An evaluation of a price transparency intervention for two commonly prescribed medications on total institutional expenditure: a prospective study

Providing feedback on cost has been demonstrated to decrease drug demand from clinicians. We conducted a prospective study with a step-wise intervention to test the hypothesis that providing information on the cost of drugs to clinicians would modify total expenditure. Participants included individuals who were admitted to the Royal Derby Hospital from -November 2013 to November 2015 under the care of physicians. The cost of all antibiotics and inhaled corticosteroids was added to the electronic prescribing system. The main outcome was the weekly cost for antibiotics and inhaled corticosteroids in the intervention period compared to baseline costs. Mean weekly expenditure on antibiotics per patient decreased by £3.75 (95% confidence intervals [CI] -6.52 to -0.98) after the intervention from a pre-intervention mean of £26.44, and then slowly increased subsequently by £0.10/week (95% CI +0.02 to +0.18). Mean weekly expenditure on inhaled corticosteroids per patient did not substantially change after the intervention (-£0.03, 95% CI -0.06 to -0.01 after the intervention from a pre-intervention mean of £5.29 per person). New clinical guidelines for inhaled corticosteroids were associated with a decrease in weekly expenditure, but provision of feedback on drug costs resulted in no sustained change in institutional expenditure. However, clinical guidelines have the potential to modify clinical prescribing behaviour.

Prospect of brain-machine interface in motor disabilities: the future support for multiple sclerosis patient to improve quality of life

Multiple sclerosis (MS) is an autoimmune neurological disorder, which has impacted health related quality of life (HRQoL) more intensively than any other neurological disorder. The approaches to improve the health standard in MS patient are still a subject of primary importance in medical practice and seek a lot of experimental exploration. The present review briefly explains the anomaly in neuron anatomy and dysfunction in signal transmission arising in the context with the chronic cerebrospinal venous insufficiency (CCSVI), a recent hypothesis related with MS pathophysiology. Subsequently, it insights brain-machine interface (BMI) as an alternative approach to improve the HRQoL of MS subjects. Information sources were searched from peer-reviewed data bases (Medline, BioMed Central, PubMed) and grey-literature databases for data published in 2000 or later. We also did systemic search in edited books, articles in seminar papers, reports extracted from newspapers and scientific magazines, articles accessed from internet; mostly using PubMed, Google search engine and Wikipedia. Out of approximately 178, 240 research articles obtained using selected keywords, those articles were included in the present study which addresses the latest definitions of HRQol and latest scientific and ethical developments in the research of MS and BMI. The article presented a brief survey of CCSVI mediated MS and BMI-approach as a treatment to serve the patients suffering from disabilities as a result of MS, followed by successful precedence of BMI approach. Apart from these, the major findings of selected research articles including the development of parameters to define HRQoL, types and development of BMIs and its role in interconnecting brain with actuators, along with CCSVI being a possible cause of MS have formed the foundations to conclude the findings of the present review article. We propose a perspective BMI approach and promises it holds for future research to improve HRQoL in MS patients. In addition, we propose that brain-computer interfaces will be the core of new treatment modalities in the future for MS disabilities.

Genotype-phenotype studies of VCP-associated inclusion body myopathy with Paget disease of bone and/or frontotemporal dementia

Valosin containing protein (VCP) disease associated with inclusion body myopathy, Paget disease of the bone and frontotemporal dementia is a progressive autosomal dominant disorder caused by mutations in Valosin containing protein gene. To establish genotype-phenotype correlations we analyzed clinical and biochemical markers from a database of 190 members in 27 families harboring 10 missense mutations. Individuals were grouped into three categories: symptomatic, presymptomatic carriers and noncarriers. The symptomatic families were further divided into ten groups based on their VCP mutations. There was marked intra and inter-familial variation; and significant genotype-phenotype correlations were difficult to establish because of small numbers. Nevertheless when comparing the two most common mutations, R155C mutation was found to be more severe, with an earlier onset of myopathy and Paget (p = 0.03). Survival analysis of all subjects revealed an average life span after diagnosis of myopathy and Paget of 18 and 19 years respectively, and after dementia only 6 years. R155C had a reduced survival compared to the R155H mutation (p = 0.03).We identified amyotrophic lateral sclerosis (ALS) was diagnosed in 13 individuals (8.9%) and Parkinson's disease in five individuals (3%); however, there was no genotypic correlation. This study represents the largest dataset of patients with VCP disease and expands our understanding of the natural history and provides genotype-phenotype correlations in this unique disease.

