Glucagon-like peptide-1 counteracts the detrimental effects of Advanced Glycation End-Products in the pancreatic beta cell line HIT-T 15.

Advanced Glycation End-Products (AGEs), a group of compounds resulting from the non-enzymatic reaction of reducing sugars with the free amino group of proteins, are implicated in diabetic complications. We previously demonstrated that exposure of the pancreatic islet cell line HIT-T 15 to high concentrations of AGEs significantly decreases cell proliferation and insulin secretion, and affects transcription factors regulating insulin gene transcription. The glucagon-like peptide-1 (GLP-1) is an incretin hormone that increases proinsulin biosynthesis, stimulates insulin secretion, and improves pancreatic beta-cell viability. The aim of this work was to investigate the effects of GLP-1 on the function and viability of HIT-T 15 cells cultured with AGEs. HIT-T 15 cells were cultured for 5days in presence of AGEs alone, or supplemented with 10nmol/l GLP-1. Cell viability, insulin secretion, redox balance, and expression of the AGEs receptor (RAGE) were then determined. The results showed that GLP-1 protected beta cell against AGEs-induced cell death preventing both apoptosis and necrosis. Moreover, addition of GLP-1 to the AGEs culture medium restored the redox balance, improved the responsiveness to glucose, and attenuated AGEs-induced RAGE expression. These findings provide evidence that GLP-1 protects beta cells from the dangerous effects of AGEs.

Investigating self-care in a sample of patients with decompensated heart failure: A cross-sectional study. / Investigando el autocuidado en una muestra de pacientes con insuficiencia cardiaca descompensada: un estudio transversal.

BACKGROUND: There is scarce evidence relating to self-care of heart failure (HF) in Spain. In particular, there is a need to establish patients' level of understanding of HF, as well as their ability to recognise signs and symptoms of decompensation. PATIENTS AND METHODS: Cross-sectional study to determine the level of self-care in a population of Spanish patients admitted to hospital with a primary diagnosis of decompensated HF. A convenience sample of 108 patients (50 women and 58 men) aged 83±8 were recruited to participate in this study. RESULTS: The Self-Care of Heart Failure Index version 6.2 was used to quantify self-care in our sample. Mean and standard deviation from the Self-Care of Heart Failure Index self-care maintenance subscale were: a) "exercise for 30 minutes", 1±1; b) "forget to take one of your medicines", 2±2; c) "ask for low-salt items when eating out or visiting others", 2±1. A percentage of 67.6 had experienced shortness of breath or ankle swelling in the past month. However, the vast majority of our patients were unlikely to independently implement a remedy: a) reduce salt, 2±1; b) reduce fluid intake, 1±1; c) take an extra diuretic, 1±1. Over 50% of our sample felt confident or very confident at following professional advice (3±1), keeping themselves free of symptoms (3±1), recognizing changes in their condition (3±1) and evaluating the significance of such changes (3±1). CONCLUSIONS: HF patients have a significantly low level of self-care when compared with HF patients from other countries, especially when it comes to managing their condition. Self-care promotion should be a priority for all healthcare professionals involved in the care and management of HF patients.

Sexually transmitted infections, sexual risk behaviors and the risk of heterosexual spread of HIV among and beyond IDUs in St. Petersburg, Russia.

AIMS: This study investigates whether sexual transmitted behaviors and infections (STIs) among injection drug users (IDUs) may promote the spread of HIV among and beyond IDUs in Russia. METHODS: We conducted a cross-sectional survey of behavior and tested for STIs in a convenience sample of 159 IDUs in St. Petersburg, Russia. RESULTS: The median age was 27 and 57% were male. Almost all were sexually active, half had casual partners and 40% reported > or =2 sex partners in the previous 3 months. Of those who answered, 81% reported sex without condoms, 44% reported having sex with at least one partner who was not an IDU. Of 139 (87%) subjects who were actively injecting, 29% reported receptive syringe sharing. Twenty percent of subjects were seropositive for HIV-1 and 42% of HIV-1-negative subjects tested positive for an STI. CONCLUSIONS: The sample exhibited high levels of sexual risk behaviors and STIs, and a large proportion had sexual partners who were not IDUs. This population requires comprehensive interventions that ensures access to condoms and sterile injection supplies and that encourage safer sexual behaviors in an attempt to keep sexual transmission of HIV low.

