Repeat antenatal HIV testing in the third trimester: a study of feasibility and maternal uptake rates.

OBJECTIVES: The study aimed to assess the feasibility and acceptability of third-trimester antenatal HIV testing within our service after two cases of HIV seroconversion in pregnancy were noted in 2008. North American Guidelines recommend universal third-trimester HIV testing in areas with an HIV prevalence of more than 1 per 1000. The HIV prevalence rate in our area is 3.01 per 1000. METHODS: Pregnant women prior to 28 weeks of gestation were recruited at booking between 1 September 2008 and 31 August 2009 and offered an additional third-trimester HIV test. Consent was obtained and testing was performed by hospital and community midwives. Information was entered into a modified existing electronic maternity database. A qualitative e-mail survey of midwives investigated barriers to participation in the study. RESULTS: A total of 4134 women delivered; three (< 0.1%) declined first-trimester testing. Twenty-two women (0.5%) tested HIV positive, of whom six were newly diagnosed. Overall, 2934 of 4134 women (71%) were offered and accepted a third-trimester HIV test and had results available. Data were unavailable for 195 women (4.7%). A total of 663 of 4131 women (16%) were not offered a third-trimester test. Of 3273 women documented as having been offered a test, 3177 (97.1%) accepted. There were no positive third-trimester tests. Forty of 50 (80%) midwives surveyed responded with questionnaire feedback and cited lack of national policy and extra workload as barriers to performing third-trimester testing. CONCLUSIONS: Third-trimester testing was feasible and consent rates were high in those offered repeat testing. Third-trimester testing has the potential to prevent paediatric HIV infection and universal testing should be considered in high-prevalence areas.

A review of the relationship between alcohol and oral cancer.

This paper aims to review the current literature regarding the association between alcohol consumption and oral cancer. The authors have discussed the constituents of alcohol-containing beverages, the metabolism of ethanol and its effect on the oral microflora. The local and systemic carcinogenic effects of alcohol have been detailed. The beneficial effects of alcohol consumption on general health have also been considered. A possible relationship between alcohol-containing mouthrinses and oral cancer has been suggested in the literature. The authors conclude that this relationship has not yet been firmly established. However, the use of alcohol-containing mouthrinses in high-risk populations should be restricted, pending the outcome of further research.

The role of the health services in the prevention of alcohol-related facial injury.

This paper outlines the preventive health strategic measures that are currently in place and it endeavours to consider how improvements can be made to our national preventive strategy with the goal of reducing alcohol-related facial injuries. It is based on a review of the literature sourced through PubMed, Ovid Medline and the Cochrane database. The main findings are that increased funding, legislative amendment and media involvement are key to improving the work of the health services in their struggle to limit the ever increasing alcohol-related incidents that are experienced by society today.

Interaction of guanine nucleotides with adenylate cyclase in normal and spontaneously transformed RL-RP-C cloned rat hepatocytes.

Spontaneous transformation of RL-PR-C hepatocytes leads to alterations in the adenylate cyclase complex which include a lower than normal basal level of activity, a loss of sensitivity to exogenous GTP, and a decreased sensitivity to isoproterenol. Both normal and transformed membranes possess substantial GTPase activity. Treatment of transformed hepatocyte membranes with either isoproterenol plus GMP or with cholera toxin, under conditions that displace tightly bound GDP, restored the GTP effect on adenylate cyclase, and eliminated the lag in the activation by guanyl-5'-yl-imidodiphosphate. Such pretreatment also enhanced guanine nucleotide effects on the adenylate cyclase of normal hepatocytes. These results are explainable on the basis that transformation increases adenylate cyclase-associated GTPase activity, and increases occupancy of nucleotide regulatory sites by inactive or inhibitory guanine nucleotides, e.g., GDP. Seemingly, both catecholamines and cholera toxin promote an exchange reaction at the regulatory sites, resulting in clearance of these sites of inhibitory nucleotides.

Contrasting monoamine oxidase activity and tyramine induced catecholamine release in PC12 and chromaffin cells.

