Occupational transmission of HIV in health care workers: A review

Health care workers have a small but real risk of acquiringHIV infection as a result of occupational exposure. In thispaper, we review all reports in the scientific literature from1984 through to December 1993 of confirmed and probable casesof HIV seroconversion after a specific occupational exposure.A total of 64 confirmed cases have been reported, 24 in Europe,36 in the USA and 4 in other countries. Most seroconversionshave resulted from percutaneous exposure (91%) to AIDS patients(62%), usually caused by hollow bore needlestick injuries inflictedduring blood drawing procedures. Almost all seroconversionshave been detected within 6 months of exposure (94%) and haveusually been preceded by an episode of acute illness (73%).Ten seroconversions have occurred in spite of partial or completecourses of zidovudine prophylaxis. An additional 113 probablecases have been reported, 75 in the USA, 35 in Europe and 3in other countries. Aggregating the results of the prospectivestudies carried out, it is calculated that the risk of seroconversionfollowing percutaneous exposure is 0.33% or 3 in 1000 exposures(95% Cl: 0.21–0.52%), while the risk following mucocutaneousexposure is much lower (0.04%, 95% Cl: 0.006–0.31%). Thedocumented failure of zidovudine prophylaxis following occupationalexposure in a number of instances indicate its effect is, atbest, only partial; furthermore, exposure to source patientswho have been receiving the drug may lead to transmission ofzidovudine-resistant strains of HIV. Risk factors for occupationalexposure to HIV and for transmission, given that an exposurehas occurred, are discussed.     

Left Axillary Implantation of Loop Recorder

Background: We compared the clinical course of 10 patients who received an implantable loop recorder (ILR) at a traditional site with 11 patients whose ILRs were implanted via a subpectoral site via a left axillary approach without complications. Methods and Results: R‐wave amplitude was determined at implantation and during follow‐up. Each patient was followed after 7 days to optimize device setting and then at 1 and 3 months. The R‐wave amplitude obtained with the new technique was significantly higher and more stable than that obtained with the standard procedure. Our preliminary experience suggests that axillary access for ILR implantation is feasible, safe, well tolerated, and reliable in terms of sensing function and device performance. Moreover, it is superior aesthetically to the standard approach and carries the potential of minimizing permanent scarring after ILR extraction. (PACE 2010; 999–1002)     

Apolipoprotein E genotype and cerebral palsy

Aim Apolipoprotein E (APOE, protein; [ApoE, gene]) is a lipid transport protein abundantly present in brain cells. We investigated whether the APOE genotype is associated with cerebral palsy (CP) and whether patients with CP with comorbid conditions and more severe neurological deficits are likely to have a particular genotype. Method In a cross‐sectional study, 243 individuals with spastic CP (135 males, 108 females; mean age at data collection 11 year ([SD 6y 7mo], 34% with hemiplegia, 37% with diplegia, 29% with triplegia/tetraplegia; 44% with mild motor involvement), 31% with moderate motor involvement, 25% with severe motor involvement, were compared with healthy individuals matched by age, race, and sex to analyse the association between APOE genotype and the incidence of CP. Associations between the APOE genotype and the incidence of comorbidities and neurological deficits were studied in the group with CP. Results The APOE ε2ε3 genotype was significantly more prevalent in the group with CP (11%) than the comparison group (5%) (odds ratio [OR] 2.8; 95% confidence interval [CI] 1.01–7.66). The presence of the ε2 allele raised the probability of having CP (OR 3.2; 95% CI 1.27–8.27). The presence of ApoE ε4 was not significantly different among groups. No relation was found between APOE genotype and severity of neurological deficit or distribution of motor involvement. Four patients with CP presented the ε4ε4 genotype, and all exhibited epilepsy and microcephaly. Eleven of 12 individuals with CP and macrocephaly carried the ε3ε3 genotype. Interpretation A higher prevalence of the APOE ε2 genotype was found among those with CP. The association of microcephaly and epilepsy with the ε4ε4 genotype and the association of macrocephaly with ε3 demand further investigation.     

Process evaluation of the implementation of a screening and brief intervention program for alcohol risk in primary health care: An experience in Brazil

Introduction and Aims. Screening and brief intervention (SBI) are considered good prevention strategies for alcohol‐related problems in Primary Health Care (PHC). The aim of this study was to evaluate the process of an SBI implementation program for alcohol risk use and evaluate the factors that facilitated or impeded this implementation, in two PHC settings at the Brazilian city of Juiz de Fora. Design and Methods. Case 1 public PHC services and case 2 the PHC service of the Military Police. Participants were trained on SBI strategies and supervised during 6 months. The qualitative methodology of action research was used. Data were analysed using thematic analysis. Results. Case 1: 70 participants; facilitating factors: good expectations about the project; simplicity of SBI technique; collaborative way the project was planned. Barriers: lack of time; discomfort in dealing with alcohol issues; focus on alcohol‐dependence; unstable political environment; other priorities; difficulties in patients' referral. Case 2: nine participants. Facilitating factors: simplicity of SBI technique; collaborative way the project was planned; importance of alcohol issues; data confidentiality and the voluntary work to do SBI. Barriers: only one health professional in the group; the variability of the institutional support; organisational culture about alcohol use. Discussion and Conclusions. The barriers and facilitators were related to two main factors: organisational culture and personal attitudes. The action research provided the opportunity to bridge the gap between research and practice, but it also showed that SBI faces significant challenges before it can be implemented as a routine procedure in PHC settings in Brazil. [Amaral MB, Ronzani TM, Souza‐Formigoni MLO. Process evaluation of the implementation of a screening and brief intervention program for alcohol risk in primary health care: An experience in Brazil. Drug Alcohol Rev 2009]     

Molecular analysis of HLA DR4-/β1 gene in malaria vaccinees. Typing and subtyping by PCR technique and oligonucleotides

The combination of the PCR technique and the synthetic oligonucleotides has proved to be a useful tool in the molecular analysis of HLA class II genes, allowing recognition of as little as a single nucleotide modification in the sequence of the gene. The molecules encoded by these genes have been associated with genetic control of the immune response and with susceptibility to certain diseases. Studies carried out in our laboratory have shown three patterns of humoral immune response in the human volunteers vaccinated with the synthetic protein SPf 66; high, intermediate and low responders. Approximately 73.3% of the low responders were serologically typed as HLA DR4 and 42% as DQw6. These results moved us to look for a subtype (Dw) correlation between the DR4 positive individuals and the different humoral immune response patterns. Using oligo-typing methods after previous amplification of the DR4 B1 exon, we subtyped 20 DR4 volunteers, classified as high, intermediate and low responders. We did not find any direct association between the HLA DR4 Dw special subtype in the high or low responders immunized with the SPf 66 vaccine.     

Carcinoma of the breast metastatic to the ureter seven years later

We present a case of ureteral metastasis from a primary breast cancer where the disease recurred with an episode of renal colic 7 years after diagnosis. A surgical operation was performed to remove the terminal ureter and the perimeatal area of the urinary bladder. Urological and radiological outcome was satisfactory after a 2-year follow up.