Utilization of HIV point-of-care testing clinics in general practice and genitourinary medicine services in south-east London

We compared the utilization of HIV point-of-care testing (POCT) clinics in a general practice and a genitourinary (GU) medicine service. Retrospective case-note review of patients attending the general practice HIV POCT clinic from February 2005 to July 2007 was undertaken. Those attending the GU medicine service over the same period were used as a comparator group. HIV POCT clinics in general practice when compared with GU medicine services were significantly more likely to be utilized by those of Black ethnicity (Black African 61/370 [16.5%] vs. 107/1231 [8.7%], P < 0.001; Black Caribbean 19/370 [5.1%] vs. 11/1231 [0.9%], P < 0.001 and Black Other 20/370 [5.4%] vs. 26/1231 [2.1%], P = 0.001, respectively). Fewer men who have sex with men attended for HIV POCT in general practice than in GU medicine; 82/238 (34.5%) vs. 337/816 (41.3%), P = 0.058. We have demonstrated that HIV POCT clinics in primary care and GU medicine attract different 'at-risk' groups and provide increased opportunity for testing.

Spectrum of chronic kidney disease in HIV-infected patients

OBJECTIVES

The aim of the study was to investigate the prevalence and aetiology of chronic kidney disease (CKD) and trends in estimated glomerular filtration rate (eGFR) in HIV-infected patients.

METHODS

Ascertainment and review of CKD cases among patients attending King's College and Brighton Hospitals, UK were carried out. CKD was defined as eGFR <60 mL/min for > or =3 months. Longitudinal eGFR slopes were produced to examine trends in renal function before, during and after exposure to indinavir (IDV) or tenofovir (TFV).

RESULTS

CKD prevalence was 2.4%. While HIV-associated nephropathy accounted for 62% of CKD in black patients, 95% of CKD in white/other patients was associated with diabetes mellitus, hypertension, atherosclerosis and/or drug toxicity. Exposure to IDV or TFV was associated with an accelerated decline in renal function (4.6-fold and 3.7-fold, respectively) in patients with CKD. In patients initiating IDV, age > or =50 years increased the odds of CKD [odds ratio (OR) 4.9], while in patients initiating TFV, age > or =50 years (OR 5.4) and eGFR 60-75 mL/min (OR 17.2) were associated with developing CKD.

CONCLUSION

This study highlights the importance of metabolic and vascular disease to the burden of CKD in an ageing HIV-infected cohort. In patients who developed CKD, treatment with IDV or TFV was associated with an accelerated decline in renal function.

Over fifty and living with HIV in London

OBJECTIVE

To examine age at diagnosis, sexual behaviour and some social characteristics of people living with HIV in London who are over the age of 50 years, with particular reference to gay men.

METHODS

Patients with HIV infection attending National Health Service outpatient clinics in north-east London between June 2004 and June 2005 were asked to complete a confidential, self-administered questionnaire.

RESULTS

1687 people with diagnosed HIV were recruited (63% response rate) including 758 gay men, 480 black African heterosexual women and 224 black African heterosexual men. Just over 10% of the whole sample (184/1687, 10.9%) were aged 50 years or above; gay men 13.1%, black African heterosexual men 8.5%, black African heterosexual women 6.9% (p<0.01). A third of the HIV-positive gay men over 50 years were diagnosed with HIV in their 50s or 60s (33.3%, 32/96). Overall, one in five HIV-positive gay men (20.1%, 144/715) reported high-risk sexual behaviour in the previous 3 months. This did not vary significantly by age (p = 0.2).

CONCLUSION

In this study of people living with HIV in London, one in seven gay men were over the age of 50 years. A third of the HIV-positive gay men over 50 years were diagnosed in their 50s or 60s, highlighting that this group is not just an ageing cohort of people who were diagnosed in their 30s or 40s. Positive prevention programmes should target HIV-positive gay men of all ages because older gay men with HIV were just as likely to report high-risk sexual behaviour as younger men.

Social and economic hardship among people living with HIV in London

OBJECTIVES

To examine the social and economic circumstances of people living with HIV in London.

METHODS

Between June 2004 and June 2005, 1687 people living with HIV (73% response) receiving treatment and care in north-east London National Health Service out-patient clinics completed a confidential, self-administered questionnaire. The questionnaire sought information on employment, income, education, residency status in the UK and housing.

RESULTS

In total, 1604 respondents were included in the analysis: Black African heterosexual women (n=480) and men (224); White (646) and ethnic minority (i.e. non-White) homosexual men (112); White heterosexual men (64) and women (39); and Black Caribbean heterosexual women (26) and men (13). Black African heterosexual men and women consistently reported more difficulties than any other group in relation to employment, income, housing and residency status. Half the Black African heterosexual men (46.8%) and women (51.2%) reported insecure residency status in the UK, significantly more than any other group (P<0.001). Just under half the respondents (46.6%) were employed at the time of the survey; Black African heterosexual women (35.3%) and men (45.4%) were less likely to be employed than White (57.6%) or ethnic minority (53.7%) homosexual men (P<0.001). Forty per cent of Black African heterosexual men and women, 22.9% of ethnic minority homosexual men and 9.6% of White homosexual men did not have enough money to cover their basic needs (P<0.001).

CONCLUSIONS

In this study of people living with HIV in London, a substantial number faced social and economic hardship, particularly Black African and other ethnic minority respondents. Our findings provide further evidence that in London HIV is associated with poverty, particularly among migrant and ethnic minority populations.

Uptake of antiretroviral treatment among people living with HIV in London: ethnicity, gender and sexual orientation

OBJECTIVE

To examine, by ethnicity, gender and sexual orientation, uptake of antiretroviral treatment among people living with HIV in London.

METHODS

Between June 2004 and June 2005, 1687 people living with HIV (73% response) receiving treatment and care in North East London National Health Service outpatient clinics completed a confidential, self administered, questionnaire. Respondents were asked whether they were currently taking HIV treatments (antiretroviral or combination therapy)

RESULTS

Overall, 73.7% (1057/1435) of respondents said they were currently taking HIV treatments: white men who have sex with men (MSM) 70.7%; ethnic minority MSM 70.9%; black African heterosexual women 75.0%; black African heterosexual men 80.8% (p<0.05). In all groups, taking HIV treatments was strongly associated with having a low CD4 cell count at diagnosis (p<0.001); 30.1% of white and ethnic minority MSM had a CD4 cell count less than 200 cells/mm(3) at diagnosis compared with 53.1% of the black African heterosexual women and 66.3% of the black African heterosexual men (p<0.001). After adjusting for CD4 cell count at diagnosis, no significant differences in uptake of HIV treatments remained between the groups: MSM AOR 1.00 (reference group); black African heterosexual women AOR 1.15, 95% CI 0.71 to 1.88, p = 0.6; black African heterosexual men AOR 0.88, 95% CI 0.43 to 1.80, p = 0.7.

