Psychological distress before and immediately after attendance at a male sub-fertility clinic.

Where treatment options are limited, the role of clinical consultation in providing information and support becomes more important. This study examines the immediate impact of medical consultation on male sub-fertility clinic attender's anxiety, depression, self-blame, information appraisal and perceptions of future fertility. Data were collected pre- and immediately post-consultation. Clinical information and consultation details were recorded. Results showed that anxiety levels were high before consultation. Following consultation anxiety and self-blame were both reduced while depression increased. Despite information about poor prognosis being given during consultation, participants remained overly optimistic about their chances of achieving a pregnancy. It appears that the consultation has a distinct psychological impact and possible mechanisms underlying this are discussed.     

Specific binding of the mononuclear phagocyte colony-stimulating factor CSF-1 to the product of the v-fms oncogene.

Cells transformed by the McDonough strain of feline sarcoma virus (SM-FeSV) express a v-fms-encoded glycoprotein whose expression at the cell surface correlates with the transformed phenotype. The mouse mononuclear phagocyte growth factor CSF-1 specifically binds to SM-FeSV-transformed cells at high-affinity sites indistinguishable from those detected on normal feline macrophages. A monoclonal antibody to a v-fms-encoded epitope competed for CSF-1 binding to SM-FeSV-transformed cells, and chemical crosslinking demonstrated that murine CSF-1 bound to the v-fms gene product at the cell surface. Although SM-FeSV-transformed fibroblast lines were found to secrete CSF-1, the growth of transformed cells was not affected by antibodies to the v-fms gene product or to the growth factor. Tyrosine phosphorylation of the v-fms products in membranes was observed in the absence of CSF-1 and was not enhanced by addition of the murine growth factor. The data support the hypothesis that the c-fms protooncogene product is related, and possibly identical, to the CSF-1 receptor and suggest that the v-fms-encoded kinase functions in the absence of an exogenous growth factor.     

Preventing HIV transmission during pregnancy and delivery: a review

Without significant reductions in maternal-infant HIV transmission, infant mortality may increase by as much as 75%. This article reviews briefly the range of interventions that have been proposed to prevent HIV transmission during pregnancy and delivery. These include the provision of HIV/AIDS counseling in family planning programs, promotion of consistent condom use, vitamin A supplementation during pregnancy, adequate prenatal care, Cesarean section delivery, vaginal lavage, and zidovudine treatment. The efficacy of mandatory HIV testing of pregnant women and zidovudine administration to HIV-positive pregnant women has not been confirmed, but both strategies should be available. Antenatal screening for this purpose should be promoted, however, only if free drug treatment for the mother and child can be offered for at least 2 years (the 9 months of pregnancy and the 18 months until the infant can be tested for HIV). Although HIV-infected pregnant women should have the option of induced abortion, termination should never be coerced. Only 10% of HIV-infected pregnant women select this option, and those who do tend to have another pregnancy within the next 2 years.     

HIV testing and prevention issues for women attending termination assessment clinics

The prevalence of HIV infection in London is nearly threefold in women who seek terminations compared to women who carry to term. Despite the higher prevalence, HIV testing is not systematically offered to women attending termination of pregnancy assessment clinics (TOPCs). The Department of Health has given clear guidance on HIV testing in antenatal clinics and most London antenatal clinics have implemented policies on HIV testing. No similar guidance exists for TOP clinics. This paper describes the results from a study examining HIV testing and prevention issues for women attending five TOPCs in North London. Data on risk disclosure, HIV testing intentions and awareness of HIV infection and testing were analysed for 141 women who completed a self-administered questionnaire. Women who expressed an intention to have an HIV test were more likely to be from ethnic minority origin, to report that their partner intends to have an HIV test and to perceive it as easier to talk to their partner about HIV testing, compared to women who did not report an intention to test for HIV The former group also were more likely to have had a previous HIV test and perceived their personal control for staying HIV negative as greater compared to others. Fifty six (39.8 per cent) women disclosed one or more potential risk factors for HIV Women with risks were more knowledgeable about HIV infection, perceived their personal chances of being HIV positive as greater and experienced greater worry about past risks, compared to women who disclosed no risks. However, women who disclosed risk factors were no more likely to intend to have an HIV test. Knowledge on HIV infection, testing and potential interventions to reduce mother-to-baby transmission was low, with fewer than one in four women being aware that transmission may be reduced by AZT, Caesarean section and bottle feeding. Given the findings about the level of risk disclosed and women's positive attitude towards information on HIV infection and testing, this client group should no longer be overlooked in the planning of future policies on HIV testing for populations at risk.     

Panic attacks may reveal previously unsuspected chronic disseminated lyme disease

The author describes the histories of three patients with panic-like episodes that turned out to be related to underlying, previously unsuspected tick-borne diseases. Each woman experienced symptoms that are not usual in panic disorder but are typical of neurological Lyme disease, including exquisite sensitivity to light, touch, and sounds, joint pain often in combination with cognitive changes including mental fogginess and loss of recent memory, and some degree of bizarre, shifting, and often excruciating neurological pain. Because these symptoms are atypical of primary panic disorder, they were very helpful in alerting the clinician to suspect an underlying physical illness. In each case, the results of testing revealed positive hallmarks of disseminated Lyme and other tick-borne diseases, including Lyme borreliosis caused by the spirochete, Borrelia burgdorferi, babesiosis, and ehrlichiosis. Since beginning treatment with intensive doses of appropriate antimicrobial medications for their tick-borne infections, all three patients have become free of panic attacks. Treatment of their infections by a specialist in Lyme disease allowed one of the women to discontinue anti-anxiety medication completely and another to reduce the dose of medication to occasional use only. The third patient is no longer anxious but her depression is resolving more slowly despite the ongoing use of an antidepressant. Two of the patients have also needed ongoing medication for pain and other symptoms of late-stage, neurological Lyme disease.     