Plasma levels of active Von Willebrand factor are increased in patients with first ST-segment elevation myocardial infarction: a multicenter and multiethnic study.

AIMS: Von Willebrand factor (VWF), a key player in hemostasis and thrombosis, is released from endothelial cells during inflammation. Upon release, VWF is processed by ADAMTS13 into an inactive conformation. The aim of our study was to investigate whether plasma levels of active VWF, total VWF, ADAMTS13, osteoprotegerin (OPG) and the ratios between VWF and ADAMTS13 are risk factors for first ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS: We assessed 1026 patients with confirmed first STEMI and 652 control subjects from China, Italy and Scotland, within six hours after their cardiovascular event. Median plasma levels of total VWF, active VWF, OPG and ratios VWF/ADAMTS13 were increased, while plasma levels of ADAMTS13 were decreased in patients compared to controls. The odds ratio (OR) of STEMI in patients with high plasma levels of active VWF was 2.3 (interquartile range (IQR): 1.8-2.9), total VWF was 1.8 (1.4-2.3), ADAMTS13 was 0.6 (05-0.8), OPG was 1.6 (1.2-2.0) and high VWF/ADAMTS13 ratios was 1.5 (1.2-2.0). The OR for total VWF, active VWF and ratios VWF/ADAMTS13 remained significant after adjustment for established risk factors, medical treatment, C-reactive protein, total VWF, ADAMTS13 and OPG. When we adjusted for levels of active VWF, the significance of the OR for VWF and ratios VWF/ADAMTS13 disappeared while the OR for active VWF remained significant. CONCLUSIONS: We found evidence that plasma levels of active VWF are an independent risk factor for first STEMI in patients from three different ethnic groups. Our findings confirm the presence of VWF abnormalities in patients with STEMI and may be used to develop new therapeutic approaches.

Clinical predictors of Pneumocystis carinii pneumonia, bacterial pneumonia and tuberculosis in HIV-infected patients.

BACKGROUND: Clinicians are frequently faced with the differential diagnosis between Pneumocystis carinii pneumonia (PCP), bacterial pneumonia, and pulmonary tuberculosis in HIV-infected patients. OBJECTIVES: To identify features that could help differentiate these three pneumonia types at presentation by evaluating the clinical characteristics of the three diagnoses among patients at two urban teaching hospitals. DESIGN: Retrospective chart review. METHODS: Cases were HIV-infected patients with a verified hospital discharge diagnosis of PCP (n = 99), bacterial pneumonia (n = 94), or tuberculosis (n = 36). Admitting notes were reviewed in a standardized manner; univariate and multivariate analyses were used to determine clinical predictors of each diagnosis. RESULTS: Combinations of variables with the highest sensitivity, specificity, and odds ratios (OR) were as follows: for PCP, exertional dyspnea plus interstitial infiltrate (sensitivity 58%, specificity 92%; OR, 16.3); for bacterial pneumonia, lobar infiltrate plus fever < or = 7 days duration (sensitivity 48%, specificity 94%; OR, 14.6); and for tuberculosis, cough > 7 days plus night sweats (sensitivity 33%, specificity 86%; OR, 3.1). On regression analysis, independent predictors included interstitial infiltrate (OR, 10.2), exertional dyspnea (OR, 4.9), and oral thrush (OR, 2.9) for PCP; rhonchi on examination (OR, 12.4), a chart mention of 'toxic' appearance (OR, 9.1), fever < or = 7 days (OR, 6.6), and lobar infiltrate (OR, 5.8) for bacterial pneumonia; and cavitary infiltrate (OR, 21.1), fever > 7 days (OR, 3.9), and weight loss (OR, 3.6) for tuberculosis. CONCLUSIONS: Simple clinical variables, all readily available at the time of hospital admission, can help to differentiate these common pneumonia syndromes in HIV-infected patients. These findings can help to inform clinical decision-making regarding choice of therapy, use of invasive diagnostic procedures, and need for respiratory isolation.

