High incidence of intermittent care in HIV-1-infected patients in Curaçao before and after starting cART.

Retention in care is one of the major challenges to scaling up and maximizing the effectiveness of combination antiretroviral therapy (cART). High attrition rates have been reported in the Caribbean region, varying from 6% to 23%. We studied the incidence of and risk factors for intermittent care in a cohort of adult HIV-1-positive patients, who entered into care in Curaçao between January 2005 and July 2009. A total of 214 therapy-naïve HIV-1-infected patients aged 15 years or older, entered HIV care between January 2005 and July 2009. Intermittent care was defined as at least one period of 365 days or longer in which there was no HIV care contact in Curaçao. Cox regression models were used to identify characteristics associated with time to intermittent care. In all, 203 (95%) patients could be classified as having intermittent or continuous care. The incidence of intermittent care before starting cART was 25.4 per 100 person years observation (PYO), whilst it was 6.1 per 100 PYO after starting cART. Being born outside Curaçao was associated with intermittent care before and after starting cART. Time from diagnosis to entry into care was an independent predictor for intermittent care before starting cART. Younger age was independently associated with intermittent care after starting cART. Half of the patients returned to care after intermitting care. Upon returning to care, median CD4 count was 264 cells/mm(3) (IQR, 189-401) for those who intermitted care before starting cART, and 146 cells/mm(3) (IQR, 73-436) in those who intermitted care after starting cART. In conclusion, the incidence of intermitting care is high in Curaçao, especially before starting cART, and intermitting care before starting cART is an independent predictor for starting cART late.

Efficacy of intrapalpebral and intramuscular application of oxytetracycline in a natural outbreak of infectious bovine kertoconjunctivitis (IBK) in calves.

In a herd of 70 bull calves (4-5 months of age) kept on pasture, 56 (80%) animals showed, after natural infection with Moraxella bovis (M. bovis), typical clinical signs of infectious bovine keratoconjunctivitis (IBK). Eyes with epiphora, photophobia, blepharospasm and/or a corneal ulcer with a diameter of less than 5 mm were considered as moderately affected. Those with a corneal ulcer > 5 mm diameter and/or even more profound findings were considered as severely affected. The objective was to study in IBK affected calves in a prospective randomized case control study the therapeutic efficacy of intrapalpebral (i.p.) injections of oxytetracycline (OTC) (200 mg OTC-hydrochloride 10% in the upper eyelid of moderately affected and in both eyelids of severely affected eyes) and intramuscular (i.m.) treatment (long-acting OTC-dihydrate; 20 mg/kg body weight for both moderately and severely affected patients). 29 animals (20 moderately affected, 9 severely affected) were treated i.p. and 27 animals (19 moderately, 8 severely affected) were treated i.m.. For fly control, deltamethrin was applied to all bulls at d 0. The OTC-treatment was repeated at intervals of 3 - 8 d until recovery. All animals recovered within 42 days. The mean number of treatments per animal and the interval between diagnosis and assessment of healing were not affected by the method of OTC administration; the latter averaged out at about 10 d for moderately affected and 17 d for severely affected eyes. Significantly less medication was required per animal for i.p. than for i.m. treatments (moderately affected: 281 vs. 2033 mg; severely affected: 1156 vs. 3982 mg). In conclusion, both methods of OTC administration were found to be similarly effective for the treatment of IBK in calves.

Influence of temperature on taste perception.

Daily experience tells us that temperature has a strong influence on how we taste. Despite the longstanding interest of many specialists in this aspect of taste, we are only starting to understand the molecular mechanisms underlying the temperature dependence of different taste modalities. Recent research has led to the identification of some strong thermosensitive molecules in the taste transduction pathway. The cold activation of the epithelial Na(+) channel and the heat activation of the taste variant of the vanilloid receptor (TRPV1t) may underlie the temperature dependence of salt responses. Heat activation of the transient receptor potential channel TRPM5 explains the enhancement of sweet taste perception by warm temperatures. Current development of methods to study taste cell physiology will help to determine the contribution of other temperature-sensitive events in the taste transduction pathways. Vice versa, the analysis of the thermodynamic properties of these events may assist to unveil the nature of several taste processes.

