Characteristics of a population-wide sample of smokers recruited proactively for the ESCAPE trial.

OBJECTIVES: To describe the characteristics of a sample of smokers recruited proactively into a smoking cessation trial, and to compare these characteristics with the wider population using data from the General Household Survey (GHS) and National Statistics Omnibus Survey. STUDY DESIGN: Sample recruited for a randomized controlled trial. METHODS: Between August 2007 and October 2008, 123 general practices mailed questionnaires to smokers in the U.K. identified from computer records. Smokers willing to participate in a trial of personalized computer-tailored feedback returned the questionnaires to the research team. The characteristics of the sample were compared with the wider population using data from the GHS and National Statistics Omnibus Survey, and Index of Material Deprivation scores. RESULTS: A response rate of 11.4% (n = 6697) was achieved. The sample was demographically similar to the population sample, with an even distribution of participants from areas of both high and low deprivation. The sample was more dependent than the GHS sample, but less dependent than clinic samples. Distribution by motivation and readiness to quit was similar to population estimates. CONCLUSIONS: Public health strategies targeting the entire population of smokers are needed to counter the low recruitment rates resulting from the traditional reactive methods of recruitment to smoking cessation studies. Using computerized records to identify and contact patients who are smokers is a simple method of recruiting a larger, more representative sample of smokers.

The impact of potent antiretroviral therapy on the characteristics of hospitalized patients with HIV infection.

OBJECTIVE: Despite advances in antiretroviral treatment, a large number of HIV-infected patients still require hospitalization. This study describes the characteristics of HIV patients requiring hospitalization before and after the advent of potent antiretroviral therapies. METHODS: Information was collected on all HIV-positive patients admitted to the New York Hospital-Cornell Medical Center in New York City. Data was collected from 1 January through 30 June 1995, and during the same 6-month interval in 1997. RESULTS: In each time period over 1500 outpatients were receiving treatment for HIV infection. There was a significant decrease in the incidence of admission [60.4 per 100 patient-years (PY) in 1995, 28.8 per 100 PY in 1997], and length of stay (10 versus 8 days). The median CD4 cell count of all HIV-infected patients admitted to the hospital doubled: 37 x 10(6)/l in 1995 versus 80 x 10(6)/l in 1997. However, there was no significant change in the median CD4 cell count of patients diagnosed with opportunistic infections. The incidence of the most common diagnosis (bacterial pneumonia, 8.0 per 100 PY in 1995 versus 3.6 per 100 PY in 1997) and the most common opportunistic infection (Pneumocystis carinii pneumonia 7.6 per 100 PY in 1995 versus 2.4 per 100 PY in 1997) decreased significantly. CONCLUSIONS: Since the introduction of potent antiretroviral therapy, a significant decrease in the incidence of hospital admission and opportunistic infections has occurred. There has been a doubling of the median CD4 cell count of inpatients. There has been no significant change in the median CD4 cell count at which patients present with opportunistic infections.

Short report: a case of fibrosing mediastinitis caused by Wuchereria bancrofti.

Wuchereria bancrofti is a mosquito-borne filarial nematode that commonly invades lymphatic vessels. Common clinical manifestations include elephantiasis, orchitis, epididymitis, and chyluria. This report concerns an Egyptian man who developed superior vena cava syndrome secondary to a mediastinal mass that was found to contain a filarial nematode consistent with W. bancrofti. This is the first case, to our knowledge, of this parasite causing fibrosing mediastinitis.

Successful treatment of fungal prosthetic valve endocarditis: case report and review.

We report a case of Candida albicans prosthetic valve endocarditis in a patient who was still alive 1 year following a homograft aortic root and valve replacement and antifungal therapy. Only 33 other cases of successfully treated fungal prosthetic valve endocarditis have been reported. We review these 33 cases and six cases of late recurrence following treatment, as well as the clinical features, diagnosis, and options for treatment of fungal prosthetic valve endocarditis.

Analysis of immunoglobulin G in multiple sclerosis brain: quantitative and isoelectric focusing studies.

Immunoglobulin G (IgG) in soluble and particulate fractions of discrete tissue samples from multiple sclerosis (MS) brain was analysed. Supernatant IgG/albumin rations and particulate-bound IgG levels were highest in samples dissected from MS plaques and adjacent white matter. Acid extracts of particulate fractions from the equivalent of 1 g of MS plaque tissue contained up to 15 micrograms IgG, an order of magnitude less than the amount in extracts from a subacute sclerosing panencephatitis (SSPE) brain, but 20 times more than those from control brain. By contrast, supernatant fractions from SSPE brain and some MS plaques contained comparable amounts (100-200 micrograms/g tissue) of IgG, which were 10 times greater than those from control brain. Samples were subjected to isoelectric focusing (IEF), and IgG was visualized by immunoperoxidase staining. The IEF patterns of IgG from control samples were diffuse but samples from demyelinated MS tissue displayed distinct oligoclonal bands of IgG. A number of common IgG bands were apparent in extracts of supernatant and particulate fractions from the same plaque. The IEF spectra of plaque samples from three MS brains were different. Furthermore, quantitative variations in certain IgG bands were observed in different plaques from the same brain.