had some effect, but much less than the unfractionated cell population. Adherent cells were however fully effective after exposure to supernatants from T cells activated either non-specifically by phytohaemagglutinin (PHA), or specifically by P. falciparum antigens. Depression of parasite growth was also observed, independent of anti-malarial antibody. This was achieved when adherent cells from healthy Europeans, as well as those from infected children, were exposed to the supernatants from previously stimulated T cells before adding to the culture. Furthermore, intra-erythrocytic parasite death occurred after a short exposure to the supernatants of 'activated' adherent cells from both infected children and Europeans.     

Mobitz Type II Second‐Degree Atrioventricular Block with Narrow QRS and Junctional Extrasystoles: What is the Mechanism?

A 74‐year‐old man underwent an electrophysiological study because of Mobitz type II second‐degree atrioventricular (AV) block with narrow QRS and frequent junctional extrasystoles. During the study, there were very frequent single His bundle depolarizations with multiple coupling intervals that reproduce the ECG findings. In this case, some His bundle extrasystoles result in retrograde concealed conduction and prolonged local refractoriness in the AV node that manifest as block of the next atrial impulse.     

Advances in Dual Chamber Implantable Cardioverter/Defibrillators

We describe the past, present, and possible future of implantable dual chamber defibrillators and take a quick look at the history of implantable cardioverter defibrillators (ICDs) to provide the background for this article. Four of the current generation dual chamber ICDs and the merits and issues surrounding these devices are compared. We then take a look at the future directions for dual chamber ICDs and discuss the research, technologies, algorithms, and issues that will drive the future of dual chamber ICDs.     

Offspring of parents with drinking problems: drinking and drug-taking as young adults

One hundred and seventy 16 to 35 year-old offspring of parents with drinking problems and 80 comparison young adults were recruited from a variety of clinical and community sources. Each was interviewed at length using a semi-structured interview and 86% were re-interviewed one year later. No between-group differences were found in current quantity of alcohol consumption nor in percentages who had ever used or were currently using illicit or prescribed drugs. However, larger numbers of offspring had commenced alcohol use in their early teens and had used other drugs in their later teens, and more offspring than comparisons were currently using alcohol in a risky way, more were using illicit drugs more than occasionally, and more were heavy smokers. These differences were not great, and gender and source of recruitment (clinical versus community) were equally important predictor variables. Analyses conducted within the offspring group offered no support for hypotheses linking adulthood risk with years of exposure, severity of childhood effects and experiences, maternal as opposed to paternal problems, or problems in the same sex parent. However, some support was found for the importance of having had two parents with drinking problems and having had a drinking parent who often drank at home.     

Combined Paclitaxel‐Eluting Balloon and Genous Cobalt–Chromium Alloy Stent Utilization in De Novo Coronary Stenoses (PEGASUS)

Objectives

The aim of this study was to examine the angiographic result and its outcome predictors using the combination of paclitaxel‐eluting balloon (PEB) and Genous stent.

Background

This approach to treat coronary stenoses is a logical strategy to strike a balance between minimizing restenosis and stent thrombosis.

Methods

From November 2010 to June 2012, 40 symptomatic patients with 44 de novo coronary lesions of diameter stenosis ≥50% were treated with the combination of PEB and Genous stents. Angiographic and clinical follow‐up were intended at 6 and 9 months, respectively.

Results

The mean age of patients was 61 ± 11 years, with male predominance (83%). Diabetes mellitus and end‐stage renal failure on peritoneal dialysis were found in 15 (38%) and 10 (25%) patients, respectively. Patients received dual antiplatelet therapy for 5.1 ± 1.5 months post procedure. The size and length of PEB used was larger than the stents (3.13 ± 0.46 mm and 28 ± 9 mm vs. 2.98 ± 0.36 mm and 23 ± 7 mm). Restudy angiography was performed on 41 (95%) lesions in 37 (93%) patients at 5.9 ± 1.7 months. Angiographic restenosis was seen in 5 (12%) lesions, and significantly associated with diabetes mellitus and dialysis dependency; the late lumen loss was 0.38 ± 0.37 mm. At 9‐month follow‐up, no stent thrombosis was observed.

Conclusions

The use of PEB combined with Genous stent is associated with a reasonably low restenosis and late lumen loss, whereas diabetes mellitus and renal failure with dialysis are poor predictors of angiographic restenosis.

     

Knowledge Regarding Hepatitis C Among Injecting Drug Users

Hepatitis C (HCV) is very prevalent among injecting drug users (IDU). Control of this infection poses a major challenge to harm reduction services. Education of all IDU regarding HCV constitutes part of the harm reduction programme. We sought to assess understanding of HCV among IDU attending an addiction treatment clinic and to identify whether or not those with increased contact with health professionals demonstrated better understanding. A total of 105 IDU were interviewed to assess their knowledge regarding modes of transmission and chronicity of HCV infection. They had first injected an average of 10.0 years previously. Interviewees were more successful at identifying activities which carried a risk of HCV transmission than they were at identifying activities which posed no risk of infection. Over one-third falsely believed that one could contract HCV infection even when injecting 'safely'. Understanding of the long-term nature of HCV infection was also impaired. A group on methadone maintenance for a median period of 1.4 years failed to demonstrate significantly better knowledge than those attending for a 21-day detoxification. Those in frequent contact with a GP performed less well than those without such contact. Understanding of HCV among IDU is inadequate and must improve if primary prevention efforts are to succeed. We question the value of didactic approaches to educating IDU and call for a more experiential teaching style which may be more successful at countering prevalent misconceptions.