Gaps in the drug-free and methadone treatment program response to Hepatitis C

Drug treatment programs are sites of opportunity for the delivery of hepatitis C (HCV) prevention and care services to drug users. Using data collected from a random nationwide sample (N = 595) of drug treatment programs in the United States, this study compares the provision of HCV services by drug-free and methadone maintenance treatment programs (MMTPs). It then examines and compares perceived inadequacies in this service provision from the perspective of the managers in these two types of programs. Findings indicate that MMTPs are providing more HCV services to their patients, and that a greater proportion of MMTPs are dissatisfied with their current level of HCV service provision. Managers of drug-free programs would like to be offering patients more HCV education, while MMTP managers would like to be providing more HCV testing to their patients, and more support and care for patients who are HCV+.     

A lignocaine infusion worsens the leukoencephalopathy due to a carbon monoxide exposure in sheep

Poisoning by carbon monoxide (CO) is common and conventional treatment of affected people is frequently unsuccessful. Lignocaine was identified as a potential therapy in this context because of the benefit shown for it in other brain injuries for which the received toxic mechanisms are similar. Twelve Romney ewes were exposed to 1% CO for 120 min were then infused intravenously with either lignocaine (N=6) or saline for 72 h, and were killed 5 days after the exposure for histological and immunohistochemical examination. This dose of CO was narcotic and caused white matter brain infarcts, with associated glial cell activation, axonal dysfunction and induction of both neuronal and glial haeme oxygenase and nitric oxide synthetase. The frequency of the white matter infarcts was significantly greater in the lignocaine-treated group. The mechanism of this adverse interaction is neither established here nor is it deducible from other published data; alternative antidotes to CO clearly need to be tested.     

The 30th anniversary of the American Board of Allergy and Immunology: then and now

Thirty years ago the Allergy Subspecialty Boards of the American Board of Pediatrics (ABP) and the American Board of Internal Medicine (ABIM) merged to form the American Board of Allergy and Immunology (ABAI). The ABAI mission was to: establish qualifications and examine physician candidates for certification as specialists in allergy and immunology; serve the public, physicians, hospitals, and medical schools by providing the names of physicians certified by the Board; assist educational and professional organizations to improve the quality of care and availability of allergists to deliver such care, to establish and improve standards for the teaching of allergy and immunology, to establish standards for training programs, and to encourage development of increased opportunities for training of physicians interested in allergy and immunology. This mission statement has guided the activities of the Board ever since by providing a strong focus on the 2 major responsibilities: examining and certifying candidates in a fair objective way, and setting standards for the content and conduct of training programs.     

Maternal alphafetoprotein screening by the polypropylene tube immunoradiometric assay on dried blood

The polypropylene tube immunoradiometric assay for alphafetoprotein (AFP) determination was applied to maternal serum along with a radioimmunoassay technique during the second trimester of pregnancy. Blood from pregnant women was collected by finger prick on strips of chromatography paper (Schleicher and Schuell No. 903C) and air dried. A 4.75 mm disc spot was eluted in anti-AFP coated tubes containing 1.0 ml of assay medium. After one hour the medium was vortexed and the tubes washed and counted on a Concept 4tm (Micromedic Systems, Horsham, PA. 19044). The sensitivity of the technique is about 9 micrograms/l (35 ng/l in the assay) by the Rodbard formula. The concordance between the dried blood and the serum RIA tests in normal pregnancies was over 90 per cent at the 95th and 97th percentiles. This assay on dried blood spotted on chromatography paper was tested on 1003 patients and proved to be an ideal alternative to whole serum screening techniques: it minimizes sample manipulations and can easily be integrated into an existing newborn screening programme.     

Psychological and behavioral impact among intravenous drug users of learning HIV test results

In 1984 as part of a New York City study to examine the prevalence of HIV infection in a substance-abusing population and to test the validity of HIV screening kits, 94 patients at the New York VAMC were tested. Results were made available to 50 (35 seronegative, 15 seropositive) patients in January 1986. Psychological and behavioral impact of learning test results was assessed using standardized psychiatric rating scales. A comparison group of 31 nontested subjects were also evaluated. Ratings were done preresults, approximately 1-2 weeks after results, and 8-10 weeks after informing patients of their HIV status. No major stress reactions were observed. Seropositives experienced a higher level of anxiety 1-2 weeks after learning results but anxiety generally diminished; they made significant behavior changes which were maintained. Seronegatives experienced relief and maintained IV drug risk reduction behavior. Anxiety about contracting AIDS increased in nontested subjects as the study progressed.