Placental histomorphology in unexplained foetal loss with thrombophilia

BACKGROUND & OBJECTIVES

Acquired and genetic thrombotic conditions, both organ and non organ specific, are associated with increased foetal wastage. This study was carried out to examine the placenta from women with abnormal pregnancies and a history of unexplained foetal loss, and to associate with maternal thrombophilia status.

METHODS

Placentas from eight women with history of unexplained foetal loss were analyzed for histopathological characteristics. All the women were simultaneously screened for the common acquired and genetic thrombophilia markers i.e., lupus anticoagulants ( LA), IgG / IgM antibodies for anticardiolipin (ACA), beta2 glycoprotein 1 (beta2GPI) and annexin V, protein C (PC), protein S (PS), antithrombin III (AT III), factor V Leiden ( FVL) mutation, prothrombin (PT) gene G20210A, methylene tetrahydrofolate reductase (MTHFR) C 677T, endothelial protein C receptor (EPCR) 23 bp insertion and plasminogen activator inhibitor ( PAI-1 4G/5G) polymorphisms

RESULTS

Six of eight women were positive for one or more thrombophilia markers. The placenta in all the cases except one, showed the characteristic features of infarct fibrin deposition and calcification. Among two women who were negative for thrombophilia, one showed clear evidence of thrombus in the placental sections while the other did not show any characteristic infarcts in the placental sections.

INTERPRETATION & CONCLUSION

Our findings showed that the histopathological examination of the placentas confirmed thrombophilia as the aetiological cause of thrombosis in 6 of the 8 women. The presence of thrombus in a negative thrombophilia woman suggests yet unidentified thrombophilia markers or probably non-haemostatic factors causing thrombosis.

Indoor air quality assessment in and around urban slums of Delhi city, India

The present study aims at investigating the indoor air quality (IAQ) in selected households in one of the urban slums i.e. the Nizamuddin slums in Delhi, the capital city of India. The study includes investigations and assessments on associated health effects on the occupants living in inefficiently designed houses having poor ventilation. The monitoring of indoor air pollutants e.g. the respirable suspended particulate matter (RSPM), the carbon dioxide (CO2), the carbon monoxide (CO), the sulphur dioxide (SO2) and the nitrogen dioxide (NO2) for all three seasons i.e. summer (April-June 2004), rainy (July-September 2004) and winter (December 2004-February 2005) have been conducted. In addition, the spirometry tests on the occupants, particularly the womenfolk and children have been performed to determine the incidence of acute respiratory infections (ARI). Questionnaire survey has also been conducted in the households during the study period to investigate the sick building syndrome (SBS). The study reveals maximum concentration of indoor air pollutants in households during winters (December 2004-February 2005) associated with aggravated respiratory problems like cough, phlegm, wheezing, and breathlessness among occupants particularly the women occupants. Besides, decrement in lung function indices (i.e. FVC and/or FEV1) due to increased concentrations of RSPM and CO2 indoors during winter period has also been observed in the women respondents. The study concludes that women and children indoors are most vulnerable to respiratory problems compared to other sexes. A high SBS score is observed in these 'urban poor' households because of inadequate ventilation.

PRACTICAL IMPLICATIONS

'High indoor airborne pollutants during winter are associated with respiratory problems for women and children in houses in urban slum in Delhi. The work demonstrated the need of further studies of indoor air quality for the 'urban poor' in developing countries.'

Indoor air quality assessment in and around urban slums of Delhi city, India

The present study aims at investigating the indoor air quality (IAQ) in selected households in one of the urban slums i.e. the Nizamuddin slums in Delhi, the capital city of India. The study includes investigations and assessments on associated health effects on the occupants living in inefficiently designed houses having poor ventilation. The monitoring of indoor air pollutants e.g. the respirable suspended particulate matter (RSPM), the carbon dioxide (CO2), the carbon monoxide (CO), the sulphur dioxide (SO2) and the nitrogen dioxide (NO2) for all three seasons i.e. summer (April-June 2004), rainy (July-September 2004) and winter (December 2004-February 2005) have been conducted. In addition, the spirometry tests on the occupants, particularly the womenfolk and children have been performed to determine the incidence of acute respiratory infections (ARI). Questionnaire survey has also been conducted in the households during the study period to investigate the sick building syndrome (SBS). The study reveals maximum concentration of indoor air pollutants in households during winters (December 2004-February 2005) associated with aggravated respiratory problems like cough, phlegm, wheezing, and breathlessness among occupants particularly the women occupants. Besides, decrement in lung function indices (i.e. FVC and/or FEV1) due to increased concentrations of RSPM and CO2 indoors during winter period has also been observed in the women respondents. The study concludes that women and children indoors are most vulnerable to respiratory problems compared to other sexes. A high SBS score is observed in these 'urban poor' households because of inadequate ventilation.

