bluuebunny/crossref_metadata_2025 huggingface dataset:
Is suboptimal phlebotomy technique impacting on potassium results for primary care?
Authors: Bailey Ian R , Thurlow Vanessa R
Published: June 2008

Background

Pre-analytical problems causing pseudohyperkalaemia have been highlighted previously. These include transit time and temperature effects when sample collection points are geographically widely spread. Similarly, inappropriate phlebotomy technique (in particular, requesting patients to fist clench to facilitate venesection) is a documented cause of pseudohyperkalaemia, but its incidence may be impossible to establish. This study illustrates how primary care population serum potassium data altered when local phlebotomy clinics optimized their technique.

Methods

The effect of improving phlebotomy was studied by plotting average monthly primary care population serum potassium data and average percentage of samples with hyperkalaemia (5.2 mmol/L or higher) against mean monthly temperature before and after changes in phlebotomy practice. Only samples from primary care were included between 2002 and 2005 inclusive.

Results

Primary care population serum potassium was inversely related to ambient temperature. Following the change in phlebotomy practice, the annual percentage of results above reference range (5.2 mmol/L or higher) was reduced from 9% to 6% and the number of results breaching the upper telephoning threshold (5.8 mmol/L or higher) fell from 0.9% to 0.5%.

Conclusions

Ensuring that phlebotomists were trained to avoid facilitating venesection by requesting patients to hand grip (fist clench), was associated with lower mean serum potassium results for the primary care patient population and a reduced incidence of hyperkalaemia. It is likely that the contribution of patient fist clenching during phlebotomy to pseudohyperkalaemia has been underestimated.
Identification of phosphotyrosyl proteins in vitreous humours of patients with vitreoretinal diseases by sodium dodecyl sulphate–polyacrylamide gel electrophoresis/Western blotting/matrix-assisted laser desorption time-of-flight mass spectrometry
Authors: Mukai Noriko , Nakanishi Toyofumi , Shimizu Akira , Takubo Takayuki , Ikeda Tsunehiko
Published: June 2008

Background

It is important to explain target proteins for the understanding of the pathogenesis of vitreoretinal diseases. In a previous study, we identified more than 100 proteins including seven angiogenic-modulated factors in vitreous humours (VHs). Although there have been many reports of expressed protein profiles in VHs, only a few of these are modified proteins, such as those undergoing phosphorylation and oxidation.

Methods

We applied Western blotting (WB), selective staining of phosphoproteins and mass spectrometry to detect and identify phosphoproteins in VHs of patients with vitreoretinal diseases. After the removal of albumin and immunoglobulins A/G in VHs, the proteins were separated by sodium dodecyl sulphate–polyacrylamide gel electrophoresis and reacted with anti-PY-20 monoclonal antibody on transfer membranes, and treated proteins were visualized with Phos-tag™ and identified by matrix-assisted laser desorption time-of-flight mass spectrometry (MALDI-TOFMS).

Results

WB analysis detected four positive bands, 20, 30, 35 and 55 kDa, in VHs of patients with vitreoretinal diseases. One of them, 55 kDa, was frequently detected in VHs of patients with macular hole (MH) and retinal detachment (RD), but the band was not found in patients with proliferative diabetic retinopathy (PDR). α-1 antitrypsin (α-1 AT) was identified in excised gel pieces of this band.

Conclusions

We identified five phosphorylated proteins such as α-1 AT in VHs of patients with vitreoretinal diseases by MALDI-TOFMS and WB analysis. Phosphotyrosyl α-1 AT was neither detected in PDR patients nor in any plasma. Phosphotyrosyl α-1 AT may be a new biomarker of MH and RD.
A rare cause of Cushing's syndrome demonstrates analytical discrepancies between the Roche E170 and Bayer Centaur testosterone assays
Authors: Hancock Sian , Still Rachel A , Fielding Andrew M , Doran John F , Stephens Jeffrey W
Published: June 2008

The initial biochemical investigations of a female patient with suspected Cushing's syndrome revealed abnormal endocrine results, including a marked elevation of serum testosterone. Overnight and low-dose dexamethasone suppression tests confirmed the diagnosis of Cushing's syndrome. Imaging investigations revealed an appearance compatible with adrenocortical carcinoma with metastases in the lungs and liver. This tumour is a rare cause of Cushing's syndrome. Two different automated testosterone immunoassays were used during the investigation of this patient, and analytical discrepancies in the patient's testosterone results were found. The two assays used, as well as potential causes of the difference in results will be discussed.
Intermittent ovarian and thyroid failure and spontaneous twin pregnancy
Authors: Mehta Shweta , Wang Tim
Published: June 2008

Intermittent failure of two endocrine systems is unusual and presents diagnostic and management challenges. We report a case of a young woman with intermittent thyroid and ovarian failure who had spontaneous twin gestation four years after the diagnosis of premature ovarian failure was made. This case demonstrates coincidental biochemical and clinical thyroid and ovarian failure both of which spontaneously resolved with no treatment, although subsequently irreversible hypothyroidism ensued after the initial recovery. Elevated gonadotrophins with a menopausal pattern on more than one occasion, in an amenorrhoeic patient with menopausal symptoms, usually indicates permanent ovarian failure. This case demonstrates that this may not be true and while this is probably a rare occurrence, clinicians need to be aware of this possibility. It also re-emphasizes the need to consider the clinical picture when interpreting biochemical results.
The determination of the 99th centile level for troponin assays in an Australian reference population
Authors: Tate Jillian R , Ferguson Wendy , Bais Renze , Kostner Karam , Marwick Thomas , Carter Andrew
Published: June 2008

Background

Current guidelines for the diagnosis and risk assessment of patients presenting with myocardial infarction recommend a single decision cut-off point for cardiac troponin (cTn) based on the 99th centile of a reference population. The 99th centile level for eight troponin assays was determined in an apparently cardio-healthy Australian reference population.

