Knowledge of the Genetic Information Nondiscrimination act among individuals affected by Huntington disease

The Genetic Information Nondiscrimination Act (GINA) of 2008 was the first US legislation to address genetic discrimination. We sought to assess understanding of GINA among individuals affected by the autosomal dominant condition, Huntington disease (HD). We conducted a cross-sectional survey of individuals with varying risk of HD to assess their familiarity with GINA. As a control, individuals were surveyed about their familiarity with the Health Insurance Portability and Accountability Act (HIPAA). Those who reported familiarity with GINA were asked about their knowledge of specific provisions of the legislation. The survey was offered to 776 participants and completed by 410 (response rate 53%). Respondents across all groups were less familiar with GINA (41% slightly, somewhat, or very familiar) than with HIPAA (65%; p < 0.0001). Of individuals with or at risk for HD who reported some familiarity with GINA, less than half correctly identified GINA's protections, and less than 15% correctly identified its limitations. Thus, among individuals affected by HD, familiarity with and knowledge of GINA are low. The effectiveness of the legislation may be limited by this lack of knowledge.

Erythropoietin for patients with malignant disease

BACKGROUND

Anaemia associated with cancer and cancer therapy is an important clinical factor in the treatment of malignant diseases. Therapeutic alternatives are recombinant human erythropoietin (EPO) and red blood cell transfusions.

OBJECTIVES

The aim of this systematic review was to assess the effect of erythropoietin to either prevent or treat anaemia in cancer patients.

SEARCH STRATEGY

We searched the Central Register of Controlled Trials, MEDLINE (01/1985 to 12/2001), EMBASE (01/1985 to 12/2001), other databases and reference lists of articles. We also contacted experts in the field and pharmaceutical companies.

SELECTION CRITERIA

Randomised controlled trials comparing the use of recombinant human erythropoietin (plus transfusion if needed) with red blood cell transfusions alone for the treatment or prevention of anaemia in cancer patients.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed trial quality and extracted data. All authors from included studies were contacted for additional information.

MAIN RESULTS

Twenty seven trials with 3,287 adults were included. Use of erythropoietin significantly reduced the relative risk of red blood cell transfusions (RR 0.67; 95% CI 0.62 to 0.73, 25 trials, n = 3,069). On average participants in the erythropoietin group received one unit of blood less than the control group (WMD -1.00; 95% CI-1.31 to -0.70, 13 trials, n = 2,056). For participants with baseline haemoglobin below 10 g/dL haematological response was observed more often in participants receiving EPO (RR 3.60; 95% CI 3.07 to 4.23, 14 trials, n = 2,347). There was inconclusive evidence whether EPO improves tumour response (fixed effect RR 1.36; 95% CI 1.07 to 1.72, seven trials, n = 1,150; random effects: RR 1.21; 95% CI 0.92 to 1.59) and overall survival (adjusted data: HR 0.81; 95% CI 0.67 to 0.99; unadjusted data: HR 0.84; 95% CI 0.69 to 1.02, 19 trials, n = 2,865). There were no statistically significant adverse effects. Evidence was inconclusive with respect to quality of life and fatigue.

REVIEWERS' CONCLUSIONS

There is consistent evidence that the administration of erythropoietin reduces the risk for blood transfusions and the number of units transfused in cancer patients. For patients with baseline haemoglobin below 10 g/dL there is strong evidence that erythropoietin improves haematological response. There is inconclusive evidence whether erythropoietin improves tumour response and overall survival. Research on side effects is inconclusive.

Initial observations on the efficacy of highly active antiretroviral therapy in the treatment of HIV-associated autoimmune thrombocytopenia

BACKGROUND

Immune thrombocytopenic purpura (ITP) occurs in as many as 40% of patients infected with the human immunodeficiency virus (HIV). We sought to evaluate the effect of highly active antiretroviral therapy (HAART) on platelet counts in such patients.

METHODS

Data collected from 11 homosexual men with HIV-associated ITP and < or = 50 x 10(9) platelets were analyzed after they were placed on HAART. At initial evaluation, 7 patients were antiretroviral naive, 2 were taking zidovudine alone, and 2 were receiving combination antiretroviral therapy for known HIV infection. For 6 patients with <30 x 10(9) platelets, prednisone was initially coadministered with HAART. The primary outcome measure was the platelet count response to HAART, which was measured weekly until counts had normalized on 3 consecutive occasions, then every 3 months while on HAART. Secondary outcome measures were HIV-viral RNA levels and CD4+ cell counts.

