Adrenocortical function in acquired immunodeficiency syndrome

Clinical features of adrenal steroid deficiency occur in patients with the acquired immunodeficiency syndrome (AIDS). To determine the frequency of aberrations in peripheral steroid levels in patients with AIDS and AIDS-related complex (ARC) we measured morning recumbent plasma cortisol, deoxycorticosterone, 18-hydroxydeoxycorticosterone (18-OHDOC), corticosterone, aldosterone, and 18-hydroxycorticosterone concentrations before and after administration of 0.25 mg ACTH (Cosyntropin) in 74 randomly selected hospitalized patients with AIDS and 19 patients with ARC. Basal (0800 h) cortisol levels in the AIDS patients were significantly higher (P less than 0.01) than those in normal subjects, while other ACTH-dependent steroids of the 17-deoxypathway, deoxycorticosterone, corticosterone, and 18-OHDOC, were normal. These latter steroids increased subnormally in response to ACTH in patients with either AIDS (P less than 0.001) or ARC (P less than 0.005), but in ARC patients plasma 18-OHDOC levels were significantly higher than in those with AIDS (P less than 0.001). Supraphysiological doses of ACTH were then administered for 3 consecutive days to 14 patients with AIDS and 9 with ARC, which confirmed and amplified the subnormal responses of these steroids in AIDS. The mean plasma cortisol response was reduced on the third day only in AIDS patients, whereas in the ARC patients the steroid responses were normal. Angiotensin III infusion and postural stimulation increased plasma aldosterone and 18-hydroxycorticosterone levels in AIDS and ARC patients. Defective stimulation of 18-OHDOC alone or in combination with defective stimulation of other 17-deoxysteroids can be a harbinger of subsequent impaired adrenal capacity in AIDS.

Human pharmacokinetics and tolerance of oral ganciclovir

Ganciclovir is a nucleoside analog which inhibits the replication of herpesviruses in vitro and which has been effective by intravenous administration for the treatment of severe cytomegalovirus infection in immunocompromised patients. Because most patients with acquired immunodeficiency syndrome and severe cytomegalovirus infection have required lifelong daily suppressive ganciclovir therapy to control disease progression, oral therapy appears to have practical advantages. We studied the pharmacokinetics of orally administered ganciclovir in four patients with acquired immunodeficiency syndrome and cytomegalovirus retinitis. Repeated oral ganciclovir doses (10 to 20 mg/kg every 6 h) were well tolerated. With a 20-mg/kg dose given every 6 h, mean steady-state peak and trough levels were 2.96 and 1.05 microM, respectively, and the area under the concentration-time curve from 0 to 24 h was 47 microM X h. Calculated absorption was 3.0%, based on urinary excretion. Because the levels achieved in serum with oral ganciclovir approximated those required to inhibit cytomegalovirus in vitro, a trial of oral maintenance therapy in immunocompromised patients with severe cytomegalovirus infections seems warranted.

Detecting margin leakage of dental composite restorations

The degree of microleakage between a restoration and the cavity wall is difficult to quantify objectively. A silver-staining method is used and compared to the radioisotope method with results that indicate a superior definition and more accurate evaluation of microleakage. In addition to the accuracy, two advantages are presented: (1) scoring of the leakage can be refined and divided into more precise numbers, and (2) teeth can be observed directly in a microscope without resorting to the indirect interpretation of film or photograph.

Epidemiological standardization of a test for susceptibility to mumps

An enzyme-linked immunosorbent assay (ELISA) for antibody to mumps virus is described. It is standardized with sera from putatively susceptible and immune populations. The ranges for 49 susceptible and 19 immune children were an optical density of -0.020 to 0.028 and 0.133 to 0.640, respectively. When compared with the microneutralization assay for evaluating vaccine responses, the ELISA appeared to be more sensitive while retaining its specificity. The failure rate after mumps vaccination in 301 children was 1.7% (5 of 301) by the ELISA and 12% (36 of 301) or 7.6% (23 of 301) by the microneutralization assay, depending on whether a high (30-100 50% tissue culture infectious dose [TCID50]) or low (10-20 TCID50) dose of virus was used.

What do young people think about screening for cystic fibrosis?

