A toroid model for in vitro investigations of toxic shock syndrome toxin-1 production.

Human behaviours and consumer products may affect vaginal microbial ecology, thereby influencing women's health. Relevant experimentation systems are needed to understand such possible links. Here, we describe the development of a practical semi-solid in vitro model to assess the effects of interactions between vaginal environment and the presence of tampons, on bacterial communities, including the production of toxic shock syndrome toxin-1 (TSST-1) by Staphylococcus aureus.

Testing the validity of c-fos expression profiling to aid the therapeutic classification of psychoactive drugs.

RATIONALE: Different stimuli, including pharmacological stimuli, induce different neuroanatomical profiles of c-fos expression. Can these profiles be used in classifying psychoactive drugs and predicting therapeutic utility? OBJECTIVE: To test the validity of c-fos expression profiling to aid therapeutic classification. METHODS: Anxiolytics, antidepressants, antipsychotics and psychostimulants were compared. (i) A meta-analysis was performed and profiles compiled from literature reports of changes in c-fos expression in rat brain regions, measured by in situ hybridisation histochemistry or immunohistochemistry, after acute injection of psychoactive drugs. (ii) Male rat brains were profiled for changes in c-fos mRNA expression induced by acute injection of psychoactive drugs. RESULTS: (i) The meta-analysis showed that anxiolytics activate few (mostly stress-related) brain regions; antidepressants activate more regions, including the central amygdaloid nucleus; antipsychotics activate more regions still, including the nucleus accumbens and striatal areas; and psychostimulants activate the greatest number of all, including the most cortical regions (especially the piriform cortex). Profiles also varied within drug classes. (ii) Our experimental profiles confirmed and extended meta-analysis profiles, showing more downregulation. (iii) Sites activated by mirtazapine (an antidepressant not previously profiled) matched those of the antidepressant imipramine. CONCLUSIONS: (i) Differences between drug classes support their classification by means of c-fos profiling. Differences within classes may reflect mechanistic variations. (ii) Greater downregulation in our experiments might be because of inclusion of low, clinically relevant, drug doses and fuller coverage of brain regions. (iii) The agreement between mirtazapine and imipramine increases our confidence in the validity of c-fos expression profiling to aid drug classification and predict therapeutic utility.

Application of transcerebral, weak (1 microT) complex magnetic fields and mystical experiences: are they generated by field-induced dimethyltryptamine release from the pineal organ?

During the last 15 years weak, complex magnetic fields have been applied across the two cerebral hemispheres at the level of the temporoparietal lobes of more than 500 volunteers. Most of these subjects have reported visual, vestibular, and proprioceptive sensations as well as experiences of detachment from the body of 'sentient beings'. Similar but more intense experiences were reported by Strassman in 2001 for volunteers who were injected with N,n-dimethyltryptamine, a compound Strassman hypothesized as the primary mediator of these experiences. If this speculation is valid, then subjects who are exposed to the very weak, complex fields known to elicit similar experiences should display significant increases in the metabolites of this compound within their blood.

Brandon/Hill selected list of print books and journals for the small medical library.

After thirty-six years of biennial updates, the authors take great pride in being able to publish the nineteenth version (2001) of the "Brandon/Hill Selected List of Print Books and Journals for the Small Medical Library." This list of 630 books and 143 journals is intended as a selection guide for health sciences libraries or similar facilities. It can also function as a core collection for a library consortium. Books and journals are categorized by subject; the book list is followed by an author/editor index, and the subject list of journals, by an alphabetical title listing. Due to continuing requests from librarians, a "minimal core list" consisting of 81 titles has been pulled out from the 217 asterisked (*) initial-purchase books and marked with daggers (dagger *) before the asterisks. To purchase the entire collection of 630 books and to pay for 143 2001 journal subscriptions would require $124,000. The cost of only the asterisked items, books and journals, totals $55,000. The "minimal core list" book collection costs approximately $14,300.

Treatment of giardiasis.

