Sentinel surveillance of human immunodeficiency virus infection in women seeking reproductive health services in the United States, 1988-1989. The Field Services Branch.

Cases of AIDS among women of reproductive age have increased dramatically since 1981; nearly a third of all cases among females were reported in 1990 alone. Surveillance of human immunodeficiency virus (HIV) infection among women is essential for monitoring the spread of HIV over time and identifying specific populations and geographic areas in need of HIV counseling, testing, and prevention services. Blinded (unlinked) serologic surveys were conducted in the United States and Puerto Rico in sentinel clinics providing reproductive health services to women, including family planning, prenatal care, and abortion services. Seventy-eight of 94 clinics (83%) in 30 cities conducting surveys during 1988 and 1989 detected at least one HIV-positive woman. Clinic-specific prevalence ranged from 0-2.28% (median 0.22%), with rates over 1% occurring in clinics predominantly on the East Coast and in Puerto Rico. Seroprevalence varied by primary type of service, race-ethnicity, and age group. Median rates were higher in clinics offering prenatal services and lower in abortion and family planning clinics in the same cities. In general, women 25-29 years of age showed the highest median rate of infection (0.32%), and rates were higher among black women (median 0.34%) than among Hispanic (median 0.11%) and white women (median 0%). Our data indicate the need to educate women about recognizing and reducing their risk of HIV infection. Reproductive health clinics with high seroprevalence should implement voluntary HIV counseling and testing with appropriate follow-up clinical evaluation and referral for infected women. Clinics with low prevalence should seize the opportunity to enhance HIV education and prevention efforts.     

Fetal lumbar spine: measuring axial growth with US

Ultrasound (US) can be used to visualize vertebral segments, suggesting a quantitative means of studying vertebral column growth in utero and thus a means of detecting developmental abnormalities. US images of the lumbar spine were obtained in 128 clinically normal fetuses between the gestational age of 11 through 41 weeks. A large-aperture, dynamically focused US system capable of regional magnification was used. Average lumbar spacing was calculated from distance between centrums of at least four lumbar bodies. The average distance between lumbar centrums increased nearly linearly throughout the second and third trimesters (r2 = 0.98). Enhanced anatomic display implies new capabilities for recognizing developmental abnormalities antenatally.     

Tear plasmin activity with contact lens wear.

Plasmin, a proteolytic enzyme, has been detected in the tears of patients experiencing anterior ocular disease, and during contact lens wear. Using a radial caseinolysis procedure, we examined tear plasmin levels in 66 patients who were wearing soft and rigid lenses for daily and extended wear. Compared to non-contact lens wearers, patients wearing soft and rigid lenses for extended wear were significantly more likely to exhibit tear plasmin activity. Eight hours of open-eye thick HEMA lens wear did not induce tear plasmin activity in a group of 10 subjects. However, significant increases in tear plasmin activity were recorded after short-term (1 hour) eye closure with and without lens wear, and following overnight (8 hours) eye closure without lens wear. Overnight eye closure also resulted in significantly increased numbers of epithelial cells and leucocytes in the tear fluid. Our results suggest that increased tear plasmin activity during extended contact lens wear may be attributable to the effects of eye closure rather than hypoxia or the presence of the contact lens per se.     

A diagnostic algorithm for male genital oedema

Male genital oedema can be defined as swelling or the appearance of swelling of the scrotum and/or the penile shaft and prepuce. Despite the various causes of genital oedema reported in the published work, a concise approach to the evaluation and management has not been sufficiently addressed.     

Maturation of executive function in autism.

BACKGROUND: Executive dysfunction has been reported at different ages in autism. It is not clear however, when this impairment emerges or how its expression is affected by development. METHODS: 61 non-mentally retarded autism participants (AUT) and 61 age, gender, and IQ matched typically developing participants (CON) were assessed with two oculomotor executive function tasks, the oculomotor delayed response task (ODR) and the antisaccade task (AS), as well as a visually-guided saccade sensorimotor task (VGS). RESULTS: The AUT group demonstrated impairments in response inhibition and spatial working memory at all ages tested. Developmental improvements in speed of sensorimotor processing and voluntary response inhibition were similar in both groups indicating sparing of some attentional control of behavior. Developmental progression in the speed of initiating a cognitive plan and maintaining information on line over time, however, was impaired in the AUT group indicating abnormal development of working memory. CONCLUSIONS: These results indicate that while executive dysfunction is present throughout development, there is evidence for both typical and atypical developmental progression of executive functions in autism. The plasticity suggested by the developmental improvements may have implications regarding appropriate developmental epochs and types of interventions aimed at enhancing cognitive capacities in individuals with autism.     

Critical reading using the READER acronym by experienced general practitioners (G.P.s) and by G.P. registrars in Southern and Northern Ireland

The READER acronym describes a simple easily applied method of critical reading, an important skill for general practitioners (GPs). The aim of the study was to evaluate an abstract using the READER method, and to compare the appraisal by GP registrars in Southern Ireland with those of GP registrars in Northern Ireland and those previously recorded by experienced GPs at the Conference of Teachers of the Irish College of General Practitioners. General practice registrars (n=41) in Southern Ireland participated in a critical reading workshop at which they appraised the abstract of a sample paper using the READER model for critical appraisal. A group of GP registrars (n=10) in Northern Ireland, and experienced GPs (n=35) at the Conference of Teachers of the Irish College of General Practitioners evaluated the complete paper using a similar methodology. There was no statistically significant difference between scores recorded by GP registrars in Southern Ireland and their Northern Irish counterparts, nor was there a statistically significant difference with experienced GP teachers. The READER model for critical reading provides GP registrars with a useful tool for critical evaluation of medical literature. GP registrars in Southern Ireland, Northern Ireland, and experienced GP’s from the Conference of Teachers in Ireland recorded similar results and the study appraised, while dealing with an intervention in one practice in south west England, appeared relevant and applicable to participants from other locations in a different health care system.     

The pharmacokinetics of isoxicam in elderly patients with rheumatoid arthritis

Nineteen patients, aged 60 years and over, with rheumatoid arthritis participated in a clinical trial to investigate the pharmacokinetics of isoxicam (a new non-steroidal anti-inflammatory drug) in this age group. The purpose of the study was to determine if the pharmacokinetics are different compared to a younger healthy population. The half-lives were independent of dosage, indicating linearity of pharmacokinetics. Furthermore, the half-lives after repeated dosing were not different from those found after single doses of 400 mg. This shows that there is neither undue accumulation of the drug nor induction of its own metabolism. These results are similar to the results obtained in other centres when isoxicam was administered to healthy subjects between 18 and 32 years.