PRACTICAL IMPLICATIONS

'High indoor airborne pollutants during winter are associated with respiratory problems for women and children in houses in urban slum in Delhi. The work demonstrated the need of further studies of indoor air quality for the 'urban poor' in developing countries.'

Identification of Streptococcus gallolyticus subsp. macedonicus as the etiological agent in a case of culture-negative multivalve infective endocarditis by 16S rDNA PCR analysis of resected valvular tissue

Today, PCR using broad-range primers is being used increasingly to detect pathogens from resected heart valves. Herein is described the first case of multivalve infective endocarditis where 16S rDNA PCR was used to detect a single pathogen from two affected valves in a 61-year-old man. Triple heart valve replacement was required despite six weeks of appropriate antimicrobial therapy. The organism was confirmed as Streptococcus gallolyticus subsp. macedonicus, a member of the 'S. equinus/S. bovis' complex. To date, only one report has been made of human infection due to this organism. This may be due to the limited resolution of the routine diagnostic methods used and/or as a consequence of the complex nomenclature associated with this group of organisms.

Use of serial maternal urine cytomegalovirus PCR to detect primary CMV infection in seronegative pregnant women

The aim of the study was to determine if serial maternal urine polymerase chain reaction (PCR) tests can detect primary CMV infection during pregnancy. This was a prospective study conducted from 1 January 1999 to 31 December 1999 in an antenatal clinic setting of a teaching hospital. The study group included women who were CMV IgG negative and aged <30 years or had a pre-school child. They were invited to self-collect urine samples monthly and send them to the laboratory by post. Cord bloods were tested for CMV IgG to detect seroconversion. An anxiety questionnaire was sent to all study participants. At first attendance, 1549 (42%) women were CMV IgG negative. Of the 696 eligible women, 609 (88%) participated in the urine PCR study. PCR was performed on 2263 urine samples (median of 4/pregnancy). Primary CMV infection was identified in one woman by urine PCR at 36 weeks (baby CMV negative). Cord blood samples were available from 152/609 infants (25%). Seroconversion was noted in only one woman. Replies to the questionnaire were received from 264/609 women (43%): 214 (81%) had little or no anxiety, and 220 (83%) felt reassured by their study participation. Serial urine PCR is a feasible method of detecting primary maternal CMV infection during pregnancy which has potential for evaluation in further studies.

Sphenoid sinus mucocele with unilateral blindness

Mucoceles of the sphenoid sinus are rare and may frequently remain undiagnosed until symptoms due to compression of surrounding structures set in. In such cases, the optic nerve, because of its close proximity to the sphenoid sinus, is at risk, and pressure exerted by the mucocele may result in visual impairment. A case of a sphenoid sinus mucocele with sudden-onset unilateral blindness as the only presenting symptom has been described. Early diagnosis and prompt surgical intervention enabled the vision to be restored completely.

Antimicrobial therapy of methicillin resistant Staphylococcus aureus infection

Methicillin-resistant Staphylococcus aureus (MRSA) is now one of the commonest causes of nosocomial infection worldwide. The mainstay of treatment until now has been the glycopeptides (vancomycin and teicoplanin). They are not without toxicity and need parenteral administration and monitoring of levels. The increasing frequency of MRSA infections, coupled with the emergence of glycopeptide resistance in S. aureus has made the introduction of new drugs active against Gram-positive organisms essential. New agents active against Gram-positive organisms represent either genuinely novel classes of antimicrobials (e.g., oxazolidinones and lipoproteins) or those derived from existing classes (e.g., tetracyclines, glycopeptides, streptogramins and cephalosporins). Some of these newer antibiotics appear to be effective against multi-resistant organisms including MRSA.