Giardia lamblia is both the most common intestinal parasite in the United States and a frequent cause of diarrheal illness throughout the world. In spite of its recognition as an important human pathogen, there have been relatively few agents used in therapy. This paper discusses each class of drugs used in treatment, along with their mechanism of action, in vitro and clinical efficacy, and side effects and contraindications. Recommendations are made for the preferred treatment in different clinical situations. The greatest clinical experience is with the nitroimidazole drugs, i.e., metronidazole, tinidazole, and ornidazole, which are highly effective. A 5- to 7-day course of metronidazole can be expected to cure over 90% of individuals, and a single dose of tinidazole or ornidazole will cure a similar number. Quinacrine, which is no longer produced in the United States, has excellent efficacy but may be poorly tolerated, especially in children. Furazolidone is an effective alternative but must be administered four times a day for 7 to 10 days. Paromomycin may be used during early pregnancy, because it is not systematically absorbed, but it is not always effective. Patients who have resistant infection can usually be cured by a prolonged course of treatment with a combination of a nitroimidazole with quinacrine.

Brandon/Hill selected list of print books and journals in allied health.

This list of 424 books and 77 journals is intended as a selection guide for print literature to be used in a library supporting allied health educational programs or allied health personnel in either an academic or health care setting. Because of the impossibility of covering the large number and wide variety of allied health professions and occupations, the recommended publications are focused primarily on the educational programs listed and recognized by the American Medical Association and other accrediting bodies. Books and journals are categorized by subject; the book list is followed by an author/editor index, and the subject list of journals by an alphabetical title listing. Items suggested for initial purchase (167 books and 31 journals) are indicated by asterisks. To purchase the entire collection of books and journals (2000 subscriptions) would require an expenditure of about $31,970. The cost of only the asterisked items totals $12,515.

Long-term maintenance of weight loss: current status.

Intervention strategies for promoting long-term weight loss are examined empirically and conceptually. Weight control research over the last 20 years has dramatically improved short-term treatment efficacy but has been less successful in improving long-term success. Interventions in preadolescent children show greater long-term efficacy than in adults. Extending treatment length and putting more emphasis on energy expenditure have modestly improved long-term weight loss in adults. Fresh ideas are needed to push the field forward. Suggested research priorities are patient retention, natural history, assessment of intake and expenditure, obesity phenotypes, adolescence at a critical period, behavioral preference-reinforcement value, physical activity and social support, better linkage of new conceptual models to behavioral treatments, and the interface between pharmacological and behavioral methods.

Occurrence and self-treatment of diarrhea in a large cohort of Americans traveling to developing countries.

There is little information available regarding traveler's diarrhea that affects a large number of Americans who differ widely in age and travel destination, and little or no information exists on self-treatment. This paper describes the clinical features, self-treatment, and outcome of diarrhea in 784 (95% follow-up) Americans who traveled for < or = 90 days, and who received detailed pre-travel advice. Diarrhea was reported by 46%. Of these, 34% (n = 270) had traveler's diarrhea (TD) defined as > or = 3 unformed stools/day +/- enteric symptoms or < 3 stools/day with > or = 1 enteric symptom, and 11% (n = 88) had loose motions (LM). Diarrhea was often severe and nearly a quarter of people with TD experienced fever and vomiting and 35% were required to alter their plans. The duration of travel and the destination itself were the strongest influences on diarrhea. Most travelers treated the illness themselves, whether or not they had LM (72%) or TD (83%). Those with LM took an antimotility agent or bismuth subsalicylate alone more frequently than those with TD (71% versus 48%, P < 0.002). Conversely, antibiotics were taken more frequently by those with TD (47% versus 27%, P < 0.03). Overall, 83% indicated self-treatment was effective (91% with LM and 80% with TD). Diarrhea is common despite pre-travel advice. Because travelers usually treat themselves, they should be provided with clear instructions on appropriate self-treatment.

Health problems in a large cohort of Americans traveling to developing countries.

