Summary: This article on false positive serological reactions for syphilis reviews the rapid developments which have taken place in the serodiagnosis of syphilis in recent years since the advent of the AIDS epidemic. An overview of non-specific and specific treponemal serological tests in relation to acute and chronic biological false positive reactions is followed by closer consideration of syphilis serology in the context of HIV infection, pregnancy and other conditions which may produce false positive reactions.
All category III chronic prostatitis cases in two hospital sites were retrospectively reviewed from the year 2000 until 2005. The mean age of the patients was 38.7 years. Of these, 56.6% were St Bartholomew's Genitourinary Medicine Department patients and 43.5% were Southend Genitourinary Medicine Clinic patients. We observed that 33.1% of these had at least one transrectal ultrasound of the prostate. The commonest abnormal findings in transrectal ultrasounds of the prostate of the series were focal calcification (16.2%), calculi (9.3%) and inflammatory changes (5.4%). Of this series, 35% were lost to follow-up. The vast majority of the remainder got better over periods ranging from approximately two weeks to approximately three years.
Polybrominated diphenyl ethers (PBDEs) have been largely replaced by organophosphate flame retardants (OPFRs) and alternative brominated flame retardants (Alt-BFRs) to meet flammability requirements. Humans are ubiquitously exposed to some variety of flame retardants through contact with consumer products directly or through household dust. To evaluate the effectiveness of house cleaning and hand washing practices to reduce exposure to flame retardants, we measured concentrations in dermal hand wipes and urinary metabolites before and after assignment to two consecutive interventions. We selected 32 mother and child dyads from an existing cohort. This analysis focuses on mothers. Participants provided baseline measurements (urine, hand wipes, and questionnaires) and were then assigned for 1 week to either a house cleaning (including instruction on proper technique and cleaning supplies) or hand washing (including instruction on proper technique and soaps) intervention arm. For the second week, participants were assigned to the second intervention in addition to their initial assignment, thus all subjects both washed their hands and cleaned according to the intervention guidelines during week 2. We collected measurements at the end of weeks 1 and 2. We found reductions in urinary analytes after week 1 of house cleaning (BCIPHIPP and ip-DPHP), week 1 of hand washing (BCIPP, BCIPHIPP, and tbutyl-DPHP), and week 2 of combined interventions (BCIPHIPP and tbutyl-DPHP), compare to baseline. We found no significant decline in hand wipes in the entire sample but did find reductions after week 1 of house cleaning (BDE 209), week 1 of hand washing (TCEP), and week 2 of combined interventions (TDCIPP and BDE 209) in women with exposure above the median at baseline (verified through simulations). Exposure to individual flame retardants was reduced by about half, in some cases, by 1 week of increased hand washing, house cleaning to reduce dust, or combined activities.
Summary A 44-year-old nurse with a 12-year history of systemic lupus erythematosus developed a schizophrenia-like psychosis due to cerebral lupus. Prednisolone in doses up to 200 mg daily was ineffective. Levels of immune complexes by the Raji cell assay were greatly increased in serum and cerebrospinal fluid. Plasma exchange was performed on 4 occasions over 4 days. Three days later, there was a marked and sustained improvement in the mental state, the psychosis resolved and tests of psychological function and electroencephalographic abnormalities improved. There was a corresponding decrease in levels of immune complexes and in titres of anti-neuronal antibody. Five months later, several serological indices had risen to pre-plasmaphaeresis levels except for the level of immune complexes. The patient remained in clinical remission. This case provides further evidence that high levels of circulating immune complexes may be a determinant of cerebral lupus and that plasmaphaeresis may be of lasting benefit in this disease.
The patient empowerment movement, spurred by AIDS activism in the 1980s, quickly evolved to encompass how study participants are considered and treated in clinical research. Initially, people fearing death of AIDS sought early access to experimental medications that had not undergone rigorous testing in hopes of extending their lives. Thirty years on, scientists are asking a different set of ethical questions about clinical research, this time in the pursuit of either a sterilising cure or long-term remission for HIV. Instead of hastening access to experimental drugs for the sickest, researchers are now testing interventions for eradicating or controlling the virus in typically very healthy HIV-positive individuals who have the most to lose from such interventions if something goes wrong. While clinical researchers and ethicists debate the merits and limits of this type of research they should avoid discounting altruistic motivations as a powerful factor in a prospective study participant's decisions to assume risks. My conversations with four men who participated in HIV cure studies confirmed the capacity of these people to make carefully considered decisions about risks and the sometimes substantial influence/sway of non-clinical benefits that may come from participation in cure-oriented research. Studies must undergo ethical and clinical review before proceeding, and not all participants of such studies will be able to weigh or understand risks and benefits as those profiled here. But respecting the self-agency of people living with HIV should be a goal in the design and conduct of cure research.
