Differential survival in blacks and Hispanics with AIDS

Objective. The object of this study was to investigate whether there are differences in survival by ethnicity in people with AIDS.

Design. The CDC Public Access Dataset was analysed. To estimate survival more accurately, a cohort of individuals diagnosed in 1987 was chosen from the dataset. Using this analysis, probabilities of survival were estimated.

Results. There were significant differences in survival in blacks and Hispanics as compared to whites diagnosed in 1987. Although there are differences in survival by transmission category, survival differences by ethnicity persisted when analysed within specific transmission categories. A model where the frequency distributions of survival were log‐transformed suggests that disease progression per se may not be the most important factor, but time of diagnosis may be. In addition, in looking at median survival by year of diagnosis, it is clear that blacks and Hispanics have not shown the same magnitude of improvement in survival time, and lag behind whites.

Conclusions. This study clearly shows differences in survival with AIDS by ethnicity. Differential access to health care may underlie such ethnic differences in survival.     

Phase I/II prospective trial of autologous platelet tissue graft in gynecologic surgery

STUDY OBJECTIVE: To perform the original phase I/II trial of autologous platelet tissue graft in gynecologic surgery to evaluate toxicity and efficacy on decreasing pain. DESIGN: Prospective nonrandomized trial (Canadian Task Force classification II-A). SETTING: Teaching hospital. PATIENTS: Fifty-five consecutive patients undergoing major gynecologic surgery were entered into this prospective phase I/II trial and were matched with 55 patients from the previous 6 months. INTERVENTION: After anesthesia was induced, peripheral venous blood (55 mL) was obtained from the patient producing, autologous platelet tissue graft (20 mL). At completion of surgery, autologous platelet tissue graft was directly applied to the surgical site. MEASUREMENTS AND MAIN RESULTS: Median pain on the day of surgery was 2.7 (mild) in the autologous platelet tissue graft group vs 6.7 (severe) in the control group, p <.001. Likewise, pain on postoperative day 1 was 2.1 (mild) in the autologous platelet tissue graft group vs 5.5 (moderate) in the control group, p < or =.001. Median of morphine per hospital stay for the autologous platelet tissue graft group was 17 mg (range 1-98 mg) vs 26 mg (range 3-90 mg) in the control group, which was statistically significant at p = .02. There were no adverse effects associated with autologous platelet tissue graft. CONCLUSIONS: In the original phase I/II prospective trial of autologous platelet tissue graft in gynecologic surgery, there were no apparent adverse effects, and pain was significantly reduced.     

Fibroblast growth factor and glutamate: opposing roles in the generation and degeneration of hippocampal neuroarchitecture

Neuritic regression and cell death (neurodegeneration) are common features of both normal nervous system development and neurodegenerative disorders. Growth factors and excitatory amino acid neurotransmitters have been suggested independently to play roles in neurodegenerative processes. The present study investigated the combined effects of fibroblast growth factor (FGF) and glutamate on the development and degeneration of cultured hippocampal neurons. Consistent with previous data, we found that FGF, but not NGF, promoted neuronal survival and dendritic outgrowth. In contrast, a low level of glutamate (50 microM) caused a reduction in dendritic outgrowth, and high levels (100 microM-1 mM) reduced neuronal survival in a dose-dependent manner. When cultures were maintained in the presence of FGF, there was a striking reduction in neuronal death normally caused by 100-500 microM glutamate. FGF raised the threshold for glutamate neurotoxicity. FGF also antagonized the outgrowth-inhibiting actions of glutamate. Measurements of intracellular calcium levels with fura-2 demonstrated a direct relationship between glutamate-induced rises in intracellular calcium and neurodegeneration. FGF reduced the glutamate-induced increases in intracellular calcium levels. However, when cultures were pretreated with the RNA synthesis inhibitor actinomycin D or with the protein synthesis inhibitor cycloheximide, FGF did not prevent glutamate-induced increases in intracellular calcium or neurodegeneration. Taken together, these results suggest that (1) interactions between growth factors and neurotransmitters may be important in brain development; (2) imbalances in these systems may lead to neurodegeneration; and (3) cellular calcium-regulating systems may be a common focus of growth factor and neurotransmitter actions.     

Selection of antifolate-resistant Plasmodium falciparum by sulfadoxine-pyrimethamine treatment and infectivity to Anopheles mosquitoes

Resistance-conferring mutations in dihydrofolate reductase (DHFR) and dihydropteroate synthase (DHPS) in Plasmodium falciparum are selected by treatment with sulfadoxine pyrimethamine (SP). We assessed the association between these mutations and transmission capacity of parasites to Anopheles mosquitoes on the Pacific coast of Colombia. Patients with uncomplicated P. falciparum malaria received SP treatment and were followed-up to compare the prevalence of DHFR and DHPS mutations before and after SP treatment. Membrane feeding assays were used to measure infectivity to mosquitoes of post-treatment gametocytes with and without these mutations. Per-protocol treatment efficacy was 95.0% (132 of 139). Gametocytes carrying resistance-conferring mutations were selected after SP treatment and were infective to mosquitoes. Seven days after treatment, infections with two DHFR mutations had a 10-fold higher probability of infecting mosquitoes than infections with no DHFR mutations (odds ratio = 10.23, P < 0.05). Low-level drug resistance mutations have the potential to enhance transmission of P. falciparum and spread resistant parasites.     

Clinical governance improves the quality of nuclear medicine reporting

OBJECTIVE: To assess the quality of nuclear medicine reporting, within a private UK hospital, of five physicians from four different National Health Service trusts and compare it with a similar previous clinical governance exercise. METHODS: Reports (n=140) were shown anonymously to all five physicians, including the one who produced the report. Each physician ranked them on a scale of 1-5, with 1 and 5 corresponding to complete disagreement and complete agreement, respectively. All reports with at least one score of <4 were subjected to consensus review by all five physicians and subsequently given a consensus score. RESULTS: Six hundred and ninety-one audit opinions were present out of a possible 700 (98.7%). Forty-three reports were reviewed, of which 11 received a consensus score of <4 (7.9%). This is not significantly different from the proportion of nontrivial errors in our earlier study (10.2%). Only three reports were present, however, with a score of <3 (2.1%), significantly fewer (P<0.02) than the proportion of nontrivial errors in our earlier study. No scores of 1 were recorded. No reporter attracted significantly more scores of <4 compared with the overall proportion of such scores. A score given by an auditing physician which was 2 or more points different from the consensus score was defined as a suboptimal audit. Forty-four of 691 suboptimal audits (6.4%) were present, significantly fewer than the proportion of suboptimal audits in our earlier study (9.7%; P<0.03). CONCLUSION: Studies such as these provide a useful framework for monitoring performance. This improved significantly in this study as compared with our previous audit.