Methods

Nine laboratories measured troponin in serum and plasma collected from 111 reference individuals. An imprecision profile was determined using up to 10 serum samples analysed on 10 separate days. Method comparison using 100 routinely tested plasma samples was performed to estimate method concordance.

Results

Generally 99th centile values determined in this study were lower than, or the same as manufacturers' levels, except for cTnI by Architect (0.020 vs. 0.012 μg/L), and imprecision at the 99th centile was 20% coefficient of variation (CV) or higher. Troponin concentrations at 10% CV were greater than those quoted in the manufacturer's package insert except by AxSYM, 0.06 vs. 0.16 μg/L cTnI, and by E-170, 0.02 vs. 0.03 μg/L cTnT. In the method comparison 74, 70, 65, 75, 58, 66, 58 and 77 samples measured by Access, Architect, AxSYM, Centaur, Dimension RxL, E-170, i-STAT and Vitros ECi assays, respectively, had troponin concentrations above the study 99th centile.

Conclusions

Depending on the selected reference population for troponin, there is likely to be variability in the 99th centile as shown in this study. Some differences in sample concordance at the 99th centile cut-off were observed between cTn methods and may result in different clinical classification.
Two-year stability of NT-proBNP in frozen samples using the Roche Elecsys system
Authors: Cauliez B , Guignery J , Marinier S , Mariau I , Lavoinne A
Published: June 2008

Background

The in vitro stability of N-terminal (NT)-proBNP (brain natriuretic peptide) at room temperature and at 4°C is excellent and has been well studied. However, less is known concerning its stability after a long-term frozen storage. This notion could be of major interest in the context of clinical evaluations.

Methods

NT-proBNP was measured on 97 heparinized samples before and after a two-year frozen storage (−20°C) using the Roche Elecsys system.

Results

There is a slight but significant decrease of NT-proBNP concentration after frozen storage. However, this decrease is <10% for more than 90% of the samples and the maximum decrease is 16%. Moreover, values on frozen samples are well correlated with values on fresh samples ( r = 0.99) using the following equation: NT-proBNPstored sample = 0.93 NT-proBNPfresh sample + 81. A similar equation was found in lower concentrations (NT-proBNP ≤ 2000 ng/L).

Conclusions

These data show that NT-proBNP can be stored for at least two years at −20°C before measurement without a substantial loss of immunoreactivity.
Polymorphism of Trp64Arg in β3-adrenergic receptor gene and serum LDL-cholesterol concentrations in healthy Japanese
Authors: Kotani Kazuhiko , Sakane Naoki , Kurozawa Youichi , Kaetsu Akihiko , Okamoto Mikizo , Osaki Yoneatsu , Kishimoto Takuji
Published: June 2008

Background

Polymorphism of Trp64Arg in the β3-adrenergic receptor (β3-AR) gene may play a critical role in lipid and lipoprotein metabolism by mediating lipolysis and thermogenesis. Since the frequency of Arg alleles of the β3-AR gene is generally low among many populations, studies on the Arg/Arg genotype in relation to lipid and lipoprotein metabolism are required in countries such as Japan which has a relatively high frequency of the Arg allele.

Methods

We genotyped 275 clinically healthy Japanese (male/female, 134/141, mean 45.7 years) without medication for β3-AR gene polymorphism by polymerase chain reaction–restriction fragment length polymorphism analysis, and investigated the effects of the gene polymorphism on clinical parameters including body mass index (BMI), blood pressure and serum lipid and lipoprotein concentrations.

Results

The genotype frequencies were: Trp/Trp, 68.0%; Try/Arg, 28.0% and Arg/Arg, 4.0%, with an allele frequency of 0.18 for Arg64. When subjects were divided into three groups according to the genotype, a significant increase of serum LDL-cholesterol (LDL-C) concentration in the Arg/Arg group (3.48 ± 1.59 mmol/L) was observed when compared with those of the Trp/Trp and Arg/Trp groups (3.15 ± 0.80, 3.25 ± 0.92 mmol/L, respectively). Genotype differences did not show any significant effect on other parameters. Spearman's rank correlation demonstrated a significant relationship between LDL-C concentrations and the number of Arg alleles, age and BMI. Multiple regression analysis, using LDL-C concentration as a criterion variable and some factors including β3-AR gene polymorphism as explanatory variables, revealed that the number of Arg alleles was a significant and independent factor for LDL-C concentrations, along with age and BMI.