CONCLUSION

Our analysis suggests that in London, once HIV infection is diagnosed, people from the two main risk groups-MSM (mostly white men) and black African heterosexual men and women-receive HIV treatment according to clinical need regardless of their ethnicity, gender or sexual orientation.

Coulomb excitation of neutron-rich Zn isotopes: first observation of the 2(1)+ state in 80Zn

Neutron-rich, radioactive Zn isotopes were investigated at the Radioactive Ion Beam facility REX-ISOLDE (CERN) using low-energy Coulomb excitation. The energy of the 2(1)+ state in 78Zn could be firmly established and for the first time the 2+ --> 0(1)+ transition in 80Zn was observed at 1492(1) keV. B(E2,2(1)+ --> 0(1)+) values were extracted for (74,76,78,80)Zn and compared to large scale shell model calculations. With only two protons outside the Z=28 proton core, 80Zn is the lightest N=50 isotone for which spectroscopic information has been obtained to date. Two sets of advanced shell model calculations reproduce the observed B(E2) systematics. The results for N=50 isotones indicate a good N=50 shell closure and a strong Z=28 proton core polarization. The new results serve as benchmarks to establish theoretical models, predicting the nuclear properties of the doubly magic nucleus 78Ni.

Human T cell lymphotropic virus: necessity for and feasibility of a vaccine

Human T cell lymphotropic virus types I and II (HTLV-I/II) are endemic in certain areas of the world. They cause two life-threatening diseases, adult T cell leukaemia/lymphoma and tropical spastic paraparesis. A vaccine is needed because in developing countries there are no other feasible preventive interventions against these diseases and in Western countries intravenous drug users at high risk for HTLV-I and HTLV-II infections and the health workers in contact with such populations must be protected. We have developed a rat model in which we observed variations of susceptibility to viral infection between inbred strains, the most susceptible being the Fischer F344, and the possibility of viral latency in the nervous system. We have prepared a recombinant adenovirus vector that expresses the HTLV-I envelope glycoprotein env in HeLa cells. A target human population in French Guyana, in which the prevalence rate reaches 5.6% in one ethnic group (Bonis), has been identified for possible intervention.

Epidemiological, social, diagnostic and economic evaluation of population screening for genital chlamydial infection

OBJECTIVES

To investigate epidemiological, social, diagnostic and economic aspects of chlamydia screening in non-genitourinary medicine settings.

METHODS

Linked studies around a cross-sectional population-based survey of adult men and women invited to collect urine and (for women) vulvovaginal swab specimens at home and mail these to a laboratory for testing for Chlamydia trachomatis. Specimens were used in laboratory evaluations of an amplified enzyme immunoassay (PCE EIA) and two nucleic acid amplification tests [Cobas polymerase chain reaction (PCR), Becton Dickinson strand displacement amplification (SDA)]. Chlamydia-positive cases and two negative controls completed a risk factor questionnaire. Chlamydia-positive cases were invited into a randomised controlled trial of partner notification strategies. Samples of individuals testing negative completed psychological questionnaires before and after screening. In-depth interviews were conducted at all stages of screening. Chlamydia transmission and cost-effectiveness of screening were investigated in a transmission dynamic model.

SETTING AND PARTICIPANTS

General population in the Bristol and Birmingham areas of England. In total, 19,773 women and men aged 16-39 years were randomly selected from 27 general practice lists.

RESULTS

Screening invitations reached 73% (14,382/19,773). Uptake (4731 participants), weighted for sampling, was 39.5% (95% CI 37.7, 40.8%) in women and 29.5% (95% CI 28.0, 31.0%) in men aged 16-39 years. Chlamydia prevalence (219 positive results) in 16-24 year olds was 6.2% (95% CI 4.9, 7.8%) in women and 5.3% (95% CI 4.4, 6.3%) in men. The case-control study did not identify any additional factors that would help target screening. Screening did not adversely affect anxiety, depression or self-esteem. Participants welcomed the convenience and privacy of home-sampling. The relative sensitivity of PCR on male urine specimens was 100% (95% CI 89.1, 100%). The combined relative sensitivities of PCR and SDA using female urine and vulvovaginal swabs were 91.8% (86.1, 95.7, 134/146) and 97.3% (93.1, 99.2%, 142/146). A total of 140 people (74% of eligible) participated in the randomised trial. Compared with referral to a genitourinary medicine clinic, partner notification by practice nurses resulted in 12.4% (95% CI -3.7, 28.6%) more patients with at least one partner treated and 22.0% (95% CI 6.1, 37.8%) more patients with all partners treated. The health service and patients costs (2005 prices) of home-based postal chlamydia screening were 21.47 pounds (95% CI 19.91 pounds, 25.99) per screening invitation and 28.56 pounds (95% CI 22.10 pounds, 30.43) per accepted offer. Preliminary modelling found an incremental cost-effectiveness ratio (2003 prices) comparing screening men and women annually to no screening in the base case of 27,000 pounds/major outcome averted at 8 years. If estimated screening uptake and pelvic inflammatory disease incidence were increased, the cost-effectiveness ratio fell to 3700 pounds/major outcome averted.

CONCLUSIONS

Proactive screening for chlamydia in women and men using home-collected specimens was feasible and acceptable. Chlamydia prevalence rates in men and women in the general population are similar. Nucleic acid amplification tests can be used on first-catch urine specimens and vulvovaginal swabs. The administrative costs of proactive screening were similar to those for opportunistic screening. Using empirical estimates of screening uptake and incidence of complications, screening was not cost-effective.

Analysis of water compartment in dengue patients

This paper describes the water compartments in healthy subjects and dengue patients on the day of defervescence of fever using bioelectrical impedance analysis. A total of 223 healthy subjects (65 males and 158 females) and 210 dengue patients (119 males and 91 females) in Hospital Universiti Kebangsaan Malaysia (HUKM), were studied. The ages for healthy subjects vary between 14 and 60 years old with mean age of 26.05 years while the ages for the dengue patients vary between 12 and 83 years old with mean age of 30.14 years. The parameters of water compartments investigated were total body water (TBW), extracellular water (ECW) and intracellular water (ICW). There were significant difference between healthy subjects and dengue patients for both male (p<0.05) and female (p<0.001) beginning on fever day 0 till fever day 4. The mean TBW and ECW values of dengue patients obtained were found to be higher than the normal healthy subjects while the mean ICW was lower. The mean TBW and ICW for male were higher than female while the mean ECW for male was lower than female for healthy subjects and dengue patients.

Development of tilt table with visual feedback function for hemiplegia patients

Due to damaged vertebrae nerves, serious disease and aging, patients who have to lie down for long period of time need to exercise to maintain up-right standing position and recover their muscle power of paralytic leg. This study describes the development of an intelligent tilt table which can provide a patient with visual feedback of exercise to increase the effect of rehabilitation. This could be possible by measuring and displaying the knee bent angle and pressure for each foot during exercise in real time. It is expected that patient's exercising effect can increase by self-monitoring these two values during exercise.

