Serotyping and genotyping of HIV-1 infection in residents of Khayelitsha, Cape Town, South Africa

It is estimated that between 5.5 and 6.1 million people are infected with HIV/acquired immunodeficiency syndrome (AIDS) in South Africa, with subtype C responsible for the majority of these infections. The Khayelitsha suburb of Cape Town has one of the highest HIV prevalence rates in South Africa. Overcrowding combined with unemployment and crime in parts of the area perpetuates high-risk sexual behavior, which increases exposure to infection by HIV. Against this background, the objective of this study was to characterize HIV-1 in residents confirmed to be seropositive. Serotyping was performed through a competitive enzyme-linked immunosorbent assay (cPEIA). Genotyping methods included RNA isolation followed by RT-PCR and sequencing of the gag p24, env gp41 immunodominant region (IDR), and env gp120 V3 genome regions of HIV-1. With the exception of a possible C/D recombinant strain, all HIV-1 strains were characterized as HIV-1 group M subtype C. One individual was shown to harbor multiple strains of HIV-1 subtype C. In Southern Africa, the focus has been to develop a subtype C candidate vaccine, as this is the major subtype found in this geographical area. Therefore, the spread of HIV-1 and its recombinant strains needs to be monitored closely.

Respiratory atopic disease, Ascaris-immunoglobulin E and tuberculin testing in urban South African children

BACKGROUND

Epidemiological relation of intestinal helminth infection and atopic disease, both associated with a T-helper (Th) 2 immune response, is controversial, as it has been reported that helminth infection may either suppress or pre-dispose to atopic disease. This relation has not been tested in an area with a high burden of Mycobacterium tuberculosis (MTB) infection, a known Th1-stimulating infection.

OBJECTIVE

To study the association of intestinal helminth infection and atopic disease in a community where helminth infection is endemic and MTB infection is high.

METHODS

Three-hundred and fifty-nine randomly selected children aged 6-14 years from a poor urban suburb were tested with allergy questionnaire, skin prick test (SPT) to common aeroallergens, Ascaris-specific IgE (Ascaris-sIgE), fecal examination for pathogenic intestinal helminths and tuberculin skin testing (TST). Histamine bronchoprovocation was tested in the group of children aged 10 years and older.

RESULTS

were corrected for demographic variables, socioeconomic status, parental allergy, environmental tobacco smoke (ETS) exposure in the household, recent anthelminthic treatment and for clustering in the sampling unit. Results Ascaris-sIgE was elevated in 48% of children, Ascaris eggs were found in 15% and TST was positive in 53%. Children with elevated Ascaris-sIgE had significantly increased risk of positive SPT to aeroallergens, particularly house dust mite, atopic asthma (ever and recent), atopic rhinitis (ever and recent) and increased atopy-related bronchial hyper-responsiveness. In children with negative TST (<10 mm), elevated Ascaris-sIgE was associated with significantly increased risk of atopic symptoms (adjusted odds ratio (OR(adj)) 6.5; 95% confidence interval (CI) 1.9-22.4), whereas in those with positive TST (>/=10 mm) this association disappeared (OR(adj) 0.96; 95% CI 0.4-2.8).

CONCLUSIONS

These results suggest that immune response to Ascaris (Ascaris-sIgE) may be a risk factor of atopic disease in populations exposed to mild Ascaris infection and that MTB infection may be protective against this risk, probably by stimulation of anti-inflammatory networks.

Efficacy of albendazole against the whipworm trichuris trichiura--a randomised, controlled trial

OBJECTIVES AND DESIGN

To test the efficacy of albendazole against the whipworm Trichuris trichiura for school-based deworming in the south-western Cape, South Africa. Children infected with Trichuris were randomised to 3 doses of albendazole (400, 800 or 1200 mg), each repeated 4 times. The boy/girl ratio was 1. A group not infected with worms was treated with placebo, creating a negative control.

SUBJECTS AND SETTING

Pupils at a primary school serving a wine-producing area approximately 90 km east of Cape Town.

OUTCOME MEASURES

Trichuris cure rates and reduction in the number of eggs/g in faeces, as well as the infection dynamics of Trichuris and Ascaris during treatment with placebo.