Conclusions

These findings suggested a role of the β3-AR gene polymorphism in regulating lipid and lipoprotein metabolism, showing small but significant effects on elevated LDL-C values in subjects with Arg/Arg, but not Trp/Arg and Trp/Trp genotypes.
Predictors of first and second dose acceptance of hepatitis B vaccine among STD clinic patients
Authors: Zimet Gregory D , Perkins Susan M , Winston Yvette , Kee Romina
Published: June 2008

Our goal was to identify attitudinal, behavioural and pragmatic factors predictive of receipt of the first and second doses of hepatitis B virus (HBV) vaccine. In this study, 431 adult sexually transmitted disease clinic patients with no reported history of prior HBV vaccination or infection completed a computer-assisted questionnaire, then were offered free HBV vaccine. Those who accepted were scheduled for follow-up doses. Twenty-nine percent received the first dose of vaccine. Of these individuals, 21% returned for the second dose. Seven participants received all three doses. Health beliefs and caring for three or more children predicted first dose acceptance. Less travel time to the clinic and caring for two or fewer children predicted return for the second dose. HBV vaccination rates were low in this study. Interventions designed to modify health beliefs may increase first dose uptake. Increases in receipt of subsequent vaccine doses might best be accomplished through approaches designed to decrease pragmatic barriers to vaccine access.
AIDS stigma among inmates and staff in a USA state prison
Authors: Derlega Valerian J , Winstead Barbara A , Brockington James E
Published: June 2008

We examined AIDS stigma among male inmates and male and female staff at a state prison in the southern region of the USA. Inmates and staff rated people with AIDS more negatively than someone with other diseases (diabetes, cancer, heart disease and high blood pressure). Inmates and staff were concerned about being treated differently if they tested seropositive. They also described AIDS stigma as a barrier to seeking HIV testing. Both instrumental (inaccurate beliefs about casual contact causing transmission of the virus) and symbolic factors (negative attitudes about injection drug use) predicted AIDS stigma. Negative attitudes about homosexuality predicted AIDS stigma among Caucasian prison staff and inmates, but not among African American staff and inmates. The results indicate the need to address HIV/AIDS stigma in developing HIV treatment, care and prevention programs in the prison environment.
Herpes simplex virus seroprevalence among children, adolescents and adults in Greece
Authors: Papadogeorgakis H , Caroni C , Katsambas A , Pimenta J M , Avdeliodi C , Kotrotsou T , Frangoulis E , Smith J S
Published: June 2008

The aim was to study the type-specific seroprevalence of Herpes simplex virus (HSV)-1 and HSV-2 infections and the associated risk factors in children, adolescents and adults in Greece. A total of 1867 serum samples from children, adolescents and adults of both genders aged from 0 to 60 years were collected from three large hospital-referral centres in Athens. All sera were tested for type-specific antibodies to HSV-1 and HSV-2 using HerpeSelect IgG ELISA tests (Focus Diagnostics Cypress, Cal, USA). Overall age-adjusted seroprevalence of HSV-1 and HSV-2 was 72.0% and 10.2%, respectively. HSV-1 seropositivity was low in children up to nine years of age, increased sharply in adolescence, and was higher in females than males in each group surveyed. HSV-2 seropositivity was low (0.8%) below 20 years of age and increased to a maximum prevalence of 18.7% in men and 22.7% in women. Multivariate risk factor analyses indicated that HSV-1 seropositivity was associated with socioeconomic indicators (e.g. lower educational level, residency outside greater Athens), whereas HSV-2 was associated with sexual behavioural factors (e.g. being divorced, greater number of lifetime sexual partners). HSV-2 risk factor profiles were similar in women and in men. This first large seroprevalence study in Greece showed a high age-standardized HSV-1 seropositivity after adolescence and a relatively low age-standardized HSV-2 seroprevalence from birth to 60 years of age. Dual seropositivity to HSV-1 and HSV-2 was low (0.6%) in females under 20 years of age, suggesting that the potential use of an HSV-2 prophylactic vaccine in adolescents could reduce the spread of HSV-2 infection.
Pharmacoepidemiological Approach to the Predisposing Factors for Highly Active Antiretroviral Therapy Failure in an Hiv-Positive Cohort from Cordoba City (Argentina) 1995–2005
Authors: Soria E A , Cadile I I , Allende L R , Kremer L E
Published: June 2008

Highly active antiretroviral therapy (HAART) restores immunity, avoids resistance and delays disease progression. Nonetheless, adverse medicament reactions (AMRs) and therapeutic failure (TF) are still deleterious events. Consequently, their predisposing factors should be evaluated. Data from 181 men and 28 women of an Argentinean cohort (1995–2005) were collected and analysed by logistic regression, studying 63 schemes (15 active principles). The AMRs were the main cause of scheme change, followed by TF and medicament simplification, without influence of age and sex. Twenty-nine schemes exhibited TF at least once. Compared with zidovudine–lamivudine–nevirapine (success: >75%), the following schemes fail more frequently (P < 0.01): pre-HAART (8-fold), indinavir-containing ones (30-fold) and retrotranscriptase inhibitors with ≥3 protease inhibitors (11-fold). Inadequate patient adherence preceded failure (>95%), but not successful treatments, with a strong AMR–TF association (P < 0.005). Although some schemes had inherently increased TF, low adherence, drug toxicity and TF were critically interrelated, interfering with HAART goals.
Drug addiction is not an independent risk factor for oncogenic human papillomavirus infections or high-grade cervical intraepithelial neoplasia: case-control study nested within the Latin American Screening study cohort
Authors: Syrjänen K , Naud P , Derchain S , Roteli-Martins C , Longatto-Filho A , Tatti S , Branca M , Eržen M , Hammes L S , Matos J , Gontijo R , Sarian L , Bragança J , Arlindo F C , Maeda M Y S , Lörincz A , Dores G B , Costa S , Syrjänen S
Published: June 2008