PC12 (phaeochromocytoma derived) cells possess the catecholamine synthesizing enzymes as well as the ability to store and release the catecholamines in response to K+. However, their monoamine oxidase activity and catecholamine release in response to tyramine has not been examined previously. PC12 cells have monoamine oxidase activity which oxidizes type A (noradrenaline and serotonin) and type A-B (dopamine, tyramine and kynuramine) substrates, and is selectively inhibited by clorgyline (IC50 approximately 10(-6) M). In contrast, PC12 cell monoamine oxidase hardly oxidizes phenylethylamine a type B substrate, and is relatively insensitive to inhibition by the selective monoamine oxidase type B inhibitor, 1-deprenyl (IC50 approximately 10(-6) M). By the above criteria it is apparent that the monoamine oxidase in PC12 is solely type A. The kinetics of the oxidase are similar to those of monoamine oxidase type A reported in other tissues including the adrenergic neuron, having apparent Km values of 400, 280, 170 and 227 microM for noradrenaline, dopamine, serotonin and tyramine. The apparent Km value for phenylethylamine is 235 microM. On the other hand, isolated chromaffin cells have the B form of monoamine oxidase with high affinity (Km approximately 25 microM) for phenylethylamine and low affinities for noradrenaline (Km approximately 1100 microM) and adrenaline (Km approximately 1700 microM). This enzyme form is selectively inactivated by the monoamine oxidase type B inhibitor, 1-deprenyl. In similar fashion to peripheral adrenergic neurons, PC12 cells share the capacity to express a tyramine releasable pool of catecholamines, a property entirely lacking in mature cultured chromaffin cells, even though the latter cells are capable of taking up tyramine by a cocaine sensitive process.(ABSTRACT TRUNCATED AT 250 WORDS)

Systematic review of adherence to infection control guidelines in dentistry.

OBJECTIVES: The purpose of this study was to determine the knowledge and attitudes of dental health care workers (DHCWs) towards infection control procedures, to examine DHCWs' practising behaviour in respect of infection control, and to determine whether a relationship exists between knowledge, attitudes and behaviour. METHODS: Within this systematic review, study quality was assessed in line with selection criteria relating to study design, participants, interventions and outcome measures. Following data extraction, the heterogeneity of study design, targeted participants, sample size and outcome measures precluded a quantitative analysis. Qualitative data synthesis followed. RESULTS: Overall, the quality of the studies reviewed was poor. Only 71 studies meeting the selection criteria were identified. Data indicated that over the period of the review there have been substantial improvements with compliance in some areas of infection control in dentistry, for example glove wearing. However, other aspects, such as the effective management of needlestick injuries, remain problematic. CONCLUSIONS: More rigorously designed studies are required to assess accurately dental team members' adherence to infection control guidelines.

Four legs or two: up front with you--preventing tragedies by keeping children and pets out of the cargo areas of pickup trucks.

Dogs and children riding in the cargo area of pickup trucks are common sights on our nation's highways, country roads, and small town streets. This scene brings to mind idyllic childhoods filled with summer days spent bouncing down roads in the back of grandpa's pickup truck, wind catching the laughter from children's throats. For hundreds of families each year, this activity is the cause of heartache, traumatic injuries, and senseless deaths. More than 200 people die each year, half of whom are younger than 18 years of age, as a direct result of falls from cargo areas of pickup trucks. Injuries and deaths resulting from riding in cargo areas of pickup trucks are not limited to humans. In a recent survey, 71% of veterinarians reported treating dogs for injuries sustained by falling or jumping from cargo areas of pickup trucks. This percentage does not take into account countless dogs that were killed and not treated. Injuries and deaths resulting from riding in cargo areas of pickup trucks are preventable. Whereas it may take millions of dollars and many years to cure diseases such as cancer, heart disease, and AIDS, pickup truck-associated deaths can be prevented simply by educating the public to not allow children and pets to ride in cargo areas. The primary objective of "Four legs or two: Up front with you" is to educate the public on the risks involved with travel in the cargo areas of pickup trucks. Making people aware that children and pets are not cargo is the first step toward decreasing senseless injuries and deaths.