We investigated the knowledge of cystic fibrosis and the views about neonatal and carrier screening in 216 school students aged 14 to 16 years. This work was completed before the published identification of the cystic fibrosis gene in September 1989. Although initial knowledge of cystic fibrosis was low (only 17% of the students knew that the disease affected the lungs), there was good recall of basic information about cystic fibrosis and of recessive inheritance after a brief lecture. A total of 86% considered that carrier detection should be offered routinely and 88% felt that an offer of prenatal diagnosis for cystic fibrosis should be made if both prospective parents were known to be carriers. We believe that pilot studies of cystic fibrosis carrier screening in schools should be undertaken.

Effects of norepinephrine on neonatal rat cardiocyte growth and differentiation

Norepinephrine stimulates the growth in size of nondividing neonatal cardiocytes. During this time the neonatal cardiocyte is in a period of transition in which the cell can synthesize DNA and yet does not divide. Because the cell undergoes karyokinesis without cytokinesis the objective of this study was to determine whether the norepinephrine-induced growth in size of the neonatal cardiocyte was accompanied by an increase in a) the number of cardiocytes synthesizing DNA, b) the number of binucleate cardiocytes, and c) organized myofibrils. One- to four-d-old neonatal rat heart cells were isolated and placed in serum-free medium which was then supplemented with serum, norepinephrine, norepinephrine plus propranolol, or isoproterenol. After 4 d the number and size of the cells was determined using a Coulter counter. In other cultures cardiocytes were fixed on Days 0, 1, 2, and 4, and an increase in the number of binucleate cardiocytes was found in all treatment groups including controls. However, the rate of binucleation was faster in the norepinephrine group. It was also determined by proliferating cell nuclear antigen (PCNA) antibody staining that by Day 4, over 50% of the cardiocytes were in the cell cycle. The percentage of cells in which PCNA could be detected was higher in the norepinephrine and norepinephrine plus propranolol groups. Furthermore, there was a concomitant increase in the amount and organization of myofibrils in the catecholamine-treated cardiocytes.

Effects of an exercise program during pediatric stem cell transplantation: A randomized controlled trial

BACKGROUND

During pediatric hematopoietic stem cell transplant (HSCT), there is significant reduction in physical activity, leading to loss of strength and function, along with decline in quality of life (QoL). This study evaluates the effects of a supervised exercise program on functional ability, mobility, strength, and QoL during and following pediatric HSCT.

METHODS

Patients ages 4-21 years presenting for HSCT were randomized to either an intervention group, who underwent exercise routines three times weekly and once weekly on discharge for 6 weeks supervised by a physical therapist, or the control group, which was treated per standard of care. Forty subjects were recruited for the study, 20 in each arm. Physical therapy and QoL assessments were conducted at three time points: pre-HSCT (baseline), on the day of hospital discharge, and 6 weeks after discharge.

RESULTS

Exercise capacity and endurance using Six-Minute Walk test (p = .023) and strength using manual muscle testing (p = .005) were improved in the exercise group, compared to the control group. There was evidence that some QoL outcomes (measured using the Patient Reported Outcomes Measurement Information System) were improved 6 weeks post discharge, with observed decreases in anxiety (p = .0009) and fatigue (p = .037).

CONCLUSION

Supervised exercise program during pediatric HSCT has positive effects on endurance, functional mobility, and muscle strength, and may also result in improvements in some aspects of QoL. This trial was registered at www.

CLINICALTRIALS

gov as NCT04663503.

Antibody response following measles-mumps-rubella vaccine under conditions of customary use

A study of 301 children who had been immunized two to 19 months previously with measles, mumps, and rubella (MMR) vaccine at 36 different sites in San Antonio, Tex, including physicians' offices and clinics, revealed that 99.7% had antibody against rubella and 98.3% had antibody against measles and mumps. None of the 49 infants who were tested prior to receipt of MMR vaccine had antibody against any of these viruses, indicating that the antibody found after immunization was unlikely to be due to false-positive results. The lack of antibody in these infants confirmed that there had not been a significant number of cases of these diseases that could contribute to the high frequency of antibody found after immunization. A single dose of MMR vaccine administered under customary conditions appears to be an effective method of conferring immunity against these diseases.