Bone marrow stromal-B cell interactions in polycyclic aromatic hydrocarbon-induced pro/pre-B cell apoptosis.

Environmental polycyclic aromatic hydrocarbons (PAH) and related halogenated hydrocarbons are immunotoxic in a variety of systems. In a model system of B lymphopoiesis, PAH exposure rapidly induces apoptosis in CD43- pre-B and CD43+ pro/pre-B cells. Apoptosis induction by 7,12-dimethylbenzo[a]anthracene (DMBA) is dependent upon AhR+ bone marrow stromal cells and likely involves DMBA metabolism within the stromal cell. However, it is not known if PAH-treated stromal cells release free metabolites or soluble factors that may directly induce B cell death or if the effector death signal is delivered by stromal cell-B cell contact. Here, we demonstrate that supernatants from DMBA-treated bone marrow stromal cells contain an activity capable of inducing apoptosis in pro/pre-B cells cocultured with stromal cells. This activity (1) is not produced when stromal cells are cotreated with DMBA and alpha-naphthoflavone (alpha-NF), an aryl hydrocarbon receptor (AhR) and cytochrome P-450 inhibitor, (2) is > or = 50 kDa, (3) is trypsin and heat sensitive, and (4) is dependent on AhR+ stromal cells, which in turn deliver the effector death signal to pro/pre-B cells. The results (1) argue against a role for a soluble, stromal cell-derived cytokine as the effector of PAH-induced pro/pre-B cell death, (2) exclude the possibility of a free metabolite acting directly on AhR- pro/pre-B cell targets, and (3) suggest the elaboration by stromal cells of a relatively stable, DMBA metabolite-protein complex capable of acting on other stromal cells at some distance. Collectively, these studies suggest that, while stromal cell products, e.g., metabolite-protein complexes, may affect the function of distant stromal cells, the effector death signal delivered by stromal cells to bone marrow B cells is mediated by cell-cell contact.     

Assignment of CSF-1 to 5q33.1: evidence for clustering of genes regulating hematopoiesis and for their involvement in the deletion of the long arm of chromosome 5 in myeloid disorders.

The CSF-1 gene encodes a hematopoietic colony-stimulating factor (CSF) that promotes growth, differentiation, and survival of mononuclear phagocytes. By using somatic cell hybrids and in situ hybridization, we localized this gene to human chromosome 5 at bands q31 to q35, a chromosomal region that is frequently deleted [del(5q)] in patients with myeloid disorders. By in situ hybridization, the CSF-1 gene was found to be deleted in the 5q- chromosome of a patient with refractory anemia who had a del(5)(q15q33.3) and in that of a second patient with acute nonlymphocytic leukemia de novo who had a similar distal breakpoint [del(5)(q13q33.3)]. The gene was present in the deleted chromosome of a third patient, with therapy-related acute nonlymphocytic leukemia, who had a more proximal breakpoint in band q33 [del(5)(q22q33.1)]. Hybridization of the CSF-1 probe to metaphase cells of a fourth patient, with acute nonlymphocytic leukemia de novo, who had a rearrangement of chromosomes 5 and 21 [ins(21;5)(q22;q31.3q33.1)] resulted in labeling of the breakpoint junctions of both rearranged chromosomes; this suggested that CSF-1 is located at 5q33.1. Thus, a small segment of chromosome 5 contains GM-CSF (the gene encoding the granulocyte-macrophage CSF), CSF-1, and FMS, which encodes the CSF-1 receptor, in that order from the centromere; this cluster of genes may be involved in the altered hematopoiesis associated with a deletion of 5q.     

An assessment of current HIV treatment adherence services in the UK

The aim of this study was to examine current approaches to supporting adherence to antiretroviral therapy in UK HIV clinics. One hundred HIV/AIDS/GUM physicians were interviewed: 97% were personally involved in discussing adherence, spending 22% of consultation time on this issue and assessing adherence most commonly by patient self-report (88%). Other personnel involved included nurses (74%), other doctors (56%), health advisers (54%) and pharmacists (48%). Among criteria for achieving treatment success, adherence support ranked fourth after 'treatment fitting well into patient's lifestyle', regular viral load monitoring and the 'experience of the clinician/healthcare team'. A variety of tools were used to support adherence including dosette boxes (53%), written information (44%) and verbal communication (42%). Only 20% of physicians followed adherence protocols or formal guidelines. Three-quarters of physicians had received no training on adherence issues. The most common ways physicians kept informed about adherence matters were by attending conferences (87%), reading literature (71%) and learning from colleagues (51%). Eighty-seven per cent of physicians believed national adherence guidelines would be valuable. In conclusion, there is a need for training and direction within current adherence support services. National guidelines could provide a valuable framework for health care professionals.