HIV infection in injecting drug users attending centres in England and Wales, 1990-1991.

OBJECTIVE: To monitor trends in HIV infection and associated risk behaviours in injecting drug users (IDU) in England and Wales. DESIGN: Ongoing voluntary unlinked anonymous cross-sectional survey. METHOD: IDU attending centres in 1990 and 1991 were invited to complete a brief questionnaire requesting demographic and behavioural information, and to provide a saliva sample to be tested for antibodies to HIV and to the core antigen of hepatitis B virus (HBV). RESULTS: In 1990, 1.2% (19 out of 1543) of samples from 33 centres, and in 1991 1.8% (25 out of 1417) of samples from 37 centres contained antibody to HIV. Antibody t9 HBV core-antigen was found in 33 and 31% of IDU in 1990 and 1991, respectively. The prevalence of HIV infection in IDU attending centres in London (4.2%) was higher than in those attending centres elsewhere (0.8%). The prevalence of HIV infection in 1991 varied between individual centres from 0 to 10.6%, and at many centres outside London no IDU were infected with HIV. In the same year the prevalence of past infection with HBV varied from 14 to 54%, and IDU who had evidence of HBV infection were found among attenders in nearly all centres. The prevalences of sharing injecting equipment and risky sexual behaviour were high at many centres. The prevalence of HIV infection was higher in IDU who had started to inject in 1985 or earlier, than in those who started injecting later. In each year, approximately half the IDU surveyed reported having had a voluntary confidential HIV-antibody test, and the prevalence of HIV infection was five times higher in those tested than in those who had not been tested. CONCLUSIONS: HIV prevalence in IDU attending centres in England and Wales was low in 1990-1991. There is some indication that IDU have modified their injecting or sexual behaviour, but even at existing reduced levels of risk behaviour, transmission can occur in HIV is introduced into previously unexposed groups.

Serum anti-p53 antibodies in lung cancer: comparison with established tumor markers.

As reported earlier, p53 antibodies are detected in the sera of patients with different types of cancer, including lung cancer. In contrast, in the serum of healthy subjects the presence of anti-p53 antibodies is extremely rare. We collected the venous blood samples of 109 patients affected with lung cancer (LC): 57 patients (46 M, 11 F) with non-small-cell carcinoma (NSCLC), 52 others (40 M, 12 F) with small-cell carcinoma (SCLC). Serum p53 antibodies were assayed using ELISA method and all positive sera were confirmed by Western-blot method. In addition, using IRMA methods we assayed serum CEA, TPA, CYFRA21-1 and NSE. Serum p53Ab are detectable (p53Ab-positive) in 35/109 (32.1%) patients with lung cancer. About 17/57 (29.8%) patients affected with NSCLC and 18/52 (34.6%) with SCLC were p53Ab-positive. CEA, TPA, CYFRA21-1 and NSE sensitivity in LC patients (NSCLC+SCLC) is 50.5%, 58.7%, 42.2%, 35.8%, respectively. The lower sensitivity (32.1%) of serum p53Ab is connected with the higher specificity and diagnostic accuracy (100% and 69%, respectively). Out of 35 patients p53Ab-positive, five (14.3%) exhibit only serum p53Ab, while serum values of the established tumor markers were lower than cut-off. Serum p53Ab assessment is a simple and a low-cost assay with a good specificity and diagnostic accuracy that in LC patients can be used at least in association with established tumor markers.

Risk factors for and knowledge of Mycobacterium tuberculosis infection among drug users in substance abuse treatment.