The incidence of occupational exposures among students in four UK dental schools.

OBJECTIVES: To evaluate: the incidence of occupational exposures (OE) to patient body fluids among a sub-group of dental students; the rate of reporting of incidents; and the association of various factors. DESIGN: Multicentre retrospective analysis. SETTING: Four UK dental schools in 2000. SUBJECTS: Dental students from 4 UK schools completed a confidential questionnaire at the end of the clinical years of their undergraduate course. RESULTS: The response rates ranged from 71-100%, showing that 12-40% of students among the schools had experienced one or more OE incidents since starting their course. No statistically significant association was found between OE incidence and age, sex, dominant hand or time of day; most OE occurred with handling of local anaesthetic syringes. 61-78% of incidents were penetrative in nature, and 28-53% of students had not reported their last OE. OE incidence was associated with school, year of course, presence of patient and presence of an assistant. There were substantial differences in the numbers of students experiencing OE among the schools. CONCLUSIONS: Within the limitations of the survey and variations within the clinical activity of schools, it may be seen that improvements are needed in some schools to reduce cross-infection risks, and increase reporting of incidents. Suggestions are offered which may increase the safety of dental treatment.

Chemotherapy induced peripheral neuropathy: the modified total neuropathy score in clinical practice.

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) is a common, potentially reversible side effect of some chemotherapeutic agents. CIPN is associated with decreased balance, function and quality of life (QoL). This association has to date been under-investigated. AIMS: To profile patients presenting with CIPN using the modified Total Neuropathy Score (mTNS) in this cross-sectional study and to examine the relationship between CIPN (measured by mTNS) and indices of balance, quality of life (QoL) and function. METHODS: Patients receiving neurotoxic chemotherapy regimens were identified using hospital databases. Those who did not have a pre-existing neuropathy were invited to complete mTNS, Berg Balance Scale (BBS), timed up and go (TUG), and FACT-G QoL questionnaire. mTNS scores were profiled and also correlated with BBS, TUG and FACT-G using Spearmans correlation coefficient. RESULTS: A total of 29 patients undergoing neurotoxic chemotherapy regimens were tested. The patients mTNS scores ranged between 1 and 12 (median = 5), indicating that all patients had clinical evidence of neuropathy on mTNS. No significant correlations were found between mTNS and BERG (r = -0.29), TUG (r = 0.14), or FACT-G (r = 0.05). CONCLUSIONS: This study found a high prevalence of CIPN in patients treated with neurotoxic chemotherapy regimens. The mTNS provided a clinically applicable, sensitive screening tool for CIPN which could prove useful in clinical practice. mTNS did not correlate with BBS, TUG or FACT-G in this sample, possibly due to relatively mild levels of CIPN and consequent subtle impairments which were not adequately captured by gross functional assessments.

Direct anesthetic-like effects of forskolin on the nicotinic acetylcholine receptors of PC12 cells.

Forskolin is thought to be a highly specific activator of adenyl cyclase. However, when applied to rat pheochromocytoma (PC12) cells at concentrations of 1 microM or higher it caused an immediate, concentration-dependent inhibition of carbachol-stimulated uptake of 86Rb+ through the nicotinic receptors, which did not appear to be related to activation of adenyl cyclase. The inhibition of receptor activation occurred instantaneously whereas cellular cAMP content did not increase for a measureable period of time. Normal receptor function was recovered rapidly upon removal of forskolin. Additional evidence that this effect of forskolin was not related to cAMP was obtained when 1,9-dideoxyforskolin (an analog of forskolin which does not activate adenyl cyclase) also caused a rapid, concentration-dependent, rapidly reversible inhibition of receptor-mediated influx of 86Rb+ into the cells. An examination of the effect of forskolin on 86Rb+ uptake at various concentrations of carbachol showed that forskolin was not acting by competing with carbachol for the receptor activation site. Given the lipophilic nature of forskolin, it probably acts like a general anesthetic to perturb the plasma membrane lipid structure and alter the function of the nicotinic acetylcholine receptors, possibly by increasing the rate of closure of open channels.