RESULTS

Albendazole treatment was associated with Trichuris cure rates of 23% (400 mg), 56% (800 mg) and 67% (1200 mg) after the final treatment. The corresponding reductions in the number of eggs/g of faeces were 96.8%, 99.3% and 99.7%. Environmental pollution by human faeces was confirmed because worm egg-negative children in the placebo group became egg-positive while the study was in progress.

CONCLUSION

The 400 mg stat dose had a low Trichuris cure rate. To repeat the dose on 2 or 3 days would increase cost, reduce compliance and complicate management. Albendazole cannot be used in deworming programmes in South Africa because it is a Schedule 4 prescription medicine. De-scheduling is needed urgently, particularly because of high efficacy against hookworm in KwaZulu-Natal and neighbouring countries.

Atherosclerosis: aortic lipid changes induced by diets suggest diffuse disease with focal severity in primates that model human atheromas

Atherosclerosis in Vervet or African Green monkeys (Cercopithecus aethiops) models the morphology and cytology of the disease of humans, and it is well established that the rate of atherogenesis in Vervets is influenced by diet. Aortic intimal concentrations of lipids and phospholipids known to be major components of atheromas were determined in female Vervets fed for 4 years on either an atherogenic (AD) or a prudent Western diet (PD). Lipid concentrations detectable microscopically as cholesterol crystals and foam cells were confirmed biochemically. In addition, the AD was associated with diffuse, invisible accumulation of lipids throughout aortic tissue to the extent that tissue with no fatty streaks or plaque (AD) contained the same or more lipids than visible fatty streaks (PD). Correlations between lipid concentrations and atherosclerosis were highly positive, which supports known correlations between aortic, plasma, and dietary lipids during atherogenesis, and validates the aortic lipid analysis. These aortic lipid concentration results imply that atherosclerosis is not confined to focal pathologic anatomy, but in terms of lipid components of the disease, it develops throughout the arterial system of Old World omnivorous primates. If the results are applicable to people, they provide new insight and emphasize the need to minimize dietary sources of atherogenic lipids.

Vervet monkeys and whole-food diets for studying the effects of dietary lipids on plasma lipoprotein metabolism and atherosclerosis

It is well established that some species of nonhuman primates are models of choice for polygenic hyperlipoproteinaemia and atherosclerosis induced and promoted by diets as occur in man. The Vervet monkey (Cercopithecus aethiops) has proved to be one such model. Our group has used this model extensively to determine the effects of a variety of dietary lipid components on plasma lipoprotein metabolism and atherosclerosis against a background of a Western atherogenic or prudent diet. The diets fed in all these studies were formulated entirely from cooked foods that are normal components of Westernised diet with no extra synthetic cholesterol added. This model has been used successfully to evaluate the effect of fish oil, amount and degree of dietary fat unsaturation and w-6/w-3 fatty acid ratio and lipid-lowering agents on plasma lipoprotein metabolism and atherosclerosis. Dietary manipulation in this model is simple, relatively inexpensive and offers almost unlimited options for future dietary intervention studies.

Confirmation of efficacy of etofibrate against peripheral atherosclerosis in non-human primates which model human lesion types I-VII

In dyslipidemic or hyperlipidemic patients etofibrate (CAS 31637-97-5, active principle of Lipo-Merz-retard) improves plasma lipoprotein profiles by reducing low density lipoprotein cholesterol and triglycerides. Experimentally, it also promotes fibrinolysis and thrombolysis and reduces the susceptibility of lipoproteins to oxidative stress. In order to investigate the possible efficacy of etofibrate on atherosclerosis, a study in African Green Monkeys was performed. To accelerate atherogenesis, balanced groups of adult male Vervetes (Cercopithecus aethiops) were fed an atherogenic diet, with and without etofibrate, while negative controls received a prudent diet. Total dietary risk exposure was 38 months, with etofibrate treatment during the final 27 months. The etofibrate dose achieved plasma concentrations of clofibric acid comparable to the one achieved clinically. Necropsy demonstrated lesions equivalent to human atherosclerosis types I-VII, which were compared between treatments both macroscopically and microscopically. Peripheral atherosclerosis was significantly less frequent after etofibrate treatment than in positive controls. In aortas, etofibrate probably ameliorated atherogenesis, as defined by proliferation of smooth muscle and foam cells, and accumulation of cholesterol crystals. Effective reduction of plasma cholesterol by etofibrate was confirmed. In conclusion, anti-atherogenic efficacy of etofibrate was demonstrated in a non-human primate model of accelerated atherogenesis. The results on peripheral atherosclerosis confirm the preliminary clinical data in patients suffering from peripheral vascular occlusion.