Incidence of severe reproductive tract complications associated with diagnosed genital chlamydial infection: the Uppsala Women's Cohort Study

OBJECTIVE

To estimate the cumulative incidence of severe complications associated with genital chlamydia infection in the general female population.

METHODS

The Uppsala Women's Cohort Study was a retrospective population based cohort study in Sweden, linking laboratory, hospital, and population registers. We estimated the cumulative incidence of hospital diagnosed pelvic inflammatory disease, ectopic pregnancy, and infertility, and used multivariable regression models to estimate hazard ratios according to screening status.

RESULTS

We analysed complete data from 43 715 women in Uppsala aged 15-24 years between January 1985 and December 1989. Follow up until the end of 1999 included 709 000 woman years and 3025 events. The cumulative incidence of pelvic inflammatory disease by age 35 years was 3.9% (95% CI 3.7% to 4.0%) overall: 5.6% (4.7% to 6.7%) in women who ever tested positive for chlamydia, 4.0% (3.7% to 4.4%) in those with negative tests, and 2.9% (2.7% to 3.2%) in those who were never screened. The corresponding figures were: for ectopic pregnancy, 2.3% (2.2% to 2.5%) overall, 2.7% (2.1% to 3.5%), 2.0% (1.8% to 2.3%), and 1.9% (1.7% to 2.1%); and for infertility, 4.1% (3.9% to 4.3%) overall, 6.7% (5.7% to 7.9%), 4.7% (4.4% to 5.1%), and 3.1% (2.8% to 3.3%). Low educational attainment was strongly associated with the development of all outcomes.

CONCLUSIONS

The incidence of severe chlamydia associated complications estimated from ours, and other population based studies, was lower than expected. Studies that incorporate data about pelvic inflammatory disease diagnosed in primary care and behavioural risk factors would further improve our understanding of the natural history of chlamydia. Our results provide reassurance for patients, but mean that the benefits of chlamydia screening programmes might have been overestimated.

Reduction of the spin-orbit splittings at the n = 28 shell closure

The N = 28 shell closure has been investigated via the 46Ar(d,p)47Ar transfer reaction in inverse kinematics. Energies and spectroscopic factors of the neutron p(3/2), p(1/2), and f(5/2) states in 47Ar were determined and compared to those of the 49Ca isotone. We deduced a reduction of the N = 28 gap by 330(90) keV and spin-orbit weakenings of approximately 10(2) and 45(10)% for the f and p states, respectively. Such large variations for the f and p spin-orbit splittings could be accounted for by the proton-neutron tensor force and by the density dependence of the spin-orbit interaction, respectively. This contrasts with the picture of the spin-orbit interaction as a surface term only.

Evidence of a marked 25-hydroxyvitamin D deficiency in patients with congenital ichthyosis

BACKGROUND

Vitamin D is essential for bone mineralization, and its deficiency may be the cause of skeletal fractures and osteomalacia. Geographical or ethnic factors may modulate the cutaneous synthesis of vitamin D. We hypothesized that major changes in keratinization may similarly alter the cutaneous synthesis of vitamin D.

OBJECTIVES

To explore calciotrophic hormones, parameters of bone remodelling and bone mineral density (BMD) in nine patients with non-bullous congenital ichthyosis.

PATIENTS AND METHODS

Six patients were European, three were North African. Four had received acitretin over a long period of time. A complete biological investigation, including serum and urinary calcium and phosphorus, calciotrophic hormones [intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25-(OH)D) and 1,25-dihydroxyvitamin D (1,25-(OH)2D)], bone formation and resorption markers, was performed on all patients during the winter season and repeated among four patients after summer. BMD was measured in all patients.

RESULTS

All patients had a marked 25-(OH)D deficiency, clearly below the deficiency threshold of 25 nmol/L. Patients from North Africa had a greater deficiency than European patients, perhaps because of the difference in skin pigmentation. iPTH remained normal in European patients but was elevated among the North Africans. After sun exposure, an improvement in vitamin status was visible in only one patient. Bone formation and resorption markers remained normal. Femoral neck osteodensitometry indicated values near the osteopaenic threshold in two young North African females. No deleterious effect of retinoids on vitamin D metabolism was observed.

CONCLUSION

Patients, and in particular pigmented patients, with congenital ichthyosis present a severe deficiency in vitamin D. Care provided to protect the skeletal future of these patients involves measuring BMD and prescribing supplementation.

Enhanced core polarization in (70)Ni and (74)Zn

The reduced transition probabilities B(E2;0(+) --> 2(+)(1)) of the neutron-rich (74)Zn and (70)Ni nuclei have been measured by Coulomb excitation in a (208)Pb target at intermediate energy. These nuclei have been produced at Grand Accélérateur National d'Ions Lourds via interactions of a 60A MeV (76)Ge beam with a Be target. The B(E2) value for (70)Ni(42) is unexpectedly large, which indicates that neutrons added above N=40 strongly polarize the Z=28 proton core. In the Zn isotopic chain, the steep rise of B(E2) values beyond N=40 continues up to (74)Zn(44). The enhanced proton core polarization in (70)Ni is attributed to the monopole interaction between the neutron in the g(9/2) and protons in the f(7/2) and f(5/2) spin-orbit partner orbitals. This interaction could result in a weakening of magicity in (78)Ni(50).

A very high incidence of low 25 hydroxy-vitamin D serum concentration in a French population of patients with primary hyperparathyroidism

Since the demonstration that vitamin D status might influence the clinical and biological expression of primary hyperparathyroidism (PHPT), a serum 25-hydroxy vitamin D (25-OHD) concentration of 50 nmol/l has been considered by an expert panel as the minimum level to be maintained in asymptomatic PHPT patients. Two yr after this recommendation, we aimed to evaluate the frequency of serum 25-OHD concentrations below this threshold in PHPT patients. In the present study, serum 25-OHD, second- and third-generation PTH, calcium, phosphate, magnesium, albumin and creatinine were measured in 72 out 145 consecutive PHPT patients operated on in our Endocrine Surgery Department, in whom blood samples were available before as well as two days after surgical intervention. Before surgery, the frequency of serum 25-OHD levels <50 nmol/l ranged from 91.5 to 100% whatever the classification used to identify patients: whole group, symptomatic vs asymptomatic, patients with calcium levels >3 vs <3 mmol/l. 25-OHD concentrations correlated negatively with the weight of adenoma, PTH levels, and total calcium concentrations measured before surgery. Pre-operative PTH levels, whatever the assay used, and total calcium concentrations were positively and significantly correlated. Two days post-surgery, 13 patients were moderately hypocalcemic. Neither pre-surgery 25-OHD nor PTH, calcium or phosphorus level or adenoma weight were predictive of post-operative hypocalcemia. The dramatic frequency of low 25-OHD concentrations in our PHPT patients demonstrates that the above-mentioned recommendation is far from being applied in France despite evidence of worsening expression of PHPT with decreasing 25-OHD serum levels.

