Direct oral questions to blood donors: the impact on screening for human immunodeficiency virus

BACKGROUND: In December 1990, the Food and Drug Administration recommended that all United States blood centers implement a policy of asking prospective donors direct oral questions (DOQs) about human immunodeficiency virus (HIV) risk behaviors to increase the safety of the blood supply. STUDY DESIGN AND METHODS: To evaluate the impact of the DOQ policy, HIV-related deferral and HIV seroprevalence data were analyzed at four American Red Cross blood centers for the year before the policy change and the year after. An epidemiologic analysis with stratification was conducted, including the calculation of odds ratios (OR) and 95-percent CIs. RESULTS: Two of the four blood centers showed an overall significant increase in HIV-related deferral after implementation of the DOQ policy: OR = 4.04, (95% CI = 3.41, 4.76); OR = 2.93, (95% CI = 2.67, 3.21). The increase in HIV-related deferral was higher for women. HIV seroprevalence decreased at all four centers, including the two that did not see an increase in HIV-related deferrals. Seroprevalence declined by 14 percent in the two centers with increases in HIV-related deferral, which was neither significant nor attributable to DOQs. CONCLUSION: Given that HIV antibody screening cannot detect HIV-seronegative (but infectious) "window-period" donations, the deferral of at-risk donors may offer some additional protection to the blood supply. However, evidence was not found of an increase in safety of the blood supply as measured by HIV seroprevalence.     

Prevalence of Hearing Impairment and Hearing Complaints in Older Adults: A Study in General Practice

In one general practice, 660 people aged 60 years or over werescreened by means of pure tone audiometry and a specific questionnaireto assess the prevalence of hearing impairment and hearing complaints.Hearing impairment was defined as an average loss of 35 dB ormore in the 1, 2 and 4 kHz frequencies in one or both ears.In total, 37.4% (95% Cl, 33.3–41.1%) of the participantswas hearing impaired. The prevalence was higher in men (55.1%)than in women (44.9%) and clearly increased with age in bothsexes. The prevalence of hearing complaints in terms of hearingdifficulties and/or tinnitus, was 37.3% (95% Cl, 33.6–41.0%),and increased with age, especially in women. Of the subjectswith hearing impairment, 64.4% reported hearing complaints.Of the subjects without hearing impairment, 21.1% experiencedhearing complaints. This study suggests that screening olderadults with relatively simple methods, may identify a largeproportion of men and women in general practice with hearingproblems. Providing information to both patients and generalpractitioners about the possibilities of hearing improvementis a crucial step in making people become more aware of hearingproblems. This could ultimately lead to improvement of the qualityof life of older men and women with hearing problems.     

Extracorporeal shock wave lithotripsy: interventional radiologic solutions to associated problems

Among 1,500 patients treated with extracorporeal shock wave lithotripsy, 1,300 had calculi less than 2.5 cm in diameter and 200 had calculi of 2.5 cm or larger. Although most patients did well and required no further radiologic intervention, 178 interventional radiologic procedures were performed. Urinary tract obstruction often developed in patients with large stones when the collecting system filled with stone fragments (steinstrasse). Nephrostomy was performed in 5.3% of the total patient population and in 29% of the patients with stones measuring 2.5 cm or more. Only 1.8% of the patients with calculi smaller than 2.5 cm required radiologic intervention. When the obstructed collecting system could not be crossed with conventional angiographic techniques, the stone fragments were removed through a percutaneous nephrostomy tract either by flushing or by suctioning with a pulsating water jet.     

The Academic Medical Center Linear Disability Score (ALDS) item bank: item response theory analysis in a mixed patient population

Background  

Currently, there is a lot of interest in the flexible framework offered by item banks for measuring patient relevant outcomes. However, there are few item banks, which have been developed to quantify functional status, as expressed by the ability to perform activities of daily life. This paper examines the measurement properties of the Academic Medical Center linear disability score item bank in a mixed population.     

The promise of microarrays in the management and treatment of breast cancer

Breast cancer is the most common malignancy afflicting women from Western cultures. Developments in breast cancer molecular and cellular biology research have brought us closer to understanding the genetic basis of this disease. Recent advances in microarray technology hold the promise of further increasing our understanding of the complexity and heterogeneity of this disease, and providing new avenues for the prognostication and prediction of breast cancer outcomes. These new technologies have some limitations and have yet to be incorporated into clinical use, for both the diagnosis and treatment of women with breast cancer. The most recent application of microarray genomic technologies to studying breast cancer is the focus of this review.     