Drug abuse (addiction) has been listed among the risk factors for human papillomavirus (HPV) infections, but no case-control studies exist to rule out sexual behaviour and other potential confounders. The aim of this study is to evaluate the role of drug addiction as an independent predictor of HR-HPV infections and (cervical intraepithelial neoplasia) CIN2+ in an age-matched case-control (1:4) study nested within the prospective Latin American Screening (LAMS) study cohort. All 109 women in the LAMS cohort (n = 12,114) reporting drug abuse/addiction were matched with four controls (n = 436) of non-abusers strictly by age. Conditional logistic regression analysis was used to estimate the co-variates of drug abuse, and the whole series (n = 545) was analysed for predictors of HR-HPV and CIN2+ using univariate and multivariate regression models. Oncogenic HPV infections were significantly (P = 0.019) more prevalent among abusers (37.7%) than in controls (21.9%), but there was no difference in high-grade squamous intraepithelial lesions (P = 0.180) or CIN2+ lesions (P = 0.201). In multivariate conditional logistic regression, number of lifetime sexual partners (P = 0.0001), ever smokers (P = 0.0001), non-use of OCs (P = 0.013), ever having sexually transmitted diseases (STD) (P = 0.041) and no previous Pap smear (P = 0.027) were independent co-variates of drug addiction. Drug abuse was not an independent risk factor of high-risk (HR)-HPV infection, which was significantly predicted by (1) age below 30 years (P = 0.045), (2) more than five lifetime sexual partners (P = 0.046) and (3) being current smoker (P = 0.0001). In multivariate model, only HR-HPV infection was an independent risk factor of CIN2+ (P = 0.031), with adjusted OR = 11.33 (95% CI 1.25–102.50). These data indicate that drug addiction is not an independent risk factor of either HR-HPV infections or CIN2+, but the increased prevalence of HR-HPV infections is explained by the high-risk sexual behaviour and smoking habits of these women.
Fever of unknown origin in patients with HIV infection in Thailand: an observational study and review of the literature
Authors: Kitkungvan Danai , Apisarnthanarak Anucha , Plengpart Panarat , Mundy Linda M
Published: June 2008

Fever of unknown origin (FUO) is a common presentation for patients with advanced human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS). We prospectively followed 72 patients, consecutively admitted to a Thai regional hospital with FUO and HIV infection to identify aetiologies and mortality in the era of available antiretroviral therapy (ART). Aetiologies of FUO were identified in 67 patients (93%), of whom 61 (85%) had an infectious aetiology. The most common infectious aetiologies were Mycobacterium tuberculosis (n = 30; 42%), Cryptococcus neoformans (n = 17; 24%), Pneumocystis jiroveci (n = 9; 13%), Toxoplasma gondii (n = 5; 7%), and salmonella bacteraemia (n = 5; 7%). Nineteen patients (26%) had co-infection with two or more pathogens. The median CD4 count was 120 cells/mm3 (range, 1–581 cells/mm3), and the all-cause mortality was 22% (n = 16). By multivariate analysis, inadequate antimicrobial treatment was the sole predictor of mortality (aOR = 4.9; 95% CI = 1.2–21.9; P = 0.02). Overall, 58 of 72 patients (81%) had an opportunistic infection suggesting that guideline use of ART and prophylactic strategies remain unmet needs that will benefit individuals and populations with HIV/AIDS in Thailand.
Audit into Blood-Borne Virus Services in Her Majesty's Prison Service
Authors: Murray E , Jones D
Published: June 2008

The main objective of this study is to assess current hepatitis C services for female prisoners. The study design includes a retrospective audit of inmates’ contact with blood-borne virus (BBV) services and outcomes of service use. The study was carried out at a prison for women in the north of England with 179 prisoners and 69 service users. The outcome measures were proportions in contact with services and outcomes of service use (time to testing/treatment; proportion positive for hepatitis C; HIV status). Almost a quarter of those arriving at the prison have contact with BBV services; most of them report a history of intravenous drug use (75.4%), although one-fifth of such individuals decline testing. The average number of days from imprisonment to testing was 86-half this time if arriving since October 2006. Fifty percent were positive for the hepatitis C antibody, the majority of whom (83.3%) had an active virus and were suitable for treatment. The average number of days from testing to referral was 38. All tested for HIV were negative. Therefore, efficiency is necessary if prisoners are to access BBV services while incarcerated. This is being achieved, although some delays still occur.
Child Sexual Abuse and Sexually Transmitted Infections: Review of Joint Genitourinary Medicine and Paediatric Examination Practice
Authors: Kawsar M , Long S , Srivastava O P
Published: June 2008

Joint examination by doctors with complementary skills and screening for sexually transmitted infections (STIs) are recommended in children who may have been sexually abused or have been found to have an STI. Our study showed that criminal proceedings were more likely to be brought in cases with physical signs of sexual abuse. It could be difficult to prove whether sexual abuse had taken place or not with microbiological evidence alone, in the absence of other evidence. Significance of viral STIs in the context of sexual abuse should be evaluated carefully. The review of our practice re-enforced the importance of joint examination of children with suspected STIs.
Successful management of prenatal hydrops fetalis in a mother with HIV
Authors: Davis James , Fernando J J Rufus
Published: June 2008