Compensating for provider nonresponse using response propensities to form adjustment cells: the National Immunization Survey

OBJECTIVES

The National Immunization Survey (NIS) uses two phases of data collection to obtain vaccination information from a sample of young children: a random-digit-dialing (RDD) survey for identifying households with children 19-35 months of age, followed by a mail survey for obtaining provider-reported vaccination histories about these children. Provider-reported vaccination histories are used to estimate vaccination coverage rates. In 1998, provider-reported vaccination histories were not obtained for 32.9% of children with a completed RDD interview. This report describes the statistical methods adopted in 1998 to reduce the bias in vaccination coverage estimates that could result from "vaccination history nonresponse," that is, differences between children for whom provider data was obtained and those for whom it was not obtained.

METHODS

In the methods adopted in 1998, children with completed NIS RDD interviews are grouped into adjustment cells defined by their propensity to have adequate provider data. Sampling weights of children with adequate provider data are divided by the cell-specific weighted response rate to allow these children to represent all children in the cell.

RESULTS

Using an "optimal" number of cells, the overall extent of bias reduction was 0.5%, suggesting that provider nonresponse bias was small. Authoritative literature suggests using five cells. No statistically significant differences were observed in vaccination coverage estimates when comparing estimates based on the "optimal" number of cells with five cells. Thus, five adjustment cells are used to reduce provider nonresponse bias in the NIS vaccination coverage estimates. No substantively important differences were observed between estimates based on the methodology used prior to 1998 and the methodology adopted in 1998.

The role of ultrasound in the expectant management of early pregnancy loss

OBJECTIVE

To define the sonographic criteria which best determine the likelihood of successful expectant management of early pregnancy failure (EPF).

METHODS

Women with an ultrasound diagnosis of EPF at 7-14 weeks' gestation were offered the option of expectant management or surgical evacuation.

RESULTS

Five hundred and forty-five women had a diagnosis of EPF; 298 with incomplete miscarriage and 247 with missed miscarriage or an embryonic pregnancy. A total of 305 women opted for expectant management, with an overall success rate of 86%. The success rate for incomplete miscarriage (96%) was significantly better than that for missed miscarriage (62%).

CONCLUSION

This study demonstrates that EPF can be safely managed expectantly. Ultrasound has an invaluable role in predicting the likelihood of successful expectant management enabling patients to make an informed choice about their medical care.

Overview of the sampling design and statistical methods used in the National Immunization Survey

Abstract: The National Immunization Survey (NIS) is a large federally funded survey designed to estimate vaccination coverage rates for children residing in the United States aged 19 to 35 months. In 1999, over 8 million telephone call attempts were made to obtain provider-reported vaccination histories on 22,521 children in the age range of interest.

Food intake patterns and gallbladder disease in Mexican Americans

OBJECTIVE

Results of previous studies on diet and gallbladder disease (GBD), defined as having gallstones or having had surgery for gallstones, have been inconsistent. This research examined patterns of food intake in Mexican Americans and their associations with GBD.

DESIGN

Cross-sectional.

SUBJECTS

The study population included 4641 Mexican Americans aged 20-74 years who participated in the 1988-94 third National Health and Nutrition Examination Survey (NHANES III). GBD was diagnosed by ultrasound. Food intake patterns were identified by principal components analysis based on food frequency questionnaire responses. Component scores representing the level of intake of each pattern were categorized into quartiles, and prevalence odds ratios (POR) were estimated relative to the lowest quartile along with 95% confidence intervals (CI).

RESULTS

There were four distinct patterns in women (vegetable, high calorie, traditional, fruit) and three in men (vegetable, high calorie, traditional). After age adjustment, none were associated with GBD in women. However, men in the third (POR = 0.42, 95%CI 0.21-0.85) and fourth (POR = 0.53, 95%CI 0.28-1.01) quartiles of the traditional intake pattern were half as likely to have GBD as those in the lowest quartile.

CONCLUSIONS

These findings add to a growing literature suggesting dietary intake patterns can provide potentially useful and relevant information on diet-disease associations. Nevertheless, methods to do so require further development and validation.

Country of birth and prevalence of gallbladder disease in Mexican Americans

OBJECTIVES

This research sought to describe the association between country of birth and gallbladder disease (GBD) in Mexican Americans, identify subgroups at especially high risk, and identify risk factors that may mediate a birthplace-GBD association.

DESIGN

Cross-sectional.

