The Use of Multidisciplinary Teams to Evaluate Bariatric Surgery Patients: Results from a National Survey in the U.S.A.

Background: The degree to which U.S. bariatric surgeons use multidisciplinary methods to evaluate patients is unknown. Methods: We conducted a national survey of practising bariatric surgeons, mailed in 3 waves from September-December 2004, to describe and determine predictors of surgeons' approach to the multidisciplinary evaluation of prospective bariatric surgery patients. Multivariate analyses were performed to determine patterns and predictors of multidisciplinary methods. Results: The response rate was 62% (813/1,312). Although 95% of respondents reported using a multidisciplinary team, only 53% had a general physician, nutritionist, and mental health specialist (NIH-recommended team). Just 47% mandated primary care, nutrition, and mental health evaluations (NIH-recommended evaluations). Practice type, size, and location as well as membership in the American Society for Bariatric Surgery did not influence these outcomes. General surgery board certification reduced the odds of having an NIH-recommended team (OR = 0.56, 95%CI 0.35-0.92). Practicing bariatric surgery for >8 years decreased the odds of reported multidisciplinary team use (OR = 0.29, 95%CI 0.10-0.82) and requiring NIH-recommended evaluations (OR = 0.36, 95%CI 0.24-0.53). Medium volume surgeons had increased odds of reporting use of a team (OR = 2.96, 95%CI 1.22-7.18) and decreased odds of requiring NIH-recommended evaluations (OR = 0.65, 95%CI 0.44-0.92). Conclusion: Inconsistent and unpredictable patterns of multidisciplinary methods were found. Further research should explore the impact of different methods on outcomes. New policies should detail a minimum standard for the multidisciplinary evaluation of bariatric surgery patients. Health professionals across disciplines are needed to assist surgeons in evaluating prospective bariatric surgery patients.     

Isolation of intestinal spirochaetes from homosexuals

Spirochaetes were isolated from rectal swabs of two homosexuals and the faeces of a third, using simple isolation techniques not previously applied to specimens of this type. The ease of culture of these organisms will enable their distribution and pathogenicity to be studied, particularly in relation to their significance in homosexuals.     

Evaluation of Race by Cranial Index of Adult Human Skull in Maharastra Population

Biologists and physical anthropologists attempted to classify human being into races according to phenotypic variations. The latter are based either on one or two phenotypic characters therefore the outcome is unable to givq clear distinction among different races. Cranial index seems to be an important,tool, which may be used to identify the races in different geographical regions. 75 dried skulls collected from different part of Maharashtra were measured to determine the cranial index. Skulls were classified by the method of Montagu (1960)2 Average maximum cranial length and breadth were found to be 17.11 cm and 12.98 cm respectively and maximum & minimum cranial lengths were observed to be 18.50 and 16.60 cm and cranial breadths were noted to be 14.50 and 12.10 cm respectively. Average cranial index (mean ± SD) was 75.49 ± 3.95. In our study most of the skulls were grouped under the Mesocranial (46.66%) and Dolichocranial (42.66%) categorises when based on Montagu and Dolichocranial categorises when 56% based Comas'. As per the conclusion Maharashtrian population belongs to Indo-Dravidian race.     

The long-term effectiveness of generic adult fixed-dose combination antiretroviral therapy for HIV-infected Ugandan children

Background

Access to pediatric antiretroviral formulations is increasing in resource-limited countries, however adult FDCs are still commonly used by antiretroviral therapy (ART) programs.

Objective

To describe long-term effectiveness of using adult FDC of d4T+3TC+NVP (Triomune) in children for HIV treatment.

Methods

Clinical, immunologic, and virologic outcomes of HIV-infected ART-naïve children aged six months to 12 years, were evaluated up to 96 weeks post-ART initiation.

Results

From March 2004 to June 2006, 104 children were followed with a median age of 5.4 years, median CD4 cell percent and HIV-1 RNA were 11.0% (IQR 6.7–13.9) and 348,846copies/mL (IQR 160,941–681,313) respectively at baseline. Using Kaplan-Meir estimates, 75% of children had undetectable viral loads (<400copies/mL) at 96weeks of ART. Children with a baseline CD4 cell percent >15% were 3 times more likely to achieve viral load <400copies/mL than those with baseline CD4 cell percent <5% after adjusting for baseline age {aHR = 3.03 (1.10–8.32), p=0.03}; no difference was found among those with CD4 cell percent >5–14.9% and <5%.

Conclusion

Treatment with generic adult FDC for HIV-infected Ugandan children led to sustained clinical, immunologic and virologic response during 96 weeks of ART. Early initiation of ART is key to achieving virological success.