Pleural Mesocestoides and cardiac shock in an obese vervet monkey (Cercopithecus aethiops)

Only one case of infection by tetrathyridia larvae of the tapeworm genus Mesocestoides was detected in 416 necropsies of captive vervet monkeys (Cercopithecus aethiops). Two hundred nine larvae were distributed between both pleural cavities. Mass and size ranges of larvae were determined. A plasma cell reaction indicated a humoral immune response to parasite antigens, which may have contributed to acute, lethal cardiac shock. Coagulative myocytolysis was confirmed. The history of this case and associated circumstantial evidence and reports in the literature suggest that infection of primates by tetrathyridia probably occurs after capture rather than before.

Cryopreservation of vervet monkey semen and recovery of progressively motile spermatozoa

A method to cryopreserve semen from the Vervet monkey (Cercopithecus aethiops) has been developed, yielding a mean post thaw recovery of 63.60% of pre-freeze progressive motility. The extender contained a TES-TRIS buffer, egg yolk, dextrose, streptomycin, penicillin, and glycerol as cryoprotectant. The pH ranged from 7.10-7.18 and the osmolality was 330-345 mOsmol/L.

Parathyroid hormone, ionised calcium, and potentially interacting variables in plasma of an Old World primate

Bone turnover and calcium homeostasis in man can only be modelled validly in Old World nonhuman primates. In order to interpret the models it is necessary to establish endocrine and biochemical parameters of bone mineral metabolism. This report is probably the first description of acute phase parathyroid responses to manipulations of blood ionised calcium, and of reference values for potentially interacting variables, in vervet monkeys. Plasma parathyroid hormone concentrations were measured in vervets under defined conditions, and ranges reported as normal for other nonhuman primates and man are summarised.

Folic acid and vitamin B12 status of vervet monkeys used for nutritional research

Plasma and red blood cell (RBC) folic acid levels, as well as plasma vitamin B12 levels were determined in Vervet monkeys (Cercopithecus aethiops). All the vervets were apparently healthy and without symptoms or lesions typical of folic acid and/or vitamin B12 deficiencies. Competitive protein binding radioassays were used to determine folate and vitamin B12 values in animals fed 4 different diets. The B12 levels for all the groups ranged between 866 and 5867 pg/ml and showed an inverse relationship with the FA measurements. The lowest mean RBC folic acid content in a group fed an atherogenic diet for 3 years was 12.8 ng/ml. For the other 3 diets, mean RBC folic acid levels were 90.7, 132.3 and 152.8 ng/ml, respectively. A megadose of 25.6 mg of folic acid per day for 99 days was given to 3 adult males. No obvious toxic effects were observed in these animals although mean RBC folic acid levels increased to 1013 ng/ml.

Comparison of the effect of the amount and degree of unsaturation of dietary fat on plasma low density lipoproteins in vervet monkeys

The effects of the degree of unsaturation and of the amount of dietary fat on low density lipoprotein (LDL) concentration and composition were determined in vervet monkeys. Diets with fat contents of 41, 31 and 18% energy, each with a low and a high polyunsaturated to saturated fatty acid ratio (P/S; 0.27-0.38 and 1.13-1.47) were fed to six female vervet monkeys for two months. Another six females were given a low fat, high P/S diet for the same period of time, to serve as a reference. The cholesterol contents of the diets were low (21-33 mg per day) and relatively constant. LDL cholesterol concentrations decreased significantly (P < or = 0.01) when the dietary fat content decreased from 31 to 18% of energy. The dietary P/S ratio only affected LDL cholesterol concentrations during moderate (31% of energy) fat intake, where LDL cholesterol increased (P < or = 0.01) with a decrease in dietary P/S. Substantial individual variations were observed in LDL cholesterol concentration responses to dietary fat changes. The changes in LDL cholesterol concentrations were the result of changes in the concentration of LDL particles, as the molecular composition did not differ significantly between dietary periods. The high density lipoprotein cholesterol and the plasma triacylglycerol concentrations were not influenced by the dietary fat changes. During the high P/S diets, the percentage of 18:2 (linoleic acid) increased (P < or = 0.01) and that of 18:1 (oleic acid) decreased (P < or = 0.01) in LDL esterified cholesterol, as compared to the low P/S diets. In adipose tissue triacylglycerol the percentage of 18:2 was three times higher (P < or = 0.01) during the high P/S diets than during the low P/S diets.(ABSTRACT TRUNCATED AT 250 WORDS)