The incidence of human immunodeficiency virus (HIV) in pregnancy worldwide is increasing. We have more invasive diagnostic and therapeutic abilities in feto-maternal medicine, creating a dilemma in our management of these pregnancies. Do we aggressively manage them with the risks of vertical transmission or do we try to avoid invasive interventions? In this case, the fetus of a 36-year-old immigrant with HIV is diagnosed with hydrops fetalis. The patient's viral load was 5800 copies/mL, therefore, early intervention was unwise. Optimal HIV management, combined with referral to a specialist feto-maternal medicine unit, regular ultrasound scans and insertion of a pleuroamniotic shunt when the viral load was low, resulted in the delivery of an HIV-negative baby with excellent outcome for both mother and baby.
Azithromycin vs. benzathine penicillin G for early syphilis: a meta-analysis of randomized clinical trials
Authors: Bai Zheng-Gang , Yang Ke-Hu , Liu Ya-Li , Tian Jin-Hui , Ma Bin , Mi Deng-Hai , Jiang Lei , Tan Ji-Ying , Gai Qiong-Yan
Published: June 2008

The World Health Organization estimates that at least 12 million people are infected with syphilis in the world. Southeast Asia accounts for 5.8 million; Africa accounts for 3.5 million. There has been controversy in using the two kinds of antibiotics for early syphilis. A systematic review comparing these antibiotics could affect treatment guidelines. The aim of this study was to evaluate the efficacy and safety of azithromycin vs. penicillin G benzathine for early syphilis and a meta-analysis to compare these two kinds of antibiotics for early syphilis. Four randomized controlled trials met the inclusion criteria; 476 patients were evaluated for their cure rate. Cure rates were 95.0% (227/239) for azithromycin and 84.0% (199/237) for penicillin G benzathine. After pooling the data, the difference in efficacy was computed. Cure rate (OR = 1.37), 95% CI (1.05, 1.77) and the risk difference for cure rate between the two drugs were statistically significant. Although the gastrointestinal adverse effect of azithromycin is five times more than the adverse effect of penicillin G benzathine, the differences are not significant. Azithromycin achieved a higher cure rate than penicillin G benzathine in a long follow-up.
Optione: Innovative Model of HIV Care Increases Satisfaction and Reduces Clinic Visits
Authors: Coyne K M , Kerley A , Mandalia S , Mcowan A G
Published: June 2008

OptionE incorporates nurse-led HIV clinics, review of blood results by doctors, patient contact by email and the option of home delivery of medication. Patient questionnaires showed increased satisfaction associated with fewer, shorter clinic visits. A retrospective case note review suggested clinical outcomes are as good as standard care.
SMS STI: A Review of the Uses of Mobile Phone Text Messaging in Sexual Health
Authors: Lim Megan S C , Hocking Jane S , Hellard Margaret E , Aitken Campbell K
Published: June 2008

Short messaging service (SMS) (a.k.a. text messaging) is a fast, low cost and popular mode of communication among young people, and these advantages can be used in a variety of ways in the field of sexual health. This paper reviews the current published and grey literature and discusses applications of SMS in sexual health and the evidence base for their effectiveness. Examples of uses of SMS in sexual health include: communication between sexual health clinics and patients, partner notification and contact tracing, contraception reminders and sexual health promotion and education. However, although SMS has been applied in many ways to improve sexual health and there is some evidence of its effectiveness, very few of the applications described in this article have been evaluated. As SMS is likely to become more and more commonly used for sexual health purposes, evaluation of its benefits and effectiveness is essential.
Bangladesh Moves from Being a Low-Prevalence Nation for Hiv to One with a Concentrated Epidemic in Injecting Drug Users
Authors: Azim T , Rahman M , Alam M S , Chowdhury I A , Khan R , Reza M , Rahman M , Chowdhury E I , Hanifuddin M , Rahman A S M M
Published: June 2008

Bangladesh has been conducting annual serological surveillance for HIV and syphilis since 1998 among most at-risk populations including sex workers, males having sex with males, injecting drug users (IDUs) and heroin smokers. During the seventh round conducted between January and June 2006, 10,368 people were sampled and the overall HIV prevalence was 0.9%. The highest HIV rate was recorded in male IDUs from the capital city Dhaka (7%), and the rates have risen significantly over the rounds (P < 0.001). In Dhaka, most of the HIV-positive IDUs (10.5%) were localized in one neighbourhood, while in the remaining neighbourhoods 1% were positive (P < 0.001). In all other groups, HIV prevalence was P < 0.001). Bangladesh has to act urgently to prevent escalation of the epidemic.
Field Evaluation of Simple Rapid Tests in the Diagnosis of Syphilis
Authors: Nessa Khairun , Alam Anadil , Chawdhury Faisal Arif Hasan , Huq Mohsina , Nahar Shamsun , Salauddin Gazi , Khursheed Shayema , Rahman Saifur , Gurley Emily , Breiman Robert F , Rahman Motiur
Published: June 2008

The aim of this study was to detect the sensitivity and specificity of rapid syphilis diagnostic tests (immunochromatographic strip [ICS] test and rapid test device [RTD]) performed by low-skilled paramedics in field clinics and by highly-skilled technologists in laboratories and compare them with the gold standard (rapid plasma reagin [RPR] and Treponema pallidum haemagglutination [TPHA]) tests for diagnosis of syphilis. A cross-sectional study was conducted among female sex workers (FSWs) in Dhaka, Bangladesh, from August 2004 to July 2005. Blood specimens were tested for syphilis using (i) ICS, (ii) RTD, (iii) RPR tests performed by low-skilled paramedics; and (i) ICS, (ii) RTD, (iii) RPR and (iv) TPHA tests by highly-skilled technologists. The sensitivity and specificity of the ICS and RTD test performed by low- and highly-skilled personnel were compared with the gold standard. A total of 684 FSWs were enrolled and the prevalence of syphilis among FSWs was 20.8% as determined by the gold standard. There was no significant difference in the performance of ICS test done by paramedics in the field when compared with the gold standard performed by highly-skilled technologists in the laboratory (sensitivity, 94.45%; specificity, 92.6%). The ICS test could fulfil the need for a non-invasive, rapid screening test for syphilis.
Temporary external lumbar drainage for reducing elevated intracranial pressure in HIV-infected patients with cryptococcal meningitis
Authors: Manosuthi Weerawat , Sungkanuparph Somnuek , Chottanapund Suthat , Tansuphaswadikul Somsit , Chimsuntorn Sukanya , Limpanadusadee Putthiporn , Pappas Peter G
Published: June 2008

