Human T cell lymphotrophic virus type 1 (HTLV-1) causes myelopathy and adult T cell leukaemia. Knowledge of its distribution in Africa is limited. We performed HTLV-1 testing by enzyme immunoassay, with immunofluorescence assay confirmation, on 931 blood donors, 88 human immunodeficiency virus (HIV) seronegative patients with clinical features of acquired immune deficiency syndrome, 23 multi-transfused haemophiliacs, 8 patients with haematological malignancies, and 32 patients with neurological disease. One blood donor and 3 neurological patients, all 3 with spinal cord syndromes, were HTLV-1-seropositive. Two of the 3 HTLV-1-positive myelopathy patients were co-infected with HIV and both experienced unusually rapid progression of neurological disease. HTLV-1 is uncommon but can be associated with myelopathy in Zimbabwe.

Adult↗

PubMedDate not supplied

Adults with cerebral malaria do not have sensory evoked responses typical of deep general anaesthesia.

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Adult↗

PubMedDate not supplied

Setting rates for Medicaid managed behavioral health care: lessons learned.

This paper reviews Tennessee's experience setting, monitoring, and updating capitation rates for Medicaid managed behavioral health care, and draws lessons from those experiences for other states. Our review of assumptions about four components of Tennessee's rate-setting process--data, benefit design, savings expectations, and processes for monitoring and updating rates--suggests that the initial rate established by Tennessee was inadequate, and its inadequacy resulted primarily from the way available information was used to set the rate, rather than from the method of rate setting selected. Tennessee's experiences illustrate how difficult rate setting is and illuminate several key lessons about the rate-setting process.

Behavioral Medicine↗

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Monitoring evoked potentials during surgery to assess the level of anaesthesia.

The hypnotic and analgesic components of anaesthesia can be assessed using middle latency auditory evoked potentials (MLAEPs) and somatosensory evoked potentials (SEPs). To monitor these potentials reliably during clinical anaesthesia, we have developed an evoked potential (EP) system based around a portable personal computer, a DSP board and an isolated pre-amplifier unit. Unlike many currently available systems, this amplifier is largely immune to diathermy interference due to excellent isolation via a digital fibre optical link, small size and RF screening and filtering. The pre-amplifier unit has integral auditory and somatosensory stimulators, and automatic calibration and impedance checking. Stimulus intensity and profile are under software control and SEP stimulus level is constantly monitored. The unit is powered by two AA cells and battery status continuously monitored by the PC software. Up to eight channels of EEG may be recorded and displayed in a smoothly scrolling window and as moving average MLAEPs and SEPs.

Anesthesia↗

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Is there a relationship between HLA type and prognostic factors in breast cancer?

No convincing association exists between HLA type and breast cancer development but certain HLA types have been suggested to be associated with poor risk disease. Here, the HLA type (class I and II) for 141 breast cancer patients was compared to a control population of 100 individuals and to the prognostic indicators for the patients. No association was found between HLA type and breast cancer development. Consideration of individual HLA/prognostic factor relationships previously reported confirmed that HLA-B7 was over-represented in premenopausal oestrogen-receptor (ER)-positive, grade 3 tumours (p = 0.04) and that HLA-A1 correlated positively with Nottingham Prognostic Index (p < 0.05) and with ER-negative disease (p < 0.05). These findings suggest that some previously identified associations between HLA type I and particular prognostic factors may be real, if weak but appear to conflict with the only other sizeable study investigating HLA type II in breast cancer (which negatively correlated HLA-DR 11 with early onset disease).

Adult↗

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Primary malignant melanoma of the meninges.

A case of primary malignant melanoma of the meninges is described in which the clinical presentation is that of visual loss and limb weakness. Clinically a diagnosis of carcinomatous meningitis was made and subsequently malignant cells were found in the cerebrospinal fluid (CSF). At autopsy the diagnosis of primary malignant melanoma of the meninges was made.

Diagnosis, Differential↗

PubMedDate not supplied

Learning disabilities. Primary planning.

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Community Health Nursing↗

PubMedDate not supplied

Meeting the health care needs of people with learning disabilities.

This article looks at the findings of a study on how primary health care teams saw the health care needs of people with learning disabilities and how those needs were being met. Among the issues discussed is the significance of relevant education in an interdisciplinary setting and the potential shift of some specialist community learning disability nurses to the primary health care team.

Attitude of Health Personnel↗