BACKGROUND. Cryptococcal meningitis (CM) remains a leading cause of acquired immunodeficiency syndrome-related death in sub-Saharan Africa. The timing of the initiation of antiretroviral therapy (ART) for human immunodeficiency virus (HIV)-associated CM remains uncertain. The study aimed to determine the optimal timing for initiation of ART in HIV-positive individuals with CM. METHODS. A prospective, open-label, randomized clinical trial was conducted at a tertiary teaching hospital in Zimbabwe. Participants were aged > or = 18 years, were ART naive, had received a first CM diagnosis, and were randomized to receive early ART (within 72 h after CM diagnosis) or delayed ART (after 10 weeks of treatment with fluconazole alone). Participants received 800 mg of fluconazole per day. The ART regimen used was stavudine, lamivudine, and nevirapine given twice daily. The duration of follow-up was up to 3 years. The primary end point was all-cause mortality. RESULTS. Fifty-four participants were enrolled in the study (28 in the early ART arm and 26 in the delayed ART arm). The median CD4 cell count at enrollment was 37 cells/mm(3) (interquartile range, 17-69 cells/mm(3)). The 3-year mortality rate differed significantly between the early and delayed ART groups (88% vs 54%; P < .006); the overall 3-year mortality rate was 73%. The median durations of survival were 28 days and 637 days in the early and delayed ART groups, respectively (P = .031, by log-rank test). The risk of mortality was almost 3 times as great in the early ART group versus the delayed ART group (adjusted hazard ratio, 2.85; 95% confidence interval, 1.1-7.23). The study was terminated early by the data safety monitoring committee. CONCLUSIONS. In resource-limited settings where CM management may be suboptimal, when compared with a delay of 10 weeks after a CM diagnosis, early initiation of ART results in increased mortality. Trial registration. ClinicalTrials.gov identifier: NCT00830856.

Background: The extent to which patients and service users are involved in medical education varies widely. There is a need for an up to date systematic review of the literature that examines what involvement (description), the potential outcome of such involvement (justification) and 'why' such involvement impacts students (clarification). Methods: Systematic searches of four databases was undertaken. Citations were screened and consensus reached for inclusion / exclusion of studies. Quality of study design and interventional presentation were assessed. Synthesis was planned at three levels-descriptive, meta-analysis and meta-ethnography, where sufficient data was available. Results: A total of 11,140 articles were initially identified, with 39 included in the review. Using the Towle Taxonomy for patient involvement in medical education we identified 4 studies that were encounter based, 17 with patients sharing their personal experiences with students, 16 with patients involved in teaching and/or evaluating students, 2 studies describing consumers as tutors and none with involvement at the institutional level. The majority (29) of studies employed outcomes at level 1 or level 2 of Kirkpatrick's hierarchy (learner reactions and modification of attitudes or skills). Outcomes in terms of benefits to learners included increased empathy and understanding of illness as experienced by patients, improved communication with patients and a greater understanding of patient-centre care. Educational quality assessment showed specific weaknesses in theoretical underpinning, curriculum outcomes, content or pedagogy. Conclusions: Patients can offer learning opportunities that are at least as effective as faculty trainers in imparting practical clinical skills and can enrich medical education by allowing learners to explore patient

Endometrial Regenerative Cells (ERC) are a population of mesenchymal-like stem cells having pluripotent differentiation activity and ability to induce neoangiogenesis. In vitro and animal studies suggest ERC are immune privileged and in certain situations actively suppress ongoing immune responses. In this paper we describe the production of clinical grade ERC and initial safety experiences in 4 patients with multiple sclerosis treated intravenously and intrathecally. The case with the longest follow up, of more than one year, revealed no immunological reactions or treatment associated adverse effects. These preliminary data suggest feasibility of clinical ERC administration and support further studies with this novel stem cell type.

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Since the introduction of anti‐Rhesus (Rh) D prophylaxis for RhD‐negative women, other Rh and non‐Rh red cell alloantibodies have become relatively more important and are now responsible for the greater proportion of haemolytic disease of the newborn. Anti‐C and anti‐E are the most commonly implicated non‐D Rh antibodies in the pathogenesis of haemolytic disease of the newborn1. In 1977 Pepperell et al.2 reported the outcome of 44 women with anti‐E. This is the only published series that investigates the implications of anti‐E during pregnancy. The present report presents a retrospective study of the outcome of 122 pregnancies in which anti‐E was the sole alloantibody detected.