Hyperglycaemia acutely decreases circulating dehydroepiandrosterone levels in healthy men

OBJECTIVE

This study was conducted in order to evaluate the effect of glucose-insulin homeostasis on adrenal steroids and was designed to separate the effects of hyperglycaemia from those of insulin.

DESIGN

Eight healthy men aged 22.6 +/- 3.4 (SD) underwent an 80 mU/m2/min hyperinsulinaemic euglycaemic 100-min clamp, a 200-min graded glucose infusion at 2-16 mg/kg/min and a measurement of fat mass.

MEASUREMENTS

Circulating glucose, insulin and adrenal steroid levels including dehydroepiandrosterone (DHEA) were determined before and during both infusion tests. Steroid variations in relation to insulinaemia and glycaemia were analysed using univariate, multivariate tests and nonlinear mixed models.

RESULTS

Hyperinsulinaemia induced no significant modification of adrenal steroid levels. By contrast, hyperglycaemia decreased all adrenal steroids except DHEA-sulphate by 47-66%. The drop occurred early, averaging 51% for 17OH pregnenolone and 57% for DHEA at the 80th minute of glucose infusion, whereas blood glucose was 7.1 +/- 1.2 mmol/1. This effect was independent of insulinaemia, fat mass and waist circumference. Thus, we estimated models that could best predict steroid variations according to blood glucose. At thresholds defining impaired fasting glycaemia and diabetes, the estimated decrease in DHEA was 40% and 45%, respectively, culminating at 60% at 9.3 mmol/1 glycaemia, with no detectable further decrease.

CONCLUSIONS

Our data suggest that hyperglycaemia dramatically decreases adrenal androgen levels in men, possibly by acting at early steps of synthesis, independently of insulinaemia and fat mass.

Modeling of hemoglobin in dengue fever and dengue hemorrhagic fever using bioelectrical impedance

This paper describes a model for predicting hemoglobin (Hb) by using bioelectrical impedance analysis (BIA) in dengue patients in the Hospital Universiti Kebangsaan Malaysia (HUKM). Bioelectrical impedance measurements were conducted on 83 (47 males and 36 females) serologically confirmed dengue fever (DF) and dengue hemorrhagic fever (DHF) patients during their hospitalization. The predictive equation for Hb was derived using multivariate analysis. We investigated all the parameters in BIA, patients' symptom and demographic data. In this developed model, four predictors (reactance (XC), sex, weight and vomiting) were found to be the best predictive factors for modeling Hb in dengue patients. However, the model can only explain approximately 42% of the variation in Hb status, thus single frequency bio-impedance stand-alone technique is insufficient to monitor Hb for the DF and DHF patients. Further investigation using multi-frequency BIA is recommended in modeling Hb to achieve the most parsimonious model.

Polarographic determination of ciclopirox olamine in pure substance and in different pharmaceutical preparations

Two simple and sensitive methods are described for the determination of ciclopirox olamine in its pure form and different dosage forms. The proposed method depends upon the polarographic activity of ciclopirox olamine at the dropping mercury electrode (DME) in Britton Robinson buffer, whereby, well-defined cathodic waves were produced over the pH range 7-9. The polarographic wave was characterized as being irreversible diffusion-controlled with limited adsorption properties. The current-concentration relationship was found to be rectilinear over the range 8-32 and 2-12 microg ml(-1) using direct current (dct) and differential pulse polarographic (DPP) modes respectively, with minimum detectability of 0.53 microg ml(-1) (2.65 x 10(-6) M) and 0.1 microg ml(-1) (5 x 10(-7) M) using the dct and DPP modes, respectively. The average percent recovery was favorably compared to spectrophotometric method. The proposed method was further applied to dosage forms including ciclopirox lotion and cream. The average percentage recoveries for lotion were 100.34+/-0.84 and 99.96+/-1.06 using dct and DPP modes, respectively, and for cream were 100.53+/-0.59 and 100.02+/-0.89 using dct and DPP modes, respectively.

Anodic polarographic determination of ciclopirox olamine in pure and certain pharmaceutical preparations

The anodic polarographic behavior of ciclopirox have been studied in Britton Robinson buffer (BRb) over the pH range 6-11. In BRb of pH 7 a well defined anodic wave was produced with diffusion current constant (Id) of 4.86+/-0.048 (n=6) using DC(t) mode. Adopting both of direct current (DC(t)) and differential pulse polarographic (DPP) modes, the current-concentration relationship was found to be rectilinear over the range 4 to 24 and 2 to 12 microg ml(-1) respectively, with minimum detectability (S/N=2) of 0.2 microg ml(-1) (1 x 10(-6) M) using the DPP mode. The average percent recovery was favourably compared to a reference method, with a satisfactory standard deviation, the proposed method was further applied to the determination of ciclopirox olamine in certain pharmaceutical preparations including lotion and cream. The average percentage recoveries for lotion were 100.06+/-0.94 and 100.06+/-1.08 using DC(t) and DPP modes respectively, and for cream were 100.17+/-0.64 and 100.34+/-1.28 using DC(t) and DPP modes, respectively. A pathway for the electrode reaction was postulated.

Voltammetric determination of nitrosocimetidine in simulated gastric juice

OBJECTIVE

To develop a voltammetric method for the determination of nitrosocimetidine in simulated gastric juice (SGJ).

METHOD

Measurement of the polarographic wave of the nitroso derivative at the dropping mercury electrode in 0.1 m HCl.

RESULTS

A well-defined diffusion-controlled cathodic wave was obtained at -0.34 V vs. Ag/AgCl electrode. The current-concentration relationship was found to be rectilinear over the range 10-80 microg/mL and 2-50 microg/mL with percentage recovery of 101.24 +/- 0.79 and 100.79 +/- 0.56 for the direct current (DCt) and differential pulse polarography (DPP) modes, respectively, with a minimum detectability (S/N=2) of 0.16 microg/ml (5.6 x 10-7 m) using DPP mode.

CONCLUSION

The proposed method was successfully applied to study the nitrosation of cimetidine in SGJ.

