- Email: [email protected]
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95% of subarachnoid haemorrhages, the panel said, but when the CT scan is normal and the subarachnoid haemorrhage is still suspected, the patient must have a lumbar puncture. The panel statement ends with a discussion of promising new treatments, including calcium channel blockers, glutamate antagonists, freeradical scavengers, and thrombolytic therapy. Starkman said panel members hope the statement promotes a new paradigm for the treatment of stroke. "... in just a few years, there are going to treatments for stroke that are really timedependent", he said. "We have to think ’Time is brain’." The National Stroke Association has also launched a nationwide series of stroke-prevention screenings. This project, whose cosponsors include the National Heart, Lung, and Blood Institute, the National Institute of Neurological Disorders and Stroke, and the American College of Chest Physicians, starts in the "stroke belt", 12 southeastern states where stroke rates are disproportionately higher than in the rest of the country, despite an overall decline in stroke deaths nationally. The high number of African-American and elderly residents in this area contributes to the excess rates. Michael
McCarthy
1. Stroke: the first six hours. National Stroke Association Consensus statement. Stroke, clinical updates, vol IV, issue 1, May 1993. Englewood, Colorado: National Stroke Association.
Print joins pixels Whenever two or three journal editors gather together, conversation is likely to turn to the threat of paperless publication. Last July saw the birth, under the midwifery of Primary Journals Online, of a joint venture by the American Association for the Advancement of Science and the Online Computer Library Center, the Online journal of Current Clinical Trials. This peer-reviewed subscription journal publishes when it has something to publish, and the interval between acceptance and "print" is very short. Recognition by the US National Library of Medicine is eagerly awaited. 0_7cut coverage includes methodology and metaanalyses, reviews and clinical trials, and more general matters, and so far 59 documents have appeared. No 60 (see p 1306) is different. It is the first example of parallel publication by The Lancet and 0,7CCT.1 Parallel, but not equal. The meta-analysis is published in full by OyCCT and in a much more concise form by The Lancet. The experiment will not please those worthies who see it merely as duplicate publication. The purpose is different-to satisfy both the busy clinician reader who will be content with the gist and the academically inclined for whom every last detail is important. Electronic access is via the OCLC system in the USA or via Internet, and further information can be had from QCCT, 1333 H Street NW, Room 1155, Washington, DC 20005, USA (1 202 326 6735
telephone;
1 202 842 2868
fax).
who attend the unit are below 15 years old. of much of this violence is likely to be the appalling poverty and unemployment that characterise many of the townships. Rape and the attendant HIV pandemic reflect the deep social and cultural conflicts faced by the inhabitants of a country in seemingly terminal economic decline. women
The
cause
Richard Horton 1. Armstrong S. south Africa’s rape epidemic fuels HIV. Panos World (no 27): 1-2.
Sharp
brevity in The Lancet. Lancet 1992; 340: 519.
South Africa’s rape epidemic What are the public health implications of the startling statistic that in South Africa a woman is raped, on average, every 83 seconds. 1 in 4 South African women will experience rape--ie, a total of 380 000 women each year-of whom 95 % are black. According to a report from Panos,l this uncontrollable series of rapes, often drug
related, is contributing to a potentially catastrophic HIV epidemic. Child abuse is becoming commonplace in overcrowded townships where gang rape--known as jackrolling-has become an almost everyday occurrence. The genital trauma and bleeding that accompanies violent rape increases the risk of HIV transmission. Attitudes amongst the black community are sometimes surprisingly indifferent: "... by knowingly moving around late at night, [women] are being reckless. Knowledge that they are indecently exposing themselves could be a contributing factor to rape", says
AIDS 1993; May
Fireflies, TB, and malaria The firefly is loved by many life scientists since it is the source of luciferase, used in the standard assay for ATP. Photons produced when luciferase catalyses the reaction between luciferin and ATP can be detected by luminometers. Luciferase has now been applied to the identification of drug sensitivity of Mycobacterium tuberculosis strains.! Phages were used to deliver the luciferase gene into M tuberculosis cells. On addition ofluciferin, the infected bacterial cells produced light signals. Production of light depended on infection with the phage, expression of the luciferase gene, and the cell’s ATP concentration. When cultured with antituberculous drugs, the drug-sensitive phage-infected bacilli lost their light signals, whereas resistant organisms retained theirs. The determination of drug susceptibility patterns took only 48 h. Another use of the luciferase gene was reported by Dyann Wirth and colleagues (Harvard University) at the second annual meeting of the International Centers for Tropical Disease research. These investigators developed a vector for the luciferase gene to be introduced into Plasmodium gallinaceum female gametes and fertilised zygotes (extracellular stages in the parasites life-cycle). Luciferase expression could be assayed 24 h later. The authors hope that the ability to introduce a foreign gene into the malaria parasite will enable development of a method of functional analysis of the
parasite genes. Sarah Ramsay 1.