The influence of fish oil supplementation on plasma lipoproteins and arterial lipids in vervet monkeys with established atherosclerosis

There is controversy about whether supplementing diets with marine fish oil can regress, promote or prevent atherosclerosis. Therefore the effects of an Atlantic pilchard oil (FO) supplement and dietary change were measured in a proven atherosclerosis model. Vervet or African Green monkeys were fed an atherogenic diet (AD) for long enough to ensure progression before treatments started. Matched groups were then treated for 20 months, either by adding FO to the AD (AD/FO), or by changing to a therapeutic diet with FO (TD/FO). Control treatments consisted of supplementing with sunflower oil (SO) instead of FO, so that treatments were AD/SO and TD/SO. The same total polyunsaturates were supplied by the FO and SO and the dose of FO was realistic (2.5% of total energy). A reference group (R) received the TD with no oil supplements. Supplementing with FO did not change the concentrations of total, low or high density lipoprotein cholesterol in plasma. After The AD/FO the intimas of aortas contained more total (p < or = 0.001), free (p < or = 0.05) and esterified (p < or = 0.05) cholesterol, total phospholipid (p < or = 0.01) and sphingomyelin (p < or = 0.05) than after the AD/SO. After FO supplementation eicosapentaenoic acid was significantly higher and arachidonic acid significantly lower in the plasma and aorta intima phosphatidylcholine. None of these changes was anti-atherogenic in terms of atherosclerosis measured in the same individuals (1). Nor did FO increase the efficacy of the TD.

Atherogenic effects in a non-human primate of Fusarium moniliforme cultures added to a carbohydrate diet

Adding less than 0.5% w/w of culture material of strain MRC 826 of the fungus Fusarium moniliforme to a carbohydrate diet low in fat resulted in an atherogenic plasma lipid profile in a non-human primate. Simultaneously increased plasma fibrinogen and activity of blood coagulation factor VII could enhance atherogenesis. This unique potential for promotion of atherosclerosis was probably secondary to chronic hepatotoxicity as indicated by liver fibrosis and elevated cholesterol, albumin and the enzymes AST, ALT, LD, GGT and ALP in serum. The cholesterol and enzymes responded in proportion to the calculated doses of fumonisin mycotoxins in the F. moniliforme MRC 826 cultures. Fumonisins are water soluble and heat stable. Thrombotic, hepatotoxic, carcinogenic and cerebral effects of MRC 826 culture material and fumonisins are well known in non-primates. The estimated fumonisin concentrations tested fall within a range due to natural contamination of human foods. The results suggest that all maize grain products should be analysed for fumonisins.

Torsion of the colon in vervet monkeys: association with an atherogenic Western-type of diet

The risk of torsion of the colon in adult male vervet monkeys (Cercopithecus aethipos) increased when they were fed with an atherogenic Western-type of diet. No cases occurred in females and rapid diagnosis is necessary to prevent lethal consequences.

Mycotoxic peripheral myelinopathy, myopathy, and hepatitis caused by Diplodia maydis in vervet monkeys

During recent historical times many Africans changed their diet to one based on maize. The grain is regularly contaminated by fungi which are toxigenic to domestic animals and birds. After one of the fungi, Diplodia maydis, in pure culture on maize, was added to the food of omnivorous primates there was demyelination of nerves, atrophy, degeneration and necrosis of muscle, and hepatitis. These preliminary results are applicable to veterinary and laboratory animal sciences. They may also be medically significant since neuromuscular syndromes of unknown cause are prevalent among Africans. Nerve conduction velocities and organ weights are defined for vervet monkeys.

