Influencing medication adherence among women with AIDS

This study examined the effects of a ten-session cognitive-behavioural stress management/expressive supportive therapy (CBSM+) intervention on adherence to antiretroviral medication. Although the intervention was not designed to influence adherence, it was theorized that improved coping and social support could enhance adherence. Women with AIDS (N = 174) in Miami, New York and New Jersey, USA, were randomized to a group CBSM+ intervention or individual control condition. Participants were African American (55%), Latina (18%) and Caribbean (18%) with drug (55%) and/or alcohol (32%) histories. Participants were assessed on self-reported medication adherence over seven days, HIV-related coping strategies and beliefs regarding HIV medication. Baseline overall self-reported adherence rates were moderate and related to coping strategies and HIV medication beliefs. Low adherent (80%) participants in the intervention condition increased their mean self-reported medication adherence (30.4% increase, t44 = 3.1, p < 0.01), whereas low adherent women in the control condition showed a non-significant trend (19.6% increase, t44 = 2.0, p > 0.05). The intervention did not improve adherence in this population; conditions did not differ significantly on self-reported adherence. Low adhering intervention participants significantly decreased levels of denial-based coping (F1,88 = 5.97, p < 0.05). Results suggest that future interventions should utilize group formats and address adherence using coping and medication-knowledge focused strategies.

Correlation of signal attenuation-based quantitative magnetic resonance imaging with quantitative computed tomographic measurements of subchondral bone mineral density in metacarpophalangeal joints of horses

OBJECTIVE

To evaluate the ability of signal attenuation-based quantitative magnetic resonance imaging (QMRI) to estimate subchondral bone mineral density (BMD) as assessed via quantitative computed tomography (QCT) in osteoarthritic joints of horses.

SAMPLE POPULATION

20 metacarpophalangeal joints from 10 horse cadavers.

PROCEDURES

Magnetic resonance (MR) images (dorsal and transverse T1-weighted gradient recalled echo [GRE] and dorsal T2*-weighted GRE fast imaging employing steady-state acquisition [T2*-FIESTA]) and transverse single-slice computed tomographic (CT) images of the joints were acquired. Magnetic resonance signal intensity (SI) and CT attenuation were quantified in 6 regions of interest (ROIs) in the subchondral bone of third metacarpal condyles. Separate ROIs were established in the air close to the joint and used to generate corrected ratios and SIs. Computed tomographic attenuation was corrected by use of a calibration phantom to obtain a K(2)HPO(4)-equivalent density of bone. Correlations between QMRI performed with different MR imaging sequences and QCT measurements were evaluated. The intraobserver repeatability of ROI measurements was tested for each modality.

RESULTS

Measurement repeatability was excellent for QCT (R(2) = 98.3%) and QMRI (R(2) = 98.8%). Transverse (R(2) = 77%) or dorsal (R(2) = 77%) T1-weighted GRE and QCT BMD measurements were negatively correlated, as were dorsal T2*-FIESTA and QCT (R(2) = 80%) measurements. Decreased bone SI during MR imaging linearly reflected increased BMD.

CONCLUSIONS AND CLINICAL RELEVANCE

Results of this ex vivo study suggested that signal attenuation-based QMRI was a reliable, clinically applicable method for indirect estimation of subchondral BMD in osteoarthritic metacarpophalangeal joints of horses.

Multiple follicular cysts of the ear canal in a dog

An 11-year-old, 18-kg, neutered male standard schnauzer was presented for evaluation of recurrent otitis externa with para-aural swelling and fistulation of the right external ear canal of 6 months' duration. Otoscopic examination was impossible because of the severe stenosis of the ear canal. Right para-aural ultrasound examination and ultrasound-guided fine-needle aspiration of a mass-like lesion were performed. Cytology was suggestive of a follicular cyst. Magnetic resonance imaging revealed severe ear canal stenosis with a heterogeneous mass in the horizontal portion of the ear canal and associated otitis media. Total ear canal ablation with lateral bulla osteotomy was performed. Histopathological diagnosis was chronic otitis externa associated with multiple follicular cysts confined to the ear canal. Surgical treatment proved curative. This is the first report of multiple follicular cysts originating from the ear canal in a dog.

Can sonographic findings predict the results of liver aspirates in dogs with suspected liver disease?