Role of a symptom-based algorithmic approach to chronic pelvic pain.

OBJECTIVE: Chronic pelvic pain (CPP) is a disorder that has a significant impact on the patient's quality of life. Laparoscopic diagnosis can be disappointing, and recurrence is common after surgical treatment. A symptom-based algorithmic approach to treatment of CPP is presented that is safe and cost-effective. METHODS: This approach is oriented towards making a potential clinical diagnosis of endometriosis. It relies on a structured evaluation of the patient and administration of medical therapy including GnRH agonists to selected patients. Evaluation begins with a history and physical examination; selected cases receive specific therapy. Non-responders undergo appropriate laboratory and imaging studies. If results remain negative, it is possible to make a clinical diagnosis of endometriosis and begin empiric treatment. RESULTS: Early results strongly indicate that using this approach allowed clinicians to make highly accurate diagnoses (correct in 85-90% of cases). CONCLUSION: Use of this approach will minimize the need for surgery.

Stability of thiols in an aqueous process flavoring.

The flavor stability of an aqueous solution of a savory model process flavoring based on ribose and cysteine was investigated during accelerated storage at 50 degrees C. Of the three sulfur-containing flavor-impact components investigated, 2-methyl-3-furanthiol was found to be the least stable (59% decrease/24 h), and it was followed by 2-furfurylthiol (28% decrease/24 h), 2-mercapto-3-butanone (14% decrease/24 h), and 2,5-dimethyl-4-hydroxy-3(2H)-furanone (max. 10% decrease/24 h). Both cysteine and ribose were found to affect the stability of various flavor compounds. A mechanism for the instability of 2-methyl-3-furanthiol is proposed, and was confirmed by H-D exchange experiments.

Medical and surgical therapies for pain associated with endometriosis.

Endometriosis is a common condition for which a number of treatments have been proposed. Medical treatments are based on the hormonal responsiveness of endometriosis implants. These therapies include progestins (with or without estrogens), androgens, and gonadotropin-releasing hormone (GnRH) analogs. Surgical treatments may include hysterectomy with oophorectomy or organ-sparing surgery involving ablation or resection of visible lesions of endometriosis and restoration of pelvic anatomy. There are no studies that directly compare the effectiveness or adverse effects of medical therapy and surgical therapy. Studies on medical therapy compare different treatments with placebo or with other active treatments. Hormone-based therapies for endometriosis show 80%-100% effectiveness in relief of pelvic pain over a 6-month course of therapy. Serious adverse outcomes after medical therapy are unusual. Studies on surgical therapy are largely anecdotal, with noncomparative reports on a variety of surgical methods. A few comparative surgical studies have been reported. Because of the noncomparative nature of many of the surgical studies, the use of combinations of surgical procedures and techniques in the reported studies, and the reporting of results from surgeons with an unusually high level of technical skill, the gynecological practitioner has little basis in the literature for assessing the optimum surgical approach. Surgical complications are believed to be underreported and may be related to how aggressive a surgical procedure is undertaken.

Role of a symptom-based algorithmic approach to chronic pelvic pain.

OBJECTIVE: Chronic pelvic pain (CPP) is a disorder that has a significant impact on the patient's quality of life. Laparoscopic diagnosis can be disappointing, and recurrence is common after surgical treatment. A symptom-based algorithmic approach to treatment of CPP is presented that is safe and cost-effective. METHODS: This approach is oriented towards making a potential clinical diagnosis of endometriosis. It relies on a structured evaluation of the patient and administration of medical therapy including GnRH agonists to selected patients. Evaluation begins with a history and physical examination; selected cases receive specific therapy. Non-responders undergo appropriate laboratory and imaging studies. If results remain negative, it is possible to make a clinical diagnosis of endometriosis and begin empiric treatment. RESULTS: Early results strongly indicate that using this approach allowed clinicians to make highly accurate diagnoses (correct in 85-90% of cases). CONCLUSION: Use of this approach will minimize the need for surgery.