RESULTS

One month after the initiation of HAART, 10 evaluable patients had an increase in mean platelet count. This improvement was sustained at 6 and 12 months' follow-up for 9 of 10 evaluable patients. Increases in mean platelet count at 6 and 12 months of the 9 responders were statistically significant. The range of follow-up in the 9 responders is 21 to 46 months (median, 30 months), with no thrombocytopenic relapses. The 9 long-term platelet responders have been maintained on HAART and at 12 months had a mean reduction of > 1.5 log10 in HIV viral RNA serum levels and a marked improvement in CD4+ T-lymphocyte cell count.

CONCLUSION

HAART seems to be effective in improving platelet counts in the setting of HIV-associated ITP, enhancing CD4+ cell counts, and reducing HIV viral loads.

Optimisation of a polarised X-ray source for the in vivo measurement of platinum in head and neck tumours

There is a continuing need to improve the understanding of kinetics of platinum-based chemotherapeutic agents, such as cisplatin and paraplatin. Although these agents demonstrate highly effective anti-cancer activity, they also have associated, often dose-limiting, side-effects such as nephrotoxocity. In vivo X-ray fluorescence (XRF) has been proven to be a suitable technique for measuring the uptake of these agents in tumour and critical organs, but radioisotope based systems have not found their way into routine clinical use due to their rapid increase in minimum detection limit (MDL) with depth. Polarised X-rays offer a solution to this problem by reducing the scattered background, which not only reduces the MDL, but also allows the intensity of the source to be increased without saturating the detector electronics. This paper describes the development and optimisation of a polarised XRF system for in vivo measurement of platinum in head and neck tumours, whose response to cisplatin is often unpredictable. The polarised X-ray source comprises a clinical X-ray therapy unit (the Pantak DXT-300) with removable purpose-built collimators. Optimisation studies have concentrated upon the operating voltage, polariser material and additional filtering. The optimum voltage was found to lie within the range 200-300 kV for all polarising materials. There was no significant difference using copper, aluminium or iron as the polariser. Increasing the additional filtering improved the MDL for a preset number of counts, but decreased the count-rate significantly, resulting in unacceptably long counting times. An MDL of 9 ppm was achieved for a phantom depth of 2 cm, using a copper polariser, 0.25 mm of tin filtering and an operating voltage of 220 kV. TLD measurements showed that the corresponding skin dose was 6 mGy. These results indicate a factor of improvement in the MDL from the previous 99mTc system, for a factor of two lower skin dose. The detection limit achieved is the lowest reported to date, and is considered adequate for a comprehensive patient study. It is anticipated that this will yield better information and the pharmacokinetics of platinum compounds and will lead to optimisation of both chemo and radiotherapy treatment. Additionally this technique can be easily integrated into any radiotherapy based department.

Penetration of ceftazidime into the human prostate gland following intravenous injection

The concentration of ceftazidime in human prostatic tissue obtained by transurethral resection was measured by microbiological assay in 24 patients after the intravenous administration of one 2 g dose. The average concentration of ceftazidime in the tissue was 10.1 micrograms/g 70 min after injection and 6.1 micrograms/g 140 min after injection; these levels were each approximately 14% of the corresponding serum levels. The concentration of ceftazidime achieved in the prostatic tissue was greater than the minimum inhibitory concentrations of ceftazidime for Gram-negative pathogens.

Ceftazidime compared to tobramycin and ticarcillin in immunocompromised haematological patients

Tobramycin and ticarcillin has been compared to ceftazidime in a clinical study on immunocompromised patients with febrile episodes. In the tobramycin and ticarcillin group (A) 70 febrile episodes occurred (10 being unassessable) in 43 patients of which 16 (23%) were bacteriologically positive. Forty-three episodes occurred during neutropenia. In the ceftazidime group (B) 54 febrile episodes (6 being unassessable) were treated in 34 patients. Eleven (20%) were bacteriologically positive and 30 episodes occurred during neutropenia. Clinical cure in group A occurred in 39 episodes, 65% of assessable cases. Cures in group B numbered 27 out of 54 episodes (56% of assessable cases). Clinical failure among evaluable cases, that is no decrease in fever in three days, was 22% in group A and 31% in group B. These results, within the limitation of the study, suggest that ceftazidime given alone at a dosage of 1 g tds is not significantly worse than tobramycin 120 mg tds plus ticarcillin 2 g tds.