While abdominal ultrasound and ultrasound-guided fine-needle aspiration cytology are often combined to help determine the type of liver disease in dogs, little is known about the relationship that may exist between the results of these tests. We hypothesized that specific sonographic findings, or combinations of findings, may predict results of liver ultrasound-guided fine-needle aspiration cytology. Hepatic and extrahepatic sonographic findings were recorded prospectively using a standardized form in 70 dogs with clinically suspected liver disease and in which liver ultrasound-guided fine-needle aspiration cytology was performed. The predictive value of sonographic findings in regard to the category of cytology results was assessed with stepwise logistic regression analysis. Sonographic detection of a hepatic mass (> or = 3cm; risk ratio [RR] 3.83, 95% Wald confidence intervals [95% CI] 2.42-3.93, P = 0.0036), ascites (RR 3.82, 95% CI 1.94-4.28, P = 0.0044), abnormal hepatic lymph node(s) (RR 3.01, 95% CI 1.22-4.88, P= 0.0262), and abnormal spleen (RR 3.26, 95% CI 1.20-3.85, P = 0.0274) were the most predictive of liver neoplasia on cytology. Conversely, sonographic detection of hepatic nodules (< 3cm; RR 1.97, 95% CI 0.95-2.96, P = 0.0666) was most predictive of vacuolar hepatopathy on cytology. In dogs with suspected liver disease, several sonographic findings, alone or combined, are thus predictive of liver ultrasound-guided fine-needle aspiration cytology results. In the light of the fact that ultrasound-guided fine-needle aspiration cytology of the liver has limitations, these predictabilities could influence the selection of diagnostic tests to reach a reliable diagnosis.

Comparison of radiography and ultrasonography for the diagnosis of osteochondritis dissecans in the equine femoropatellar joint

REASONS FOR PERFORMING STUDY

Osteochondritis dissecans (OCD) lesions of the femoropatellar (FP) joint are diagnosed routinely by radiography, but lesions located in the trochlear groove or without accompanying subchondral bone changes can be difficult to visualise. Ultrasonography allows evaluation of articular cartilage and subchondral bone in the FPjoint.

OBJECTIVES

To document the radiographic and ultrasonographic appearance of OCD lesions in the equine FP joint, grade ultrasonographic lesions and compare their accuracy in the diagnosis of these lesions.

METHODS

The medical records of all horses diagnosed with FP OCD between 1995 and 2006 were assessed. Inclusion criteria included availability of both radiographic and ultrasonographic images. Lesion characteristics were evaluated in each trochlear ridge and trochlear groove. For assessment of the accuracy (sensitivity and specificity) of both imaging techniques in the diagnosis of OCD, only cases with an arthroscopic or necropsy examination were studied.

RESULTS

Twenty-one horses were included. OCD lesions were diagnosed by radiography (30/32 joints) and ultrasound (32/32 joints). The lateral trochlear ridge (LTR, 91%) and the medial trochlear ridge (MTR, 17%) were involved on radiography. The localisation on ultrasound examination was similar (97% LTR, 25% MTR). All but one lesion seen on radiography were also detected with ultrasound; 2 LTR and 3 MTR lesions, not seen on radiography were diagnosed by ultrasound and confirmed at arthroscopy or necropsy. The specificity was 100% regardless of the site and imaging procedure except for the distal third of the MTR (94% for ultrasound). The sensitivity varied, depending on lesion site.

CONCLUSION

Ultrasonography is a valuable diagnostic tool to diagnose OCD lesions in the FP joint and more sensitive than radiography for lesions affecting the MTR of the distal femur.

CLINICAL RELEVANCE

Ultrasound should be considered as a useful adjunct to radiography for diagnosing equine FP OCD, especially in cases of high clinical suspicion but equivocal radiographic findings. Images can be generated immediately when digital radiography is not available, permitting an immediate on-site diagnosis.

Phenotypic variation in FAM83H-associated amelogenesis imperfecta

FAM83H gene mutations are associated with autosomal-dominant hypocalcified amelogenesis imperfecta (ADHCAI), which is typically characterized by enamel having normal thickness and a markedly decreased mineral content. This study tested the hypothesis that there are phenotype and genotype associations in families with FAM83H-associated ADHCAI. Seven families segregating ADHCAI (147 individuals) were evaluated. Phenotyping included clinical, radiographic, histological, and biochemical studies, and genotyping was by mutational analysis. Multiple novel FAM83H mutations were identified, including two 2-bp-deletion mutations, the first non-nonsense mutations identified. Craniofacial deviation from normal was more prevalent in the affected individuals. Affected individuals having truncating FAMH3H mutations of 677 or fewer amino acids presented a generalized ADHCAI phenotype, while those having mutations capable of producing a protein of at least 694 amino acids had a unique and previously unreported phenotype affecting primarily the cervical enamel. This investigation shows that unique phenotypes are associated with specific FAM83H mutations.

Comparison of radiography and ultrasonography to detect osteochondrosis lesions in the tarsocrural joint: a prospective study

REASONS FOR PERFORMING STUDY

Lesions located on the medial malleolus of the tarsocrural joint can be difficult to image radiographically. Ultrasonography allows evaluation of articular cartilage and subchondral bone.

