AIDS education: the SMAHEC (Southeastern Massachusetts Area Health Education Center) experience

Massachusetts ranks 10th in the nation in numbers of reported AIDS cases. The state had 3,877 AIDS cases reported through June 1991. The Southeastern Massachusetts region consisting of 70 cities and towns totaling approximately 1,735 square miles has the second highest incidence of HIV infection of regions in the state. Total cumulative cases of full-blown AIDS in the region have numbered 406, approximately 14 percent of the state total. This article describes the experience of Southeastern Massachusetts Area Health Education Center, Inc. (SMAHEC) in implementing AIDS educational efforts.     

Benign prostatic hyperplasia treated with saw palmetto: a literature search and an experimental case study

European physicians treat benign prostatic hyperplasia (BPH) with saw palmetto extract (SPE), while American physicians generally disregard SPE because "research is lacking." The authors investigated this discrepancy with a literature search and a clinical trial. The literature search began with MEDLINE, then expanded to "alternative" databases, including AGRICOLA, EMBASE, IBIS, and Cochrane, plus a manual search of unindexed herbal journals. The clinical trial was an experimental case study in which a 67-year-old man with symptomatic BPH was randomly administered SPE (160 mg standardized extract twice daily) or placebo. Outcome measures included the American Urological Association Symptom Index (AUASI), serum prostate-specific antigen, and prostate volume. Our expanded literature search revealed 58 clinical trials, whereas MEDLINE yielded only 19 clinical trials, or 33% of the total. Our clinical trial measured a baseline AUASI score of 20, which improved to 7 after unblinded administration of SPE. Subsequent double-blinded placebo produced a score of 14, and final single-blinded allotment of SPE produced a score of 11. Prostate-specific antigen was 10.3 ng/mL at baseline and 10.7 ng/mL at trial's conclusion. Baseline prostatic volume was 92 mL, and end volume was 75 mL. In conclusion, MEDLINE proved inadequate as a stand-alone search engine for locating information about an herbal medicine. Our experimental case study, similar to N = 1 research methodology, proved suitable for clinical evaluation of an herbal medicine in a rural private practice. SPE improved the patient's BPH. Unstandardized look-alike herbs may act as nontherapeutic placebos and may undermine consumer confidence in herbal medicine.     

First-Hand Accounts of Interoceptive Difficulties in Autistic Adults

Journal of Autism and Developmental Disorders - Interoceptive awareness refers to one’s ability to detect, discriminate, and regulate internal bodily and mental processes. Interoceptive...     

Language and Aggressive Behaviors in Male and Female Youth with Autism Spectrum Disorder

Journal of Autism and Developmental Disorders - Aggressive behaviors are common among youth with autism spectrum disorder (ASD) and correlate with pervasive social-emotional difficulties....     

The Effect of Elevated Body Mass Index on Outcomes Following Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

Background

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) can prolong survival in peritoneal-based malignancies. These malignancies harbor in visceral and omental adipose tissue, and as a result, obesity may contribute to greater tumor burden. Obesity also is an independent risk factor for perioperative complications following major surgery. No studies to date have investigated the effect of elevated body mass index (BMI) on disease burden and perioperative outcomes in CRS-HIPEC patients.

Methods

Observational study of consecutive patients taken to the operating suite from 2007 to 2012 for CRS-HIPEC. Data were reviewed retrospectively, and patients for whom complete cytoreduction was not achieved and those with BMI <18.5 were excluded. Various operative data points, including peritoneal cancer index, surgery length, and estimated blood loss, were measured prospectively. Perioperative complications were identified and recorded.

Results

Complete data for review was available for 114 patients. Patients were subdivided based on BMI (group A 18.5–24.9, n = 43; group B 25–29.9, n = 49; group C ≥ 30, n = 22). There was no statistically significant difference in tumor burden, operative length, probability of unresectable disease, operative blood loss, or length of stay between groups. Rates of respiratory, gastrointestinal, infectious, renal, and hematologic complications were not statistically different, with the exception of deep vein thrombosis (A = 0, B = 13.5 %, C = 0; p = 0.026).

