Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group

BACKGROUND AND METHODS: We examined the influence of viral load in relation to other risk factors for the heterosexual transmission of human immunodeficiency virus type 1 (HIV-1). In a community-based study of 15,127 persons in a rural district of Uganda, we identified 415 couples in which one partner was HIV-1-positive and one was initially HIV-1-negative and followed them prospectively for up to 30 months. The incidence of HIV-1 infection per 100 person-years among the initially seronegative partners was examined in relation to behavioral and biologic variables. RESULTS: The male partner was HIV-1-positive in 228 couples, and the female partner was HIV-1-positive in 187 couples. Ninety of the 415 initially HIV-1-negative partners seroconverted (incidence, 11.8 per 100 person-years). The rate of male-to-female transmission was not significantly different from the rate of female-to-male transmission (12.0 per 100 person-years vs. 11.6 per 100 person-years). The incidence of seroconversion was highest among the partners who were 15 to 19 years of age (15.3 per 100 person-years). The incidence was 16.7 per 100 person-years among 137 uncircumcised male partners, whereas there were no seroconversions among the 50 circumcised male partners (P<0.001). The mean serum HIV-1 RNA level was significantly higher among HIV-1-positive subjects whose partners seroconverted than among those whose partners did not seroconvert (90,254 copies per milliliter vs. 38,029 copies per milliliter, P=0.01). There were no instances of transmission among the 51 subjects with serum HIV-1 RNA levels of less than 1500 copies per milliliter; there was a significant dose-response relation of increased transmission with increasing viral load. In multivariate analyses of log-transformed HIV-1 RNA levels, each log increment in the viral load was associated with a rate ratio of 2.45 for seroconversion (95 percent confidence interval, 1.85 to 3.26). CONCLUSIONS: The viral load is the chief predictor of the risk of heterosexual transmission of HIV-1, and transmission is rare among persons with levels of less than 1500 copies of HIV-1 RNA per milliliter.     

Is the incidence of malignant melanoma decreasing in young Australians?

Recent reports have detected a decrease in the incidence of malignant melanoma (MM) in young Australian women, but an increase in older Australians. The incidence rates were calculated for the entire population and no adjustments were made to take into account the change in the racial composition of the Australian population. In the past 25 years there has been an influx of immigrants from Asia, the Pacific Islands, and the Middle East who are at low risk for MM. The migrants are relatively young and there are more Asian women than men. The large increase in the percentage of the population that has a low risk for MM may be an important reason why the incidence has fallen in some population groups.     

Distress and quality of life after autologous stem cell transplantation: a randomized clinical trial to evaluate the outcome of a web-based stepped care intervention

Background  

Psychological distress (i.e. depression and anxiety) is a strong predictor of functional status and other aspects of quality of life in autologous stem cell transplantation following high-dose chemotherapy. Treatment of psychological distress is hypothesized to result in improvement of functional status and other aspects of quality of life. The aim is to evaluate the outcome of stepped care for psychological distress on functional status and other aspects of quality of life in patients with hematological malignancy treated with autologous stem cell transplantation.     

Effects of Laropiprant,a Selective Prostaglandin D2 Receptor 1 Antagonist,on the Pharmacokinetics of Rosiglitazone

Laropiprant (LRPT), a prostaglandin D₂ receptor‐1 antagonist shown to reduce niacin‐induced flushing symptoms, has been combined with niacin for treatment of dyslipidemia. This open‐label, randomized, 2‐period crossover study assessed the pharmacokinetics of single‐dose rosiglitazone in the presence and absence of multiple‐dose LRPT. Twelve healthy male and female subjects, 34–64 years of age, received two, once‐daily oral treatments in random sequence separated by ≥3‐day washout: (1) multiple‐dose LRPT 40 mg/day for 7 days (Days 1 to 7) coadministered with single‐dose rosiglitazone 4 mg on Day 6; (2) single‐dose rosiglitazone 4 mg on Day 1. Comparability was declared because the 90% confidence interval (CI) for the AUC_0‐∞ geometric mean ratio (GMR; rosiglitazone + LRPT/rosiglitazone alone) [0.92 (0.86, 0.99)], was contained within prespecified bounds (0.70, 1.43). The C_max GMR (90% CI) for rosiglitazone was 0.98 (0.95, 1.02). There was no evidence of clinically meaningful alterations in the pharmacokinetics of rosiglitazone, a probe CYP2C8 substrate, following coadministration of multiple‐dose LRPT in healthy subjects. Therefore, findings suggest that LRPT does not inhibit CYP2C8‐mediated metabolism.     

Improvement of pruritus and quality of life of children with atopic dermatitis and their families after joining support groups

Introduction  Atopic dermatitis places a large burden on patients and their families, with greater risk of emotional disorders and behavioural problems. Preliminary evidence suggests that support groups and educational programs are helpful in reducing stress, disease and pruritus severity and improves quality of life (QoL).
Objectives  To evaluate the intensity of pruritus and the QoL in children with atopic dermatitis and their families after joining support groups.
Material and methods  Subjects were randomly assigned to intervention or control group and completed the Children's Dermatology Life Quality Index (CDLQI) and Family Dermatitis Impact (FDI). Pruritus was evaluated by the Yosipovitch's questionnaire for pruritus. Each patient/family unit was considered as one 'patient'. Participants were divided into two different groups: one with children under 16 years and the second with patients' relatives. Each unit was accompanied during 6 months.
Results  Thirty-two patients and their relatives completed the questionnaires satisfactorily. After intervention, pruritus intensity was similar ( P =  0.42), but the pattern of pruritus improved in the intervention group. Overall QoL for CDLQI instruments improved significantly ( P <  0.01) and, when specific domains were analysed, personal relationships ( P =  0.02) and leisure ( P =  0.04) showed marked enhancement. FDI scores failed to demonstrate differences in the QoL of patients' relatives after treatment.
Conclusion  The improvement on pruritus and QoL showed that atopic dermatitis patients had benefits with the attendance to support groups. We consider that these non-pharmacological approaches can be a very effective accessory tools in the management of recalcitrant forms of the disease.     

Oral Health-related quality of life after coronectomy for impacted mandibular third molar in the first postoperative week

Background Coronectomy of a mandibular impacted third molar is a surgical treatment to minimize the risk for inferior alveolar nerve damage. We aimed to determine whether this procedure affected the oral health-related quality of life (OHRQoL) within the first postoperative week.Material and Methods This prospective study included 50 patients that underwent a coronectomy for an impacted mandibular third molar. The patients completed the Oral Health Impact Profile-14 (OHIP-14) questionnaire and questions about pain and analgesic intake on every day during the first postoperative week.Results Mean OHIP-14 scores were highest during the first three postoperative days; the highest mean score (26.40, SD: 8.67) was observed on the first postoperative day. Mean OHIP scores gradually declined during the first postoperative week, and the mean OHIP-14 score was 9.82 (SD: 9.15) on the seventh day. Physical pain was the highest contributor to the overall OHIP-14 score. Pain gradually declined with time; the lowest mean pain score (3.38, SD: 2.2) was observed on the seventh day. OHIP-14 and pain scores were not significantly different between sexes or between different grades of impaction. OHIP-14 scores were positively correlated with pain scores.Conclusions A mandibular third molar coronectomy had a strong effect on patient OHRQoL, particularly during the first three postoperative days. Key words:Third molars, coronectomy, pain, OHRQoL.