OBJECTIVES

To compare dorso30 degrees lateral-plantaromedial-oblique (DL-PIMO) and dorso45 degrees views to detect lesions on the medial malleolus, to validate the use of ultrasonography to show lesions in the tarsocrural joint and to compare its sensitivity to radiography.

METHODS

Tarsocrural joints (n=111) with osteochondrosis were evaluated ultrasonographically and radiographically prior to arthroscopic lesion debridement. A complete radiographic examination was made and the best view to detect each lesion recorded. Longitudinal and transverse ultrasonography of the dorsal aspect of the joint was performed and the best scan plane to image each lesion recorded.

RESULTS

There were 94 joints with lesions on the distal intermediate ridge of tibia, 24 with lesions on the medial malleolus, and 4 with lesions on the lateral trochlear ridge. The sensitivity of radiography to detect lesions on the medial malleolus and distal intermediate ridge of tibia was 71 and 96%, respectively. Eighty-two percent of lesions on the medial malleolus were better imaged on dorso30 degrees view. The sensitivity of ultrasonography to detect lesions on the medial malleolus and distal intermediate ridge of tibia was 83 and 98%, respectively. Ultrasonography was significantly more sensitive than radiography to detect lesions on the medial malleolus and distal intermediate ridge of tibia.

CONCLUSION

Dorso30 degrees lateral-plantaromedial-oblique view was the best to image lesions on the medial malleolus. Ultrasonography was a valuable diagnostic tool to diagnose lesions in the tarsocrural joint and was more sensitive than radiography for lesions located on the medial malleolus and distal intermediate ridge of tibia.

CLINICAL RELEVANCE

Radiographic examination should include a dorso30 degrees view for detection of lesions on the medial malleolus and ultrasonography should be considered to diagnose osteochondrosis in the tarsocrural joints.

Use of routine clinical multimodality imaging in a rabbit model of osteoarthritis--part II: bone mineral density assessment

OBJECTIVE

To assess bone mineral density (BMD) at different depths from the articular surface in vivo and temporally in a rabbit model of osteoarthritis (OA) using clinical computed tomography (CT) equipment.

METHODS

The knee joints of rabbits (N=10 with Anterior cruciate ligament transection (ACLT) and contralateral sham joints, and N=6 unoperated controls) were scanned in a transverse image plane with a single-slice helical CT scanner. BMD was calculated at defined depths from the articular surface to the growth plate in the lateral femoral condyle (LFC), medial femoral condyle (MFC), lateral tibial plateau (LTP) and medial tibial plateau (MTP). Baseline BMD was measured at 2 weeks before surgery, and then repeated at weeks 2, 4 and 8 post-surgery in all 10 operated rabbits, and again at week 12 in five of the operated rabbits and at weeks -2 and 8 in the six control rabbits.

RESULTS

In the control joints, BMD decreased with increasing distance into the epiphysis and remained stable over time within each depth. A significant reduction in BMD was observed at week 2 post-operatively in three compartments (LFC, MFC and MTP) in the ACLT joints and persisted to week 12. A modest reduction in BMD occurred in the LTP and MTP of the sham joints at week 12 alone.

CONCLUSION

Clinical CT equipment permitted rapid, repeated, in vivo, non-invasive BMD assessment in a rabbit model of OA. A marked BMD reduction was measured with progression of OA until the end point at 12 weeks.

Use of routine clinical multimodality imaging in a rabbit model of osteoarthritis--part I

OBJECTIVE

To evaluate in vivo the evolution of osteoarthritis (OA) lesions temporally in a rabbit model of OA with clinically available imaging modalities: computed radiography (CR), helical single-slice computed tomography (CT), and 1.5 tesla (T) magnetic resonance imaging (MRI).

METHODS

Imaging was performed on knees of anesthetized rabbits [10 anterior cruciate ligament transection (ACLT) and contralateral sham joints and six control rabbits] at baseline and at intervals up to 12 weeks post-surgery. Osteophytosis, subchondral bone sclerosis, bone marrow lesions (BMLs), femoropatellar effusion and articular cartilage were assessed.

RESULTS

CT had the highest sensitivity (90%) and specificity (91%) to detect osteophytes. A significant increase in total joint osteophyte score occurred at all time-points post-operatively in the ACLT group alone. BMLs were identified and occurred most commonly in the lateral femoral condyle of the ACLT joints and were not identified in the tibia. A significant increase in joint effusion was present in the ACLT joints until 8 weeks after surgery. Bone sclerosis or cartilage defects were not reliably assessed with the selected imaging modalities.

CONCLUSION

Combined, clinically available CT and 1.5 T MRI allowed the assessment of most of the characteristic lesions of OA and at early time-points in the development of the disease. However, the selected 1.5 T MRI sequences and acquisition times did not permit the detection of cartilage lesions in this rabbit OA model.

