Correlation of genetic and serologic approaches to HIV-1 subtyping in Thailand

The aim of this study was to compare the performance of differential polymerase chain reaction (PCR) typing and peptide enzyme-linked immunosorbent assay (V3-EIA) for human immunodeficiency virus type 1 (HIV-1) subtyping in Thailand using heteroduplex mobility assay (HMA) as the reference standard. Paired peripheral blood mononuclear cells (PBMC) and sera were collected from 38 HIV-1 seropositive persons in Thailand. HMA was done by standard methods; differential PCR employs primer pairs that differentially amplify either subtype E or B. V3-EIA used peptides specific for subtypes E or B. Thirty-two cases (84%) were found by HMA to be infected with subtype E: and six with (16%) subtype B. The results obtained with differential PCR were 100% concordant with those of HMA; V3 EIA correctly predicted the subtype in 95% (36 of 38). Six samples that molecularly subtyped as E were repeatedly dual reactive by screening V3-EIA, but these resolved to subtype E using an antigen-limiting EIA. Two samples were serologically nontypeable because of overall low levels of V3 antibody. Using HMA as the standard, differential PCR was shown to subtype HIV-1 reliably from patient PBMC samples. V3-EIA correctly predicted HIV-1 subtype in most (95%) of our cases. Because of the less rigorous sampling requirements, specimen processing, and logistical and technical requirements of serotyping compared with molecular techniques, it appears to be practical for screening purposes in a field environment. Samples that cannot be definitively subtyped serologically should undergo differential PCR and antigen-limiting V3 EIA. These approaches to HIV-1 subtyping should be used in complementary fashion in Thailand, where subtypes B and E are currently known to cocirculate.

Long-term development of lens opacities after exposure to ultraviolet radiation at 300 nm

The long-term development of lens opacities after short-term exposure to ultraviolet radiation (UVR) was determined. Altogether, 200 Sprague-Dawley rats received unilaterally 5 or 20 kJ/m2 UVR (lambda MAX = 300 nm, lambda 0.5 = 10 nm) in vivo, during 15 min. At 1, 4, 8, 16 and 32 weeks after exposure subgroups of 20 rats from each dose group were sacrificed. Both lenses were removed for measurement of intensity of forward scattered light. It was found that exposed lenses scatter light more than their contralaterals and that a higher dose induces more light scattering. After exposure to 5 kJ/m2, the mean difference in scattering remained unchanged between 1 and 32 weeks' latency, but the distribution of the individual differences in scattering became skew. For several animals, lens opacities induced by 5 kJ/m2 seemed to decrease during the observation period. Earlier observations in complement to current findings implicate that it is optimal to detect close-to-threshold UVR-induced cataract at 1 week after exposure.

Casemix--what is it and what does it mean to ophthalmology?

The Australian government is committed to the establishment of a prospective payment system based on casemix information for acute hospital care in the near future, because these systems are demonstrably socially equitable and more efficient than present 'historical' systems. Since ophthalmology is an outpatient-based specialty, the establishment of a good ambulatory casemix system is essential to this specialty. Considerable input from clinicians will be required to establish a satisfactory system, and to maintain it in years to come.

Case based funding--how or when

Casemix is on the move, and as with all new crazes, there are instances of the sensible running in parallel with the outrageous. There is certainly a danger that a desire to satisfy everyone's interests will lead to complex and convoluted systems with as little credibility as the current arrangements. The essential elements of case based funding systems are available and can be used to introduce more equity and common sense into health funding. The only thing missing is a clear commitment to use the available tools and limit opportunities to manipulate the system through political means.

Non-inpatient costing study

Flinders Medical Centre, a University teaching hospital located in the south of Adelaide, spends approximately 27% of its annual budget in the treatment of ambulatory patients. In an attempt to gain a better appreciation of the profile of resource use by this group of patients, the hospital undertook a detailed cost survey. This study has made it possible to identify the cost impact of ambulatory attendances on each of the service areas of the hospital and compare variation in cost within and between specialist clinics.

Vectors with multiple insertion sites for expression of cloned genes by T7 RNA polymerase: expression of a peptide from EBV thymidine kinase (TK)

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An unusual presentation of gluteal hematoma during anticoagulation therapy for deep venous thrombosis in spinal cord injury

Soft tissue bleeding can be manifested clinically by swelling, skin discoloration, pain and tenderness. Early recognition can be difficult in the spinal cord-injured population in whom sensation is impaired. We are presenting a case of occult bleeding into the gluteal region during anticoagulation therapy in a paraplegic patient that presented as migrating pain and tenderness in the hip and pelvic area.

[Significance of parathyroid hormone (PTH) within the scope of central nervous system disorders in hemodialysis patients]

The role of PTH as possible uraemic toxin within the scope of disturbances of the central nervous system (progressive dialysis encephalopathy, PDE) was investigated in 88 patients undergoing haemodialysis. A radioimmunoassay covering the C-terminal PTH fragment was used. Patients undergoing haemodialysis with a PDE showed the highest values with 2,015.4 +/- 457.9 pg/ml, and also in the preclinical stage of a PDE the PTH values with 1,845.7 +/- 663.1 pg/ml lay significantly above those ones of the patients undergoing haemodialysis without PDE (794.8 +/- 364.7 pg/ml). The findings speak for the importance of PTH in the development of complications of the central nervous system within the scope of the uraemia syndrome.

[Morphometric and histochemical studies of the skeletal muscles of patients with chronic renal failure and dialysis patients]

In 19 patients with chronic renal insufficiency in the stage of compensated retention, 20 patients undergoing dialysis and 24 patients with normal renal function muscle tissue was taken by an open biopsy and investigated histologically, histochemically as well as morphometrically. A neurogenic atrophy stood in the foreground of the histologic changes of the striated musculature in uraemia, a pure type II atrophy was found more infrequently. In the patients undergoing dialysis frequency and size of these disturbances were more distinct. Except for a possible influence of a disturbed calcium metabolism other pathogenetic factors supposed in literature could not be found.

