AIDS-STD Prevention in Traveller's Clinics.
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Journal Article↗
Biomedical subjects
D Tessier
Publications and source records attributed to D Tessier.
[How to plan travel vaccinations when they are numerous or the traveler is pressed for time?].
Deciding on the best immunizations and their best sequence of administration for some travellers may be wavering. Numerous resources documents and tools are available to help the travel medicine expert in his or her decision making process. Still, many factors are to be considered and weighed. These include time, money, uncertain itinerary, health status, fears and beliefs of the traveller and the number of available injection sites. The specific needs of the traveller should be assessed with minutia. The evaluation will look at the type of accommodation planed, the purpose of the travel, the distance covered, the mode of transportation, and previous travel experience. Inevitably, some travellers will leave the country without receiving all recommended immunizations. They should be part of the decision process when some are to be sacrificed. Information is essential for an enlightened choice, and it is the responsibility of the travel medicine expert to provide it.
Drug Costs↗
[First aid kits: for whom and why?].
Anyone traveling far from home should take along a first aid kit. Contents should be chosen carefully with the awareness that infection is not the main problem facing travelers. The basic kit is the same regardless of the purpose or duration of the trip or of the health and knowledge of the traveler. Priority should be given to allergic risks, to the quality of the thermometer, to the packaging of indispensable medications to a medical certificate justifying transport of drugs and syringes for personal medical use, and to preventive devices for sexually transmitted diseases. Travel in tropical zones raises special requirements especially with regard to infectious risks such as traveler's diarrhea, malaria, fungal and bacterial contamination. Protection against insect-borne disease and sun exposure are also important considerations for travel in the tropics. Depending on planned activities, travelers should carry medication for prevention and treatment of motion sickness and emergency treatment of envenimation. Due to local inavailabilities, it may be necessary to pack contraceptives, personal hygiene products, and common medications.
Bites and Stings↗
Crystallization of a soluble form of the Kex1p serine carboxypeptidase from Saccharomyces cerevisiae.
A soluble form of the killer factor and prohormone-processing carboxypeptidase, "Kex1 delta p," from Saccharomyces cerevisiae, has been crystallized in 17-22% poly(enthylene glycol) methyl ether (average M(r) = 5,000), 100 mM ammonium acetate, 5% glycerol, pH 6.5, at 20 degrees C. A native data set (2.8 A resolution) and four derivative data sets (3.0-3.2 A resolution) were collected at the Photon Factory (lambda = 1.0 A). The crystals belong to space group P2(1)2(1)2(1) with a =56.6 A, b = 84.0 A, c = 111.8 A. Freezing a Kex1 delta p crystal has facilitated the collection of a 2.4-A data set using a rotating anode source (lambda = 1.5418 A). Molecular replacement models have been built based on the structures of wheat serine carboxypeptidase (CPDW-II; Liao DI et al., 1992, Biochemistry 31:9796-9812) and yeast carboxypeptidase Y.
Animals↗
NIDDM in the elderly.
OBJECTIVE: We conducted this study to assess the metabolic alterations in elderly patients with NIDDM. RESEARCH DESIGN AND METHODS: Healthy, lean (n = 15; age, 73 +/- 1 years; BMI, 23.8 +/- 0.5 kg/m2), and obese (n = 10; age, 71 +/- 1 years; BMI, 28.9 +/- 1.2 kg/m2) control subjects and lean (n = 10; age, 75 +/- 2 years; BMI, 24.0 +/- 0.5 kg/m2) and obese (n = 23; age, 73 +/- 1 years; BMI, 29.9 +/- 0.7 kg/m2) NIDDM patients underwent a 3-h glucose tolerance test, a 2-h hyperglycemic glucose clamp study, and a 3-h euglycemic glucose clamp study with tritiated glucose methodology to measure glucose production and disposal rates. RESULTS: Waist-to-hip ratio (WHR) was greater in both lean and obese NIDDM patients than in control subjects. Insulin responses during the oral glucose tolerance test were similar in obese subjects (control subjects: 417 +/- 64 pmol/l; NIDDM patients: 392 +/- 47 pmol/l) but were reduced in lean NIDDM patients (control subjects: 374 +/- 34 pmol/l; NIDDM patients: 217 +/- 20 pmol/l, P < 0.01). Lean and obese NIDDM patients had absent first-phase insulin responses during the hyperglycemic clamp. Second-phase insulin responses were reduced in lean (P < 0.01 vs. control subjects by analysis of variance) but not obese NIDDM patients. Hepatic glucose output was not increased in lean or obese NIDDM patients. Steady-state (150-180 min) glucose disposal rates were 16% less in lean NIDDM patients (control subjects: 8.93 +/- 0.37 mg.kg LBM (lean body mass)-1.min-1; NIDDM patients: 7.50 +/- 0.28 mg.kg LBM-1.min-1, P < 0.05) and 37% less in obese NIDDM patients (control subjects: 8.17 +/- 0.38 mg.kg LBM-1.min-1; NIDDM patients: 5.03 +/- 0.36 mg.kg LBM-1.min-1, P < 0.001). CONCLUSIONS: Lean elderly NIDDM patients have a profound impairment in glucose-induced insulin release but mild resistance to insulin-mediated glucose disposal. Obese elderly NIDDM patients have adequate circulating insulin, but marked resistance to insulin-mediated glucose disposal. Hepatic glucose output is not increased in elderly NIDDM patients.