LC of pharmaceutically important halogenated 8-hydroxyquinolines after precolumn derivatization with Pd (II)

An accurate, sensitive, and selective reversed phase high performance liquid chromatographic (HPLC) method was developed for the analysis of two halogenated 8-hydroxyquinoline derivatives; clioquinol (CQN) and iodoquinol (IQN). The proposed method depends on the complexation ability of the studied compounds with Pd(II) ions. Reversed phase chromatography was conducted using a 300 x 3.9 mm i.d. stainless steel column packed with 10 microm Bondclone phenyl at ambient temperature. A solution containing 0.005% w/v of Pd(II)-chloride in a mixture of acetonitrile-methanol-water (3:3:4 v/v/v) of pH 3.7 as a mobile phase pumped at a flow rate of 0.75 ml min(-1). UV-detection was performed at 282 and 285 nm for CQN and IQN, respectively. The method showed excellent linearity in the range 0.05-1.8 and 0.1-3.0 microg ml(-1) with limit of detection (S/N=2) 4.8 ng ml(-1) (1.57 x 10(-8) M) and 6.4 ng ml(-1) (1.61 x 10(-8) M) for CQN and IQN, respectively. The suggested method was successfully applied for the analysis of the studied drugs in bulk with average% recoveries of 99.68+/-0.44 for CQN and 99.65+/-0.53 for IQN. The proposed method was successfully applied for the analysis of the studied drugs in single or combined dosage forms with average% recoveries of 99.41+/-0.51-100.02+/-0.63. The proposed method could be used successfully for the determination of the studied compounds in the presence of their degradation product as they could be eluted with different retention times. The presence of metronidazole (MNZ) or tolnaftate (TFT) with the studied drugs does not affect their accurate determination. The results obtained were favorably compared with those obtained by the reference method. The results were satisfactorily, accurate, and precise.

LC determination of dinitrosopiperazine in simulated gastric juice

A simple and specific reversed phase HPLC method for the determination of dinitrosopiperazine in simulated gastric juice using UV detection was reported. The chromatographic resolution of the analyte and the internal standard isosorbide dinitrate was performed without extraction from the gastric juice on a reversed phase ODS column. Isocratic elution was carried out with methanol-0.02 M sodium dihydrogen phosphate (60:40 v/v, pH 3.0) at a flow rate of 1.0 ml min(-1) with UV detection at 238 nm. The calibration graph was linear over the concentration range 0.072-2.88 microg ml(-1) of dinitrosopiperazine with minimum detectability (S/N=2) of 0.01 microg ml(-1) (8 x 10(-8) M). Inter-day and intra-day precisions calculated as % RSD were in the range 0.32-0.38% and 0.19-0.25% respectively. Inter-day and intra-day accuracies calculated as % error were in the range 0.18-0.21 and 0.08-0.11% respectively. The proposed method was successfully applied to the study of the possible in-vivo production of DNPZ under the standard nitrosation conditions recommended by WHO.

Voltammetric determination of praziquantel in tablets and biological fluids

A simple method is described for the determination of praziquantel (CAS 55268-74-1) in its pure form, tablet formulations and biological fluids. The proposed method depends upon the polarographic activity of praziquantel at the dropping mercury electrode (DME) in Britton Robinson buffers, whereby a well-defined catholic wave is produced over the pH range 7-12. The wave was characterized as being irreversible diffusion-controlled with limited adsorption properties. The diffusion current constant (Id) was 0.56 +/- 0.004 (n = 11). The current-concentration relationship was found to be rectilinear over the range 8-48, 3.2-38.4 and 0.48-20 micrograms.ml-1 using direct current (DCt), differential pulse polarographic (DPP) and alternating current (ACt) odes, respectively, with minimum detection limit (S/N = 2) of 0.32 microgram.ml-1 (1.02 x 10(-6) mol/l and 0.02 microgram.ml-1 (6.4 x 10(-8) mol/l) for DPP and ACt modes respectively. The average percent recovery was favourably compared to a reference method with a satisfactory standard deviation. The proposed method was applied to spiked human urine and plasma. The percentage recoveries were 99.33 +/- 0.79 and 98.23 +/- 0.53, respectively.

Derivative spectrophotometric analysis of 4-quinolone antibacterials in formulations and spiked biological fluids by their Cu(II) complexes

A derivative UV-spectrophotometric analytical procedure was developed for determination of three 4-quinolone antibacterials: norfloxacin (NFX), ciprofloxacin (CFX), and sparfloxacin (SFX). The method depends on the complexation of Cu(II) with the studied compounds in aqueous medium. A third order, measurement was applied for their quantification. A linear correlation was established between the amplitude of the peak and concentration for all the studied drugs in the range of 15-80, 35-120, and 200-700 ng/mL, with minimum detectability (S/N = 2) of 1.0, 1.3, and 5.1 ng/mL for NFX, CFX, and SFX, respectively. The method was successfully applied for accurate, sensitive, and selective determination of the studied drugs in bulk and tablets formulation with average percentage recoveries of 99.22 +/- 0.55 to 100.33 +/- 1.60. The results obtained were favorably compared with those of the reference method. The method was also used to determine sparfloxacin in spiked human plasma and urine. The results obtained were satisfactory, accurate, and precise.

Voltammetric analysis of certain 4-quinolones in pharmaceuticals and biological fluids

The voltammetric behaviour of Enrofloxacin (I), Sparfloxacin (II) and Fleroxacin (III) was studied using direct current (DCt), differential pulse (DPP) and alternating current (ACt). All the drugs manifest cathodic waves in Britton Robinson buffer over the pH range of 4.0-11.98. The waves were characterized as being irreversible, diffusion-controlled with limited adsorption properties. The diffusion current concentration relationships were found to be rectilinear over the ranges 4 x 10(-5) x 10(-4) M, 1 x 10(-5)-2 x 10(-4) M, 1 x 10(-5)-4 x 10(-4) M using DCt mode for I, II and III, respectively and 1 x 10(-6)-4 x 10(-5) M, 1 x 10(-6)-1 x 10(-4) M, and 2 x 10(-6)-8 x 10(-5) M, using DPP mode for I, II and III respectively, with minimum detectability (S/N = 3) of 1 x 10(-7) M for I, II and 2 x 10(-7) M for III. The proposed method was successfully applied to the determination of the studied compounds either per se or in formulations and biological fluids. The results obtained were concordant to those given using reference methods.

Voltammetric determination of N,N'-dinitrosopiperazine in simulated gastric juice

A voltammetric method has been developed for the determination of N,N'-dinitrosopiperazine (DNPZ) in simulated gastric juice. The method is based on measuring the differential pulse polarographic peak produced in pH 3 Britton Robinson buffer. A well defined, diffusion-controlled cathodic wave was obtained at -0.77 V versus Ag/AgCl over the range 0.4-24 microg/ml with minimum detectability (S/N = 2) of 0.072 microg/ml (5 x 10(-7) M). The proposed method was successfully applied to study the possible in vivo production of the nitroso-derivatives of piperazine under the standard nitrosation reaction conditions recommended by WHO. The method has some distinct advantages over the reported GC methods.