Monocyte-dependent regulation of T lymphocyte activation through CD98

CD98 is a 125 kDa heterodimer, which is strongly expressed on the surface of activated and proliferating cells. Its expression is strikingly regulated during T cell differentiation and activation, but the role of CD98 during T lymphocyte responses is not yet understood. We report here that proliferation of resting peripheral blood mononuclear cells (PBMC) induced by lectin, superantigen (SAg) or conventional antigens was blocked by anti-CD98 heavy chain (CD98hc) mAb. In contrast, anti-CD98hc did not block responses of T cell clones or lines. Anti-CD98hc inhibited IL-2 receptor expression and progression of T cells from G1 to S phase, but did not reduce expression of the IL-2 gene. Anti-CD98hc mAb did not regulate the initial activation events involving the TCR and co-receptor structures, but instead inhibited T lymphocyte responses even when added 18 h or more after the activation stimulus. Further experiments demonstrated that anti-CD98 was not directly affecting T cells in this system, but was instead acting on accessory cells. This was supported using a novel xenogeneic system that takes advantage of the lack of xenoreactivity of purified human T cells against mouse splenocytes. Despite absence of a direct xenoresponse to murine spleen cells, human T cells were activated by SAg presented by murine splenic antigen-presenting cells (APC). Murine anti-human CD98hc did not block T cell proliferation in this system. Furthermore, responses using monocyte-depleted PBMC as APC were not blocked by anti-CD98hc. Taken together, the present data suggests that triggering of human monocyte CD98 can suppress T cell proliferation by a process that halts progression through the cell cycle of recently activated T lymphocytes. This may represent a novel pathway for monocyte regulation of T cell activation.      

Heart Rate Turbulence Impairment and Ventricular Arrhythmias in Patients with Systemic Sclerosis

Background: Arrhythmias, conduction disturbances, and cardiac autonomic nervous system dysfunction are the most frequent cardiovascular complications in systemic sclerosis (scleroderma). The aim of the study was to assess heart rate turbulence (HRT) in systemic sclerosis patients and to identify the relationship between HRT and occurrence of arrhythmias. Methods: Forty‐five patients with scleroderma (aged 54.6 ± 14.7 years) and 30 healthy sex‐ and age‐matched subjects were examined. In addition to routine studies, 24‐hour Holter monitoring with assessment of HRT was performed. Results: As compared to controls, HRT was significantly impaired in systemic sclerosis patients. Abnormal HRT defined as turbulence onset (TO) ≥0.0% and/or turbulence slope (TS) ≤2.5 ms/RR (ms/RR interval) was found in 19 (42%) scleroderma patients and in no members of the control group. Serious ventricular arrhythmias Lown class IV (VA‐LownIV), for example, couplets and/or nonsustained ventricular tachycardias, were observed in 16 (36%) scleroderma patients. The median value of TS was significantly lower in systemic sclerosis patients with VA‐LownIV than in patients without VA‐LownIV (3.68 vs 7.00 ms/RR, P = 0.02). The area under curve of ROC analysis for prediction of VA‐LownIV was 0.72 (95% confidence interval [CI] 0.56–0.87) and revealed that TS <9.0 ms/RR was associated with VA‐Lown IV occurrence, with sensitivity of 93.7% and specificity of 44.8%. Univariate and multivariate analyses confirmed that lower values of TS were associated with VA‐LownIV occurrence (odds ratio 1.52, 95% CI 1.09–2.12, P = 0.01). Conclusions: Patients with systemic sclerosis are characterized by significant HRT impairment. Assessment of HRT and especially TS is useful in the identification of patients at risk for ventricular arrhythmias. (PACE 2010; 920–928)     

The effects of aqueous extracts of Tetracarpidium conophorum seeds on the hormonal parameters of male guinea pigs

ObjectiveTo investigate the effects of the aqueous extracts of the seeds of Tetracarpidium conophorum and the effect of Proviron (12.5 mg/kg) (as standard) on the hormonal parameters of male guinea pigs, compare the effects of the seeds of Tetracarpidium conophorumand Proviron, and screen the phytochemical constituents of the seeds of Tetracarpidium conophorum.MethodsThe hormonal effects of the Tetracarpidium conophorum and Proviron were tested by hormonal assay, using enzyme immuno assay method. This was done by reaction of antibody with serum testosterone and testosterone label, magnetic solid phase separation and colour development step. Phytochemical screening was done using standard procedures.ResultsThe aqueous extract of the Tetracarpidium conophorum seeds (100–400 mg/kg) caused a statistically significant increase (P < 0.05, ANOVA) in the level of testosterone of male guinea pigs, from (2.60 ± 0.06) ng/mL to (3.40 ± 0.05) ng/mL, (3.00 ± 0.60) ng/mL and (3.30 ± 0.45) ng/mL on the 7th, 14th and 21st day of the administration of the extracts, respectively. The highest increase was obtained after the 7th day of treatment [(3.40 ± 0.05) ng/mL]. These effects were very comparable to the effects of Proviron on the testosterone of male guinea pigs, which were obtained to be (2.80 ± 0.01) ng/mL, (2.90 ± 0.16) ng/mL and (3.10 ± 0.30) ng/mL on the 7th, 14th and 21st day, respectively. These effects were dose-and time-dependent. The optimum effect on testosterone level under dose-dependent study [(4.70 ± 0.45) ng/mL] was obtained at 300 mg/kg of Tetracarpidium conophorum after 7 days treatment. Finally, the phytochemical screening of the seeds of Tetracarpidium conophorum revealed the presence of flavonoids, tannin, alkaloids, carbohydrate, volatile oils, terpenoids, saponins and cardiac glycosides.ConclusionThis study supports the claims on the use of the seeds of this plant by traditional medicine practitioners as a fertility agent. However, further studies need to be done to isolate and characterize the active principle(s) responsible for this activity in this plant.