Patients' attitudes to rubber dam.

AIM: The aims of this study were to record patients' views of their experience of RD use in an objective manner, and to evaluate the influence of some personal and clinical factors on patients' opinion. METHODOLOGY: A questionnaire was designed which was then distributed to patients receiving dental treatment under RD by (a) final-year dental students at Birmingham Dental School, and (b) general dental practitioners. Patients completed the confidential questionnaire anonymously after treatment, outside the treatment room. After 100 correctly completed forms were collected from group (a) and 106 from group (b), data were entered into a database and subsequently analyzed using SPSS. Analyses were confined to simple cross-tabulations of the patients' responses and potential associated factors, with chi-square analysis and appropriate follow-up comparisons wherever necessary. RESULTS: In both groups, the majority of patients said they would prefer RD to be used at their next appointment, and most had a positive opinion of the experience. No statistically significant association between age, sex, procedure, application time or duration of use and preference for rubber dam was found. Prolonged RD use showed some association with a negative opinion of the experience of RD. Compared with the dentists, students took longer to apply rubber dam and it was in place for longer. Fewer student patients preferred RD next time, and were less positive about its use than the dentists' patients. CONCLUSIONS: Further evidence is presented that (i) Patients generally are not averse to RD. (ii) Placement of rubber dam does not take long. (iii) Operator experience improves patient compliance.

Stabilization of a sodium channel state with high affinity for saxitoxin by intramolecular cross-linking. Evidence for allosteric effects of saxitoxin binding.

Incubation of purified rat brain sodium channels at 37 degrees C or at high ionic strength causes a concomitant loss of saxitoxin-binding activity and dissociation of beta 1 subunits. Reaction with hydrophilic carbodiimides produced a resistance against the loss of saxitoxin binding and caused covalent cross-linking of alpha, beta 1, and beta 2 subunits. In the presence of saxitoxin, this cross-linking reaction led to formation of a state with increased affinity for saxitoxin. However, analysis of the concentration dependence of covalent cross-linking and its inhibition by hydrophilic nucleophiles showed that the stabilization of the saxitoxin-binding activity was due to the formation of a small number of isopeptide bonds in the alpha subunit rather than to cross-linking of alpha and beta 1 subunits. In the presence of amine nucleophiles, carbodiimides caused loss of saxitoxin binding, which was prevented in the presence of the toxin. Nucleophiles yielding positively charged amide products were more effective than those forming uncharged or negatively charged products. Under conditions where saxitoxin protected the binding activity of the sodium channel from inactivation, the overall availability of carboxyl groups for reaction was increased, providing evidence for a toxin-induced conformational change on binding. These results are considered in terms of an allosteric model of saxitoxin binding, in which the functional form of the sodium channel having high affinity for saxitoxin can be stabilized against inactivation by noncovalent interactions with beta 1 subunits, binding of saxitoxin and tetrodotoxin, or intramolecular cross-linking of amino acid residues within the alpha subunit.

Discrimination of the notifiable pathogen Gyrodactylus salaris from G. thymalli (Monogenea) using statistical classifiers applied to morphometric data.

The identification and discrimination of 2 closely related and morphologically similar species of Gyrodactylus, G. salaris and G. thymalli, were assessed using the statistical classification methodologies Linear Discriminant Analysis (LDA) and k-Nearest Neighbours (KNN). These statistical methods were applied to morphometric measurements made on the gyrodactylid attachment hooks. The mean estimated classification percentages of correctly identifying each species were 98.1% (LDA) and 97.9% (KNN) for G. salaris and 99.9% (LDA) and 73.2% (KNN) for G. thymalli. The analysis was expanded to include another 2 closely related species and the new classification efficiencies were 94.6% (LDA) and 98.% (KNN) for G. salaris; 98.2% (LDA) and 72.6% (KNN) for G. thymalli; 86.7% (LDA) and 91.8% (KNN) for G. derjavini; and 76.5% (LDA) and 77.7% (KNN) for G. truttae. The higher correct classification scores of G. salaris and G. thymalli by the LDA classifier in the 2-species analysis over the 4-species analysis suggested the development of a 2-stage classifier. The mean estimated correct classification scores were 99.97% (LDA) and 99.99% (KNN) for the G. salaris-G. thymalli pairing and 99.4% (LDA) and 99.92% (KNN) for the G. derjavini-G. truttae pairing. Assessment of the 2-stage classifier using only marginal hook data was very good with classification efficiencies of 100% (LDA) and 99.6% (KNN) for the G. salaris G. thymalli pairing and 97.2% (LDA) and 99.2% (KNN) for the G. derjavini-G. truttae pairing. Paired species were then discriminated individually in the second stage of the classifier using data from the full set of hooks. These analyses demonstrate that using the methods of LDA and KNN statistical classification, the discrimination of closely related and pathogenic species of Gyrodactylus may be achieved using data derived from light microscope studies.

