Standards of access and quality in primary care.

This paper reviews recent changes in the provision and organization of primary care in the UK. Access and availability are of prime importance to patients, particularly when medical care is sought urgently, and are therefore important elements of quality. The paper also discusses the possible impact of further changes in the delivery of primary care, including overlapping responsibilities of general practice and accident and emergency (A&E) departments and the role of NHS Direct, a telephone advice service.

Further development of the baboon as a model for acute schistosomiasis.

Baboons develop a syndrome, including eosinophilia and transient fever, after infection with cercariae of Schistosoma mansoni that is consistent with the human syndrome of acute schistosomiasis. Radiotelemetry can be used to follow the course of fever in infected baboons. Individual variations in intensity of disease were noted in baboons. These symptoms and signs were more closely linked to the onset of oviposition by the newly matured worms than they were to the presence of migrating schistosomula or maturing worms. The baboon is concluded to be a suitable and useful model for human acute schistosomiasis mansoni.

Relationship of route of infection to susceptibility and immune response of inbred mice to Y strain Trypanosoma cruzi.

C3HeB/FeJ (C3H) mice infected ip with 10(6), 5 x 10(5), and 10(5) blood-form trypomastigotes (BFTs) of the Y strain of Trypanosoma cruzi were more resistant than C57B1/6 (B6) mice infected in the same manner. This pattern of susceptibility is opposite that reported for other stocks of this parasite. In a second experiment, C3H and B6 mice were infected ip or sc with 2 x 10(6), 10(6), 5 x 10(5), 10(5), or 10(3) Y strain BFTs. C3H mice infected ip with the 3 highest doses were again more resistant than the B6 mice, while mice infected ip with the 2 lowest doses were essentially equivalent in resistance. Thus, the difference in susceptibility was detectable, in terms of parasitemia levels and survival, primarily at the higher infection doses. For the groups infected sc, the pattern of susceptibility reversed. B6 mice infected with the 3 highest doses had lower parasitemia levels than the corresponding C3H mice, while C3H and B6 mice infected with 10(5) or 10(3) BFTs were similar in resistance. Blastogenic responses of lymphoid cells to phytohemagglutinin (PHA) and a soluble trypanosome extract (STE) were compared for C3H mice infected ip or sc to determine if the susceptibility to infection obtained with the 2 routes would be associated with differences in immune responses. Mesenteric lymph node cells (MLNCs) of mice infected ip were responsive to the STE early in infection, while superficial lymph node cells (SLNCs) of these mice were not. C3H mice infected sc had SLNCs which yielded strong responses to STE, while their MLNCs were relatively unresponsive. PHA stimulated responses by lymphoid cells from mice infected ip or sc were similar.(ABSTRACT TRUNCATED AT 250 WORDS)

Relative resistance of Brazil strain trypomastigote forms of Trypanosoma cruzi to in vitro antibody-dependent complement-mediated lysis.

Various assay conditions were employed in experiments examining the susceptibility of trypomastigote forms of the Brazil strain of Trypanosoma cruzi to antibody-dependent complement-mediated lysis. To identify optimal assay conditions, both guinea pig serum and normal human serum were used as complement sources, and fibroblast-derived or blood-form trypomastigotes were either coincubated with immune sera and complement together, or the parasites were first precoated with antibodies and then were incubated in complement. Under conditions promoting maximal lysis by antibodies and complement, 60-90% of the trypomastigote forms were not lysed. These results indicate that trypomastigotes of certain isolates of T. cruzi, such as the Brazil strain, may possess an escape mechanism by which they evade complement-mediated lysis.

Production and characterization of clones of the Brazil strain of Trypanosoma cruzi.

Six clones and 4 subclones were isolated from the Brazil strain of Trypanosoma cruzi and were passaged in C3H(He) mice. Parasitemia levels and survival times of mice infected with 8 of the isolates were equivalent to the Brazil strain in virulence. Two clones, designated WFTc-5.1 and WFTc-6.1 (WFTc = Wake Forest Trypanosoma cruzi) were of lower virulence in C3H mice than the other isolates and the Brazil strain. C57BL/6 mice infected with WFTc-5.1 had significantly lower parasitemias and higher survival rates than C57BL/6 mice infected with the Brazil strain or a clone designated WFTc-3.2. Levels of anti-T. cruzi IgM and IgG antibodies were the same in mice infected with higher virulence or lower virulence isolates. Based on these results the Brazil strain of T. cruzi is composed of distinct subpopulations which are heterogeneous with respect to virulence.