A cost-effective approach to the management of endometriosis.

Endometriosis is a common disease that affects a large number of women throughout the world. Whereas in the past laparoscopy was commonly used for the diagnosis and treatment of women with endometriosis and pelvic pain, recent studies have demonstrated that surgical therapy offers no better results in terms of pain relief than medical therapy with a gonadotrophin-releasing hormone agonist. Surgical therapy requires considerable experience and expertise on the part of the surgeon and the results are likely to be operator dependent. The results of the very best surgeons, as published in the medical literature, often cannot be replicated by the average gynecologist. Medical treatment, on the other hand, is not operator dependent. The efficacy of clinical diagnosis given a thorough evaluation has been proved, and the outcomes of empiric medical therapy with a gonadotrophin-releasing hormone agonist are substantial. Given the similar results obtained with a gonadotrophin-releasing hormone agonist and surgical intervention and the fact that medical treatment is less expensive, primary therapy with a gonadotrophin-releasing hormone agonist appears to be the most cost-effective approach to the management of endometriosis and pelvic pain. Because of the limited information currently available, a statement regarding endometriosis and infertility would probably be inappropriate at this time.

Modeling of medical and surgical treatment costs of chronic pelvic pain: new paradigms for making clinical decisions.

Additional complexity has been added to the healthcare decision-making process by the socioeconomic constraints of the industry and a population that is increasingly educated about healthcare. As a result, decisions balanced on the basis of outcomes and economic realities are needed. This modeling of surgical versus medical treatment costs for chronic pelvic pain and endometriosis factors in the large number of women with chronic pelvic pain, direct and indirect costs of the condition, and clinical benefits, projected costs, and savings of the therapies. This process of calculation becomes an aid for decision making in the current healthcare system.

Is the standard of care what we think it is?

For the most part, gynecologists are actually unaware of the issues involving surrogate versus quality of life outcomes, the "deceptive practice of medicine" and the true incidence of complications as they relate to the standard of care. An anonymous survey of 1958 practicing gynecologists attending seven national symposia revealed a significant number of unreported complications. Clearly, the standard of care (at least with regard to complication risk) is markedly different than has been suggested by the medical literature. Concomitantly, we suggest that physicians need to take a more active role in the policing of our own specialties.

Purification and characterization of a novel class III peroxidase isoenzyme from tea leaves.

A novel, basic (isoelectric point > 10), heme peroxidase isoenzyme (TP; relative molecular weight = 34,660 +/- 10, mean +/- SE) that can account for a significant part of the ascorbate peroxidase activity in tea (Camellia sinensis) leaves has been purified to homogeneity. The ultraviolet/visible absorption spectrum is typical of heme-containing plant peroxidases, with a Soret peak at 406 nm (epsilon = 115 mM-1 cm-1) and an A406/A280 value of 3.4. The enzyme has a high specific activity for ascorbate oxidation (151 mumol min-1 mg-1), with a pH optimum in the range of 4.5 to 5.0. Substrate-specificity studies have revealed significant differences between TP and other class III peroxidases, as well as similarities with class I ascorbate peroxidases. TP, like ascorbate peroxidase, exhibits a preference for ascorbate over guaiacol, whereas other class III isoenzymes are characterized by 2-orders-of-magnitude higher activity for guaiacol than for ascorbate. TP also forms an unstable porphyrin pi cation radical-type compound I, which is converted to compound II within approximately 2 min in the absence of added reductant. Amino acid sequence data show TP to be the first example, to our knowledge, of a class III peroxidase with a high specificity for ascorbate as an electron donor.

Evaluation of a new HTLV-I/II polymerase chain reaction.