METHODS

Our study population included 4157 Mexican Americans aged 20-74 who participated in the 1988-94 third National Health and Nutrition Examination Survey. GBD was diagnosed by ultrasound. Information on country of birth, education, income, and selected GBD risk factors was obtained from interviews. Prevalence odds ratios (POR) for GBD in Mexico- vs. US-born Mexican Americans were estimated by unconditional logistic regression, along with 95% confidence intervals (CI). To evaluate the extent to which GBD risk factors mediated the birthplace-GBD association, PORs for country of birth were compared in models with and without additional covariates.

RESULTS

Age-adjusted GBD prevalence was lower in Mexico- than in US-born Mexican-American women (POR = 0.70, 95% CI 0.50, 0.98) and men (POR = 0.63, 95% CI 0.40, 0.97). The difference was especially pronounced among subjects of lower socioeconomic status. Despite substantial differences in GBD risk factor distributions by birthplace, none could completely explain the prevalence difference.

CONCLUSIONS

The observation that GBD prevalence is higher among US-born Mexican Americans is consistent with research showing poorer health in this group. Further research is needed to identify strategies for reducing morbidity from GBD in Mexican Americans.

Prevalence and ethnic differences in gallbladder disease in the United States

BACKGROUND & AIMS

Gallbladder disease is one of the most common conditions in the United States, but its true prevalence is unknown. A national population-based survey was performed to determine the age, sex, and ethnic distribution of gallbladder disease in the United States.

METHODS

The third National Health and Nutrition Examination Survey (NHANES III) conducted gallbladder ultrasonography among a representative U.S. sample of more than 14, 000 persons. The diagnosis of gallbladder disease by detection of gallstones or cholecystectomy was made with excellent reproducibility.

RESULTS

An estimated 6.3 million men and 14.2 million women aged 20-74 years had gallbladder disease. Age-standardized prevalence was similar for non-Hispanic white (8. 6%) and Mexican American (8.9%) men, and both were higher than non-Hispanic black men (5.3%). These relationships persisted with multivariate adjustment. Among women, age-adjusted prevalence was highest for Mexican Americans (26.7%) followed by non-Hispanic whites (16.6%) and non-Hispanic blacks (13.9%). Among women, multivariate adjustment reduced the risk of gallbladder disease for both Mexican Americans and non-Hispanic blacks compared with non-Hispanic whites.

CONCLUSIONS

More than 20 million persons have gallbladder disease in the United States. Ethnic differences in gallbladder disease prevalence differed according to sex and were only partly explained by known risk factors.

Influence of ethnic origin on nuchal translucency screening for Down's syndrome

OBJECTIVE

To determine the influence of ethnic origin on access to and equity of nuchal translucency screening for Down's syndrome in a multiethnic population.

DESIGN

An observational study in a district general hospital with a large multiethnic population.

SUBJECTS

1944 women attending at a hospital antenatal clinic.

MAIN OUTCOME MEASURES

First-trimester fetal nuchal translucency measurements at 10-14 weeks in women from different ethnic groups.

RESULTS

The racial origin of the screened population was not significantly different from that of the population attending for initial antenatal examination. Multiple regression analysis showed a small but significant difference in nuchal translucency measurement between fetuses of different ethnic origin.

CONCLUSION

Nuchal translucency screening can be effectively and equitably delivered to a multiethnic population. Although there are significant differences in nuchal translucency measurement between ethnic groups, these differences are too small to require correction when nuchal translucency is used to screen for Down's syndrome.

The current status of methods for estimating the prevalence of human immunodeficiency virus in the United States of America

The prevalence of human immunodeficiency virus (HIV) infection can be estimated by two distinct methods. One method, back-calculation, is a complex statistical procedure that estimates the HIV epidemic curve. The second method is based on data from population-based surveys, which provide estimates of the proportion of persons infected with HIV within subgroups, and on the known or estimated population totals for these subgroups. Estimates from these methods are subject to substantial uncertainty and bias, both of which are difficult to quantify. We review recent use of these procedures to estimate HIV prevalence in the United States of America. We also summarize new data on the uncertainty and the bias in these estimates. Reliable estimates of HIV prevalence can be made only by synthesizing estimates from several procedures and by a comprehensive evaluation of relevant data. Future estimates of HIV prevalence will require modifications of these methods or the development of new methods.

