Oral Fluids as an Alternative to Serum for Measurement of Markers of Immune Activation

Oral fluids are convenient alternatives to blood sampling for evaluating significant metabolic components. Two forms of oral fluids, oral mucosal transudates (OMT) and saliva, were collected and compared for content of soluble products of immune activation. The data confirm that OMT and saliva represent distinct body fluids. The concentrations, outputs, and analyte/protein ratios of β-2-microglobulin (β2M), soluble tumor necrosis factor alpha receptor II (sTNFαRII), and neopterin were measured. Both the OMT and the saliva of most of the individuals in the control healthy populations had measurable levels of all three activation markers. When the immune system is activated, as in human immunodeficiency virus (HIV) infection, the levels of β2M and sTNFαRII are increased in both OMT and saliva compared to those in a healthy control population. OMT levels correlated better with levels in serum than did saliva and appear to reflect systemic immune activation in HIV infection. Because acquisition of oral fluids is noninvasive and easily repeatable, measurement of β2M and/or sTNFαRII content in OMT could be useful in the assessment of disease activity in patients with HIV infection or chronic inflammatory diseases.     

Urinary bladder perforation: an unusual complication of neonatal nasogastric tube feeding

Nasogastric tube (NGT) feeding is an accepted method of feeding premature infants. This case report records an unusual and previously unreported complication of NGT feeding in a neonate. Received: 15 January 1997 Accepted: 4 April 1997     

Dysplasia in chronic ulcerative colitis; more problems and few solutions

Dysplasia in ulcerative colitis was defined as an unequivocal neoplastic change that is intraepithelial and within the confinement of the glandular basement membrane. Although that definition has stood the test of time and the classification is still the golden standard, the recommendations of treatment and follow up has significantly debated and changed. The purpose of this lecture is to outline the difficulties and controversies associated with dysplasia.     

Preferences for antimuscarinic therapy for overactive bladder

Study Type – Preference (discrete choice experiment) Level of Evidence 2a What’s known on the subject? and What does the study add? Whilst antimuscarinic treatments are widely used little work has been done to understand how patients consider the relative benefits and costs associated with their use. This study provides data which demonstrates both the perceived value of symptom reduction and burden associated with common antimuscarinic AEs. These findings may prove useful in informing prescribing decisions. OBJECTIVE ? To examine patient preferences and strength of preferences for treatment for the various symptoms of overactive bladder and adverse events associated with the use of antimuscarinic treatments. PATIENTS AND METHODS ? A discrete choice experiment (DCE) survey was developed that detailed treatment choices in terms of attributes relating to their efficacy in reducing symptoms and the likelihood of experiencing typical adverse events. Levels for each attribute were based on a literature review, qualitative interviews and a meta‐analysis of clinical trial data. ? Attributes were combined into choice sets using a fractional orthogonal design that had been folded over. Pairs of choice sets were presented to overactive bladder (OAB) patients (n= 332), who indicated which treatment alternative they preferred. Data were analysed using the conditional logit model. RESULTS ? Participants expressed the strongest preference for the avoidance of urgency incontinence episodes, followed by preference for a reduction in the experience of urinary urgency and the number of micturition episodes. The influence of the likelihood of experiencing an adverse event on treatment preference was also estimated. ? Finally, marginal rates of substitution were calculated to demonstrate the relative value of trade‐offs between the various attributes. ? Treatment preferences were found to be broadly similar across two patient age groups (i.e. under 45 s and 45 and over). CONCLUSION ? The study demonstrates that individuals with OAB place significant emphasis on the prospect of reduction in symptoms. Avoidance of incontinence episodes is particularly valued and equivalent to a much greater reduction in the frequency of micturition or experience of urgency. However, even a modest increase in the likelihood of experiencing an adverse event could easily motivate a change in treatment preference.