Jacobs WR, Barletta RG, Udani R, et al. Rapid assessment of drug susceptibilities of Mycobacterium tuberculosis by means of luciferase reporter phages. Science 1993; 260: 819-22.
Needs of David
1. Editorial. More
Myeni, the leader of the Inkatha Freedom Party’s Youth League. Only about 1 in 20 rape cases is reported and fear of going to the police has led to the opening of a special abuse unit in the grounds of Baragwanath Hospital where legal and medical services are placed together and female police officers are on hand. Half of all
Mursa
patients with epilepsy
Services for patients with epilepsy in the UK are "poor in quality, fragmentary, and poorly organised", says a report initiated although not funded by the Department of Health. Entitled An Epilepsy Needs Document, the report defmes the medical, paramedical, and nursing care needed to provide adequate support for those with epilepsy. If funding is provided, the plan is to circulate the report to purchasers of health care to attempt to stimulate change in current
practice. Central to the report is the need for increased liaison between hospitals and primary care. There are less than a dozen specialist assessment centres in the UK, of which some are dependent on charitable donations and voluntary help. The report calls for the establishment of at least one specialist clinic in every health district. A properly funded epilepsy service staffed by trained professionals as exists, for example, in the Netherlands, is essential
improve the care of patients with epilepsy, according to Dr Stephen Brown of the David Lewis Centre for Epilepsy, Cheshire,
to
UK, one of the authors of the report. He estimates that the annual cost of the report’s recommendations is around [10 million. The document is available from the Well come Foundation Ltd, Crewe, Cheshire CW1 1UB.
Astrid James
95% of subarachnoid haemorrhages, the panel said, but when the CT scan is normal and the subarachnoid haemorrhage is still suspected, the patient must have a lumbar puncture. The panel statement ends with a discussion of promising new treatments, including calcium channel blockers, glutamate antagonists, freeradical scavengers, and thrombolytic therapy. Starkman said panel members hope the statement promotes a new paradigm for the treatment of stroke. "... in just a few years, there are going to treatments for stroke that are really timedependent", he said. "We have to think ’Time is brain’." The National Stroke Association has also launched a nationwide series of stroke-prevention screenings. This project, whose cosponsors include the National Heart, Lung, and Blood Institute, the National Institute of Neurological Disorders and Stroke, and the American College of Chest Physicians, starts in the "stroke belt", 12 southeastern states where stroke rates are disproportionately higher than in the rest of the country, despite an overall decline in stroke deaths nationally. The high number of African-American and elderly residents in this area contributes to the excess rates. Michael
McCarthy
1. Stroke: the first six hours. National Stroke Association Consensus statement. Stroke, clinical updates, vol IV, issue 1, May 1993. Englewood, Colorado: National Stroke Association.
Print joins pixels Whenever two or three journal editors gather together, conversation is likely to turn to the threat of paperless publication. Last July saw the birth, under the midwifery of Primary Journals Online, of a joint venture by the American Association for the Advancement of Science and the Online Computer Library Center, the Online journal of Current Clinical Trials. This peer-reviewed subscription journal publishes when it has something to publish, and the interval between acceptance and "print" is very short. Recognition by the US National Library of Medicine is eagerly awaited. 0_7cut coverage includes methodology and metaanalyses, reviews and clinical trials, and more general matters, and so far 59 documents have appeared. No 60 (see p 1306) is different. It is the first example of parallel publication by The Lancet and 0,7CCT.1 Parallel, but not equal. The meta-analysis is published in full by OyCCT and in a much more concise form by The Lancet. The experiment will not please those worthies who see it merely as duplicate publication. The purpose is different-to satisfy both the busy clinician reader who will be content with the gist and the academically inclined for whom every last detail is important. Electronic access is via the OCLC system in the USA or via Internet, and further information can be had from QCCT, 1333 H Street NW, Room 1155, Washington, DC 20005, USA (1 202 326 6735
telephone;
1 202 842 2868
fax).
who attend the unit are below 15 years old. of much of this violence is likely to be the appalling poverty and unemployment that characterise many of the townships. Rape and the attendant HIV pandemic reflect the deep social and cultural conflicts faced by the inhabitants of a country in seemingly terminal economic decline. women
The
cause
Richard Horton 1. Armstrong S. south Africa’s rape epidemic fuels HIV. Panos World (no 27): 1-2.