Sulfation and constitutive secretion of dopamine beta-hydroxylase from rat pheochromocytoma (PC12) cells.

The biosynthesis and secretion of dopamine beta-hydroxylase were investigated by radiolabeling rat pheochromocytoma (PC12) cells in culture. Intracellular dopamine beta-hydroxylase from a crude chromaffin vesicle fraction and secreted dopamine beta-hydroxylase from culture medium were immunoprecipitated using antiserum made against purified bovine soluble dopamine beta-hydroxylase. Analysis of the immunoprecipitated enzyme on sodium dodecyl sulfate-polyacrylamide gel electrophoresis showed that: 1) the membrane-bound form of the hydroxylase from crude secretory vesicle membrane extracts contained two nonidentical subunits in approximately stoichiometric amounts (Mr = 77,000 and 73,000); 2) the soluble hydroxylase from the lysate of these secretory vesicles was composed predominantly of a single subunit (Mr = 73,000); and 3) the hydroxylase secreted into the medium under resting conditions was also composed of a single subunit (approximate Mr = 73,000). All subunits of the multiple forms of hydroxylase were glycoproteins. Under resting conditions, the rate of secretion of hydroxylase was approximately 6% of total cellular enzyme/15 min. The secreted form of the hydroxylase incorporated [35S]sulfate, whereas no significant [35S]sulfate was incorporated into the cellular forms of enzyme. We propose that in addition to the dopamine beta-hydroxylase which is found in catecholamine storage vesicles and released during stimulus-coupled exocytosis, PC12 cells also have a constitutive secretory pathway for dopamine beta-hydroxylase and that the enzyme released by this second pathway is sulfated.

Occupational exposures occurring in students in a UK dental school.

BACKGROUND: Students whilst training may encounter a number of incidents where infection from patient body fluids may occur, especially as their manual skills are underdeveloped and their clinical experience is limited. PURPOSE OF STUDY: (a) To assess the nature of the occupational exposures occurring to students in a UK dental school, (b) to assess the rate of reporting of incidents, and (c) to evaluate the association of various factors with these exposures. Students in the third, fourth and final years of the 5-year undergraduate dental course at the University of Birmingham were asked to complete a questionnaire that inquired into personal details, number and nature of incidents, their reporting and follow-up. A 100% response rate was achieved. RESULTS: Across the years, there was no significant correlation (p > 0.01) between sex, dominant hand, use of protective glasses or time of day. Slightly more exposures occurred in males, right-handed students, and in the afternoon. A significant decrease in exposures (p < 0.01) occurred within final year, and when an assistant was employed. Significantly more incidents occurred while a patient was being treated than during operational clean-up procedures. A substantial number of dental students had experienced one or more occupational exposures during training. Of these, percutaneous injuries predominated. Junior students appear to be more likely to experience exposures, and in these students, needlestick injuries are the most common source. CONCLUSIONS: To reduce the incidence of these exposures, more instruction and training may be required in the earlier clinical years and more chairside assistance. Improvements are required in the monitoring of post-screening for seroconversion after HBV immunization, and in the reporting of test results in the event of an exposure incident. Under-reporting of incidents is common and ways to encourage and facilitate reporting should be sought.