Maribavir prophylaxis for prevention of cytomegalovirus infection in allogeneic stem cell transplant recipients: a multicenter, randomized, double-blind, placebo-controlled, dose-ranging study

The anti-cytomegalovirus (CMV) activity and safety of oral maribavir in CMV-seropositive allogeneic stem-cell transplant recipients were evaluated in a randomized, double-blind, placebo-controlled, dose-ranging study. After engraftment, 111 patients were randomized to receive CMV prophylaxis with maribavir (100 mg twice daily, 400 mg once daily, or 400 mg twice daily) or placebo. Within the first 100 days after transplantation, the incidence of CMV infection based on CMV pp65 antigenemia was lower in each of the respective maribavir groups (15%, P = .046; 19%, P = .116; 15%, P = .053) compared with placebo (39%). Similarly, the incidence of CMV infection based on plasma CMV DNA was lower in each of the respective maribavir groups (7%, P = .001; 11%, P = .007; 19%, P = .038) compared with placebo (46%). Anti-CMV therapy was also used less often in patients receiving each respective dose of maribavir (15%, P = .001; 30%, P = .051; 15%, P = .002) compared with placebo (57%). There were 3 cases of CMV disease in placebo patients but none in the maribavir patients. Adverse events, mostly taste disturbance, nausea, and vomiting, were more frequent with maribavir. Maribavir had no adverse effect on neutrophil or platelet counts. These results show that maribavir can reduce the incidence of CMV infection and, unlike ganciclovir, does not cause myelosuppression.     

What a differential a virus makes: a practical approach to thoracic imaging findings in the context of HIV infection--part 1, pulmonary findings

OBJECTIVE: The Centers for Disease Control and Prevention reported more than one million people with HIV infection in the United States in 2006, an increase of 11% over 3 years. Worldwide, nearly 34 million people are infected with HIV. Pulmonary disease accounts for 30-40% of acute hospitalizations of HIV-infected patients, underscoring the importance of understanding the pulmonary manifestations in this population. When presented with a chest radiograph or CT image of a patient with the clinical history of HIV infection, one approach is to start by identifying and categorizing key imaging findings. In some instances, the key findings may be further subcategorized to narrow the differential diagnosis, such as distinguishing between perilymphatic distribution and the random distribution of micronodules. The differential diagnosis of these key imaging findings can also be further refined by incorporating clinical data, such as patient demographics, CD4 count, and presenting symptoms. Finally, the change of thoracic disease and clinical status in response to treatment provides important diagnostic information. The purpose of this article is to discuss pulmonary findings in patients with HIV. CONCLUSION: By developing a systematic and practical approach to key pulmonary imaging findings in HIV-infected patients, radiologists can generate clinically relevant and succinct differential diagnoses and thereby improve patient care.     

Development of a one-tube extraction and amplification method for DNA analysis of sperm and epithelial cells recovered from forensic samples by laser microdissection

Laser microdissection can be used in forensic casework to isolate specific cell types from mixtures of biological samples. Extraction of DNA from selected cells is still required prior to STR amplification. Because of the relatively pristine nature of the recovered cells, laser microdissection is more sensitive than more traditional methods of DNA analysis, theoretically resulting in DNA profiles from less cellular material. A one-tube extraction and amplification method minimises loss of DNA through liquid transfers and reduces the potential for contamination events occurring. In this paper, the development of a one-tube method for the effective extraction of DNA from laser microdissected sperm and epithelial cells is described. The performance of the in-house method was compared to that of a commercial DNA extraction kit for extraction of DNA from sperm and the downstream compatibility with STR amplification was determined for both sperm and epithelial samples. Full Identifiler? profiles after 28 amplification cycles were obtained from as few as 15 epithelial cells and 30 sperm.     

Cognitive style and gender differences in children's motor task performance

Memory storage capacity and system flexibility of 7 year-old children were examined through performance on a novel ball-intercepting task. Field dependence/independence served as the theoretical base for the study. The task required students [n = 56] to analyze the speed and direction of a ball rolling down a ramp and adjust their speed and angle of approach to intercept it within a limited space. Data were collected using video cameras positioned behind and to the side of the child's pathway. Data were reduced using a qualitative categorical system and analyzed using a MANOVA. Results indicated that field-independent children used a sharper initial angle of approach than did field-dependent children. Males used both a sharper angle of approach and a more developmen-tally advanced grasping pattern than did females. Discussion focused on the field-dependent children's modifications of the task to decrease demands on storage capacity and preclude the development of alternative motor pathways or systems.     

Two subgroups of gender-problem children

Gender-referred children who met the DSM-III diagnostic criteria for gender identity disorder of childhood (n =21) and gender-referred children who did not meet these criteria (n =15) were compared with regard to demographic, gender role, and behavioral disturbance information. As judged by parental questionnaires and behavioral tests, the cross-gender role behavior of gender-referred children who met the DSM-III criteria was generally more extreme than that of their non-DSM-III counterparts. These two diagnostically defined subgroups did not, however, differ in the degree of their behavioral and emotional disturbance. The DSM-III children were significantly younger than the non-DSM-III children, but the extent to which the disparity in age accounted for the gender role differences appeared equivocal. The implications of these findings for the diagnosis and assessment of gender-referred children are discussed. This study was supported by a grant from the Laidlaw Foundation and funding from the Sonor Foundation.     

Circumstances of first crystal methamphetamine use and initiation of injection drug use among high-risk youth

Background . Despite the widely noted increase in crystal methamphetamine (CM) use, there are few studies on circumstances of first CM use or correlates of use among high‐risk populations (e.g. street‐involved youth). Methods . Street‐involved youth in Vancouver, Canada, were enrolled in the At‐Risk Youth Study (ARYS) prospective cohort. Extensive outreach produced a representative sample of Vancouver street youth who use illicit drugs. We examined circumstances of first CM use and factors associated with CM use among the cohort. Results . Among 478 participants, 339 (70.9%) had used CM previously. Despite intensive covariate adjustment, a history of CM use was associated independently with having initiated injection drug use [OR = 3.15 (95% CI: 1.89–5.2); p < 0.001]. Among those who had used CM, route of first administration included: 11 (3.2%) oral ingestion; 25 (7.4%) injected; 105 (31.0%) snorted; 231 (68.1%) smoked. The proportion of respondents reporting current CM injection was significantly greater than the proportion reporting injection as the route for first CM use (18.3% vs. 7.4%; McNemar's test p < 0.001). Ability to obtain CM the first time was reported as ‘very easy’ or ‘easy’ by 93.5% and 5.3% of participants, respectively. Conclusions . Crystal methamphetamine use was independently associated with injection drug use, and significant increases in injecting as the primary mode of administration were observed when patterns of use were considered longitudinally. The easy accessibility of CM and its common use during transition into injection drug use demonstrate the need for innovative drug policy to address this growing concern.