A simple kinetic spectrophotometric method for the determination of oxamniquine in formulations and spiked biological fluids

A simple and sensitive kinetic method for the determination of oxamniquine in pharmaceutical preparations and biological fluids was developed. The procedure is based upon a kinetic investigation of the oxidation reaction of the drug with alkaline potassium permanganate at room temperature for a fixed time of 20 min. The absorbance of the colored manganate ions was measured at 610 nm. Alternatively, the decrease in the absorbance of potassium permanganate after addition of the drug was measured at 525 nm. The absorbance concentration plots in both procedures were rectilinear over the range 0.5-4 microg ml(-1). The concentration of oxamniquine is calculated using the corresponding calibration equation for the fixed-time method. The determination of oxamniquine by fixed-concentration and rate-constant methods was feasible with the calibration equations obtained but the fixed time method had been found to be more applicable. Both procedures were applied to the determination of oxamniquine in formulations. The results obtained were in good agreement with those obtained using the official method. The fixed time method of 20 min was further applied to spiked human urine and plasma, the recoveries (%) were 100.94 +/- 0.57 and 98.07 +/- 0.88 for urine and plasma, respectively, at 610 nm, and 97.51 +/- 1.27 and 95.69 +/- 1.23 for urine and plasma, respectively, at 525 nm.

A Simple Kinetic Spectrophotometric Method For The Determination of Certain 4-Quinolones in Drug Formulations

An accurate simple and selective kinetic procedure for the determination of certain 4-quinolones namely, norfloxacin (I), ofloxacin (II), enrofloxacin (III), fleroxacin (IV), ciprofloxacin (V) and pefloxacin (VI) is described. The procedure is based on reacting the studied compounds in acidic media (0.1 M HCL) with 3-methyl-2-benzothiazolinone hydrazone hydrochloride (MBTH) in presence of cerium (IV) ammonium sulphate as an oxidant at room temperature for a fixed time of 20 min. for (I), (III), 12 min for (II) and 30 min for IV , V and VI, then the absorbance of the reaction product is measured at 630 nm. The concentration of the studied compounds is computed using the corresponding calibration curve equation for the fixed-time method. The absorbance-concentrations plot is rectilinear over the range 20-100 ug.ml-1 for (I), 2 - 20 ug.ml-1 for (II), 10 - 74 ug.ml-1 for (III), 10 - 60 ug.ml-1 for IV, 10 - 50 ug.ml-1 for IV and 8 - 40 ug.ml-1 for VI. The determination of the studied compounds by the fixed-concentration and rate constant methods is feasible with the calibration equation obtained, but the fixed-time method proved to be more applicable. The procedure was applied successfully to commercial tablets and ampoules and the results obtained were compared statistically with the reference methods.

Spectrofluorimetric analysis of certain 4-quinolone in pharmaceuticals and biological fluids

A highly sensitive spectrofluorimetric procedure is developed for the analysis of certain 4-quinolone antibiotics: sparfloxacin (I), oxolonic acid (II), flumequine (III) and enrofloxacin (IV) in their pharmaceutical dosage forms or in biological fluids. This procedure is based upon the intrinsic fluorescence in acetonitrile for sparfloxacin or upon the highly enhanced fluorescence obtained by the interaction of the drugs with AlCl3. The optimum pH for the maximum fluorescence intensity is 8-8.5 for I, 5-6 for II, III and pH 3.5 for IV. The different experimental parameters that affect the fluorescence intensity were carefully studied and incorporated into the procedure.

Percutaneous drainage of tuberculous iliopsoas abscesses under image guidance

Most intra-abdominal and other types of fluid collections are now successfully drained percutaneously under image guidance. The utility of percutaneous drainage of tuberculous abscesses, especially those associated with osseous changes, is, however, less well established. Six patients with tuberculous iliopsoas abscesses were successfully managed by percutaneous drainage combined with antituberculous therapy. The abscesses were bilateral in one patient and unilateral in the other five. Drainage was by needle aspiration under ultrasound (US) guidance in one patient, and by catheter under CT guidance in the other patients. Three patients had associated osseous changes. There were no procedural complications. Tuberculous iliopsoas abscess can be successfully treated by percutaneous drainage and appropriate antituberculous therapy.

Fluorimetric determination of oxamniquine in biological fluids

A highly sensitive and specific fluorimetric method was developed for the determination of oxamniquine in biological fluids (urine and plasma). The proposed method is based on the reduction of oxamniquine using zinc/calcium chloride to obtain its nitroso derivative. The latter is then allowed to react with 2-cyanoacetamide to get a highly fluorescent product. The different experimental parameters affecting the intensity of the fluorescence were carefully studied and incorporated into the procedure. Under the described conditions, the method is applicable over the concentration range of 0.08-0.88 microgram/ml with a minimum detectability (S/N = 2) of 8 ng/ml. The percentage recoveries from spiked urine and plasma were 99.75 +/- 1.58 and 97.46 +/- 0.44%, respectively.

Interleukin-1-beta, tumor necrosis factor-alpha, insulin secretion and oral glucose tolerance in non-diabetic siblings of children with IDDM

Recent reports suggest that the pancreas participates in tumor necrosis factor alpha (TNF-A) production during stress, and that the islets are predominantly responsible for such synthesis. In vitro TNF-A and interleukin 1-beta (IL-1-beta) inhibit insulin release from islet beta-cells. We measured the circulating levels of IL-1-beta, TNF-A and islet cell antibody (ICA) in 30 children with IDDM (10 of them at their first presentation), 30 of their non-diabetic siblings, and 30 normal age-matched children. In the non-diabetic children we investigated the early phase of insulin release after intravenous bolus of glucose and evaluated tolerance to oral glucose (OGTT). IL-1-beta and TNF-A concentrations were significantly higher in IDDM-siblings (31.8 +/- 7.7 pg/ml and 650 +/- 155 pg/ml respectively) versus normal children (21.2 +/- 6.4 pg/ml and 383 +/- 122 pg/ml respectively). IL-1-beta and TNF-A concentrations did not differ significantly between the diabetic children and healthy age-matched controls. ICA were detected in 60% of the recently diagnosed diabetic children vs. 30% of those with longer duration of diabetes (3.1 +/- 1.2 years). Despite the significantly high prevalence of ICA in the recently diagnosed children with IDDM, their IL-1-beta and TNF-A concentrations were lower than those for the normal children. In experimental animals these cytokines can induce round cell infiltration (insulinitis) and inhibit insulin secretion by beta-cell. The presence of significantly higher concentrations of these cytokines in IDDM siblings, with high prevalence of ICA (16%), was associated with normal oral glucose tolerance and normal peak insulin response (60 +/- 10.4 mlU/ml) after i.v. glucose bolus compared to normal children (52.3 +/- 9.5 mlU/ml). However, after 2 years of follow up, one of them developed IDDM and another developed IGT but none of the normal controls developed abnormal glucose tolerance. It appears that the process of autoimmune aggression against beta-cells, and its effect on insulin release and glucose homeostasis, is a slow and chronic process. However, the production of these cytokines and consequently the degree of beta-cell destruction, in a genetically susceptible subject, might be enhanced by several factors including viral infections. In summary, IL-1-beta and TNF-A levels can be used as indicators of continuing autoimmune aggression against beta-cells before the development of extensive beta-cell destruction.