Atherosclerosis. Chronic effects of fish oil and a therapeutic diet in nonhuman primates

Prolonged testing of marine fish oil (FO) as a dietary supplement is necessary because of widespread claims that it is antiatherogenic. The basis for such claims is inadequate because atherogenesis is chronic and may not respond to short-term changes induced by dietary treatments. A proven (vervet) model of atherosclerosis promoted by an atherogenic diet (AD) was used to test dietary supplementation with Atlantic pilchard FO for 20 months in 47 omnivorous nonhuman primates. Responses were controlled against known favorable effects of changing from the AD to a therapeutic diet (TD). Compliance was achieved, and tissue responses to the FO dose were confirmed. Compromise of reflex vasoconstriction by atherosclerosis was demonstrated for the first time in the model. Aortic, peripheral, coronary, and cerebral atherosclerosis were assessed by light microscopy and computerized image analysis. No component of atherosclerosis regressed after dietary FO, and several deteriorated. After a change to the TD, stainable lipid was cleared from aortas and there were few lipophages, but advanced atherosclerosis was not reduced. Male vervets developed more severe atherosclerosis than did females, and the association among aortic, peripheral, and coronary atherosclerosis was positive in males. Females were resistant to coronary atherosclerosis. Only mild cerebral atherosclerosis was detected. In conclusion, the FO used was not antiatherogenic in the model, and there is a need for caution. The TD regresses some components of atherosclerosis, but it was not effective against fibrosis, mineralization, and cholesterol crystals within 20 months.

Effect of ethanol on semen characteristics of vervet monkeys

The effect of alcohol on spermatogenesis and sperm morphology has been of interest to many andrologists. Six adult male vervet monkeys were utilized to evaluate the effect of ethanol on semen quality. A decrease of the percentage of normal spermatozoa was observed after 10 months of exposure to alcohol.

Adverse drug reaction monitoring in Mississippi home health care agencies

A statewide survey of home health care agency directors in Mississippi was conducted to determine the extent of Adverse Drug Reaction (ADR) monitoring and reporting by health care professionals. A 24-item questionnaire was sent to agency directors eliciting responses on agency characteristics, rate of occurrence of ADRs, and attitudes toward responsibility for monitoring ADRs. A total of 77 questionnaires were returned yielding a response rate of 48%. The average program enrolled 104 patients with 3.5 ADRs reported by health care professionals per year (range 0-65). Agency directors reported that physicians, nurses, pharmacists, and members of the pharmacy and therapeutics committee should monitor ADRs. Results indicated a need for all health-care professional involved in home health care to increase their ADR monitoring and reporting activities.

Meta-analysis of correlates of diabetes patients' compliance with prescribed medications

This study quantitatively integrated the results of independent research papers containing correlates of objectively measured diabetes patients' compliance with prescribed medications. A total of 183 correlations were extracted from 26 studies. Separate meta-analytic syntheses were conducted to calculate average correlations for different subsets of studies, each of which represented homogeneous results. In general, emotional stability, internal and external motivations, perceived benefit, and supportive structure were positively associated with patients' compliance; perceived barriers and negative social environment were correlated with poor compliance. The directions of relationships of knowledge and age with compliance varied, depending on other study characteristics.

Biodistribution of 131I-radiolabelled plasma low density lipoprotein in hyperlipidaemic vervet monkeys

Low density lipoprotein (LDL) labelled with 131I has been administered to 6 Vervets 2 of which were high responders to an atherogenic Western diet in terms of plasma cholesterol, 2 were low responders and 2 were fed a high carbohydrate control diet. The ratio of hepatic to cardiac activity was recorded for up to 10 days after administration of the labelled LDL. Liver activity had a longer biological half life in the high-responders and this can be interpreted in terms of a variation of hepatic metabolism of LDL, with direct relevance to the human situation.

Increased peripheral lymphocytes, lymphoid hepatitis and anaemia in African vervet monkeys seropositive to retroviruses

Wild-caught African Vervet monkeys are commonly infected by Simian T-lymphotropic virus I (STLV1) and Simian immunodeficiency virus (SIV), yet the natural histories of these infections are largely unknown. Seropositivity was associated with increased total, T and atypical lymphocytes. In seropositive females there was mild, normocytic, normochromic anaemia. Lymphoid hepatitis was present in seven seropositive cases. African Vervets used in biomedical research, vaccine production and organ transplantation research are often infected by exogenous retroviruses which can be oncogenic and immunosuppressive in captive monkeys. Elimination of these infections may be possible by breeding Vervets in captivity.

