Rapid, low-technology MIC determination with clinical Mycobacterium tuberculosis isolates by using the microplate Alamar Blue assay.

A colorimetric, microplate-based Alamar Blue assay (MABA) method was used to determine the MICs of isoniazid (INH), rifampin, streptomycin (SM), and ethambutol (EMB) for 34 Peruvian Mycobacterium tuberculosis isolates (including both pansensitive and multidrug-resistant strains) and the H37Rv strain by using bacterial suspensions prepared directly from solid media. Results for all isolates were available within 8 days. Discordant results were observed on initial tests for 3 of 16 INH-susceptible isolates, 5 of 31 EMB-susceptible isolates, and 2 of 4 SM-resistant isolates (by the BACTEC 460 system). The overall agreements between the MICs obtained by MABA and the results obtained with the BACTEC 460 system were 87.9% for initial results and 93.6% after retesting 12 of 17 samples with discrepant results. Interpretation of MABA endpoints improved with technical experience. The MABA is a simple, rapid, low-cost, appropriate technology which does not require expensive instrumentation and which makes use of a nontoxic, temperature-stable reagent.

Calcium antagonists in elderly and black hypertensive patients. Therapeutic controversies.

Calcium antagonists are now recommended as monotherapy for the treatment of mild to moderate essential hypertension by the Joint National Committee (JNC) on the Detection, Evaluation, and Treatment of High Blood Pressure. Based on a statement in the 1988 JNC report that black and elderly patients tend to respond better to calcium antagonists, we reviewed the literature to examine the predictive value of age and race to the antihypertensive response of calcium antagonists. The majority of studies we reviewed failed to substantiate the JNC statement and well-promulgated reports in the literature suggesting preferential action of calcium antagonists in the elderly, or their superiority when compared with diuretics, beta-adrenergic blockers, and angiotensin-converting enzyme inhibitors. Although not noted by the JNC, pretreatment blood pressure appeared to be an important predictor of the antihypertensive response to calcium antagonists. The literature reviewed indicates that calcium antagonists have comparable efficacy in black and white hypertensive patients. However, the limited comparative studies reviewed support the JNC statement that, as with diuretics, blacks have a greater antihypertensive response with calcium antagonists than with beta-adrenergic blockers or angiotensin-converting enzyme inhibitors.

Antihypertensive response to ketanserin: influence of race and weight.

The antihypertensive effects of the 5-HT2 receptor antagonist ketanserin were evaluated in 16 patients with uncomplicated essential hypertension. Following a three week single-blind placebo treatment period, patients were randomized to receive in a double-blind manner oral ketanserin 20 mg or 40 mg twice a day for 10 weeks. In the racially mixed patient population, mean (+/- SD) seated blood pressure 12 hours after the last dose of placebo was 161 +/- 11/99 +/- 9 mm Hg and 155 +/- 19/98 +/- 10 mm Hg after ketanserin (P greater than .05). Ketanserin 20 mg twice a day did not lower blood pressure significantly. In contrast, 40 mg twice a day significantly decreased systolic blood pressure (P less than .02), and lowered diastolic blood pressure (P = .06). White patients (N = 7) showed a significant decrease in blood pressure (BP) with ketanserin treatment (158 +/- 5/98 +/- 8 vs. 147 +/- 13/92 +/- 6 mm Hg, P less than .05) while black patients (N = 9) did not (165 +/- 13/100 +/- 9 vs. 161 +/- 21/102 +/- 10 mm Hg, P greater than .05). For black patients only, significant correlations were observed between body weight and the change in diastolic BP (r = -.86, P less than .005). The racial difference in response to ketanserin could not be attributed to differences between the two groups in age, sex, body weight, pretreatment blood pressure or ketanserin dose. The nature of the racial difference in the chronic antihypertensive response to ketanserin warrants further evaluation.

Declining appeal of foreign medical education for U.S. students.

Concerns over the poor educational standards of some foreign medical schools and the cost of postgraduate education at a time of a projected physician surplus in the United States have led to efforts to pass federal legislation that would limit or remove access of U.S. graduates of foreign medical schools to residency programs in the United States. However, the need for such legislation has been diminished since the appeal of foreign medical education for U.S. students is on the decline. In this paper, the author reviews the economic and educational environment that in the mid-1970s led to the growth in the numbers of U.S. students who sought foreign medical education and contrasts it with the environment in the mid-1980s. Recent data are cited that support a reversal of that earlier trend.

Declining appeal of foreign medical education for U.S. students

Concerns over the poor educational standards of some foreign medical schools and the cost of postgraduate education at a time of a projected physican surplus in the United States have led to efforts to pass federal legislation that would limit or remove access of U.S. graduates of foreign medical schools to residency programs in the United States. However, the need for such legislation has been diminished since the appeal of foreign medical education for U.s. students is on the decline. In this paper, the author reviews the economic and educational environment that in the mid-1970s led to the growth in the numbers of U.S. students who sought foreign medical education and contrasts it with the environment in the mid-1980s. Recent data are cited that support a reversal of that earlier trend.(AU)

The epidemiology of end-state renal disease: the six-year South-Central Los Angeles experience, 1980-85.

Using the End-Stage Renal Disease Medical Information System and 1980 census information, the crude cumulative incidence among Blacks, Hispanics, and Whites in south central Los Angeles was determined to be 160.1, 49.28, and 55.3 per 100,000 respectively. Sex-specific rates were slightly greater in males. Among Blacks, nephrosclerosis and diabetes represented 41.5 and 30.2 per cent of the cases respectively and increased during the period 1980-85.

Reduction of young child malnutrition and mortality in rural Jamaica.

PIP: A systematic program to improve health and survival for the 6651 preschool children in Hanover Parish, Jamaica began in 1973. Regular anthropometric surveillance ensured early identification of malnourished children in whose homes nutritional advice was then provided. In addition some children were provided with supplemental dried skim milk and basic medical care. The program was begun in the eastern half of the parish in 1974; it was thus possible to observe sequential decline in the prevalence of malnutrition and mortality. 10.9% of the children in the eastern section were considered to be malnourished at the start of the program in 1973; by 1974 that figure was 5.9% and the number in the west where the program was just beginning was 13%. By 1975 the prevalence in both sections was about 6.4%. In addition the mortality rate was 14.5/1000 before the program and 6/1000 afterwards, a drop of 60%. Other factors which might have influenced these conditions were not found to be significant. These tests confirm earlier findings in Jamaica that even a simple program such as this could provide substantial improvement of child health in rural areas of developing countries.^ieng