Efficient Isolation of Human Immunodeficiency Virus Type 1 RNA from Cervical Swabs

An efficient method for the isolation of human immunodeficiency virus type 1 (HIV-1) nucleic acids from dry cervical swabs was developed. HIV-1 gag and env were detected in 96% (25 of 26) and 81% (21 of 26), respectively, of the samples tested by PCR from HIV-1-seropositive women in a Kenyan cohort study. Eighty-eight percent of the swabs (22 of 25) were positive for gag RNA, and 85% (17 of 20) were positive for env RNA. Fewer than 1,000 copies of HIV-1 gag RNA were detected in four swabs in which a competitive quantitative PCR assay was used. The method described here may be useful for both qualitative and quantitative analyses of HIV RNA in mucosal secretions as well as amplification and cloning of full-length viral genes for functional studies.     

A multicomponent behavioural and drug intervention for nocturia in elderly men: rationale and pilot results

OBJECTIVES

To evaluate the number of medical and urological conditions associated with nocturia in a cohort of older men who were primary‐care enrolees, and to assess the feasibility and efficacy of using a multicomponent intervention to reduce nocturia and its bother.

SUBJECTS AND METHODS

Men aged ≥50 years and with two or more episodes of nocturia were recruited from the primary‐care clinics at one Veterans Affairs Medical Center to participate in a 4‐week, open‐label, prospective pilot study. A multicomponent intervention composed of behavioural therapy and targeted drug therapy was administered according to a specified protocol based upon identified risk factors for nocturia. Outcome measures included self‐reported nocturia and bother on the American Urological Association (AUA)‐7 Symptom Index, 3‐day bladder diaries and self‐reported sleep‐related measures recorded using 7‐day sleep diaries.

RESULTS

Fifty‐five men completed the protocol (mean age 67 years, sd 8.3); they had a mean of 4.5 of nine defined conditions potentially related to nocturia. Highly prevalent conditions included moderate‐to‐severe benign prostatic hyperplasia (87%), hypertension (86%) and urinary frequency (71%). The mean diary‐recorded nocturia decreased from 2.6 to 1.9 (P < 0.001), and bother score reduced from 3.1 to 1.1, representing a change from a ‘medium’ to a ‘very small’ problem (on a 5‐point scale). Sleep diary‐derived measures also improved significantly (time to initiate sleep, time to return to sleep after awakening, quality of sleep).

CONCLUSIONS

Given that individual older patients often have multiple coexistent risk factors for nocturia, identifying a principal cause of nocturia, a concept emphasized in treatment guidelines, proved to be difficult. Implementing a multicomponent behavioural intervention combined with drug(s) was feasible in older men and reduced nocturia frequency, bother from nocturia, and time to initiate sleep, within 4 weeks. These promising results merit repeating using a randomized, controlled trial.     

Learning through community participation: immunization program at an elementary school.

Many universities are establishing programs to bring health professions students, faculty, and communities together to address the communities' needs using public health models and tools. Such partnerships provide students with the opportunity to put into practice what they learn in the classroom, work together in interdisciplinary teams, and provide communities with access to preventive care and health education. The authors describe the experience of the partnership developed between a Washington, D.C., elementary school and a group of students from the schools of medicine, nursing, and public health and health services of the George Washington University and George Mason University. Working with both an academic preceptor and a community preceptor, the students assessed the schoolchildren's immunization status; prepared informational packets for parents; and organized and conducted an immunization fair at the elementary school. The authors describe how the program was implemented, the results of the program, and lessons learned.     

Clinical and laboratory features of severe and complicated falciparum malaria the experience from Gonder Hospital

Over a period of 6 months in 1988, 104 patients with severe and complicated falciparum malaria were admitted to the Gonder College Hospital (GCH), Gonder, Ethiopia; 85 male (81.7%) and 19 female (18.3%). The age ranged between 14 and 70 years with a mean age of 31 years. Eighty-one patients (78.3%) had moved from a nonendemic to a malariaendemic area shortly before their illness. Altered state of consciousness, hyperparasitaemia and severe anaemia were the most frequent complications found. Fifty-three patients (51.0%) died. Non-immune status and unknown duration of symptoms were significantly associated with mortality. Among those who died, comatose state on admission, hyperparasitaemia and acute renal failure were more frequently seen. Forty-six (86.8%) had developed two or more complications and 15 (28.3%) had superimposed bacterial infections. Inadequate preventive measures and treatment facilities may be two important factors accounting for the high mortality.