BACKGROUND: Millions of Americans visit developing countries each year, however, little is known about their health during travel. This study describes health problems in a large cohort of American travelers during and after their trip. METHODS: A 2-year survey of 784 travelers (95% follow-up) was conducted for persons traveling for < or = 90 days. At the pretravel visit, travelers were given a postcard to record adverse health events. Following travel, standardized telephone interviews were performed for any positive responses, or if the card was not returned. All travelers were contacted 2 months after return to determine late occurring illness and compliance with antimalarials. RESULTS: Travelers had a mean age of 44 years, a median duration of 19 days, and visited 123 countries. An illness was reported by 64% (1.6 illnesses per traveler). Ill travelers were more often female, and traveled longer than those who were not ill; depending upon destination, each day of travel increased by 3 to 4% the chance of becoming ill. Diarrhea was most common, occurring in 46%; 34% met a strict definition for traveler's diarrhea. Respiratory illness occurred in 26%, skin disorders in 8%, acute mountain sickness in 6%, motion sickness in 5%, accidents and injuries in 5%, and isolated febrile episodes in 3%. Medical care was sought by 8% of all travelers and 12% of those reporting illness. On return, 26% of travelers were ill, 56% of whom became ill after return. Diarrhea, respiratory illness, skin disorders, and febrile syndromes were most common, and 46% of those who were ill sought medical care. Complete compliance with antimalarials was 80%. Noncompliant individuals usually discontinued medications on return. Side effects were reported by 4% of those taking chloroquine, 11% of those taking chloroquine plus proguanil, and 14% of those taking mefloquine, with half of these neuropsychiatric. The incidence of documented malaria was 3.8 cases per 1,000 travelers. CONCLUSIONS: Many travelers experience adverse health events during and after travel to the developing world. Attention to the prevention and therapy of traveler's diarrhea, prophylaxis of malaria, management of respiratory illness, personal safety, and access to medical care during travel, and, recognition of clinical syndromes after return, will help to improve the traveler's health.

Knowledge of travel medicine providers: analysis from a continuing education course.

BACKGROUND: With millions of international travelers, there has been an increase in the scope and variability of travel medicine providers. A study was conducted to measure the baseline knowledge of providers, determine factors affecting this knowledge, and assess acquisition of knowledge after a continuing education course. METHODS: A one-day continuing medical education course was held for health care professionals interested in travel medicine. Prior to the course, attendees completed a test determining knowledge in malaria chemoprophylaxis, traveler's diarrhea management, vaccines, jet lag, the returned traveler, and other areas. An identical test was given after completion of the course. Performance on the test was analyzed by profession, area of specialty training, and experience in travel medicine. RESULTS: Seventy-seven attendees completed the precourse test. Forty-eight percent were physicians and 47% were nurses; 29% specialized in infectious diseases, 22% in occupational medicine and student health, and 18% in family or internal medicine; 60% had >/= 1 year of travel medicine experience while 20% had no experience. The precourse test score for all participants was 62.7% 6 6.5 (sd). Analysis by profession found that physicians scored the highest (71%). Providers with >/= 1 year of travel medicine experience scored higher than those with no experience (67% vs 53%, p <.01). Statistically significant correlations were found between precourse exam results and profession (+.432, p <.001) and travel medicine experience (+.365, p =.002). No significant correlation was found between precourse exam and area of specialty training. Combined mean score on the postcourse exam improved to 81.8% 6 4.5, an increase of 17.2% over the precourse score for those who took both tests (p <.001). CONCLUSIONS: The profession of the provider and the duration of experience in travel medicine were the most important correlations of baseline knowledge in travel medicine. All groups improved their knowledge following the course.

Brandon/Hill selected list of books and journals for the small medical library.

The interrelationship of print and electronic media in the hospital library and its relevance to the "Brandon/Hill Selected List" in 1999 are addressed in the updated list (eighteenth version) of 627 books and 145 journals. This list is intended as a selection guide for the small or medium-size library in a hospital or similar facility. More realistically, it can function as a core collection for a library consortium. Books and journals are categorized by subject; the book list is followed by an author/editor index, and the subject list of journals by an alphabetical title listing. Due to continuing requests from librarians, a "minimal core" book collection consisting of 82 titles has been pulled out from the 214 asterisked (*) initial-purchase books and marked with daggers ([symbol: see text]). To purchase the entire collection of books and to pay for 1999 journal subscriptions would require $114,900. The cost of only the asterisked items, books and journals, totals $49,100. The "minimal core" book collection costs $13,200.