Sharp
brevity in The Lancet. Lancet 1992; 340: 519.
South Africa’s rape epidemic What are the public health implications of the startling statistic that in South Africa a woman is raped, on average, every 83 seconds. 1 in 4 South African women will experience rape--ie, a total of 380 000 women each year-of whom 95 % are black. According to a report from Panos,l this uncontrollable series of rapes, often drug
related, is contributing to a potentially catastrophic HIV epidemic. Child abuse is becoming commonplace in overcrowded townships where gang rape--known as jackrolling-has become an almost everyday occurrence. The genital trauma and bleeding that accompanies violent rape increases the risk of HIV transmission. Attitudes amongst the black community are sometimes surprisingly indifferent: "... by knowingly moving around late at night, [women] are being reckless. Knowledge that they are indecently exposing themselves could be a contributing factor to rape", says
AIDS 1993; May
Fireflies, TB, and malaria The firefly is loved by many life scientists since it is the source of luciferase, used in the standard assay for ATP. Photons produced when luciferase catalyses the reaction between luciferin and ATP can be detected by luminometers. Luciferase has now been applied to the identification of drug sensitivity of Mycobacterium tuberculosis strains.! Phages were used to deliver the luciferase gene into M tuberculosis cells. On addition ofluciferin, the infected bacterial cells produced light signals. Production of light depended on infection with the phage, expression of the luciferase gene, and the cell’s ATP concentration. When cultured with antituberculous drugs, the drug-sensitive phage-infected bacilli lost their light signals, whereas resistant organisms retained theirs. The determination of drug susceptibility patterns took only 48 h. Another use of the luciferase gene was reported by Dyann Wirth and colleagues (Harvard University) at the second annual meeting of the International Centers for Tropical Disease research. These investigators developed a vector for the luciferase gene to be introduced into Plasmodium gallinaceum female gametes and fertilised zygotes (extracellular stages in the parasites life-cycle). Luciferase expression could be assayed 24 h later. The authors hope that the ability to introduce a foreign gene into the malaria parasite will enable development of a method of functional analysis of the
parasite genes. Sarah Ramsay 1.
Jacobs WR, Barletta RG, Udani R, et al. Rapid assessment of drug susceptibilities of Mycobacterium tuberculosis by means of luciferase reporter phages. Science 1993; 260: 819-22.
Needs of David
1. Editorial. More
Myeni, the leader of the Inkatha Freedom Party’s Youth League. Only about 1 in 20 rape cases is reported and fear of going to the police has led to the opening of a special abuse unit in the grounds of Baragwanath Hospital where legal and medical services are placed together and female police officers are on hand. Half of all
Mursa
patients with epilepsy
Services for patients with epilepsy in the UK are "poor in quality, fragmentary, and poorly organised", says a report initiated although not funded by the Department of Health. Entitled An Epilepsy Needs Document, the report defmes the medical, paramedical, and nursing care needed to provide adequate support for those with epilepsy. If funding is provided, the plan is to circulate the report to purchasers of health care to attempt to stimulate change in current
practice. Central to the report is the need for increased liaison between hospitals and primary care. There are less than a dozen specialist assessment centres in the UK, of which some are dependent on charitable donations and voluntary help. The report calls for the establishment of at least one specialist clinic in every health district. A properly funded epilepsy service staffed by trained professionals as exists, for example, in the Netherlands, is essential
improve the care of patients with epilepsy, according to Dr Stephen Brown of the David Lewis Centre for Epilepsy, Cheshire,
to
UK, one of the authors of the report. He estimates that the annual cost of the report’s recommendations is around [10 million. The document is available from the Well come Foundation Ltd, Crewe, Cheshire CW1 1UB.
Astrid James