RT-PCR comparative study of viral load levels in the HIV positive population in Puerto Rico before and after protease inhibitor regimen implanted

Ponce School of Medicine AIDS Research Program conducted a large scale viral load assessment of Puerto Ricans who are infected by human immunodeficiency virus type 1 (HIV-1) during the summer of 1996 through the Roche ACCESS program before general implementation of combination therapy. Since January 1997, it has monitored those HIV-1 patients who are under treatments at most HIV-1 health care clinics, including both public and private. The present study was conducted to evaluate how the new treatment has generally impacted on the HIV-1 disease status of HIV-1 infected population in the eight Immunology Clinics. Assessment was made by consecutively monitoring the changes in HIV-1 viral load profiles of the population from January to September, 1997. A large majority of samples were delivered for viral load assessment without information of their treatment status, and only a small number of samples were identifiable either as baseline or followup. Despite the paucity of individual information, remarkable improvements of HIV-1 (+) population at large were evident. For example, in the summer of 1996 (ACCESS), population median viral load was 51,842; only 9% of the population had viral load less than 500 viral RNA copies/ml plasma and 72% had over 10,000 copies/ml. By July-September, 1997, the population median dropped to 8,679 (83%); 23% were below 500 copies/ml (+156%) and the proportion of patients who had over 10,000 copies/ml was reduced to 48% (-33%). The group of individuals who were positively identified as "follow-up" (i.e., under active treatment) had a median of 37128 copies/ml (-94%); 28% were below 500 copies/ml (+211%) and only 40% had more than 10,000 copies/ml (-44%). It is obvious that the implementation of triple combination therapy by PASET in 1997, has very markedly improve the HIV-1 disease status of HIV-1 (+) population in Puerto Rico.     

A review of methodologies for assessing drug effectiveness and a new proposal: randomized database studies

The need to evaluate the effects of health technologies in clinical practice is increasingly important. In this article, we review the advantages and limitations of naturalistic randomized clinical trials (RCTs) and database analyses, the two primary methods for evaluating treatment effectiveness. Also, we comment on a newer research strategy, cross-design synthesis, which proposes the complementary use of both experimental RCTs and observational database methodologies to avoid the main weaknesses of each: respectively, the lack of external and internal validity. Finally, we propose a new strategy--randomized database studies--capable of generating results with an acceptable balance between internal and external validity. This strategy consists of the simultaneous use of both experimental and observational tools in the assessment of drugs' effectiveness. Randomization is essential to minimize comparison bias, and one possibility for such studies is that randomization modules could be included in computer-based patient records. Although we identify some of the difficulties in implementing the process, the progressive standardization of clinical practice and the development and widespread adoption of improved computer-based patient records could facilitate the use of randomized database studies as a new method of research.     

Mass chemotherapy for intestinal Taenia solium infection: effect on prevalence in humans and pigs

Mass treatment of the human population with niclosamide was carried out in 2 villages in rural Guatemala where Taenia solium was endemic, to determine how this would affect the epidemiology of the parasite. Intestinal taeniasis was diagnosed by microscopy and coproantigen testing, and porcine cysticercosis by a specific Western blot. Before mass treatment, the prevalence of human taeniasis was 3.5%; 10 months after treatment it was 1%, a significant decrease (P < 10(-4)). All tapeworms that could be identified to the species level were T. solium. Similarly, the seroprevalence of antibodies to cysticercosis in pigs declined from 55% before treatment to 7% 10 months after treatment, once again a significant decrease (P < 10(-6)). These effects were seen in both villages. The possible use of mass chemotherapy as a tool in the control of T. solium is discussed.     

B-lymphoproliferative disorders in patients with hepatitis C virus infection

Blastomycosis is an endemic systemic fungal infection that usually involves the lungs and superficial skin. Although head and neck involvement has been reported in the literature, no previous cases of neck mass resulting from direct extension of a pulmonary lesion have been published. We encountered an immunocompetent 31-year-old woman with a rapidly enlarging subcutaneous neck mass and a chronic upper lung infiltrate. Imaging studies showed contiguity between both lesions. Blastomyces dermatitidis was recovered from the sputum, and typical yeast was observed in fungal stains of needle aspirate from the neck mass. The patient responded favorably to a 6-month course of itraconazole. Blastomycosis should be considered in patients with subcutaneous neck masses in areas where this disease is endemic.     

Progressive scoliosis with vertebral rotation after lumbar intervertebral disc herniation in a 10-year-old girl

A case report of a 10-year old girl with a herniated disc is presented. The most significant symptoms were progressive scoliosis with a flat back and paravertebral muscle spasm. An absent H reflex on the left and an increased latency of the somatosensory-evoked potentials of the left posterior tibial nerve were found. The computed tomographic scan of the lumbar spine showed a large central left-sided disc protrusion at the L5-S1 level. Our case presents the youngest patient with documented intervertebral disc herniation and the only one with severe scoliosis and vertebral rotation. The curve was not structural because it improved with surgery and an orthosis was not necessary.     