The aim of this study was to investigate safety and impact of temporary external lumbar drainage for continuous release of cerebrospinal fluid among patients with HIV-associated cryptococcal meningitis and elevated intracranial pressure (ICP). We conducted a retrospective cohort study among patients with cryptococcal meningitis in whom temporary external lumbar drains were placed to reduce intractable elevated ICP between January 2002 and December 2005. Patients were followed for three months after the procedure. Among 601 HIV-infected patients with cryptococcal meningitis, 54 (8.9%) underwent lumbar drain placement. Of these patients, mean age was 33 years and 80% were males. The median duration of an indwelling lumbar drain was seven days. There were 61 placement procedures among 54 patients, totalling to 473 device-days of observation. Overall incidence of secondary bacterial infections was 6.3 per 1000 device-days, and three (4.9%) of 61 catheters became secondarily infected with nosocomially acquired bacteria. All three drains were removed and appropriate antibiotics were given. There was no difference in median duration of placement between infected and uninfected drains (six days vs. seven days, P = 0.572). The overall mortality rate was 5.6% in this cohort of 54 patients. In conclusion, the incidence of nosocomial infection of external lumbar drains is low. In resource-limited settings, the use of temporary external lumbar drainage is a safe and effective management strategy for intractable elevated ICP in HIV-infected patients with cryptococcal meningitis.
HIV in prisons: the London experience
Authors: Natha M , Kegg S , Spice W , Hadfield J , Kelly B , Lau R , Pakianathan M
Published: June 2008

The commissioning of health services for all prisoners in publicly run prisons in England was transferred to local Primary Care Trusts in April 2006, pledging to provide an equivalent standard of health care as that in the community. We reviewed our experience of providing a specialist in-reach HIV service by performing a retrospective case notes review of all HIV-positive prisoners who accessed care from the prison genitourinary medicine service in three London prisons. A total of 112 HIV-positive prisoners were seen by the prison health-care service between April 2004 and 2006. This is the first study to look at how well HIV services are being provided during this transitional period of commissioning health services and provides insight into the challenges facing prison health-care providers. Good HIV outcomes are possible in prison but frequent transfers within the prison system and lack of effective HIV training among prison staff represent barriers to good care.
Increased resistance of Streptococcus pneumoniae isolates to antimicrobial drugs, at a referral hospital in north-west Ethiopia
Authors: Erqou Sebhat , Kebede Yenew , Mulu Andargachew
Published: June 2008

SUMMARY

Beta lactam antibiotics were very effective against Streptococcus pneumoniae. However, resistance to this class of antibiotics has become an increasing problem. Reports of penicillin resistant and multidrug resistant strains are being made in many parts of the world. We examined the drug sensitivity pattern of S. pneumoniae isolates in a retrospective analysis of laboratory records of S. pneumoniae isolates between March 2001 and April 2005 at Gondar University Hospital, Ethiopia. A significant proportion of the isolates were found to be resistant to one or more of the commonly used antibiotics. Furthermore, the isolates appear to be acquiring an increasing resistance to crystalline penicillin, cotrimoxazole and ampicillin. This situation needs immediate attention.
An overnight sedimentation method: improving the diagnosis of tuberculosis when electrical centrifuge is not available
Authors: Rasheed M U , Dechu Tsegaye
Published: June 2008

SUMMARY

An experimental comparative study was conducted in order to compare the positivity pattern of sputum microscopy using the direct and overnight sedimentation Ziehl-Neelsen (ZN) smears, direct and NaOCl pretreated centrifuged ZN smears and overnight sedimentation and NaOC1 pretreated centrifuged ZN smears methods. We examined 660 sputum smeared slides for the presence of acid-fast bacillus from 220 sputum samples. Compared with the direct microscopy method, positivity increased by 91.1% after centrifugation ( P < 0.001, χ2 = 18.27) and by 71.1% after overnight sedimentation ( P < 0.001, χ2 = 11.61). No statistical significant difference was observed between the results of two different concentration techniques ( P > 0.05, χ2 = 0.789).

The application of overnight sedimentation (in a laboratory without electricity) and/or the centrifugation technique could make a positive impact on the effectiveness of national tuberculosis control programmes.
Of ‘microbes’ and ‘millet’: the practice of tea tea in northern Uganda
Authors: Westerhaus Michael Jon , Zabulon Yoti
Published: June 2008

