Positive serological tests for syphilis and administration of intravenous immunoglobulin.

We report the case of a man who tested positive for syphilis following the intravenous administration of human normal immunoglobulin as part of the treatment of Guillain-Barré syndrome. The chronology of the testing suggested the passive acquisition of treponemal antibody. This phenomenon is not widely documented in the medical literature, but is a theoretical risk of treatment, and serves as a reminder to be cautious in the interpretation of such serological tests.

A cooperative approach to standardizing care for patients with AMI or heart failure.

Background: In fall 2003 the five hospitals in Wichita, Kansas, formed a collaborative to improve care for patients presenting with acute myocardial infarction or heart failure (HF). Standard order sets were developed from guidelines developed by the American College of Cardiology and the American Heart Association. THE WICHITA CITYWIDE HEART CARE COLLABORATIVE GETS TO WORK: The order sets, which highlighted the appropriate interventions and made their implementation a "checkbox" activity, were placed in the progress note section of the medical record.

Inhibition of HIV-1 infection by viral chemokine U83A via high-affinity CCR5 interactions that block human chemokine-induced leukocyte chemotaxis and receptor internalization.

HIV-1 strains use C-C-chemokine receptor 5, CCR5, as a coreceptor for host transmission. Human CCR5 chemokine ligands inhibit binding and infection, whereas CCR5 mutations also inhibit infection by preventing surface expression, resulting in delayed progression to AIDS. Here, we describe a human herpesvirus 6 (HHV-6A) chemokine, U83A, which binds CCR5 with higher affinity than human chemokines, displacing their binding and leading to inhibition of chemotaxis of human leukocytes.

Nasopharyngeal aspiration for diagnosis of pulmonary tuberculosis.

Background: Confirmation of pulmonary tuberculosis (PTB) in young children is difficult as they seldom expectorate sputum.

Aim: To compare sputa obtained by nasopharyngeal aspiration and by sputum induction for staining and culture of Mycobacterium tuberculosis.

Patients And Methods: Patients from Mulago Hospital, Kampala with symptoms suggestive of PTB were considered for inclusion in the study.

Randomized controlled comparison of ofloxacin, azithromycin, and an ofloxacin-azithromycin combination for treatment of multidrug-resistant and nalidixic acid-resistant typhoid fever.

Isolates of Salmonella enterica serovar Typhi that are multidrug resistant (MDR, resistant to chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole) and have reduced susceptibility to fluoroquinolones (nalidixic acid resistant, Na(r)) are common in Asia. The optimum treatment for infections caused by such isolates is not established. This study compared different antimicrobial regimens for the treatment of MDR/Na(r) typhoid fever.

Changes in the nasal carriage of drug-resistant Streptococcus pneumoniae in urban and rural Vietnamese schoolchildren.

Studying the antimicrobial drug resistance of nasopharyngeal or nasal carriage isolates of Streptococcus pneumoniae in children is likely to have predictive potential for invasive isolates. Streptococcus pneumoniae nasal carriage was studied in 1422 Vietnamese children. Forty-six percent of 536 isolates showed reduced susceptibility to penicillin and 7% showed intermediate susceptibility to ceftriaxone; and 50% of 518 isolates showed resistance to erythromycin.

Injury-related behaviour among South African high-school students at six sites.

Objectives: To document and compare prevalence rates of adolescent injury-related risk behaviours at six sites in South Africa.

Design: The identical self-administered instrument was used at all sites. Prevalence rates (with 95% confidence intervals) were calculated taking the multistage cluster sampling strategy into account.

A qualitative exploration of a patient-centered coaching intervention to improve care transitions in chronically ill older adults.

Persons with chronic illness frequently find they need to navigate the health care system but are ill equipped to do so. Using interview data from 32 participants, this study explored patients' experiences with a coaching intervention that provided patients with support and tools to enhance self-management during care transitions. The findings suggest the efficacy of the model in enhancing self-management, particularly because it fostered the perception of a caring relationship, leading to greater patient investment in the program.

Epidemiology, diagnosis and treatment of enteric fever.

Enteric fever continues to be a common and serious problem worldwide, and the need for reliable and cheap alternatives to culture methods for diagnosis remains. Epidemics of different strains may coexist in the same geographical area and the rapid emergence of resistance to fluoroquinolones, independent of plasmid mediated multidrug resistance, means that alternative drugs for chemotherapy are also needed.

The care transitions intervention: results of a randomized controlled trial.

Background: Patients with complex care needs who require care across different health care settings are vulnerable to experiencing serious quality problems. A care transitions intervention designed to encourage patients and their caregivers to assert a more active role during care transitions may reduce rehospitalization rates.

Methods: Randomized controlled trial.

