A favorable clinical trend is associated with CD8 T-cell immune responses to the human papillomavirus type 16 e6 antigens in women being studied for abnormal pap smear results.

OBJECTIVE: The goal of this study was to examine the role of CD8 T-cell responses to human papillomavirus type 16 (HPV-16) in a favorable clinical trend in women being studied for abnormal Pap smear results. MATERIALS AND METHODS: Human papillomavirus-deoxyribonucleic acid testing and enzyme-linked immunospot assay using the HPV-16 E6 and E7 antigens were performed. The subjects with subsequent normal histologic diagnoses were considered to be "regressors" (n = 28), whereas those with histologic diagnoses of cervical intraepithelial neoplasia 1, 2, or 3 were considered to have short-term persistence of cervical abnormality and were designated to be "persistors" (n = 37). RESULTS: There was a higher percentage of CD8 T-cell responses to the E6 antigen in the regressors (15/28 or 53.6%) when compared with the persistors (10/37 or 27.0%; p = .04), but there was no recorded response difference for the E7 antigen. Results were the same when the analyses for E6 included only subjects who were high-risk HPV-positive (p = .01). CONCLUSIONS: The CD8 T-cell immune responses to the HPV-16 E6 antigens but not to E7 antigens are associated with a favorable clinical trend regardless of HPV types currently detected.

Dextromethorphan.

Dextromethorphan is reviewed in its role as an emerging drug of abuse, and the effects of dextromethorphan, along with those of co-ingredients in OTC formulations, are discussed. The Drug Abuse and Warning Network (DAWN) national data in the United States are examined in the context of data from other poison control centers, and possible national trends are postulated. Implications for dextromethorphan as an emerging drug of abuse are explored. Data from the Arkansas Poison Control Center (APCC) show emerging trends in the abuse of dextromethorphan, particularly in this rural area of the United States.

Effect of telemedicine on patients' diagnosis and treatment.

We conducted a post-consultation survey during 1998-2002 (n = 412 consultations) in the Rural Hospital Telehealth Project run by the University of Arkansas for Medical Sciences. Changes in the patient's diagnosis and treatment plan as a result of the telemedicine session were assessed. There were 47 consultants, who conducted 2-82 consultations each. The teleconsultants established a diagnosis in 74 consultations. This was 26% of the 286 respondents. Of the 63 respondents for cases where there was a prior diagnosis and a change was applicable, 17 consultants (27%) reported that there was a change in the patient's diagnosis. The consultants established a patient treatment plan in 139 consultations. This was 52% of the 268 respondents. Of the 123 respondents for cases where there was a prior treatment plan and a change was applicable, 82 (67%) consultants reported a change in the treatment plan. The changes in diagnosis and management imply benefits for the rural population in Arkansas as a result of the use of telemedicine.

Personality type and clinical evaluations in an obstetrics/gynecology medical student clerkship.

OBJECTIVE: The purpose of this study was to determine whether the Myers-Briggs type inventory extraversion is associated with clinical evaluation ratings that students earn during their (obstetrics/gynecology) junior medical student clerkship. STUDY DESIGN: The Myers-Briggs type inventory was administered to medical students during their obstetrics/gynec clerkship. Bivariate correlations between clinical evaluations, National Board of Medical Examiners subject scores, and data from the Myers-Briggs type inventory extraversion scale were analyzed. RESULTS: Pearson product-moment correlation between clinical and National Board of Medical Examiners subject scores was not significant (r = .25; P = .05). The National Board of Medical Examiners did not show significant correlations with the Myers-Briggs type inventory extraversion data. The clinical evaluations showed a significant correlation (r = .35; P = .005) with Myers-Briggs type inventory extraversion. CONCLUSION: Results show that Myers-Briggs type inventory extraversion is correlated positively with clinical evaluations. The National Board of Medical Examiners subject examination and clinical evaluations were not correlated significantly. Findings question whether clinical evaluation data should be included in the obstetrics/gynecology medical student evaluation process.

Drug abuse trends among youth in the United States.

Several years of survey data indicate that illicit drug use among U.S. youth was at its highest level in 1979. Generally, the use of some illicit drugs declined progressively throughout the 1980s, stabilized, and then decreased slightly. Reducing illicit drug use among U.S. youth continues to be a priority of federal, state, and local law enforcement agencies. The U.S. government tracks youth illicit drug use through three nationally representative surveys: National Household Survey on Drug Abuse, Monitoring the Future Study, and Youth Risk Behavior Survey. Other surveys include the Partnership Attitudes Tracking Study, conducted annually to assess youth and parental attitudes about drugs, and Drug Abuse Awareness Network (DAWN), a national surveillance system that monitors trends in drug-related emergency department visits and deaths. Although survey methods differ, similar trends in drug use are well documented by these surveys. Among American youth, illicit use of drugs such as tobacco, alcohol, inhalants, marijuana, LSD, cocaine, heroin, and methamphetamine has remained relatively stable. However, a noteworthy exception is the increased use of MDMA (methylenedioxymethamphetamine). The physical consequences of "club and recreational drug use" are evidenced in the increased numbers of emergency department visits, specifically those related to MDMA and gamma-hydroxy-butyrate use, which may represent a new and emerging trend in illicit drug use.