SUMMARY

In northern Uganda, incisions called tea tea are commonly placed on the chests of children outside of the biomedical setting to relieve respiratory distress. To better characterize tea tea, we administered a questionnaire to 224 caretakers, whose children had evidence tea tea cuts. In 148 cases (66.4%), the grandparents made the decision to have the cuts performed, at times against the wishes of the caretakers. One seventy-six (80.0%) of the patients were seen by a medical professional just prior to receiving the cuts. Traditional healers and grandmothers, respectively, performed the cuts in 164 (73.5%) and 42 (18.8%) cases. Caretakers paid at least 500 USh (US$0.29) for tea tea in 129 cases (57.8%) and nothing in 71 cases (31.4%). This study shows that tea tea is a healing practice with associated costs that is regularly advocated for and performed by grandmothers and traditional healers.
Herba Artemisiae annuae tea preparation compared to sulfadoxine-pyrimethamine in the treatment of uncomplicated falciparum malaria in adults: a randomized double-blind clinical trial
Authors: Blanke Christoph H , Naisabha Godson B , Balema Mussa B , Mbaruku Godfrey M , Heide Lutz , Müller Markus S
Published: June 2008

SUMMARY

Tea preparations from the herb Artemisia annua L. (Aa) which is used in traditional Chinese medicine might offer an inexpensive way of producing artemisinin drugs locally. We compared Aa with sulfadoxine-pyrimethamine (SP) in the treatment of uncomplicated falciparum malaria in semi-immune adults. After seven days, the cure rate was 7/10 for the Aa compared to 7/9 for SP; this dropped to 4/10 for Aa and 4/9 for SP at day 14 and to 1/9 for Aa and 3/8 for SP at day 28.
Reduction of hepatitis B seroprevalence in blood banking units by combined utilization of self-exclusion forms and clinical evaluation of blood donation candidates in Turkey
Authors: Yenicesu Idil , Dilsiz Günter , Öztürk Gülyüz
Published: June 2008

SUMMARY

In this retrospectively designed study, we evaluate the influence of the permanence and qualifications of health-care professionals on blood disposal rates due to hepatitis seropositivity. We observed a decrease of 44.2% in the number of blood units being rejected due to the donor's hepatitis B seropositivity in the second study period in which self-exclusion forms and where blood donation candidates were evaluated by a family physician. However, a similar decrease of the disposal rate due to hepatitis C seropositivity was not observed. This is especially important in countries which cannot afford many of the expensive modern laboratory tests. A comprehensive evaluation of self-exclusion forms and a brief examination prior to donation will greatly increase transfusion safety. Unfortunately, there are blood banks in Turkey which employ no physicians at all.
Drug substitution therapy: a new approach in preventing the spread of HIV/AIDS in Malaysia
Authors: Razali S M
Published: June 2008

SUMMARY

The prevalence of HIV/AIDS among drug addicts in Malaysia is high, especially among intravenous drug users. The present treatment and rehabilitation of drug addiction is considered as a failure. The government finally decided to start on Drug Substitution Therapy in early 2005 as an effort to prevent the spread of HIV/AIDS in the country.
External ophthalmomyiasis by oestrus ovis: an unknown endemic eye disease in rural parts of central India
Authors: Misra S , Misra N , Reddy B
Published: June 2008

SUMMARY

Although much general information has accumulated about ocular myiasis, there are very few reports about the same amongst the Indian population. We present a case series, comprising of 13 documented cases of external ophthalmomyiasis due to Oestrus ovis, detected at regular intervals in a small geographical area of rural central India, which strongly indicated the presence of a previously unknown endemic eye disease of this region.
Chikungunya: a review
Authors: Jain Manisha , Rai Sumit , Chakravarti Anita
Published: June 2008

SUMMARY

The Chikungunya virus (CHIKV) is a mosquito-borne Alphavirus, which causes epidemics of fever, rash and polyarthralgia in Africa and Asia. First isolated in 1953 in Tanzania, CHIKV has caused numerous well-documented outbreaks and epidemics in both Africa and South-East Asia. The epidemic of Chikungunya fever that affected the population of La Reunion at Christmas in 2005 will be remembered as the most serious public health crises in the island's history. A widely circulating mutant CHIKV is a possible explanation for the epidemiological pattern of the disease in this region. In this review, we have tried to give the latest information about the present outbreak and have tried to analyse the possible reasons for the same.
A two-level ultrasonographic service in a maternity care unit of a rural district hospital in Tanzania
Authors: Stein W , Katunda I , Butoto C
Published: June 2008

SUMMARY

Ultrasonography has been shown to improve obstetric management in sub-Saharan Africa. This study demonstrates that basic ultrasonography can be performed by midwives and that a two-level ultrasonographic service in the maternity care unit of a rural sub-Saharan district hospital is feasible.
Prong sign: a simple measure to enhance safety of laparoscopic sterilization
Authors: Puri Manju , Pasrija Shikha , Trivedi S S
Published: June 2008

SUMMARY

Laparoscopic female sterilization is widely practiced and is very safe. However, mesosalpingeal tears and mesosalpingeal haematomas are common complications especially when performed by an inexperienced surgeon. It was found that the observation of a simple ‘prong sign’ could prevent these complications and possibly reduce failure rates.
Training needs, practices and barriers in the work of community reproductive health workers in Masindi district, Uganda
Authors: Martinez R , Vivancos R , Visschers B , Namatovu L , Nyangoma E , Walley J
Published: June 2008

SUMMARY

Community reproductive health workers play a valuable role in family planning counselling and the distribution of contraceptive methods in rural communities. However, they face stigma, misconceptions and a lack of support. Regular supervision by health workers and support from community leaders can help address these issues.
Epidemiological shift, seasonal variation and antimicrobial susceptibility patterns among enteric fever pathogens in south India
Authors: Vidyalakshmi K , Yashavanth R , Chakrapani M , Shrikala B , Bharathi B , Suchitra U , Dhanashree B , Dominic R M S
Published: June 2008