Molecular cloning and functional expression of the human glycine transporter GlyT2 and chromosomal localisation of the gene in the human genome.

Neurotransmitter transport systems are major targets for therapeutic alterations in synaptic function. We have cloned and sequenced a cDNA encoding the human type 2 glycine transporter GlyT2 from human brain and spinal cord. An open reading frame of 2391 nucleotides encodes a 797 amino acid protein that transports glycine in a Na+/Cl--dependent manner. When stably expressed in CHO cells, human GlyT2 displays a dose-dependent uptake of glycine with an apparent Km of 108 microM. This uptake is not affected by sarcosine at concentrations up to 1 mM. Radiation hybrid analysis mapped the GlyT2 gene to D11S1308 (LOD=8.988) on human chromosome 11p15.1-15.2.

Brandon/Hill selected list of books and journals in allied health.

This list of 410 books and 78 journals is intended as a selection guide to be used in a library supporting allied health educational programs or allied health personnel in either an academic or health care setting. Because of the impossibility of covering the large number and wide variety of allied health professions and occupations, the recommended publications are focused primarily on the educational programs listed and described in the AMA's Health Professions Education Directory, 1997-1998, plus physical therapist and medical secretary. Some programs do not have their own specific literatures. Books and journals are categorized by subject; the book list is followed by an author/editor index, and the subject list of journals by an alphabetical title listing. Items suggested for initial purchase (160 books and 31 journals) are indicated by asterisks. To purchase the entire collection of books and journals (1998 subscriptions) would require an expenditure of about $29,180. The cost of only the asterisked items total $11,390.

Neuromuscular blocking and cardiovascular effects of Org 9487, a new short-acting aminosteroidal blocking agent, in anaesthetized animals and in isolated muscle preparations.

This study was undertaken to investigate the neuromuscular blocking profile and cardiovascular effects of Org 9487, a new aminosteroidal, non-depolarizing, neuromuscular blocking agent structurally related to vecuronium, in anaesthetized animals and in isolated muscle preparations. In in vitro functional assays of neuromuscular blocking activity, Org 9487 was between eight and 15 times less potent than vecuronium. In cats and monkeys the potency of Org 9487 was approximately one-seventh and one-twentieth, respectively, that of vecuronium. In both species, Org 9487 induced rapidly developing (onset times between 1.5 min and 1.9 min) neuromuscular paralysis, which was shorter-lasting than that of vecuronium and similar in time course to suxamethonium. The vagal: neuromuscular blocking dose ratio for Org 9487 was 3 and ganglion block was seen only at approximately 20 times the neuromuscular blocking dose. There was no evidence in the rat that Org 9487, administered at doses up to 3 mg kg-1, inhibited noradrenaline re-uptake. In anaesthetized dogs, Org 9487 (3 x 90% blocking dose) induced only relatively small and transient haemodynamic effects. The administration of clinically relevant doses of neostigmine or pyridostigmine shortened the time-course profile of Org 9487, even when administered during profound neuromuscular block. In animals, Org 9487 is a low potency, nondepolarizing neuromuscular blocking agent with a time course profile similar to that of suxamethonium. Although Org 9487 is less selective than vecuronium for the neuromuscular junction, it is unlikely to produce prohibitive cardiovascular side effects in man.

Pasteurella multocida infectious arthritis with acute gout after a cat bite.

A 74-year-old man with chronic lymphocytic leukemia, immune purpura, and gout presented with a painful, swollen ankle after a cat bite to his leg. On aspiration of the ankle, gram negative pleomorphic rods and monosodium urate crystals were seen and Pasteurella multocida was cultured. He was treated with ampicillin/sulbactam, joint aspiration, and intraarticular steroids, with resolution of infection and return of joint function. The syndromes of Pasteurella arthritis and crystal arthropathy with septic arthritis are reviewed.