Bladder psoas hitch. Report of 11 cases

Bladder psoas hitch is an surgical technique which, in very complicated cases, like repeated failures of vesico-ureteral re-implants or undiversions, allow us to bridge the shortness of the ureter and obtain a good vesico-ureteral reimplant. The surgical maneuver is described and several of the 11 cases operated by this technique are commented. The results are presented.     

A preliminary study on the status of invasive palm squirrels in Oman

ABSTRACT

Palm squirrels of the genus Funambulus are reported as invasive in the Sultanate of Oman for the first time. These squirrels have been recorded in seven locations in northern Oman contributing to a total of 11 records. Seven records were of the Five-striped northern palm squirrel, Funambulus pennantii (Wroughton, 1905) and species identification was indeterminate for four records. Funambulus pennantii was supposed to be the only species in United Arab Emirates (UAE), but here evidence is shown for the presence of the Three-striped Indian palm squirrel, Funambulus palmarum (Linnaeus, 1776) in Ras Al Khaimah. So, there is a possibility that this species may also occur in Oman. These palm squirrels are feeding on the fruits of Ziziphus spina-christi (L.) Desf. and the date palm, Phoenix dactylifera (L.) Mill. There is an indication that these species could become pests on date palms. Their abundance is low at present in Oman, but they are well established in the adjacent UAE from where sustained invasion is possible. They are also available through pet shops in Oman. The invasion of Oman by the palm squirrels is in its infancy and strategies should be formulated to eradicate/control them as a matter of priority.     

Adsorption of gold-thiourea complex on activated carbon

The adsorption kinetics of the gold-thiourea complex on activated charcoal was studied. Experimental runs were made in a batch reactor at constant temperatures and stirred by a magnetic system. Samples were taken at different periods of time and were analyzed for gold in a Perkin-Elmer Model 360 atomic absorption spectrophotometer. The samples were prepared with synthetic solution of gold with thiourea, sulfuric acid, and iron sulfate with concentrations similar to the ones in the leaching process. The gold adsorbed on activated charcoal was 99% at 20°C. The adsorption behavior was characterized by the Freundlich model at different temperatures (20°C, 35°C and 50°C).     

Measurement and specification of the colors of the polychromatic roof of the altamira cave

Color measurements were carried out in September, 1981, and again in January, 1982, on a total of 102 color zones in 12 different figures in the polychromatic roof of the Paintings Room of the Altamira Cave. The comparative study was carried out to evaluate any seasonal variations in reflectance and color between these two months, in which the humidity of the rock base for the paintings differs widely. No differences outside of experimental error were found.     

Manometric study of the effects of experimental fundoplication in rats

BACKGROUND: The manometric effects of surgical repair of gastroesophageal reflux remain largely unknown, making the interpretation of the changes in the esophagogastric high pressure zone after fundoplication difficult. AIM: To measure in a murine model the transdiaphragmatic pressure gradients, intraabdominal esophageal length, and lower esophageal sphincter pressure and length after Nissen fundoplication. MATERIAL AND METHODS: Adult Wistar rats were divided into two groups Control group (n = 10): in which measurements were made after laparotomy and intraabdominal esophageal dissection. Nissen Group (n = 15): in which measurements were made at baseline, after fundoplication and 1 week after surgery. We considered the following variables: end-inspiratory and end-expiratory transdiaphragmatic gradient (TDIG and TDEG respectively), lower esophageal sphincter pressure (LESP) length (LESL), and length of the intraabdominal segment of the esophagus (LIAS). RESULTS: The LIAS increased significantly after esophagogastric dissection in the control group (11.38 +/- 3.22 mm vs 16.02 +/- mm, p < 0.05). No differences between pre- and postoperative status were found in TDIG, TDEG, LESP and LESL in the control group. However, LESP increased significantly after fundoplication (14.22 +/- 13.3 vs 32.96 +/- 7.8 mmHg, p < 0.05) and these differences were still present one week later (30.72 +/- 6.73 mmHg, p < 0.05). LESL was also increased (1.91 +/- 1.76 mm vs 7.68 +/- 1.83 mm) after fundoplication (p < 0.05), and reached 7.02 +/- 2.18 mm (p < 0.05) 1 week later. No differences were found in pre- and postoperative TDIG, TDEG and LIAS in the Nissen Group. CONCLUSION: In this murine experimental model, intraabdominal esophageal dissection increased the length of the intraabdominal esophagus without modifying the esophagogastric high pressure zone, while Nissen fundoplication increased lower esophageal sphincter pressure and length, without modifying the length of the intraabdominal esophagus or the transdiaphragmatic pressure gradients.