Counterfeit phosphodiesterase type 5 inhibitors pose significant safety risks.

Counterfeit drugs are inherently dangerous and a growing problem; counterfeiters are becoming increasingly sophisticated. Growth of the counterfeit medication market is attributable in part to phosphodiesterase type 5 inhibitor (PDE5i) medications for erectile dysfunction (ED). Millions of counterfeit PDE5is are seized yearly and account for the bulk of all counterfeit pharmaceutical product seizures. It has been estimated that up to 2.5 million men in Europe are exposed to illicit sildenafil, suggesting that there may be as many illegal as legal users of sildenafil. Analysis of the contents of counterfeit PDE5is shows inconsistent doses of active pharmaceutical ingredients (from 0% to > 200% of labelled dose), contaminants (including talcum powder, commercial paint and printer ink) and alternative ingredients that are potentially hazardous. In one analysis, only 10.1% of samples were within 10% of the labelled tablet strength. Estimates place the proportion of counterfeit medications sold over the Internet from 44% to 90%. Of men who purchase prescription-only medication for ED without a prescription, 67% do so using the Internet. Counterfeit PDE5is pose direct and indirect risks to health, including circumvention of the healthcare system. More than 30% of men reported no healthcare interaction when purchasing ED medications. Because > 65% actually had ED, these men missed an opportunity for evaluation of comorbidities (e.g. diabetes and hypertension). Globally, increased obstacles for counterfeiters are necessary to combat pharmaceutical counterfeiting, including fines and penalties. The worldwide nature of the counterfeit problem requires proper coordination between countries to ensure adequate enforcement. Locally, physicians who treat ED need to inform patients of the dangers of ordering PDE5is via the Internet.

A standard set of terms for critical incident recording?

The Anaesthetic Specialty Working Group of the Clinical Terms Project has been creating clinical terms for inclusion in the Read clinical classification. It is the intention to include terms to describe critical incidents. Many difficulties were encountered and these are discussed. The current definitions of a critical incident in the anaesthetic literature are too wide to allow a circumscribed set of terms to be generated. The interpretation of a critical incident is not only subjective but also requires a great deal of contextual information to describe it accurately. A method of critical incident reporting using the terms that will be contained within the enhanced Read clinical classification is proposed. These terms may be useful in the construction of a nationwide critical incident register.

The application of Read Codes to anaesthesia.

The Anaesthetic Specialty Working Group of the Clinical Terms Project is creating a set of terms for anaesthesia. These terms can be used to describe the activities of an anaesthetist, and are designed for use in computerised systems such as automated anaesthetic record-keeping systems. These terms will be coded as Read Codes, and will be introduced to the National Health Service in 1994. The method for, and the reasoning behind the creation of these terms, is discussed below. The way that these terms can be used in the field of anaesthesia is outlined.

Plasma exchange in refractory cutaneous vasculitis.

Eight patients with intractable cutaneous leucocytoclastic vasculitis were given a trial of plasma-exchange therapy. All but one improved, five substantially. Four have been successfully treated by intermittent plasma exchange for periods of 5-12 years. Apart from one episode of hepatitis B, possibly related to administration of fresh frozen plasma, no major adverse effects have occurred. Plasma exchange can be a valuable therapeutic option in patients with severe refractory cutaneous vasculitis.

Appropriate sex education for black teens.

This article is based on a year-long study of 207 low-income black youths. The major purpose of the research was twofold: (1) to study black teens' perceptions of family relationships in an effort to identify family member(s) who had the most potential for encouraging greater contraceptive responsibility and influencing teens' decisions about being or becoming sexually active, and (2) to study dating and sexual behavior, attitudes toward contraception, and sources of information, in an effort to identify more specific sex education needs of black teens and provide a basis for delineating pertinent characteristics of an effective sex education curriculum.

PIP: This study was designed to better determine the sex education needs of black youngsters in the US and also determine the various family members or other traditional caretakers who shape the teens values and behaviors regarding sexuality and sexual behavior. 207 black teenagers from low income families were questioned. The subjects rated, on a Lickert-type scale, how positive their relationships were with either parent at different stages of their development. The teens were also questioned on their own sexual behavior (e.g. have they already had sex, what age, reason, type birth control used both during their 1st time and now). They were also questioned on who they learned birth control from, and who they trust the most outside of the family. The results reflected the alarming rate of unsafe sex practiced by both boys and girls during their 1st sexual encounter, and the need to provide sex education to these children before their teens. Mothers are represented by the data as the most influential in shaping the youngsters' values in regard to to their becoming sexually active. The subjects were reluctant to confide about sex to a school teacher or counsellor. A school based source of information and services, as an alternative to "friends and others" that the youngsters seek for advice, was advised as a potential answer to the dilemma.

Therapeutic applications of plasma exchange.

Therapeutic plasma exchange has been used in a wide range of disorders in which circulatory macromolecules are thought to be pathogenic. In this review, we discuss briefly the practical aspects of the procedure, and consider the evidence for its benefit.

Chromomycosis in Zaire.

Biopsy specimens from 17 Zairians with chromomycosis are described. Patients ranged in age from 20 to 50 years, with a mean of 37.2 (+/- 10.2). Chromomycosis was suspected clinically in only 3 of the 17 patients. In 14 patients the lesions were on the lower limbs and in 3 on the arms. The lesions were chronic, in one patient persisting for 9 years. The diagnosis was established in each patient by finding typical thick-walled brown fungi within the lesions. Some fungi were in abscesses, others were in histiocytes or giant cells. The fungi and the inflammatory reaction were concentrated in the upper dermis. Acanthosis, hyperkeratosis, and parakeratosis were constant features and pseudoepitheliomatous hyperplasia (PEH) was a feature in 10 patients. Transepithelial elimination (TEE) of fungi was a conspicuous feature in eight specimens. Microscopic features suggested TEE in an additional three. PEH and TEE were associated in all specimens. In patients with TEE, the diagnosis may be confirmed quickly by smearing surface scrapings and finding the characteristic brown fungi.