Role of the genetic background of rats in infection by HTLV-I and HTLV-II and in the development of associated diseases

Three aspects of the rat model of HTLV-I/II infection were investigated. (i) The efficacy of HTLV-I-transformed rat cell lines in infecting different strains of rats: WKY and Lewis HTLV-I-transformed cell lines were injected into adult WKY, Lewis and Brown Norway rats, representing syngeneic and allogeneic combinations. The HTLV-I provirus was not detected in peripheral-blood mononuclear cells (PBMC) from these rats 18 weeks after inoculation, showing that HTLV-I-transformed rat cells are not suitable for virus challenge in vaccination experiments. Rats inoculated with Lewis HTLV-I-transformed cells produced an antibody response to HTLV-I, which was higher in allogeneic (WKY and Brown Norway) than in syngeneic rats. (ii) The susceptibility of rats to HTLV-II infection: After human HTLV-II-producing cells (MO) were injected into adult WKY rats, the HTLV-II provirus was detected in PBMC 12 weeks later. Sequencing of a portion of this provirus confirmed its identity with the HTLV-II from MO cells. (iii) The role of MHC haplotype in susceptibility to neurological disease in rats inoculated as newborns with HTLV-I: The hypothesis that the RT-Ik haplotype confers susceptibility was tested by inoculating newborn OKA (RT-Ik), WKY (RT-Il), Lewis (RT-Il) and Fischer 344 (RT-I lvl) rats with human HTLV-I-producing cells (MT-2). Eighteen months later, only the WKY rats showed histological abnormality of the spinal cord, without clinical paralysis. Fischer 344 rats developed cutaneous tumors and OKA rats mammary tumors. The HTLV-I provirus was not detected in these tumors.

Molecular epidemiology of 58 new African human T-cell leukemia virus type 1 (HTLV-1) strains: identification of a new and distinct HTLV-1 molecular subtype in Central Africa and in Pygmies

To gain new insights on the origin, evolution, and modes of dissemination of human T-cell leukemia virus type I (HTLV-1), we performed a molecular analysis of 58 new African HTLV-1 strains (18 from West Africa, 36 from Central Africa, and 4 from South Africa) originating from 13 countries. Of particular interest were eight strains from Pygmies of remote areas of Cameroon and the Central African Republic (CAR), considered to be the oldest inhabitants of these regions. Eight long-term activated T-cell lines producing HTLV-1 gag and env antigens were established from peripheral blood mononuclear cell cultures of HTLV-1 seropositive individuals, including three from Pygmies. A fragment of the env gene encompassing most of the gp21 transmembrane region was sequenced for the 58 new strains, while the complete long terminal repeat (LTR) region was sequenced for 9 strains, including 4 from Pygmies. Comparative sequence analyses and phylogenetic studies performed on both the env and LTR regions by the neighbor-joining and DNA parsimony methods demonstrated that all 22 strains from West and South Africa belong to the widespread cosmopolitan subtype (also called HTLV-1 subtype A). Within or alongside the previously described Zairian cluster (HTLV-1 subtype B), we discovered a number of new HTLV-1 variants forming different subgroups corresponding mainly to the geographical origins of the infected persons, Cameroon, Gabon, and Zaire. Six of the eight Pygmy strains clustered together within this Central African subtype, suggesting a common origin. Furthermore, three new strains (two originating from Pygmies from Cameroon and the CAR, respectively, and one from a Gabonese individual) were particularly divergent and formed a distinct new phylogenetic cluster, characterized by specific mutations and occupying in most analyses a unique phylogenetic position between the large Central African genotype (HTLV-1 subtype B) and the Melanesian subtype (HTLV-1 subtype C). We have tentatively named this new HTLV-1 genotype HTLV-1 subtype D. While the HTLV-1 subtype D strains were not closely related to any known African strain of simian T-cell leukemia virus type 1 (STLV-1), other Pygmy strains and some of the new Cameroonian and Gabonese HTLV-1 strains were very similar (>98% nucleotide identity) to chimpanzee STLV-1 strains, reinforcing the hypothesis of interspecies transmission between humans and monkeys in Central Africa.

Interleukin-1-beta, tumour necrosis factor-alpha, islet-cell antibody, and insulin secretion in children with thalassemia major on long-term blood transfusion

In vitro, cytokines like interleukin-1-beta (IL-1-B) and tumour necrosis factor-alpha (TNF-A) inhibit insulin release and can destroy islet B-cells. We measured blood levels of IL-1-B, TNF-A, and islet cell antibody (ICA) in 20 children with IDDM, 20 of their non-diabetic siblings, 20 children with thalassemia major on long-term hypertransfusion therapy and iron chelation, and 10 normal age-matched children. In the non-diabetic and thalassemic children we investigated the early phase of insulin release after i.v. glucose (0.5 g/kg, 30 per cent solution) and evaluated tolerance to oral glucose (1.75 g/ kg). Circulating IL-1-B and TNF-A concentrations were significantly higher in IDDM-siblings (33.7 +/- 12.7 pg/ml and 655 +/- 165 pg/ml, respectively) v. normal children (21.1 +/- 6.4 pg/ml and 383 +/- 122 pg/ml, respectively). Thalassemic children had no detectable circulating ICA. The prevalence of ICA was 30 per cent in children with IDDM and 60 per cent of their siblings. Impaired oral glucose tolerance was detected in five children with thalassemia (25 per cent), but in none of the IDDM-siblings. The early phase of insulin release was significantly depressed in thalassemic children (peak insulin = 29.2 +/- 5.1 mIU/ml) v. normal children (52.3 +/- 9.5 mIU/ml) and IDDM-siblings (45.3 +/- 12.4 mIU/ml). It appears that thalassemic children had significantly decreased insulin secretion and impaired glucose tolerance, however, the mechanism of B-cell dysfunction is not mediated by ICA nor by cytokines.

Isolation and characterization of a new simian T-cell leukemia virus type 1 from naturally infected celebes macaques (Macaca tonkeana): complete nucleotide sequence and phylogenetic relationship with the Australo-Melanesian human T-cell leukemia virus type 1

A study of simian T-cell leukemia virus type 1 (STLV-1) infection in a captive colony of 23 Macaca tonkeana macaques indicated that 17 animals had high human T-cell leukemia virus type 1 (HTLV-1) antibody titers. Genealogical analysis suggested mainly a mother-to-offspring transmission of this STLV-1. Three long-term T-cell lines, established from peripheral blood mononuclear cell cultures from three STLV-1-seropositive monkeys, produced HTLV-1 Gag and Env antigens and retroviral particles. The first complete nucleotide sequence of an STLV-1 (9,025 bp), obtained for one of these isolates, indicated an overall genetic organization similar to that of HTLV-1 but with a nucleotide variability for the structural genes ranging from 7.8 to 13.1% compared with the HTLV-1 ATK and STLV-1 PTM3 Asian prototypes. The Tax and Rex regulatory proteins were well conserved, while the pX region, known to encode new proteins in HTLV-1 (open reading frames I and II), was more divergent than that in the ATK strain. Furthermore, a fragment of 522 bp of the gp21 env gene from uncultured peripheral blood mononuclear cell DNAs from five of the STLV-1-infected monkeys was sequenced. Phylogenetic trees constructed with the long terminal repeat and env (gp46 and gp21) regions demonstrated that this new STLV-1 occupies a unique position within the Asian STLV-1 and HTLV-1 isolates, being, by most analyses, related more to the Australo-Melanesian HTLV-1 topotype than to any other Asian STLV-1. These data raise new hypotheses on the possible interspecies viral transmission between monkeys carrying STLV-1 and early Australoid settlers, ancestors of the present day Australo-Melanesian inhabitants, during their migrations from the Southeast Asian land mass to the greater Australian continent.