OBJECTIVE: To determine the prevalence, incidence and risk factors for Mycobacterium tuberculosis infection, as well as to assess TB knowledge and attitudes, among a group of known drug users in a city with low TB incidence (11.3 per 100,000 in 1995). METHODS: Patients of an urban drug treatment facility enrolled in opioid substitution, opioid antagonist and other drug treatment programs were screened for TB, including tuberculin skin testing and standardized data collection on TB risk factors. A subsample of clients was interviewed about TB knowledge and attitudes. RESULTS: Between 1 June 1995 and 31 May 1996, 1055 individuals were screened. The prevalence of infection was 15.7% (CI: 13.2-18.2%). PPD positivity was associated with older age (per annum, OR = 1.08, CI: 1.05-1.11), non-white race (OR = 2.81, CI: 1.72-4.60), foreign birth (OR = 4.24, CI: 2.35-7.62) and a history of injecting drug use (OR = 1.89, CI: 1.14, 3.12). The incidence of infection was 2.9 per 100 person-years (CI: 1.8-4.7). Thirty-two per cent of 79 drug users interviewed about TB knowledge and attitudes thought TB could be prevented by bleaching or not sharing needles/syringes. Fifty-one per cent thought anyone with a positive TB skin test was contagious. CONCLUSION: M. tuberculosis infection was common in this population and associated with injecting drugs and several demographic factors. The incidence of new infection was relatively low. In this non-endemic environment, the detection and treatment of latent infection are important aspects of TB control. Misconceptions about TB transmission were also widespread in this population. Drug treatment programs can play a key role by undertaking screening programs that educate about TB and identify infected subjects who would benefit from preventive therapy.

The Health of the Nation target on syringe sharing: a role for routine surveillance in assessing progress and targeting interventions.

The Health of the Nation initiative in the United Kingdom includes a target aimed at reducing the proportion of current injecting drug users who share syringes. The PHLS Collaborative Survey of Salivary Antibodies to HIV and Hepatitis B core in injecting drug users is a comprehensive and national surveillance mechanism which routinely collects data that can be used to monitor progress toward this target. Nineteen per cent of injecting drug users (353/1876) in 1992 and 18% (375/2138) in 1993 shared previously used injecting equipment (difference of -1.3%, 95% Cl -3.7%, 1.1%). Only with further years of data collection will it be possible to tell if this decline represents a real change in behaviour. There was a substantial reduction in the proportion of sharers who received previously used needles and syringes from more than one person, from 45% (138/305) in 1992 to 27% (81/298) in 1993 (fall of 18%, 95% Cl 11%, 26%). This decline could indicate a real reduction in risk behaviour that is not reflected in the target. Monitoring this aspect of sharing could be an important supplementary measure. Women were more likely to have share (adjusted OR = 1.87, 95% Cl 1.53, 2.28) and the likelihood of sharing declined with age (adjusted OR of each 5-year age band = 0.75, 95% Cl 0.72, 0.79). Particular attention should be given to interventions which aim to reduce sharing among women and young people. Clients of agencies at which the main service provided was syringe exchange were less likely to have shared than attenders of other types of agencies (adjusted OR = 0.69, 95% Cl 0.51, 0.93). This suggests that syringe exchange schemes play a role in reducing the transmission of HIV infection.

Tuberculosis chemoprophylaxis using a liquid isoniazid-methadone admixture for drug users in methadone maintenance.