Conclusions

CRS-HIPEC can be safely performed in overweight and obese patients without significant increase in perioperative morbidity. Despite the limitations in physical examination and increase in visceral fat, they do not appear to present later than patients with normal BMI, nor do they have higher tumor burden.     

Start with a subjective assessment of skin temperature to identify hypoperfusion in intensive care unit patients

OBJECTIVE: To determine whether physical examination alone or in combination with biochemical markers can accurately diagnose hypoperfusion. METHODS: Data from 264 consecutive surgical intensive care unit patients were collected by two intensivists and included extremity temperature, vital signs, arterial lactate, arterial blood gases, hemoglobin, and pulmonary artery catheter values with derived indices. Days of data were divided into data collected from patients with cool extremities (cool skin temperature [CST] group) versus warm extremities (warm skin temperature [WST] group). Values are means +/- SD. Comparisons between groups were made by two-tailed unpaired t test; significance was assumed for p < or = 0.05. RESULTS: There were 328 days of observations in the CST group versus 439 in the WST group. There were no differences (p > 0.05) between CST and WST data with regard to heart rate (107 +/- 14 vs. 99 +/- 19 beats/min), systolic blood pressure (118 +/- 24 vs. 127 +/- 28 mm Hg), diastolic blood pressure (57 +/- 14 vs. 62 +/- 15 mm Hg), pulmonary artery occlusion pressure (14 +/- 6 vs. 16 +/- 5 mm Hg), Fio2 (0.48 +/- 0.7 vs. 0.45 +/- 0.2), hemoglobin (8.8 +/- 1.6 vs. 9.3 +/- 1.3 g/dL), Pco2 (44.3 +/- 11.8 vs. 40.7 +/- 9.2 mm Hg), or Po2 (96.4 +/- 12.6 vs. 103.8 +/- 22.2 mm Hg). However, cardiac output (5.3 +/- 2.2 vs. 8.2 +/- 2.6 L/min), cardiac index (2.9 +/- 1.2 vs. 4.3 +/- 1.2 L/min/m2), pH (7.32 +/- 0.2 vs. 7.39 +/- 0.07), TCO2 (19.5 +/- 3.1 vs. 25.1 +/- 4.8 mEq/L), and Svo2 (60.2 +/- 4.4% vs. 68.2 +/- 7.8%) were all significantly lower (p < 0.05) in CST patients compared with WST patients. By comparison, lactate (4.7 +/- 1.5 vs. 2.2 +/- 1.6 mmol/L, p < 0.05) was significantly elevated in patients with cool extremities. CONCLUSION: Combining physical examination with serum bicarbonate and arterial lactate identifies patients with hypoperfusion as defined by low Svo2 and cardiac index. Hypoperfusion may occur despite supranormal cardiac indices. Patients with cool extremities and elevated lactate levels may benefit from a pulmonary artery catheter to guide but not initiate therapy.     

REM sleep in primary depression: a computerized analysis.

REM sleep in 35 inpatients with primary depression was automatically analyzed for 7 consecutive nights during placebo administration. For the total night of sleep, as well as each individual REM period, the number of REMs, their total voltage integral over time, the sum of their durations and the average REM size were automatically calculated. Validity of these automated REM measures was established by significant correlations with manually scored REM measures. Changes in REM sleep across the night were also investigated. Similar to findings in normal subjects, REM time did not change from REM period to REM period. Average REM size increased significantly from REM period 2-3 and 3-4. Contrary to what is seen in normal subjects, REM frequency was high during the first REM period, significantly decreased from the first to second REM period and then remained constant. Finally, a significant inverse correlation between REM frequency for the first REM period and REM latency was noted. This pattern of REM sleep is interpreted as indicating a high pressure for phasic REM at the beginning of the night which is dissipated by the first REM period.