A prospective study of oral lesions and their predictive value for progression of HIV disease

OBJECTIVE: This report evaluates and compares individual oral lesions and combinations of lesions in predicting progression-free survival in a seroprevalent cohort of men and women with HIV infection. DESIGN: This was a prospective study of HIV-infected patients, initially AIDS-free, followed for approximately 30 months. SETTING: Patients were volunteers examined at an academic medical center and at an inner-city hospital in New York. Participants identified themselves as homosexual men or as injection drug users (IDU).OUTCOME MEASURES: The primary outcome being assessed is time from a baseline oral examination until the development of an AIDS-defining condition or death from any cause within 12 months of the last study visit. Correlation is measured by relative risk (RR).RESULTS: While oral lesions were not predictive of progression among subjects with CD4s=200, they were highly predictive of progression among those with CD4<200.For subjects with CD4<200, the only individual lesion that was significantly associated with progression-free survival was oral candidiasis (RR=4.12, P= 0.009).Positivity for one or more lesions in a set demonstrated greater prognostic value among those with CD4<200, with RR's of 6.03 (P= 0.018) for the set consisting of oral candidiasis, hairy leukoplakia, and necrotizing ulcerative gingivitis (NUG), and 8.77 (P= 0.036) for the set consisting of the above lesions plus linear gingival erythema (LGE).Analysis by cohort suggested that the improvement in correlation was stronger in homosexual men than in IDU, but this question could not be resolved conclusively with these data. CONCLUSIONS: Lesion sets might be better prognosti-cators of progression-free survival than individual lesions among HIV-infected subjects with CD4<200.Prognostic value of the core lesion set (oral candidiasis and hairy leukoplakia) was enhanced by the addition of other lesions (NUG and LGE) not usually included in HIV staging systems. These results suggest that staging systems for HIV might be improved by the inclusion of other, survival-related oral lesions.     

Aetiological factors and development in subjects with obstructive sleep apnoea

OBJECTIVE: To examine whether maternal pregnancy complications, adverse birth events, respiratory illnesses, or developmental difficulty were increased in neurologically normal children with obstructive sleep apnoea (OSA) and whether severity of OSA adversely affects the child's development and temperament. METHODOLOGY: Maternal report of perinatal events, respiratory illness and developmental difficulty in 37 children with OSA was contrasted with a comparison group (n = 67). Children with OSA were assessed developmentally (Griffiths Scales), had a parental rating of temperament (Australian Temperament Scale) and attended an overnight polysomnographic sleep study. RESULTS: Children with OSA had an increased prevalence of adverse maternal pregnancy and perinatal events, respiratory disease and developmental concerns. Limited associations were found between the severity of OSA and development or temperament difficulty. CONCLUSIONS: This study suggests a relationship between OSA, though not its severity, and pre/perinatal adversity and child development. Polysomnographic and detailed developmental assessment of community-based samples of children with OSA and control children are necessary to confirm these findings.     

Validity of Clinical Symptoms in Benign Esophageal Disease,Assessed by Questionnaire

ABSTRACT. A questionnaire designed to test the value of questions identifying benign esophageal disease was sent to patients representing four well-defined entities: angina pectoris (n=30), benign esophageal disease (n=25), gastroduodenal ulcer or former gallstones (n=27) and normal subjects (n=38). By means of logistic regression, three key-questions were selected. A combination of an affirmative answer to “difficulty in swallowing solid food” and to “pain in the chest” or “heartburn at night” or both did not occur in the group of normal subjects, while occurring in 68% of the patients with esophageal diseases. The combination occurred in only 10% of the patients with angina pectoris and 15% of those suffering from gastroduodenal ulcer or gallstones. The predictive accuracy of the combination of the three questions is estimated for various hypothetic prevalences of esophageal disease. These questions appear to identify approximately two-thirds of individuals with esophageal disease with acceptable false-positive rates and can therefore be used in epidemiological studies.     

Palpable solid breast masses: retrospective single- and multimodality evaluation of 201 lesions

The diagnostic virtues and limitations of single- and multimodality testing in the evaluation of solid palpable breast masses were studied. Two hundred one consecutive patients who had a solid palpable breast mass and who underwent biopsy between September 1982 and July 1986 were included for blinded retrospective analysis of their physical examination, mammographic, ultrasonographic (US), thermographic, and pathologic characteristics. Benign breast disease was diagnosed histologically in 106 women, while carcinoma was established in 95. The sensitivities of physical examination, mammography, US, and thermography were 0.88, 0.94, 0.78, and 0.49, respectively. US alone had the highest sensitivity in correct diagnosis of a benign solid breast mass and had the highest accuracy (0.84). Use of four modalities increased the preoperative diagnostic true-positive rate to 0.97, with some decline in specificity. Multimodality testing seems particularly beneficial in pre- and perimenopausal patients.     

Modulation of the effect of l-ß-D-Arabinofuranosylcytosine based on changes of Cytidine Deaminase activity in Hl60 Cells

The effect of changes in cytidine deaminase activity on the growth inhibitory effect of 1-ß-D-arabinofuranosylcytosine (Ara-C) has been investigated in the human promyelocytic cell line, HL60. 1,25 Dihydroxy vitamin D₃ (vit. D₃), which is an inducer of differentiation, caused an increase of cytidine deaminase in HL60 cells simultaneous with an inhibition of the effect of Ara-C. On the other hand, retinoic acid, which also induces differentiation had no influence on either the activity of cytidine deaminase or the effect of Ara-C. An atoxic inhibitor of cytidine deaminase tetrahydrouridine, THU, enhanced the effect of Ara-C. THU also enhanced the effect of Ara-C, even if the Ara-C effect was inhibited by deoxycytidine. These results show that it is possible to modulate the effect of Ara-C by changing the activity of cytidine deaminase. Furthermore, changes in the activity of cytidine deaminase and the effect on the Ara-C growth inhibition vary dependent on the differentiating inducer used.