Ciprofloxacin treatment of bacterial peritonitis associated with chronic ambulatory peritoneal dialysis caused by Neisseria cinerea.

Bacterial peritonitis is a well-recognized complication of chronic ambulatory peritoneal dialysis (CAPD) in patients with end-stage renal failure. We present a case of peritonitis due to an unusual pathogen, Neisseria cinerea, unresponsive to the standard intraperitoneal (i.p.

Substance use, sexual risk, and violence: HIV prevention intervention with sex workers in Pretoria.

This paper describes an HIV prevention intervention designed in the US that was adapted and implemented in South Africa. Using an experimental design, 93 women who reported recent substance use and sex trading were randomly assigned to a modified Standard HIV intervention or to a Woman-Focused HIV prevention intervention. Eighty women completed the one-month follow-up interview.

Heroin treatment demand in South Africa: trends from two large metropolitan sites (January 1997-December 2003).

Accurate prevalence data on heroin use, that points to where problems exist and the extent of these problems, is necessary to guide the formulation of effective substance abuse policy and practice. The purpose of this study was to provide surveillance information about the nature and extent of heroin use in South Africa. Data were collected from 41 specialist alcohol and other drug treatment centres in two metropolitan sites (Cape Town and Gauteng Province) between January 1997 and December 2003.

Thematic evidence of psychosocial thriving in childhood cancer survivors.

Advances in medical treatment for childhood cancer have resulted in dramatically increased survival rates and a growing population of long-term survivors. Until recently, researchers reported primarily negative psychosocial sequelae of childhood cancer. Emergent conceptual frameworks propose that the assumption of pathology or long-term deficits in functioning might obscure an understanding of the full range of outcomes.

Use of paired serum samples for serodiagnosis of typhoid fever.

Using an enzyme-linked immunosorbent assay we demonstrate that, in adult patients with typhoid fever, the sensitivity of a serological test based on the detection of anti-lipopolysaccharide immunoglobulin G is increased when used with paired serum samples taken 1 week apart.

Cannabis and other drug use among trauma patients in three South African cities, 1999-2001.

Objective: To assess the extent of cannabis and other drug use among patients presenting with recent injuries at trauma units in Cape Town, Port Elizabeth and Durban from 1999 to 2001.

Design: Cross-sectional surveys were conducted during a 4-week period at each of the above sites in 1999, 2000 and 2001. The concept of an idealised week was used to render representative samples.

Alcohol use and sexual behaviour among risky drinkers and bar and shebeen patrons in Gauteng province, South Africa.

This paper describes the South Africa component of a World Health Organization multi-site rapid assessment and response project seeking to develop a methodology for studying factors associated with alcohol use-related sexual risk behaviour in diverse cultural settings. This report focuses on the qualitative assessments that were conducted in order to profile alcohol use and sexual behaviour in the communities concerned, ascertain the relationships between alcohol use and sexual behaviour, and develop a conceptual model of the relationships between alcohol use and sexual risk behaviour. The participants consisted of adults aged between 25 and 44 years in a township and city site in Gauteng province.

Learning in the thick of it.

The U.S. Army's Opposing Force (OPFOR) is a 2,500-member brigade whose job is to help prepare soldiers for combat.

Indicators of substance abuse treatment demand in Cape Town, South Africa (1997-2001).

Few studies have investigated the demand for substance abuse treatment in South Africa. This article uses data collected from specialist substance abuse treatment centres to describe substance abuse treatment demand and patterns of service utilisation in Cape Town for the period January 1997 to December 2001. Findings suggest that although treatment demand for alcohol-related problems remains high, treatment demand for substances other than alcohol has increased over time.

Breast abscess caused by Propionibacterium avidum following breast reduction surgery: case report and review of the literature.

Propionibacterium avidum was isolated from bilateral breast abscesses following breast reduction surgery. This report highlights the potential pathogenicity of the normal microbial flora following surgical interventions.

Alcohol use and trauma in Cape Town, Durban and Port Elizabeth, South Africa: 1999--2001.

Objective: To assess acute alcohol intoxication among patients presenting with recent injuries at trauma units in Cape Town, Port Elizabeth and Durban from 1999 to 2001.

Design: Cross-sectional surveys were conducted during a four-week period in each of the above sites in 1999, 2000 and 2001. The concept of an 'idealised week' was used to render representative samples.

Alcohol use in South Africa: findings from the first Demographic and Health Survey (1998).

Objective: This study formed part of the 1998 South African Demographic and Health Survey, which included questions assessing the extent of alcohol use, risky drinking and alcohol problems among South Africans to obtain up-to-date baseline estimates of consumption and risky drinking and to inform intervention efforts.

Method: A two-stage random sample of 13,826 persons ages 15 or older (59% women) was included in the survey. Alcohol use was assessed through eight questions, including the CAGE questionnaire.