BACKGROUND: Tuberculosis is common in drug users, although compliance with therapy may be difficult in this population. OBJECTIVE: To evaluate an approach to enhancing compliance with tuberculosis chemoprophylaxis in drug users enrolled on methadone maintenance utilizing an isoniazid (INH)-methadone admixture. DESIGN: A prospective cohort study. SETTING: A drug treatment program in New Haven, Connecticut, USA. PATIENTS: Opioid-dependent drug users enrolled in methadone maintenance. INTERVENTION: Liquid isoniazid was mixed into subjects' daily dose of methadone. Vitamin B6 was given to subjects for self-administration. MEASUREMENTS AND MAIN RESULTS: Number of eligible subjects, reasons for not starting therapy, number starting therapy, proportion completing therapy and median duration of INH therapy were calculated. Thirty-nine subjects were eligible for INH chemoprophylaxis: 34 (87%) received INH mixed directly in their methadone and five (13%) had their INH consumption supervised by a nurse. Among these subjects, 72% (28/39) completed therapy. Among the 11 subjects who discontinued INH, discharge from the methadone maintenance program was the most common reason--73% (8/11). Thus, among the 31 subjects who were not discharged from methadone maintenance, 90% (28/31) successfully completed INH prophylaxis. The median duration of therapy was 182 days. CONCLUSIONS: Tuberculosis chemoprophylaxis using a liquid isoniazid-methadone admixture appears to be an effective approach to enhancing compliance with this therapy in methadone-maintained drug users.

Immunofluorescence patterns in chronic membranoproliferative glomerulonephritis (MPGN).

90 patients, whose renal biopsies showed on light microscopy a pattern of MPGN, have been studied by immunofluorescence. 10 cases showed dense intramembranous deposits. Fluoresceinated antisera against IgG, IgA, IgM, C3, fibrinogen, IgD, IgE, C4, C1q, properdin and C3A were employed. Granular depostis of C3 were observed in all cases; IgG, IgM, properdin, C1q and C4 were found in 2/3 cases; IgA, IgE and C3A were rarely found. The localization of these deposits was parietal and often also mesangial. On the basis of glomerular deposition of C3 with or without immunoglobulins (Ig), we separated the cases into three groups: 1) C3 + Ig (59 cases), 2) predominant C3 (19 cases), 3) isolated C3 (12 cases). Most patients with dense deposits disease were classified in the third group. Deposits of C1q and C4 were found only in the first two groups. The localization of C3 deposits showed a more frequent mesangial extension in the second and third groups. Patients in these 3 groups also had different serum complement profiles. No significant differences in the major clinical features could be found in the 3 groups. Variable immunofluorescence patterns, in agreement with other serological parameters, confirm the heterogeneity of pathogenetic mechanisms in patients with MPGN.

Serum concentration of free T3, free T4 and TSH in healthy children.

OBJECTIVE: It is rare that manufacturers report age-related FT3, FT4 and TSH normal ranges in healthy children. STUDY DESIGN: Using a solid phase time-resolved fluoroimmunometric method, we determined serum FT3, FT4 and TSH in 3,360 healthy children, age 2-16 years, that we grouped into two age ranges (2-7 yr and 9-16 yr). RESULTS: Boys' and girls' mean serum thyroid hormone values substantially overlap in all age groups. In the age range 2-7 yr, FT3, FT4 and TSH values were 0.10-0.67 ng/dl (mean 0.37 ng/dl), range 0.45-2.29 ng/dl (mean 1.18 ng/dl) and 0.10-5.9 microU/ml (mean 2.2 microU/ml), respectively. In the age range 9-16 yr, FT3, FT4 and TSH values were 0.11-0.53 ng/dl (mean 0.35 ng/dl), 0.69-1.69 ng/dl (mean 1.07 ng/dl) and 0.20-6.1 microU/ml (mean 2.3 pU/ml), respectively. CONCLUSION: Our results represent a useful set of reference values in children and can help physicians in the management of thyroid diseases.

Assessment of visual contrast sensitivity in hyperbaric oxygen.

Hyperbaric oxygen therapy is used in ophthalmology in ischemic pathologies of the anterior and posterior segments. Our experiment was done on a healthy group of volunteers aged between 10 and 50 yr. We examined the subject's vision before and after acute HBO exposure (60 min at 2.5 atm abs with pure oxygen) to verify whether vasoconstriction induced by hyperoxemia can influence eyesight. We measured the psychophysical determination of the threshold contrast according to Maione-Maffei's zebra test. The results demonstrated that contrast sensitivity is significantly improved for almost all the studied frequencies in normal subjects after acute HBO exposure. We hypothesize that the visual system has a reserve which is activated by an improvement of retinal oxygenation.