Internalization of dengue virus-induced suppressor cytokine during transmission of the suppressor signal via macrophage

In dengue type 2 virus (DV)-induced suppressor T cell cascade TS1 cells secrete a suppressor cytokine (SF) which acts via syngeneic macrophages (M phi) to recruit TS2 cells. SF binds to both high and low affinity receptors (SF-R) on M phi. In the present study the fate of SF in M phi during transmission of suppressor signal is investigated. It was observed that SF bound to high affinity receptors internalized through receptor mediated endocytosis. This was inhibited by pretreatment of M phi with anti-SF-R-antiserum and didansylcadaverine, a potent inhibitor of endocytosis. Internalized SF was degraded by lysosomal activity as shown by inhibition of suppressor activity by pretreatment of M phi with monensin and NH4Cl. Degraded SF was transported to a site other than SF-R on M phi membrane for recruitment of TS2 cells. This was inhibited by anti-SF-antiserum. Transmission of suppressor signal is inhibited if M phi are treated first with H-2K-mAb and then with SF (shown earlier) but when M phi were treated first with SF and after 1 hr with H-2K-monoclonal antibody, the inhibition did not occur. As SF requires binding to H-2K and SF-R for mediation of suppression, the binding of H-2K occurred with degraded SF within the cell. Thus SF is internalized, degraded and binds to H-2K antigen before its recognition by native T cells.

Role of nitric oxide in transmission of dengue virus specific suppressor signal

Production of NO2- was maximum when peritoneal M phi was incubated with SF (40 mg) for 45 min. Pretreatment of M phi with anti-SF-antisera inhibited production of NO2- Pretreatment of M phi with NG monomethyl L-arginine (L-NMA) or arginase, an inhibitor of L-arginine dependent pathway, inhibited production of NO2- and transmission of suppressor signal in a dose-dependent manner. This indicates that NO and Ca2+ serve as intracellular signal in transmission of DV-induced suppressor signal.

Update on the seroepidemiology of human immunodeficiency virus in the United States household population: NHANES III, 1988-1994

To update the estimate of seroprevalence of HIV from the third National Health and Nutrition Examination Survey (NHANES III), data from the second phase of the survey were combined with previously published data to produce a more precise estimate. The testing was performed anonymously on 11,203 individuals 18-59 years of age examined from 1988 to 1994. Fifty-nine individuals were HIV positive, for an overall prevalence of 0.32%. The number of individuals living in households with HIV infection based on this estimate was 461,000, with a 95% confidence interval of 290,000-733,000. Analysis of nonresponse demonstrated that white and black men 40-59 years of age were least likely to participate in the survey. A sensitivity analysis demonstrated that this nonresponse may have biased the NHANES III estimate downward by 190,000 persons. Data from the second phase of the survey were used to analyze the association between drug use and HIV infection. Black women who used cocaine were 12 times more likely to be HIV positive compared with all tested black women (6.5% vs. 0.55%). This survey provides an estimate of HIV prevalence for individuals who reside in households but excludes some persons who are at higher risk for HIV infection, including prisoners and the homeless not residing in shelters.

Prevalence of HIV infection in the United States, 1984 to 1992

OBJECTIVE

To estimate the number of persons infected with the human immunodeficiency virus (HIV) living in the United States and the change in HIV infection prevalence since 1984.

DESIGN

We estimated HIV prevalence from 3 data sources. We estimated past HIV infection rates from a statistical procedure based on national acquired immunodeficiency syndrome (AIDS) case surveillance data and estimates of the time from HIV infection to AIDS diagnosis. We also analyzed HIV prevalence data from 2 national surveys, a survey of childbearing woman and a household survey of current health status. We used other data sources to adjust these survey estimates to include groups not covered in the surveys.

RESULTS

Approximately 0.3% of US residents (650,000-900,000 persons) were infected with HIV in 1992. Approximately 0.6% of men (including adolescent boys > or = 13 years of age) were infected, including approximately 2% of non-Hispanic black men and 1% of Hispanic men. Approximately 0.1% of women (including adolescent girls > or = 13 years of age) were infected, including approximately 0.6% of non-Hispanic black women. Approximately half of all infected persons were men who had sex with men, and one fourth were injecting drug users. The prevalence of HIV infection increased from 1984 to 1992, with a greater relative increase among women than men.

CONCLUSIONS

The 3 different data sources and methods are consistent in estimating that 650,000 to 900,000 persons were infected with HIV in the United States in 1992. Among adolescents and adults of both sexes, the proportion infected was substantially higher among non-Hispanic blacks and Hispanics than among non-Hispanic whites. HIV-related illness will be a major clinical and public health problem in the United States for years to come.