Semen characteristics of vervet monkeys

Semen samples (91) from 47 vervet monkeys were collected by electroejaculation over a 2 year period. Seventy-eight of these were from 37 singly caged males of unknown fertility and 13 from 10 breeding males of known fertility. Mean values for semen characteristics of the singly caged males were: volume 0.45 ml, pH 7.8, concentration 184 x 10(6)/ml, forward progression rating 2.95 (scale 0-4), motility 55.4%, live 68% and abnormal morphology 3.5%. Mean values for semen characteristics for the breeding males were: volume 0.86 ml, pH 9.00, concentration 117.15 x 10(6)/ml, forward progression rating 3.00 (scale 0-4), motility 43.6%, live 53.3% and abnormal morphology 6%. Semen volumes in the singly caged males were lower than the volumes reported in other studies.

Plasma low density lipoprotein composition in relation to atherosclerosis in nutritionally defined Vervet monkeys

An atherogenic diet (AD) consisting entirely of normal foods for westernized people was fed to female Vervet monkeys for 4 years. The plasma low density lipoprotein (LDL) cholesterol pool was increased and progression of atherosclerosis was enhanced by the AD compared to a more prudent Western diet. The increased LDL-cholesterol was carried by a 3-fold increase in particles of relatively normal composition and not by packing cholesterol esters into the cores of enlarged LDL particles, as has been reported after feeding semisynthetic diets loaded with extra cholesterol. Nevertheless, these LDL particles were atherogenic. The AD changed the fatty acid composition of LDL-cholesterol esters and triacylglycerol, notably by increasing arachidonic and reducing linoleic acid. Multivariate analysis showed that measures and scores of atherosclerosis were significantly dependent on sphingomyelin and phosphatidylcholine in LDL and on arachidonic acid in LDL-triacylglycerol. Although apolipoprotein B, free cholesterol, esterified cholesterol and lysophosphatidylcholine in plasma LDL and atherosclerosis were significantly positively correlated in bivariate analysis they were not selected by multivariate analysis as the strongest determinants of atherogenesis. Cholesterol in plasma high density lipoprotein was not changed by the AD and lecithin:cholesterol acyltransferase activity in plasma was inversely linked to atherosclerosis. Subcutaneous fatty acids reflected dietary fatty acids.

Anaphylactic reaction secondary to a medication administration error in a patient receiving intravenous antibiotics

The occurrence of either medication administration errors or adverse drug reactions (ADRs) in hospitalized patients are well documented events. The combination of the two sequelae to drug therapies can lead to potentially life threatening episodes. In the case reported here, a medication administration error led to an ADR which threatened the life of a 12-month-old boy. The patient was receiving doses of cefotaxime sodium and nafcillin sodium, and was inadvertently administered a dose of cefoxitin sodium through a nursing staff medication administration errors. The patient experienced marked flushing; pitting edema, tachycardia, and a rapid respiration rate. Wheezing was absent. The patient recovered spontaneously after discontinuance of the inappropriately administered cefoxitin sodium dose, and discontinuance of cefotaxime sodium as well. Pharmacists must remain diligent in the review of the drug use process in institutions. Appropriate reconstitution, labeling, and dispensing of prescribed IV medications does not necessarily lead to appropriate administration of the drug. Pharmacy staff reviewal of the medication administration process must be carried out in conjunction with the nursing staff to ensure appropriate drug use. Patient and professional alike will benefit from such actions.

Low density lipoprotein kinetics in African Green monkeys showing variable cholesterolaemic responses to diets realistic for westernised people

African Green (vervet) monkeys were fed either an atherogenic Western diet (WD), a prudent diet (PD), or a high carbohydrate diet (HCD) for various lengths of time. Monkeys differed greatly in their response to the WD, and a strong negative correlation was observed between the fractional catabolic rates (FCR) of low density lipoprotein (LDL) and the total plasma cholesterol concentrations (r = -0.83 P = 0.0029). Similarly the individual synthetic rates (SR) of LDL plotted against the total plasma cholesterol concentrations showed a correlation coefficient of r = 0.94 P = 0.01 for WD animals. There was no correlation for PD or HCD animals for either SR or FCR and the total plasma cholesterol concentrations. The aortic lesion scores correlated with the SRs (r = 0.66 P = 0.040) but not with the FCRs. LDL turnover was also studied using 125I-labelled native LDL and methylated 131I-labelled LDL in African Green monkeys showing high or low cholesterolaemic response to an atherogenic Western diet. Measurements after 4 weeks and again after 6 months on the diet showed a decrease in both total and non-receptor mediated clearance of LDL. Receptor-mediated catabolism was significantly lowered in the hyperresponding group (P = 0.0011) and not in the hyporesponding group with a resultant significant difference between the two groups being P = 0.0355 after 6 months. Non-receptor mediated catabolism of LDL was similarly affected in that there was no significant difference between the two groups at 4 weeks but the clearance of methylated LDL was markedly lowered at 6 months, for the hyporesponding group P = 0.0003 and for the hyperresponding group P = 0.0184. Furthermore the hyperresponding group was depressed to a significantly greater extent when compared to the hyporesponding group (P = 0.0241).