AIM: Evaluation of a qualitative HTLV-I/II DNA polymerase chain reaction (PCR) test for the detection of HTLV-I/II DNA (Roche Diagnostic Systems, Branchburg, N.J., USA) in various panels. METHODS: The panels consisted of fresh EDTA blood samples from blood donors who were anti-HTLV-I/II ELISA repeatably reactive: 53 were Western blot (WB) positive, 228 were WB indeterminate and 15 were WB negative. Elevent ELISA-negative blood donors were used as negative controls. Furthermore, specimens from 1 HTLV-II-infected intravenous drug user and from 1 HTLV-II-infected blood donor were included in the panel. Peripheral blood lymphocytes were prepared by red blood cell lysis with the Roche washing solution and stored at < -23 degrees C until processing. Amplification products were analyzed with the HTLV-I/II detection kit. RESULTS: All 53 anti-HTLV-I/II ELISA- and WB-positive samples and both HTLV-II-positive samples tested positively by PCR. All 228 anti-HTLV-I/II ELISA-positive and WB-indeterminate, all 15 ELISA-positive and WB-negative and all II ELISA-negative control samples tested negative by PCR. CONCLUSION: The Roche Amplicor HTLV-I/II test is a simple test, suitable for the confirmation of HTLV-I and-II infection in individuals with indeterminate or positive WB patterns.

The regulation of plasminogen activators and plasminogen activator inhibitor type 1 in endothelial cells by sex hormones.

OBJECTIVE: The purpose of this study was to assess the effect of 17 beta-estradiol, progesterone, and testosterone on secretion of plasminogen activators and plasminogen activator inhibitor type 1 by cultured endothelial cells. STUDY DESIGN: Bovine aortic endothelial cells were cultured in medium that contained 17 beta-estradiol, progesterone, or testosterone at various concentrations (10(-13) to 10(-6) mol/L). Plasminogen activator activity in culture medium in the presence of cells was assayed after a 36-hour incubation using chromogenic substrate and iodine 125-labeled fibrin plate assays. Plasminogen activator inhibitor type 1 antigen was detected in conditioned media of bovine aortic endothelial cells by Western blotting analysis. RESULTS: All three steroid hormones exhibited biphasic dose-response effects, characterized by stimulation of plasminogen activator secretion at lower concentrations and inhibition of plasminogen activator secretion at higher concentrations. A significant stimulatory effect on plasminogen activator secretion (74% over control) was observed at a 17 beta-estradiol concentration of 10(-12) mol/L (p < 0.03). At higher concentrations of 17 beta-estradiol, progesterone, and testosterone, inhibition of plasminogen activator secretion was observed (p < 0.05). Decreased levels of plasminogen activator inhibitor type 1 antigen were detected in supernatants treated with either 17 beta-estradiol or progesterone at a concentration of 10(-12) mol/L and were maximal at 10(-7) mol/L 17 beta-estradiol, progesterone, and testosterone. CONCLUSION: The secretion of plasminogen activators and plasminogen activator inhibitor type 1 is regulated in a biphasic dose-dependent manner by sex hormones in bovine aortic endothelial cells.

The role of surgery in the management of pediatric pelvic rhabdomyosarcoma.

PURPOSE: We assessed the role of surgery, particularly exenteration, in the treatment of children with lower urinary tract and pelvic rhabdomyosarcoma. MATERIALS AND METHODS: We treated 23 children with bladder and/or prostate (11), or pelvic retroperitoneal tumors (12). Initial management was tumor resection in 6 cases, anterior pelvic exenteration in 5 and biopsy only in 12, combined with chemotherapy in 23 and radiotherapy in 20. RESULTS: The bladder salvage rate for surviving patients with pelvic tumors was 92% versus 27% for those with prostate/bladder tumors. Estimated 5 and 10-year survival probability for patients with pelvic retroperitoneal tumors was 49 +/- 50% compared to 81 +/- 24% for those with bladder and/or prostate tumors (log rank test, p = 0.11). CONCLUSIONS: Exenterative surgery is frequently required to achieve a durable complete response.

Evaluation of a combined lysate/recombinant antigen anti-HTLV-I/II ELISA in high and low endemic areas of HTLV-I/II infection.

