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3461. Coronary heart disease: seven dietary factors.
The dietary factors believed to be linked with the incidence of coronary heart disease are reviewed in the light of evidence with regard to their functional role, either in protection or in promotion. Detailed analysis of the evidence shows that the relations are more complex than the current lipid hypothesis suggests. It is proposed that, in particular, the polyunsaturated/saturated ratio as a measure of the propensity of the diet to influence the incidence of coronary heart disease should be replaced by indices of atherogenicity and thrombogenicity.
3464. Changes in the World Health Organisation essential drug list.
The World Health Organisation Model List of Essential Drugs is an attempt to provide guidelines for selection of essential pharmaceuticals. Analysis of the six lists produced between 1977 and 1990 shows an increase in the number of items from 205 to 268. 120 drugs have been added and 57 deleted; however, only 16 of the additional drugs can be considered new clinical entities or to have new indications. The original purpose of the essential drug list was to itemise the minimum number of essential drugs. Many additions were due to a change in perception about the usefulness of a particular drug, not scientific advances. Nevertheless, the list remains a useful guide for countries selecting their own national lists.
3470. Adverse reactions to co-trimoxazole in HIV infection.
The origin of the increased frequency of side-effects to co-trimoxazole in HIV-positive patients is unknown. Data on plasma concentrations of the parent compounds are inconclusive. Evidence points to the hydroxylamine derivatives of sulphamethoxazole as the reactive metabolites that cause adverse reactions to co-trimoxazole. HIV-positive individuals have a systemic glutathione deficiency, and therefore a reduced capacity to scavenge such metabolites. This process would lead to an increased exposure to toxic intermediates and would explain the high frequency of adverse reactions to co-trimoxazole in these patients.
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