The effect of immune serum and complement on the in vitro phagocytosis of Babesia rodhaini

The effect of immune serum and complement on the in vitro phagocytosis of Babesia rodhaini was investigated. Infected erythrocytes and parasites released from erythrocytes by lysis were phagocytosed by mouse peritoneal macrophages in vitro when the infected erythrocytes or parasites were exposed to hyperimmune B. rodhaini serum. Complement, in the presence of immune serum, did not reproducibly enhance phagocytosis of infected erythrocytes or parasites alone. When adjusted for its effect on normal erythrocytes and normal serum, complement generally inhibited rather than enhanced phagocytosis. When coupled with other published data, our data suggest that the activation of the immune system in vivo against this species of Babesia involves a series of mechanisms of which phagocytosis is but one.     

Nasal mask continuous positive airway pressure in the treatment of chronic nocturnal cough in a young child

Abstract The objective of this case report was to define the effects of nasal mask continuous positive airway pressure (CPAP) on the respiratory and sleep characteristics of a 3 year-old boy with a 2 year history of snoring and 1 year history of chronic nocturnal cough. The method employed was all-night polysomnography before and during treatment with CPAP after the identification of partial upper airway obstruction in association with cough. The results indicated that the child had evidence of mild upper airways obstruction on initial all-night sleep study. Nasal mask CPAP was instituted. On a subsequent sleep study 4 weeks later, this was documented to prevent the upper airway obstruction at a pressure of 5.2 cm of water. In addition, nasal mask CPAP markedly reduced the nocturnal coughing, the total number of coughs decreasing from 92 to one. The rate of cough per h of study (cough disturbance index) decreased from 9.8—0.1. Sleep efficiency (total sleep time as a percentage of study duration) improved on CPAP from 87 to 99%. This study suggests that chronic nocturnal cough can result from upper airway obstruction in sleep in children and is an important initial observation.     

Proliferation signal inhibitors in the treatment of lupus nephritis: Preliminary experience

Aim: Proliferation signal inhibitors (PSI) have demonstrated efficacy in prevention and treatment in an animal model of lupus nephritis (LN) but there are no data regarding the use of PSI in human LN. We report here our experience of using PSI treatment in seven patients with severe proliferative lupus nephritis. Methods: This is a retrospective study on patients with proliferative lupus nephritis who had received PSI treatment. Results: Seven patients were included. Two patients had concomitant membranous lupus nephropathy. The indications for PSI included mycophenolate mofetil intolerance (n = 4), history of malignancy (n = 2) and leucopoenia (n = 1). Five patients were given PSI when disease was active. Two had treatment discontinued because of acute cholecystitis and leucopoenia, respectively. In the other three patients combined steroid and PSI treatment as induction therapy led to improvements in serology, renal function and proteinuria. In two patients treated with PSI and low‐dose steroid as maintenance immunosuppression, both maintained stable lupus serology, renal function and proteinuria over 18 months. Side‐effects included dyslipidemia and oral ulcers. Conclusion: Proliferation signal inhibitors warrants further investigation as an alternative immunosuppressive treatment in lupus nephritis.     

What happens to drug misusers? A medium-term follow-up of subjects new to treatment

In a 2.5–5 year follow-up study of 150 drug misusers who were new to treatment at three London Drug Treatment agencies, a 77% follow-up rate was obtained. High rates of self-reported abstinence from opiates and other drugs were found. Some 37% of those followed-up were totally drug free at follow-up. Seventy-one per cent were living in the community and of those 73% were opiate free and 35% were totally drug free. Only 18% had injected in the 4 weeks prior to follow-up. Thirteen per cent were in prison and 12% were resident in a therapeutic community. Being told about the dangers of HIV had persuaded some people to give up using drugs.     

The relationship between alcohol dependence and alcohol–related problems in a clinical population

The relationship between alcohol dependence and alcohol–related problems was studied in a group of 103 problem drinkers. Responses to a 46–item Alcohol Problems Questionnaire (APQ) were compared with the Severity of Alcohol Dependence Questionnaire (SADQ), alcohol consumption and demographic data. A strongly positive correlation was found between aggregate problems and dependence scores (r= 0.63; p = 0.001) which existed independently of the quantity of alcohol consumed. Analysis of questionnaire subscales revealed that certain problem domains were more closely related to particular aspects of dependence than others. A higher level of problems was found in subjects of younger age and lower socio-economic class. No significant sex differences were found. The implications of these findings are discussed.     

Hepatitis viruses: A Pandora's box?