Transmission of dengue virus-specific suppressor signal depends on the presence of calcium

The present study was undertaken to investigate the role of calcium in the production of dengue type 2 virus (DV) induced suppressor cytokine (SF) and in transmission of the suppressor signal via syngeneic macrophage (M phi) to recruit the second subpopulation of suppressor T(TS2) cell. Effect of calcium channel blocking drugs, Verapamil and Nifedipine, on the production and activity of SF was investigated. The production of SF was inhibited in a dose dependent manner by the calcium channel blockers. The suppressor activity of SF was also inhibited by calcium channel blocking drugs. SF could not be produced when spleen cells were cultured in a calcium free medium, the production being restored on substitution with calcium chloride. Treatment of M phi with the calcium channel blockers inhibited the transmission of the suppressor signal from TS1 to TS2 cells in a dose dependent manner. The influx of calcium during transmission of the suppressor signal was studied by measuring the 45Ca uptake. Calcium channel blocking drugs inhibited the 45Ca uptake by T lymphocytes. Thus, presence of calcium is obligatory for the production and suppressor activity of SF and it plays a critical role in transmission of the suppressor signal.

The seroepidemiology of human immunodeficiency virus in the United States household population: NHANES III, 1988-1991

To provide an estimate of the seroprevalence of human immunodeficiency virus (HIV) in a representative sample of the U.S. household population, serum samples from participants in the third National Health and Nutrition Examination Survey (NHANES III) were tested for HIV antibody. The testing was performed anonymously on 5,430 individuals 18-59 years old from phase 1 of NHANES III conducted from 1988 to 1991. Twenty-nine individuals were HIV positive. The total weighted prevalence was 0.39%. The population estimate of infected individuals was 547,000, with a 95% confidence interval of 299,000-1,020,000 infected persons. Black participants were four times more likely to be HIV positive than white/other individuals and three times more likely than Mexican Americans. Men were three times more likely to be infected than women. Higher nonresponse to the survey and to phlebotomy was observed in young white men; therefore these data provide a conservative estimate of HIV infection in the general household population. This estimate does not include individuals who do not live in households and who may be at higher risk of infection, such as persons in penal institutions, the homeless, or certain hospitalized patients.

Determination of bone width in malnourished children under 5, and its inter relationship with mid arm muscle thickness, subcutaneous fat thickness and the mid upper arm girth

The mid upper arm of 516 malnourished children (one to five years) were studied radiographically for changes in bone width, muscle mass and subcutaneous fat, of malnutrition at different ages. The data was studied by statistical analysis, determining the correlation coefficients of each of the factors. The findings indicate that previous assumptions about the components and the changes of the mid upper arm girth (MUG) in chronic severe malnutrition, were perhaps too simplistic.

Poisoning in children--analysis of 250 cases

This study is an analysis of 250 cases over a period of 2 years, admitted to our hospital for various poisonings. The total incidence of poisoning was 11.9%, much higher as compared to the other series. Of these, 58.4% were seen in the age group of 1-4 years. Male to female ratio was 1.7:1. Incidence of food poisoning was 48.8% followed by that of kerosene (24%), pesticides (9.6%), chemicals and medicaments (8.4%), plant (3.6%) and animal bites (3.2%). Overall mortality was 0.8%.

Salmonella in surface waters of central New York state

Six tributary streams and southern Cayuga Lake in central New York state were sampled for the presence of Salmonella on swabs immersed for 4 days. Of a total of 322 swabs, 39% yielded salmonellae. Swabs were cultured in tetrathionate enrichment at 41.5 degrees C. Isolations were made from brilliant green agar. Salmonellae were isolated from many sites on the streams and from some lake sites. Twenty-five serotypes (11 somatic antigen groups) and a distinct biotype of S. typhimurium (H2S negative) were found. Most frequent isolates, in order of decreasing occurrence, were S. typhimurium, S. thompson, S. oranienburg, and S. enteritidis. Several uncommon isolates also appeared. When tested for mouse infectivity, the isolates generally showed little or no virulence. The incidence of clinical salmonellosis among humans was low in the area and the variety of serotypes had not been noted among cattle. The presence of Salmonella in waters ranging in classification from potable to agricultural and industrial indicated the existence of a low level and undefined reservoirs of the bacteria in the region.