SUMMARY

Between January 2005 and December 2006, a higher incidence of paratyphoid fever (53.8%) compared to typhoid fever (44.9%) has been observed at a tertiary hospital in South India. A definite seasonal pattern of incidence is seen in paratyphoid fever (peak incidence during October–December, i.e., post monsoon period) but not in typhoid fever. Decreased fluoroquinolone susceptibility is much higher in S. Paratyphi A (98.8%) as compared to S. Typhi (46.5%). These findings are of importance in therapeutic decision making, development of vaccination strategies and implementing public health measures for disease control.
Cytotoxic effect of drugs eluted from polymethylmethacrylate on stromal giant-cell tumour cells
Authors: Savadkoohi D. Gouran , Sadeghipour P. , Attarian H. , Sardari S. , Eslamifar A. , Shokrgozar M. A.
Published: June 2008

Curettage and packing with polymethylmethacrylate cement is a routine treatment for giant-cell tumour (GCT) of bone. We performed an in vitro evaluation of the cytotoxic effect of a combination of cement and methotrexate, doxorubicin and cisplatin on primary cell cultures of stromal GCT cells obtained from five patients. Cement cylinders containing four different concentrations of each drug were prepared, and the effect of the eluted drugs was examined at three different time intervals.

We found that the cytotoxic effect of eluted drugs depended on their concentration and the time interval, with even the lowest dose of each drug demonstrating an acceptable rate of cytotoxicity. Even in low doses, cytotoxic drugs mixed with polymethylmethacrylate cement could therefore be considered as effective local adjuvant treatment for GCTs.
Closed reduction with traction for developmental dysplasia of the hip in children aged between one and five years
Authors: Rampal V. , Sabourin M. , Erdeneshoo E. , Koureas G. , Seringe R. , Wicart P.
Published: June 2008

The treatment of developmental dysplasia of the hip diagnosed after the first year of life remains controversial. A series of 36 children (47 hips), aged between one and 4.9 years underwent gradual closed reduction using the Petit-Morel method. A pelvic osteotomy was required in 43 hips (91.5%). The patients whose hips did not require pelvic osteotomy were among the youngest. The mean age at final follow-up was 16.1 years (11.3 to 32). The mean follow-up was 14.3 years (10 to 30).

At the latest follow-up, 44 hips (93.6%) were graded as excellent or good according to the Severin classification. Closed reduction failed in only two hips (4.3%) which then required open reduction. Mild avascular necrosis was observed in one (2.1%).

The accuracy of the reduction and associated low complication rate justify the use of the Petit-Morel technique as the treatment of choice for developmental dysplasia of the hip in patients aged between one and five years.
Elevated intraosseous pressure in the intertrochanteric region is associated with poorer results in osteonecrosis of the femoral head treated by multiple drilling
Authors: Lee M. S. , Hsieh P.-H. , Chang Y.-H. , Chan Y.-S. , Agrawal S. , Ueng S. W. N.
Published: June 2008

Multiple drilling is reported to be an effective treatment for osteonecrosis of the head of femur, but its effect on intra-osseous pressure has not been described. We undertook multiple drilling and recorded the intra-osseous pressure in 75 osteonecrotic hips in 60 patients with a mean age of 42 years (19 to 67). At a mean follow-up of 37.1 months (24 to 60), 42 hips (56%) had a clinically successful outcome. The procedure was effective in reducing the mean intra-osseous pressure from 57 mmHg (SD 22) to 16 mmHg (SD 9). Hips with a successful outcome had a mean pressure of 26 mmHg (SD 19). It was less effective in preventing progression of osteonecrosis in hips with considerable involvement and in those with a high intra-osseous pressure in the intertrochanteric region (mean 45 mmHg (SD 25)). This study is not able to answer whether a return of the intra-osseous pressure to normal levels is required for satisfactory healing.
Validation of orthopaedic bench models for trauma surgery
Authors: Leong J. J. H. , Leff D. R. , Das A. , Aggarwal R. , Reilly P. , Atkinson H. D. E. , Emery R. J. , Darzi A. W.
Published: June 2008

The aim of this study was to validate the use of three models of fracture fixation in the assessment of technical skills. We recruited 21 subjects (six experts, seven intermediates, and eight novices) to perform three procedures: application of a dynamic compression plate on a cadaver porcine model, insertion of an unreamed tibial intramedullary nail, and application of a forearm external fixator, both on synthetic bone models. The primary outcome measures were the Objective Structural Assessment of technical skills global rating scale on video recordings of the procedures which were scored by two independent expert observers, and the hand movements of the surgeons which were analysed using the Imperial College Surgical Assessment Device.

The video scores were significantly different for the three groups in all three procedures (p < 0.05), with excellent inter-rater reliability (α = 0.88). The novice and intermediate groups specifically were significantly different in their performance with dynamic compression plate and intramedullary nails (p < 0.05). Movement analysis distinguished between the three groups in the dynamic compression plate model, but a ceiling effect was demonstrated in the intramedullary nail and external fixator procedures, where intermediates and experts performed to comparable standards (p > 0.6). A total of 85% (18 of 21) of the subjects found the dynamic compression model and 57% (12 of 21) found all the models acceptable tools of assessment.

This study has validated a low-cost, high-fidelity porcine dynamic compression plate model using video rating scores for skills assessment and movement analysis. It has also demonstrated that Synbone models for the application of and intramedullary nail and an external fixator are less sensitive and should be improved for further assessment of surgical skills in trauma. The availability of valid objective tools of assessment of surgical skills allows further studies into improving methods of training.