Pioglitazone attenuates the detrimental effects of advanced glycation end-products in the pancreatic beta cell line HIT-T15.

Pioglitazone is an anti-diabetic agent that preserves pancreatic beta cell mass and improves their function. Advanced Glycation End-Products (AGEs) are implicated in diabetic complications. We previously demonstrated that exposure of the pancreatic islet cell line HIT-T15 to high concentrations of AGEs significantly decreases cell proliferation and insulin secretion, and affects transcription factors regulating insulin gene transcription. The aim of this work was to investigate the effects of Pioglitazone on the function and viability of HIT-T15 cells cultured with AGEs. HIT-T15 cells were cultured for 5 days in the presence of AGEs alone, or supplemented with 1 µmol/l Pioglitazone. Cell viability, insulin secretion and insulin content, redox balance, expression of the AGE receptor (RAGE), and NF-kB activation were then determined. The results showed that Pioglitazone protected beta cells against AGEs-induced apoptosis and necrosis. Moreover, Pioglitazone restored the redox balance and improved the responsiveness to low glucose concentration. Adding Pioglitazone to the AGEs culture attenuated NF-kB phosphorylation, and prevented AGEs to down-regulate IkBα expression. These findings suggest that Pioglitazone protects beta cells from the dangerous effects of AGEs.

Investigando el autocuidado en una muestra de pacientes con insuficiencia cardiaca descompensada: un estudio transversal / Investigating self-care in a sample of patients with decompensated heart failure: a cross-sectional study

Antecedentes: La información sobre el autocuidado en la insuficiencia cardiaca (IC) en España es escasa. En concreto, existe la necesidad de fijar el nivel de comprensión de los pacientes sobre la IC, así como su capacidad para reconocer los signos y los síntomas de la descompensación. Pacientes y métodos: Estudio transversal para determinar el nivel de autocuidado en una población de pacientes españoles ingresados en el hospital con un diagnóstico primario de IC descompensada. Para el estudio, se reclutó una muestra de conveniencia integrada por 108 pacientes (50 mujeres y 58 hombres) con una edad de 83+/-8 años. Resultados: Para cuantificar el autocuidado en nuestra muestra se empleó el Índice de Autocuidado en Insuficiencia Cardiaca versión 6.2. La media y la desviación estándar de la subescala de mantenimiento de autocuidado del Índice de Autocuidado en Insuficiencia Cardiaca fueron: a) «ejercicio durante 30 minutos», 1+/-1; b) «olvida tomar una de sus medicinas», 2+/-2; c) «pedir productos bajos en sal cuando sale a comer o de visita», 2+/-1. En el mes previo, el 67,6% experimentó dificultad para respirar o inflamación del tobillo. Sin embargo, era improbable que la gran mayoría de nuestros pacientes implementaran de forma independiente un remedio: a) reducir sal, 2+/-1; b) reducir la ingesta de líquidos, 1+/-1; c) tomar un diurético extra, 1+/-1. Más del 50% de los pacientes de nuestra muestra se sintieron confiados o muy confiados siguiendo los consejos profesionales (3+/-1), manteniéndose libres de síntomas (3+/-1), reconociendo los cambios en su enfermedad (3+/-1) y valorando la importancia de dichos cambios (3+/-1). Conclusiones: Al comparar a nuestros pacientes con IC con los de otros países el nivel de autocuidado es significativamente bajo, especialmente en lo que se refiere a la gestión de su enfermedad. La promoción del autocuidado debería ser una prioridad para todos los profesionales de la salud involucrados en la gestión de los pacientes con IC