Abstract The term hepatitis virus is reserved for those viruses that are predominantly hepatotropic, although several new agents have been assigned to this category in the absence of hepatotropism and clinical disease. The hepatitis viruses can be broadly divided into those transmitted via the fecal‐oral route, and those by blood, blood products and body fluids. Hepatitis A (picornaviridae), hepatitis B (hepadnaviridae) and hepatitis C (flaviviridae) represent the major public health problems. The epidemiology of hepatitis A virus (HAV) and hepatitis B virus (HBV) is changing in response to vaccination. In the case of HAV, older age groups are now deemed at risk, particularly of fulminant hepatitis if exposed over the age of 50. Chronic hepatitis B in some regions is now predominantly of the so‐called precore mutant type where high levels of HBV replication persist in the presence of anti‐hepatitis B virus (HBe) antibodies. The HBV vaccination is among the most cost‐effective health care measures. The epidemiological significance of mutations found increasingly in the HBV S gene isolated from vaccinated children is unclear. Evidence that hepatitis G and TT virus are significant causes of hepatitis is lacking. Of interest, however, is the finding that the related GBV‐B agent of monkeys may be a model for developing new antiviral agents against HCV. Animal models of hepatitis infections are providing new insights into the pathogenesis of hepatitis in humans. Indeed it is possible that hepatitis E is primarily an agent of pigs and other domesticated livestock. Intriguingly, the new TT virus shares many properties with the circoviruses, significant pathogens of chickens and pigs. The challenge in the next decade will be to assess the significance of these new agents in terms of public health and resources. Value judgements will have to be made in assessing the risks associated with blood containing trace amounts of these adventitious agents. © 2002 Blackwell Publishing Asia Pty Ltd     

Electrophysiologic Study and Radiofrequency Ablation in Patients with Intracardiac Tumors and Accessory Pathways:

Ablation with Intracardiac Tumors. Introduction : There is a strong association of cardiac rhabdomyomas with the Wolff-Parkinson-White syndrome. This report describes the results of investigations in two patients with accessory pathway-mediated AV reciprocating tachycardia coexisting with intracardiac tumors.
Methods and Results : Two patients with intracardiac tumors had mapping of the accessory pathway. Echocardiograms obtained in the electrophysiology laboratory while the ablation catheter was at the site of successful radiofrequency ablation demonstrated a close correspondence between the site of intracardiac tumor and the location of the accessory pathway.
Conclusions : These results lend support to the hypothesis that accessory pathways in patients with intracardiac tumors, such as rhabdomyomas, are not typical Kent bundles, hut instead are either part of the intracardiac tumor or are closely related to the tumor. Ablation is possible in at least some patients with accessory pathways associated with intracardiac tumors.     

Replacement of a Prescribing Service by an Opiate-free Day Programme in a Glasgow Drug Clinic

Following a change in clinic policy from prescribing to non-prescribing in 1983, patients attending an opiate-free day programme differ significantly from a group which was previously described attending a methadone prescribing clinic in the same location, between 1981 and 1982. The opiate-free programme patients were younger, more likely to be single and living with parents. They reported a similar level of criminality and drug-related illness at a younger age and tended to approach the opiate-free programme earlier in their drug career. Patients with a longer history of drug taking attend as often as those with a short history. Other factors influencing attendance are discussed. It is concluded that the younger opiate taker is more likely to approach an opiate-free day programme than a methadone prescribing clinic.     

HIV prevention and drug treatment services for drug misusers: a national study of community pharmacists' attitudes and their involvement in service specific training

Aims. To investigate the attitudes of community pharmacists towards HIV prevention services for drug misusers and the relationship between these and their involvement in service provision. Design. Postal survey of a one in four random sample of community pharmacies (N = 2654) in England and Wales, stratified by Family Health Service Authority, in 1995, using up to four mailshots. Setting. Community pharmacies in England and Wales. Participants. The community pharmacist in charge of the dispensary at the random sample of community pharmacies. Measurements. Information on attitudes and behaviour were collected through self-completion and postal return of structured questionnaires using questions with both category responses and Likert scales. Findings. A 74.8% response rate was achieved. Community pharmacists were positive about their role in HIV prevention and the provision of clean injecting equipment to injecting drug users—positive attitudes that were more evident among those pharmacists already providing these services. However, they had concerns over the effect drug misusers may have on business and indicated a need for more training and for more role support. Only a minority had taken pan in training on drug misuse and HIV prevention (34.7% and 21.3%, respectively). Many community pharmacists supported the proposal that there should be extensions of their involvement, to include services such as supervising the consumption of methadone in the pharmacy (38.6%) and collecting used prescribed ampoules front patients (33.8%). Positive relationships were identified between training and attitude, and between attitude and service provision. Changes in attitude responses between this 1995 survey and the earlier 1988 survey are also presented. Conclusions. Recommendations are made for further training and greater communication between prescriber/carer and the community pharmacists, for involvement of community pharmacies in new possible forms of service provision, and for there to be greater attention to the value of role support.