Pharmacists' views about health promotion practices

A mail survey was conducted among a sample of 1,115 Mississippi pharmacists. The survey instrument included 25 statements concerning personal health practices which the respondents were asked to rate, using a Likert scale, on their importance to the health of an average person. Only one item, "Avoidance of alcohol altogether," received a mean score in the unimportant range. The item rated highest was "Taking prescriptions exactly as prescribed." Paradoxical attitudes concerning cigarettes and vitamins are discussed.

Reporting of adverse drug and biologic reactions in Mississippi hospitals

There can be no doubt of the therapeutic need for adverse drug reaction (ADR) monitoring in hospitals. In addition, JCAHO requirements mandate the maintenance of concurrent ADR monitoring programs. In order to obtain data pertaining to ADR reporting in hospitals in Mississippi, a survey of statewide hospital-pharmacy directors was conducted. Respondents indicated the average number of ADRs reported to the pharmacy departments was 19.2 ADRs per year. An average of 2.2 ADRs were forwarded to the FDA yearly. Respondents who had recently (since 1984) undergone JCAHO inspection agreed to a greater extent than others that it was the P & T Committee's responsibility to monitor ADRs. The results indicate a need for other health professionals in hospitals to monitor and report ADRs. In addition, submission of ADRs to the FDA must occur to a greater extent than presently is occurring.

The pathology of chronic Drechslera campanulata toxicosis in inbred rats

Cultures on autoclaved maize of the phytopathogenic fungus, Drechslera campanulata, were incorporated into diets and fed to male inbred BDIX rats. In a pilot trial, a diet containing 30% D. campanulata culture material killed 5 out of 5 rats in 15-25 days. Lesions included gastric corpus erosions, gastrorrhagia and ulcerative typhlitis. Diets containing 5% or 10% culture material induced erosive to ulcerative typhlitis and oedema and hyperplasia of the ileocaecal lymph nodes in 40 out of 40 rats. Other changes included: mass loss; normocytic, hyperchromic anaemia; leukocytosis with neutrophilia; reductions in plasma proteins, creatinine, calcium and cholesterol; elevated serum enzymes; hepatosis, nephrosis and mycoplasma-like interstitial pneumonia. No lesions were present in control rats, and their profiles were normal. Ulcerative typhlitis induced by D. campanulata in rats resembles that seen in chronic piperonyl butoxide intoxication as well as that due to single treatments of indomethacid, although small intestinal ulcers are more frequent in the latter. Overgrowth of intestinal flora may be involved in ulcer pathogenesis. The pathology of drechsleratoxicosis in rats is compared to that in sheep and goats where necrotic lesions in the forestomach and, to a lesser extent, in the caecum are characteristic findings.

Predictors of patient satisfaction with pharmacy services in a health maintenance organization

In a study of Health Maintenance Organization (HMO) patients, five variables were shown to be predictive of patient satisfaction with pharmacy services through multiple regression analysis. The variables of satisfaction with the HMO in general, convenience of prescription filling, self-assessed positive health status, communication between provider and patient, and the view of prescription drugs as being inexpensive accounted for 26.4% of the variance in patient satisfaction with HMO pharmacy services. The results suggest areas in which attention should be directed toward maintenance of patient satisfaction with pharmacy services, especially when considering that patients may have the option of utilizing in-house or out-of-plan pharmacies for services. The authors suggest administrators of HMOs, pharmacy directors, and out-of-plan vendor pharmacists should periodically assess HMO pharmacy patient satisfaction.

Estimating demand for health information: pharmacy counseling services

Consumers want more information about their health care. Before giving more information, health care providers need valid, reliable estimates of the amounts consumers will pay for health information. Using the example of pharmacist counseling services, the authors demonstrate a method for developing, estimates of consumer demand for health information.