Aged↗
Electrochemical and microstructural study of oxide films formed electrochemically at microcrystalline Al-Fe-V-Si alloys.
A recent advance in metallurgical technology has been the application of rapid solidification techniques to Al alloy production. FVS0812 is the designation given to a microcrystalline Al-based alloy consisting of 8 wt% Fe, 1 wt% V and 2 wt% Si. It is a two-phase alloy, consisting of ca. 27 vol percent of approximately spherical Fe-V-Si-rich dispersoids in an essentially pure Al matrix. The high strength, low density properties of this advanced material, and other related alloys, have not yet been realized, however, due, in part, to the inability of the alloy to form a thick, adherent, abrasion-resistant outer surface oxide film, a feature readily achieved at conventional Al alloys by normal anodizing methods. The present research has involved an electro-chemical study of oxide film growth at the 812 alloy, with the specific goals being to seek an understanding of the origin of the oxide film growth problem and ultimately to propose alternative approaches to the formation of a thick, stable oxide film at this material. The techniques used in this research have included electrochemical methodologies such as cyclic voltammetry and electrochemical impedance spectroscopy. Crucial information has been obtained through transmission electron microscopy (TEM) of ultramicrotomed specimens. Experiments were carried out initially in neutral borate solutions to characterize the compact barrier oxide film formed in this environment and expected to be present beneath the porous oxide film formed in the normal sulfuric acid anodizing medium.(ABSTRACT TRUNCATED AT 250 WORDS)
Alloys↗
Diabetes in the elderly.
Diabetes affects at least 20% of the population over the age of 65. Half of these patients are unaware that they have the disease. Diabetes in middle-aged subjects is characterized by an impairment in glucose induced insulin release, increased fasting hepatic glucose output and resistance to insulin mediated glucose disposal. In contrast, diabetes in the elderly is primarily associated with insulin deficiency. The presentation of diabetes in the aged is often non-specific. The elderly have an increased frequency of complications from diabetes. They are particularly susceptible to hypoglycaemia, because of reduced awareness of hypoglycaemic warning symptoms and altered release of counterregulatory hormones. Although no data are yet available from randomized controlled trials, there is abundant epidemiological evidence to suggest that adequate control of blood glucose can be expected to reduce the risk of long-term complications. A team approach is ideal for the management of the elderly patient with diabetes. Little data is available on which to base a diet and exercise prescription for elderly patients. Gliclazide appears to be the sulphonylurea of choice in the aged because it is associated with a lower frequency of hypoglycaemic reactions. Urine glucose testing is unreliable, and capillary glucose monitoring is preferred. Fructosamine may prove to be superior to haemoglobin A1C for monitoring long-term control.
Aged↗
Glibenclamide vs gliclazide in type 2 diabetes of the elderly.
The objective of this study was to compare the effect of two sulphonylureas on the frequency of hypoglycaemic events and glycaemic control in elderly patients with Type 2 diabetes. Twenty-two untreated elderly patients were treated with glibenclamide or gliclazide in a randomized double-blind fashion. Prior to treatment, a biochemical profile, an oral glucose tolerance test, and a 2-h hyperglycaemic glucose clamp (glucose 5.4 mmol l-zs-1 above baseline) were performed. Patients were seen regularly over 6 months to assess glycaemic control and the frequency of hypoglycaemic reactions. Hyperglycaemic clamp studies and oral glucose tolerance tests were repeated at 1 and 6 months. The area under the curve for the oral glucose tolerance test (glibenclamide: 15.5 +/- 0.7; gliclazide: 14.9 +/- 0.8 mmol l-1 (p = NS)) and the haemoglobin A1C (glibenclamide: 7.4 +/- 0.2%; gliclazide: 7.9 +/- 0.5% (p = NS)) were similar at 6 months. Hypoglycaemic reactions were significantly more frequent with glibenclamide than with gliclazide: 17 vs 4 (p < 0.01). Insulin sensitivity index (ml kg-1 min-1 pmol-1 x 100) was increased significantly by glibenclamide but not gliclazide (glibenclamide: 0.284 +/- 0.116 (baseline) vs 0.518 +/- 0.102 (6 months) (p < 0.05), gliclazide: 0.260 +/- 0.048 (baseline) vs 0.358 +/- 0.048 (6 months) (p = NS)). We conclude that glycaemic control was equivalent with the two drugs but the incidence of hypoglycaemic reactions was significantly greater with glibenclamide probably because this drug increases insulin sensitivity to a greater degree.