The Wellcozyme HTLV-I/II ELISA (Murex Diagnostics) was evaluated in 7800 samples of various serum panels. Repeat activity was found by Wellcozyme in (A) 1/2181 (0.05%) Dutch blood donors, (B) 44/3036 (1.4%) Curaçao (Caribbean area) blood donors, (C) 46/2533 (1.8%) individuals of different Ethiopian population subsets, (D) 30/30 (100%) confirmed anti-HTLV-I positive samples and (E) 20/20 (100%) HTLV-II PCR-positive samples. All 91 Wellcozyme-positive samples were tested for confirmation by Western blot (WB, Diagnostic Biotechnology). Among Wellcozyme HTLV-I/II ELISA-positive individuals, HTLV-I/II WB positivity was found in 0/1 Dutch blood donors, 40/44 (88.9%) Curaçao blood donors and 20/46 (43.5%) Ethiopian individuals. HTLV-I positivity was found in 40 (1.3%) WB-positive Curaçao blood donors and in 9 (0.35%) Ethiopian individuals. HTLV-II positivity was found in 11 (0.43%) WB-positive Ethiopian individuals. The Wellcozyme HTLV-I/II ELISA had a specificity of 99.95% in Dutch blood donors and a sensitivity of 100% on confirmed HTLV-I- and HTLV-II-positive samples. In Ethiopia 55% of the HTLV-I/II WB-positive individuals were exclusively HTLV-II positive, whereas in Curaçao no HTLV-II infections were found.

Laparoscopic gray-scale and color Doppler US: preliminary animal and clinical studies.

PURPOSE: To evaluate a semiflexible ultrasound (US) transducer inserted through a laparoscopic port to image abdominal structures. MATERIALS AND METHODS: Laparoscopic US with a 9.6-mm-diameter, 5.0-7.5-MHz semiflexible transducer with gray-scale, color, and spectral Doppler capabilities was performed in three miniature swine and in 25 patients with a variety of abdominal abnormalities. RESULTS: This miniature US probe was used to locate normal structures such as blood vessels, allowing the surgeon to decide the best approach for dissection. Color and spectral Doppler US proved especially useful in differentiating vascular from nonvascular structures. The presence or absence of stones in the gallbladder and common bile duct was readily determined. It was possible to detect masses and to provide guidance for their aspiration or biopsy within abdominal organs. In 10 cases (40%), laparoscopic US helped the surgeon make the decision for clinical management and altered the surgical procedures. CONCLUSION: Laparoscopic US was useful in assisting laparoscopic evaluation of abnormalities in the abdomen.

Gonadotropin-releasing hormone agonists. Current uses for these increasingly important drugs.

Use of gonadotropin-releasing hormone (GnRH) agonists produces a transient increase and subsequent long-term reduction in concentrations of pituitary hormones, resulting in gonadal hormone suppression. This reversible suppression is useful in treating diseases dependent on these hormones. GnRH agonists have been approved for use in patients with endometriosis, advanced prostate cancer, and precocious puberty. As research continues, GnRH agonists are expected to change the clinical approach to the treatment of many other reproductive and nonreproductive diseases.

Multiple myeloma in the Afro-Caribbean population of Curaçao.

To determine the incidence and course of multiple myeloma (MM) in the Afro-Caribbean population of Curaçao, we studied all MM patients discharged from the only hospital on the island during an 11-year period starting in 1980. As 50 patients fulfilled the diagnostic criteria for MM proposed by Durie, the average annual incidence (AI) of MM was estimated at 3.1/100,000 person years; AI was similar in males and females, but showed a steep increase with age in both sexes; 10% of all MM patients were < 40 years of age. At diagnosis 68% of patients were in Stage III, in 26% serum creatinine levels were > 20 mg/l, 36% had hypercalcaemia, and 50% had multiple bone lesions. Median survival was 20.5 months; Stage III myeloma and bone marrow plasma cell percentage > 50 were independent risk factors for poor survival. Infections were the immediate cause of death in 54% of the non-survivors. We conclude that the incidence rate of MM in the Afro-Caribbean population of Curaçao is one of the lowest reported in black populations; however, the presentation and course of MM follow the pattern seen in most other countries.