Barrett's oesophagus and Helicobacter pylori

In order to demonstrate the presence of Helicobacter pylori in the metaplastic epithelium of Barrett's oesophagus and to evaluate its possible association with this entity, we examined 29 cases of Barrett's oesophagus where concomitant antral biopsies were also available. These cases were compared with an equal number of age and sex matched controls of uncomplicated reflux oesophagitis. H. pylori was present in 11 of 29 cases of Barrett's oesophagus (38%). No increase in the frequency of H. pylori antral gastritis was found in patients of Barrett's oesophagus compared to the control group of uncomplicated reflux oesophagitis. The positivity of Barrett's oesophagus for H. pylori correlated with the presence of H. pylori antral gastritis (P < 0.05), although in two cases of H. pylori-positive Barrett's oesophagus antral biopsies were negative for H. pylori. No difference was found in the severity of inflammatory and dysplastic changes of H. pylori-positive and H. pylori-negative Barrett's oesophagus. Presence of H. pylori does not seem to alter the natural history of Barrett's oesophagus.

Infection of rats with human T-cell leukemia virus type-I: susceptibility of inbred strains, antibody response and provirus location

The susceptibilities of different strains of inbred rats to infection with the human T-cell leukemia virus (HTLV-I) after inoculation of human HTLV-I producer cell lines were compared. The Fisher F344 and Brown Norway strains developed the highest antibody response to HTLV-I, while the Lewis and BB strains were low responders. Antibodies against the HTLV-I gag proteins, and env gp21 but not env gp46, were detected in Western blots with sera from HTLV-I-infected Fischer F344 and Brown Norway rats. These sera were inactive in an in vitro syncytium-formation inhibition test. The HTLV-I provirus was detected by polymerase chain reaction in all Fischer F344, and some Lewis and Brown Norway rats, but not in the BB, which lack CD8+ T lymphocytes. The most frequent locations of the HTLV-I provirus in the Fischer F344, Lewis and Brown Norway rats at 12 weeks after infection were the peripheral blood mononuclear cells (PBMC) and spinal cord. In a second experiment in Brown Norway rats, the provirus was again detected in the PBMC of rats at 12 weeks, but not at 22 weeks, and among the other organs tested at 22 weeks the sympathetic nerve ganglia were positive. It is concluded that HTLV-I infection occurs in adult rats, but is suppressed with time.

Ureteric injuries during gynaecological surgery

Thirty-two patients with 35 ureteric injuries encountered during gynaecological surgery are presented. Their mean age was 41 years. Eight ureteric injuries were recognized during surgery, the nature and sites of injury were diagnosed peroperatively using an illuminated size 5 F ureteric probe (Storz) passed through a cystoscope. Three ureteric injuries were diagnosed during convalescence as continuous drainage of urine or urinoma collection, while three patients developed total anuria due to ligation of both ureters. Eighteen patients presented with late urinary fistulae, being uretero-uterine in 8 and ureterovaginal in 10. The ureteric injury occurred during emergency Caesarean section in 15 patients, the indication for Caesarean section being obstructed prolonged labour in 70% of them. Twelve urinary fistulae followed hysterectomy. Intravenous urography, antegrade and retrograde ureterography were useful methods of locating the sites of the fistulae. Ureteroneocystostomy was performed in 18 patients, utilizing a Boari flap in 3 and a bladder psoas hitch in 2. Other methods of treatment are discussed. The mean follow-up was 3 years.

[Evaluation of a rapid technique for detecting the type A Streptococcus antigen (Test Pack Strep A)]

OBJECTIVE

To test a rapid technique of Antigen Detection (TAD) of Type A Betahemolitic Streptococci (BHSA) in Acute Tonsillitis (AT), comparing it with and using as a point of reference traditional Blood Agar Cultivation (BAC). Additionally, the use of Clinical Data as a method of supposed Diagnosis was studied.

DESIGN

Prospective observational study. SITE. Health Primary Care (Maspalomas Health Centre).

PATIENTS AND OTHER PARTICIPANTS

118 patients between the ages of 1 and 71 affected by AT.

MEASUREMENTS AND MAIN RESULTS

There was a proportion of 13.56% BHSA in the AT of our sample, with a Confidence Interval (CI) of 95% (7.38-19.74) using the BAC; and 17.80% with a CI of 95% (10.90-24.70) using the TAD. The following values were obtained for the TAD: Sensitivity (S) of 93.75%, Specificity (Sp) of 94.12%, Positive Predictive Value (PPV) of 71.43% and Negative Predictive Value (NPV) of 98.9%. Of the clinical variables studied, only the presence/absence of Exudate and Adenopathies were linked to the presence of BHSA in the Cultivations (p less than 0.05 and p less than 0.01 respectively); with, however, inconclusive S, Sp, PPV and PNV values.

CONCLUSIONS

We found insufficient correlation between clinical findings and the presence of BHSA to consider it a valid method of supposed diagnosis. There was however a statistical link between the presence of Exudate and local Adenopathies, and a positive result in the cultivation. The TAD is shown to be a rapid method, easy to use, and highly reliable for the discovery of the presence of BHSA in AT.

Spectrophotometric determination of some MAO inhibitors using 7,7,8,8-tetracyanoquinodimethane and iodine monochloride

Two simple and sensitive spectrophotometric methods are described for the assay of three MAO inhibitors: isocarboxazid, tranylcypromine sulphate and iproniazid phosphate. The first method is based on the formation of a highly coloured stable radical anion between the drug as an n-donor and 7,7,8,8-tetracyanoquinodimethane (TCNQ) as a pi-electron acceptor. Beer's law is obeyed in the concentration range 0.2-3, 0.2-4 and 0.5-4 micrograms ml-1 for isocarboxazid, tranylcypromine sulphate and iproniazid phosphate, respectively. The second method involves the use of iodine monochloride (ICl) as an sigma-acceptor. It was found that ICl reacts quantitatively only with isocarboxazid and tranylcypromine sulphate; with iproniazid phosphate results were very poor. Beer's law is obeyed in the concentration range 2-20 micrograms ml-1 for both drugs. The optimum experimental parameters for colour production in each case were determined. The percentage recoveries obtained were in accordance with those obtained by the official methods. The proposed methods are characterized by high sensitivity.