Background: There is scarce evidence relating to self-care of heart failure (HF) in Spain. In particular, there is a need to establish patients' level of understanding of HF, as well as their ability to recognise signs and symptoms of decompensation. Patients and methods: Cross-sectional study to determine the level of self-care in a population of Spanish patients admitted to hospital with a primary diagnosis of decompensated HF. A convenience sample of 108 patients (50 women and 58 men) aged 83+/-8 were recruited to participate in this study. Results: The Self-Care of Heart Failure Index version 6.2 was used to quantify self-care in our sample. Mean and standard deviation from the Self-Care of Heart Failure Index self-care maintenance subscale were: a) "exercise for 30 minutes", 1+/-1; b) "forget to take one of your medicines", 2+/-2; c) "ask for low-salt items when eating out or visiting others", 2+/-1. A percentage of 67.6 had experienced shortness of breath or ankle swelling in the past month. However, the vast majority of our patients were unlikely to independently implement a remedy: a) reduce salt, 2+/-1; b) reduce fluid intake, 1+/-1; c) take an extra diuretic, 1+/-1. Over 50% of our sample felt confident or very confident at following professional advice (3+/-1), keeping themselves free of symptoms (3+/-1), recognizing changes in their condition (3+/-1) and evaluating the significance of such changes (3+/-1). Conclusions: HF patients have a significantly low level of self-care when compared with HF patients from other countries, especially when it comes to managing their condition. Self-care promotion should be a priority for all healthcare professionals involved in the care and management of HF patients

How many people in England and Wales risk infection from injecting drug use?

Injecting drug users who share equipment may transmit and acquire bloodborne virus infections, including HIV, hepatitis B virus, and hepatitis C virus. Even without sharing, injection with non-sterile equipment, drugs, or mixing agents may result in infection due to bacteria or fungi. Estimates of the number of people who are currently at risk of infection from injecting drug use are needed in order to plan services and care, and to interpret surveillance data. This paper examines the data from registries of drug use and two recent surveys of the general population from which estimates of the number of current injecting drug users in England and Wales have been derived. Drug registries include only those whose drug use is identified during contact with drug or medical services, so these sources provide minimum estimates but may be used to monitor trends: 25,706 drug users in England and Wales were notified to the Home Office in 1993, 12,253 of whom were current injectors. Estimates derived from surveys of the general population suggest, however, that between 51,900 (95% confidence interval (CI): 33,000-71,600) and 77,700 (95% CI: 4100-151,200) people in England and Wales are at risk of infection from current injecting drug use, of whom between 10,400 (95% CI: 7200-13,800) and 15,500 (95% CI: 800-30,200) are at risk of bloodborne virus infections as a result of sharing injecting equipment. In the 16 to 34 year age group about one in 200 men, and one in 400 to 500 women may be current injectors.(ABSTRACT TRUNCATED AT 250 WORDS)

Electroretinographic findings in congenital oculomotor apraxia (Cogan's syndrome).

We performed visual evoked potential testing and electroretinography in five patients with Cogan's oculomotor apraxia. The visual evoked potentials were normal, confirming previously reported data. Electroretinograms were abnormal in two of the five patients examined. A previous study showed normal electroretinogram responses bilaterally in one patient. Our findings suggest the existence of two variants of the syndrome; the one with electroretinogram anomalies has a worse visual prognosis.

Serum and glomerular complement in 205 cases of glomerulonephritis.

In 205 cases of GN the glomerular deposits of C3, C1q, C4, and C3A and the serum levels of the same complement components at the time of biopsy were studied. Alterations of serum complement profile were found only in acute GN, membranoproliferative GN and lupus nephritis, while glomerular deposition was observed with a different incidence and intensity in all nephropathies. A strict correlation between the intensity of deposits and the degree of hypocomplementaemia was found only in early acute GN and in active lupus nephritis.

Acute renal failure due to rifampicin (R-ARF).

Five episodes of acute renal failure due to rifampicin (R-ARF) were observed in four patients and the clinical and histological data were compared with the records of 52 episodes reported in the literature. The bulk of data supports the assumption that the by far most frequent renal injury responsible for R-ARF is acute tubular necrosis produced by a vasomotor mechanism. Nevertheless a few data, above all immunohistological findings, suggest the local presence of allergic process. It may be, that the development of an immunological renal lesion is prevented or blunted by the consequences of vasomotor effects.