[Histochemical localization of aluminum deposits in bones and their relation to the clinical and histomorphometric findings in patients with chronic renal failure]

In 60 patients with chronic renal insufficiency and 36 dialysis patients an iliac crest biopsy was performed, on the undecalcified bone morphometric determinations were carried out as well as the aluminium deposition was investigated histochemically. Histologically were found in 3 patients normal findings, in 11 patients a fibroosteoclasia, in 23 patients an osteoidosis and in 59 patients a combination fibroosteoclasia and osteoidosis. 3 oft the 60 patients with a chronic renal insufficiency had aluminium depositions in the polyblasts. Of the 36 dialysis patients 19 (55.4%) had a positive aluminium histology: 30.7% of the patients with osteoidosis and 23.7% with a mixed form. There was a positive correlation to the bone and osteoid volume, to the osteoid surface and a negative relation to the activity of osteoblasts, the absorption surface and the activity of osteoclasts. Aluminium depositions on the mineralisation border might be of importance for the changes.

Clonidine and guanfacine in hypertension

Guanfacine, 1 to 3 mg/day, and clonidine, 0.1 to 0.3 mg twice a day, were compared in a 24-week double-blind, randomized, parallel study of 42 patients with hypertension that was inadequately treated by chlorthalidone, 25 mg/day. Mean reduction of blood pressure was 18/9 mm Hg after guanfacine and 14/8 mm Hg after clonidine. To determine the incidence of rebound hypertension, subjects were hospitalized for 7 days during chlorthalidone therapy for collection of baseline data and once again immediately after abrupt withdrawal of the alpha-agonist after 24 weeks of dosing. Although blood pressure and heart rate rose significantly in both groups, the changes after clonidine withdrawal were greater and occurred earlier (day 2) than those after guanfacine withdrawal (day 4). Forty percent of the subjects receiving guanfacine and 64% of subjects receiving clonidine had diastolic blood pressure elevations greater than or equal to 10 mm Hg from baseline. There were increases in urinary norepinephrine levels in both groups after drug withdrawal, but these correlated poorly with blood pressure rise. Side effects after guanfacine were much the same as those after clonidine. Guanfacine taken once a day provides an effective and safe alternative to clonidine in the management of essential hypertension.

Antihypertensive and biochemical effects of indacrinone enantiomers

The enantiomers of indacrinone (I), an investigational loop diuretic, have different pharmacologic activity. The (-) enantiomer is natriuretic, and the (+) enantiomer is uricosuric. To determine the antihypertensive effects and an isouricemic ratio of indacrinone enantiomers, 37 patients with sitting diastolic blood pressure (BP) between 90 and 104 mm Hg, after a 4-week placebo washout, randomly received one of the ratios of I enantiomers, namely -2.5/+80 mg (A), -5/+80 mg (B), -10/+80 mg (C) or placebo (P), once daily for 12 weeks in a double-blind, parallel study. The mean reductions (baseline-end of treatment) in BP of 23/8, 20/10 and 25/10 mm Hg with treatments A, B and C respectively were greater (p less than 0.01) than that on P (0/3). Initially, serum uric acid decreased with treatments A and B but not with C. Mean changes in serum uric acid were -0.3, -0.4, 0.2 and 0.3 mg/dl respectively with treatments A, B, C and P. The ratio of -10/+80 mg produced least variation in serum uric acid. Reduction in serum K+ and Cl- appeared to be dose related to (-) enantiomer. No serious adverse effects were reported. A 1:9 ratio of I enantiomers intended for wide-scale use as a diuretic also showed good antihypertensive activity, a favorable uric acid profile and absence of hepatic toxicity in 14 patients.

A further assessment of predictors of the child's behavior in dental treatment

The child's disruptiveness during dental treatment was related modestly to his age as well as his state, trait, and dental anxiety. In three samples comprising 132 experienced and 49 inexperienced pedodontic patients, the child's behavior during treatment could not be predicted from any aspect of maternal anxiety -- trait, state, or dental. Previous conceptions of maternal influence on the child's dental anxiety should be re-evaluated.

Nonsterile self-intermittent catheterization for male quadriplegic patients

Individuals with cervical lesions at C6-7 level are capable of performing self-intermittent catheterization if they are deemed appropriate candidates for this type of bladder management by a urologist, and if they are provided with adaptations to help them compensate for limitations in hand function. The purpose of this paper is to present methods used at one university medical center for evaluating a quadriplegic patient's ability to manage self-intermittent catheterization, and to describe the adaptive devices needed for this form of independent bladder management.

[Correlations between human portal and peripheral venous insulin and proinsulin concentrations under glucose infusion]

In 8 female patients carbohydrate tolerance was proved by means of glucose infusion test 3 days after cholecystectomy. Parameters analyzed in portal and peripheral vein blood are compared with that of 47 healthy persons. All patients demonstrate a pathological carbohydrate tolerance after cholecystectomy, further characterized by an increased lipolysis, a paradoxical rise of HGH, a diminished insulin secretion during the early and increased IRI output in the second phase. There is a significant positive correlation between portal and peripheral vein IRI concentration despite the rising portalperipheral venous IRI difference with raised portal venous IRI concentration. Corresponding differences for proinsulin concentrations can be established in the early phase only. Relations existing between blood glucose and IRI are shown by multiple regression analysis. They suggest that the altitude of IRI concentration is determined by previous blood glucose concentration.