Aged↗
[HIV and travel. Advice concerning immunizations and pre-travel evaluation].
HIV and AIDS infection has reached epidemic proportions; however, advances in treatment have made it possible for an increasing number of infected individuals to travel. These patients should be given travel advice before they leave. Mainly for political reasons, they should be advised to avoid certain countries. For other destinations, more detailed information might be required.
Clinical Protocols↗
The effect of improved glycemic control on cognitive functions in the elderly patient with diabetes.
BACKGROUND: A number of studies have found that cognitive function is impaired in elderly patients with non-insulin dependent diabetes mellitus (NIDDM) when compared with age-matched non-diabetic controls. In addition, it has been reported that elderly NIDDM patients who have poor glycemic control have a greater impairment in cognition that elderly NIDDM patients with good control. We conducted the following prospective study to determine if improved glycemic control would result in an improvement in cognitive function in elderly patients with NIDDM: METHODS: Sixteen untreated elderly patients with NIDDM underwent a battery of neuropsychologic tests on two occasions, separated by at least two weeks. They were then started on an oral hypoglycemic agent. After they had been on a stable dose of medication for 6 months the neuropsychologic tests were repeated. RESULTS: Fasting glucose decreased significantly after treatment (before: 13.8 +/- 1.2 mmol/l; after 8.4 +/- 0.4 mmol/l, p < .01). After 6 months of treatment patients had improvement in their scores on the Grooved Pegboard, Trail Making-Part A, Stroop-Word Naming, Cued Recall and Picture Arrangement tests (all p < .05). CONCLUSIONS: Improved glycemic control in the elderly patient with NIDDM may have beneficial effects on selective areas of cognition.
Affect↗
Alterations in glucose metabolism in the elderly patient with diabetes.
OBJECTIVE: To determine the alterations in glucose metabolism in elderly patients with NIDDM. RESEARCH DESIGN AND METHODS: We studied 9 healthy elderly control subjects (73 +/- 1 yr of age; body mass index 25.7 +/- 0.4 kg/m2) and 9 untreated elderly NIDDM patients (72 +/- 2 yr of age; BMI 25.9 +/- 0.5 kg/m2). Each subject underwent a 3-h oral glucose tolerance test (40 g/m2); a 2-h hyperglycemic glucose clamp study (glucose 5.4 mM above basal); and a 4-h euglycemic insulin clamp (40 mM.m2.min-1). Tritiated glucose methodology was used to measure glucose production and disposal rates during the euglycemic clamp. RESULTS: Patients with NIDDM had a higher fasting glucose (9.3 +/- 0.3 vs. 5.1 +/- 0.1 mM in control subjects vs. NIDDM patients, respectively, P < 0.001) and a greater area under the curve for glucose during the OGTT (16.0 +/- 0.6 vs. 6.7 +/- 0.3 mM in control subjects vs. NIDDM patients, respectively, P < 0.01) than the healthy control subjects. During the hyperglycemic clamp, patients with NIDDM had an absent first-phase insulin response (112 +/- 6 vs. 250 +/- 31 pM in control subjects vs. NIDDM patients, respectively, P < 0.01), and a blunted second-phase insulin response (159 +/- 11 vs. 337 +/- 46 pM in control subjects vs. NIDDM patients, respectively, P < 0.01). Before the euglycemic clamp, fasting insulin (99 +/- 5 vs. 111 +/- 10 pM in control subjects vs. NIDDM patients, respectively) and hepatic glucose production (11.8 +/- 0.7 vs. 11.5 +/- 0.5 mumol.kg-1-min-1 in control subjects vs. NIDDM patients, respectively) were similar. Steady-state (180-240 min) glucose disposal rates during the euglycemic clamp were slightly, but not significantly, higher in the normal control subjects (36.5 +/- 1.1 vs. 33.1 +/- 1.9 mumol.kg-1-min-1 in control subjects vs. NIDDM patients, respectively, NS). CONCLUSIONS: We conclude that NIDDM in nonobese elderly subjects is characterized by a marked impairment in insulin release. This may be attributable to the toxic effects of chronic hyperglycemia on the beta-cell. When compared with age-matched control subjects, the NIDDM patients showed no increase in fasting insulin or hepatic glucose production, and insulin resistance was mild.
