Human T-lymphotropic virus (HTLV) types I and II infection in sexual contacts and family members of blood donors who are seropositive for HTLV type I or II. American Red Cross HTLV-I/II Collaborative Study Group

Interviews and laboratory testing were conducted for 168 contacts referred by former blood donors identified as seropositive for antibody to human T-lymphotropic virus type I (HTLV-I) or type II (HTLV-II). Thirty-two (28%) of 114 heterosexual contacts of seropositive donors, including 12 women and 20 men, were found to be antibody positive. None of 40 offspring (except one adult man who reported sexual contact in Puerto Rico) or 14 other (nonspousal) family members were seropositive. Thirty-one of the seropositive contacts were typeable as having either HTLV-I (52%) or HTLV-II (48%). Assessment of couples found that the median duration of the sexual relationship was significantly longer (p = 0.03) for those in which both partners were infected than in discordant pairs. Analysis of risk history data for 22 infected couples revealed that, in three cases, risk factors (Japanese ancestry or sexual contact with an injecting drug user) could be identified in the women, but not in their male partners. Among couples in which the male had the greater risk history, the risk factor was either a history of transfusion, birth or sexual exposure in an endemic area, or injected drug use. Counseling strategies for individuals with HTLV-I or HTLV-II infection should take into account the relatively high seroprevalence in their partners and should address the potential for sexual transmission in both directions.     

A systematic approach to diabetic foot infections

Foot infection is the most common reason for hospitalization and subsequent lower extremity amputation among persons with diabetes. Foot ulceration caused by diabetic neuropathy, trauma, and peripheral vascular disease can lead to a limb- or life-threatening infection. The optimum treatment of these potentially devastating conditions depends on a multidisciplinary approach that addresses the related or underlying disorders and thus ensures proper wound healing and a positive outcome. In addition to antibiotic therapy, severe soft-tissue or bone infections may necessitate surgical treatment, including drainage, débridement, and vascular reconstruction. Initial (empiric) antibiotic therapy should provide coverage against staphylococci and streptococci and should be revised according culture results. Antibiotic therapy is not indicated in clinically noninfected wounds. The duration of antibiotic treatment can range from 1 week for mild infections to 6 weeks or more for residual osteomyelitis and severe deep tissue infections. Aggressive (and sometimes repeated or staged) surgical intervention and appropriate antibiotic therapy can reduce the likelihood of a major amputation and the duration of hospitalization.     

Lower Resting State Heart Rate Variability Relates to High Pain Catastrophizing in Patients with Chronic Whiplash‐Associated Disorders and Healthy Controls

Vagally mediated heart rate variability (vmHRV) is widely respected as a psychophysiological measure of emotion regulation capacity and serves as a readily available index of executive brain areas that exert an inhibitory influence on subcortical structures. Pain catastrophizing (PC) is conceptualized as the tendency to misinterpret and exaggerate pain‐related situations that may be threatening. Chronic pain patients show lower vmHRV and higher PC. Previously, no study has investigated the association of PC and vmHRV. We examined the association of PC and vmHRV in a sample of patients with chronic whiplash‐associated disorders (WAD, n = 30) and healthy controls (n = 31). Patients with WAD showed lower vmHRV, indexed by high‐frequency HRV (effect size, Cohen's d = 0.442), and greater PC (d = 0.815). Zero‐order and partial correlations controlling for age and sex revealed that vmHRV and PC are inversely related. The results provide evidence for a psychophysiological mechanism underlying PC, in particular in chronic pain patients.     

HLA-DRB1*1502 allele,subtype of DR15, is associated with susceptibility to ulcerative colitis and its progression

HLA-DRB1 allele typing was performed by the PCR-RFLP method on 59 ulcerative colitis (UC) patients and 136 healthy controls. Phenotypic frequencies of HLA-B52 and DR2 were significantly increased among the UC patients, serologically. DNA typing of HLA-DRB1 revealed that the genotypic frequency of DRB1*1502 was higher in UC than in the controls (49.2% vs 17.6%;P<0.0001). In the analysis of clinical parameters, 82.8% of patients bearing DRB1*1502 were treated with corticosteroids. DRB1*1501 and DRB1*1502 differ in only one amino acid at residue 86 (valine vs glycine), and 66% of the UC patients carried two glycines at position 86 in the HLA-DR-chain (vs 51% of control;P<0.05). These observations suggest that the presence of Gly-86 in the HLA-chain and surrounding amino acid sequence of HLA-DRB1*1502 is strongly associated with susceptibility to UC.     

Identification of amylase isoenzymes in intestinal contents

Samples of intestinal contents were obtained from 16 patients: 5 from the midjejunum, 10 from the distal ileum, and 1 from the cecum. The presence of pancreatic and nonpancreatic isoamylases in these fluids was evaluated by an inhibitor assay (Pharmacia Corporation) and by polyacrylamide gel electrophoresis. In every sample the inhibitor assay detected the presence of pancreatic-type isoamylase but not salivary-type isoamylase. Electrophoresis confirmed that salivary-type isoamylase was totally absent. Therefore, in intestinal disorders which disrupt the intestinal mucosal barrier (such as ischemia, perforation, ulceration, or obstruction), the amylase which escapes from the intestinal lumen and is reabsorbed into the circulation is likely to consist entirely of pancreatic-type isoamylases. In these circumstances, measurement of serum amylase isoenzymes will not distinguish acute pancreatitis from an acute intraabdominal catastrophe requiring surgery.