Evidence of linkage in a Hispanic cohort with a Class III dentofacial phenotype

Despite the prevalence of craniofacial disorders, the genetic contribution remains poorly understood. Class III malocclusion represents a specific craniofacial problem that can be handicapping, both functionally and socially. We hypothesized that the Class III phenotype is genetically linked to specific loci that regulate maxillary or mandibular growth. To determine the region linked to the Class III phenotype in four Hispanic families, we performed a genome-wide scan and linkage analysis using 500 microsatellite markers. Pedigree and linkage analyses revealed that the Class III phenotype (primarily maxillary deficiency) segregates in an autosomal-dominant manner, and that 5 loci (1p22.1, 3q26.2, 11q22, 12q13.13, and 12q23) are suggestive of linkage. Candidate genes within the 12q23 region (ZLR=2.93) include IGF1, HOXC, and COL2A1. Chromosome 1 results (ZLR=2.92) were similar to those reported previously in an Asian cohort with mandibular prognathism, suggesting that a common upstream genetic element may be responsible for both mandibular prognathism and maxillary deficiency.

Adiponectin and leptin are independently associated with insulin sensitivity, but not with insulin secretion or beta-cell function in overweight Hispanic adolescents

The aim of the study was to investigate the independent effects of leptin and adiponectin on insulin sensitivity as well as insulin secretion and beta-cell function in overweight Hispanic adolescents. Despite pubertal changes in hormone secretion, studies investigating the independent effect of both hormones on insulin sensitivity and beta-cell function in adolescents are lacking. In a cross-sectional study, 175 overweight Hispanic adolescent boys (n=101) and girls (n=74) with a family history of diabetes were recruited and insulin sensitivity (SI), acute insulin response to glucose (AIR), disposition index (DI), body composition, total serum adiponectin, and leptin were assessed. Over age, leptin significantly increased in girls but not in boys (p for age x gender interaction=0.005) while adiponectin was similar in boys and girls. Leptin was not correlated to adiponectin. Leptin (partial r=-0.180; p=0.019) and adiponectin (partial r=0.230; p=0.003) predicted SI independent of age, gender, body fat, lean body mass, and Tanner stage but together, they explained 5% of the unique variation in SI (p for R (2)-change<0.001). Leptin or adiponectin were not related to AIR or DI. With regard to SI, AIR, and DI, no significant gender, age, or Tanner stage interactions were observed suggesting similar effects of adiponectin and leptin among gender, age, and Tanner stages. Leptin and adiponectin were independently associated with SI, but not with insulin secretion or beta-cell function.

Evaluation of a thoracoscopic technique using ligating loops to obtain large lung biopsies in standing healthy and heaves-affected horses

OBJECTIVE

To evaluate use of pre-tied ligating loop to perform thoracoscopic, large lung biopsy in normal and heaves-affected horses.

STUDY DESIGN

Prospective clinical study.

ANIMALS

Normal (n=5) and heaves-affected (n=6) horses.

METHODS

Lung biopsies, 1 from each hemithorax, were collected thoracoscopically using a pre-tied ligating loop. Horses were either normal (C) or heaves-affected with the latter being in remission (Ha) for the initial biopsy and in exacerbation (Hs) for the 2nd biopsy. Clinical variables, PaO(2), and PaCO(2) were used to determine the effect of surgical biopsy. Postoperative pneumothorax was monitored by serial thoracic radiographic examinations.

RESULTS

Thoracoscopic lung biopsy (n=29, 22 procedures) was well tolerated by all horses. Complication rate was 31%, including 8 ligature slippage and 1 pulmonary hemorrhage. Intranasal oxygen was administered intraoperatively to 6 horses (2 C, 1 Ha, 3 Hs) with severe hypoxemia or labored breathing. There was a significant decrease in PaO(2) during surgery in horses not supplemented with oxygen. Postoperative pneumothorax (21/22 procedures) detected radiographically resolved within 3 weeks.

CONCLUSION

Thoracoscopic lung biopsy using pre-tied ligating loops was minimally invasive, relatively inexpensive, and fairly efficient. Heaves-affected horses tolerated the surgery well, even when in exacerbation; however, the technique was associated with non life-threatening complications in 31% of the biopsies, most of which required correction with additional ligating loops or more sophisticated instrumentation.

CLINICAL RELEVANCE

Using laparoscopic pre-tied ligating loop for thoracoscopically-assisted lung biopsy can be considered in horses with normal and impaired lung function but alternative instrumentation and access to intranasal oxygen must be available to the surgeon in case of complications.

Use of magnetic resonance imaging in the diagnosis of upper respiratory obstruction in a calf

In a calf with dyspnea, a mass located dorsal to the pharynx was visualized by ultrasonography. Magnetic resonance imaging (MRI) revealed a severe enlargement of the left medial retropharyngeal lymph node, compatible with an abscess. This is the first reported case of MRI use in bovine upper respiratory disease.