Aged↗
[Langerhans-cell histiocytosis of the vulva. General review and a case history].
Localisation of Langerhans' cell histiocytosis (HCL) is rare. In solitary form the prognosis for this pathology is good, if the tumour occurs in a woman of 36 years of age. (In this case the woman's age was 91) The appearances may be misleading clinically. The diagnosis is made by histological examination of P-S 100 positive cells and by finding Birbeck's granules on electron microscopy. Treatment may be surgical or as in our case medical.
Administration, Topical↗
Expression in yeast of a cDNA copy of the K2 killer toxin gene.
A cDNA copy of the M2 dsRNA encoding the K2 killer toxin of Saccharomyces cerevisiae was expressed in yeast using the yeast ADH1 promoter. This construct produced K2-specific killing and immunity functions. Efficient K2-specific killing was dependent on the action of the KEX2 endopeptidase and the KEX1 carboxypeptidase, while K2-specific immunity was independent of these proteases. Comparison of the K2 toxin sequence with that of the K1 toxin sequence shows that although they share a common processing pathway and are both encoded by cytoplasmic dsRNAs of similar basic structure, the two toxins are very different at the primary sequence level. Site-specific mutagenesis of the cDNA gene establishes that one of the two potential KEX2 cleavage sites is critical for toxin action but not for immunity. Immunity was reduced by an insertion of two amino acids in the hydrophobic amino-terminal region which left toxin activity intact, indicating an independence of toxin action and immunity.
Amino Acid Sequence↗
Performance characteristics of two bioassays and high-performance liquid chromatography for determination of flucytosine in serum.
We compared the accuracy and precision of two microbiological methods and one high-pressure liquid chromatography (HPLC) procedure used to measure the concentrations of flucytosine in serum. On the basis of an analysis of six standards, all methods were judged reliable within acceptable limits for clinical use. With the biological methods, a slight loss of linearity was observed in the 75- to 100-micrograms/ml range. Compared with the bioassays, the HPLC method did not present linearity problems and was more precise and accurate in the critical zone of 100 micrograms/ml. On average, results obtained with patient sera containing 50 to 100 micrograms of flucytosine per ml were 10.6% higher with the HPLC method than with the bioassays. Standards for the biological assays may be prepared in serum or water.
Biological Assay↗
Homophobia and attitudes about AIDS.
A random sample of 407 French Canadian adults responded to a questionnaire about perception of AIDS. Negative attitudes about AIDS are better predicted by homophobia than other measures as are attitudes about extramarital relations and attitudes abut adolescent heterosexuality.
Acquired Immunodeficiency Syndrome↗
Increasing referral of at-risk travelers to travel health clinics: evaluation of a health promotion intervention targeted to travel agents.
BACKGROUND: Increases in travel-related illness require new partnerships to ensure travelers are prepared for health risks abroad. The travel agent is one such partner and efforts to encourage travel agents to refer at-risk travelers to travel health clinics may help in reducing travel-attributable morbidity. METHODS: A health promotion intervention encouraging travel agents to refer at-risk travelers to travel health clinics was evaluated. Information on the knowledge, attitudes, and behaviors of travel agents before and after the intervention was compared using two self-administered questionnaires. The Wilcoxon signed rank test was used to compare the mean difference in overall scores to evaluate the overall impact of the intervention and also subscores for each of the behavioral construct groupings (attitudes, barriers, intent, and subjective norms). Multiple regression techniques were used to evaluate which travel agent characteristics were independently associated with a stronger effect of the intervention. RESULTS: A small improvement in travel agents overall attitudes and beliefs (p =.03) was found, in particular their intention to refer (p =.01). Sixty-five percent of travel agents self-reported an increase in referral behavior; owners or managers of the agency were significantly more likely to do so than other travel agents (OR = 7.25; 95% CI: 1.64 32.06). Older travel agents, those that worked longer hours and those with some past referral experience, had significantly higher post-intervention scores. CONCLUSIONS: Travel agents can be willing partners in referral, and agencies should be encouraged to develop specific referral policies. Future research may be directed toward investigating the role of health education in certification curricula, the effectiveness of different types of health promotion interventions, including Internet-facilitated interventions, and the direct impact that such interventions would have on travelers attending travel health clinics.
Adult↗
Blood and body fluid exposure as a health risk for international travelers.
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Adult↗