Background:  Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death. Adrenaline is recommended as the initial treatment of choice for anaphylaxis. Objectives:  To assess the benefits and harms of adrenaline in the treatment of anaphylaxis. Methods:  We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 1), MEDLINE (1966 to March 2007), EMBASE (1966 to March 2007), CINAHL (1982 to March 2007), BIOSIS (to March 2007), ISI Web of Knowledge (to March 2007) and LILACS (to March 2007). We also searched websites listing ongoing trials: http://www.clinicaltrials.gov/, http://www.controlledtrials.com and http://www.actr.org.au/ and contacted pharmaceutical companies and international experts in anaphylaxis in an attempt to locate unpublished material. Randomized and quasi‐randomized controlled trials comparing adrenaline with no intervention, placebo or other adrenergic agonists were eligible for inclusion. Two authors independently assessed articles for inclusion. Results:  We found no studies that satisfied the inclusion criteria. Conclusions:  On the basis of this review, we are unable to make any new recommendations on the use of adrenaline for the treatment of anaphylaxis. In the absence of appropriate trials, we recommend, albeit on the basis of less than optimal evidence, that adrenaline administration by intramuscular injection should still be regarded as first‐line treatment for the management of anaphylaxis.

Based on this review, we are unable to make any new recommendations on the use of adrenaline for the treatment of anaphylaxis. Although there is a need for randomized, double-blind, placebo-controlled clinical trials of high methodological quality in order to define the true extent of benefits from the administration of adrenaline in anaphylaxis, such trials are unlikely to be performed in individuals with anaphylaxis. Indeed, they might be unethical because prompt treatment with adrenaline is deemed to be critically important for survival in anaphylaxis. Also, such studies would be difficult to conduct because anaphylactic episodes usually occur without warning, often in a non-medical setting, and differ in severity both among individuals and from one episode to another in the same individual. Consequently, obtaining baseline measurements and frequent timed measurements might be difficult, or impossible, to obtain. In the absence of appropriate trials, we recommend, albeit on the basis of less than optimal evidence, that adrenaline administration by intramuscular (i.m.) injection should still be regarded as first-line treatment for the management of anaphylaxis.

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Although formal teaching on allergic disorders has been identified in a number of modules throughout the five years, it is not comprehensively described in the course documentation and significant gaps exist. We accept that the delivered curriculum may not be captured by the level of detail present in the learning objectives and recommend that further mapping and triangulation is undertaken through student focus groups and information gathering from teaching staff. We also recommend that in the absence of informal and clinical attachment opportunities in allergic disorders, the stated learning objectives be developed into a coherent vertical element throughout the medical curriculum. This, together with an advocate and suitable assessment, would increase the impact of allergy training on students and emphasise the knowledge and skills required to deliver high quality allergy care.

Although illegal in Egypt, prostitution exists. The prevalence of HIV infection among female sex workers (FSWs) in Cairo is not precisely known. This cross-sectional study investigated the high-risk behaviour for HIV infection and HIV prevalence among FSWs in greater Cairo. A total of 431 FSWs were interviewed about their sexual history with paid and unpaid partners, condom use and risky behaviour for HIV infection; all were tested for HIV. Use of alcohol and drugs was reported by 39.9% and 49.0% of the women respectively; 37.6% only used such substances while with a client. Male condoms were known by 72.6% but their use in the previous month was low (32.8%) and only 22.4% had used one with their last client. The main reasons for not using condoms were not thinking of it (40.6%) and client refusal (20.5%). All the women tested negative for HIV infection. The high-risk behaviour of many FSWs necessitates intervention programmes to reduce their risk of HIV infection. Health and Community Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt (Correspondence to I.A. Kabbash: iafkabbash@gmail.com RÉSUMÉ Bien qu'illégale en Égypte, la prostitution existe. La prévalence de l'infection à VIH chez les professionnelles du sexe au Caire n'est pas connue précisément. La présente étude transversale a étudié les comportements associés à un risque important de contracter une infection à VIH et la prévalence de ce virus chez les professionnelles du sexe en activité dans le Grand Caire. Au total, 431 professionnelles du sexe ont été interrogées au sujet de leurs antécédents en matière de rapports sexuels avec des partenaires rémunérant ou non leurs services, d'utilisation du préservatif et de comportements à risque pour l'infection à VIH ; toutes les personnes interrogées ont été soumises à un test de dépistage du VIH. Parmi celles-ci, 39,9 % déclaraient consommer de l'alcool et 49,0 % de la drogue ; 37,6 % en consommaient uniquement avec leurs clients. Les préservatifs masculins étaient connus de 72,6 % d'entre elles mais elles étaient peu nombreuses (32,8 %) à en avoir utilisé au cours du mois précédent et seulement 22,4 % en avaient utilisé un avec leur dernier client. Les principales raisons de leur absence d'utilisation des préservatifs étaient l'oubli (40,6 %) et le refus du client (20,5 %). Toutes les professionnelles du sexe de l'étude ont obtenu des résultats négatifs dans le dépistage du VIH. Le comportement à haut risque de nombreuses professionnelles du sexe appelle des programmes d'intervention afin de réduire leur risque d'infection à VIH. 1 Department of Public‫املتوسط‬ ‫لرشق‬ ‫الصحية‬ ‫املجلة‬ ‫عرش‬ ‫الثامن‬ ‫املجلد‬ ‫التاسع‬ ‫العدد‬ 921

Abstract:Background: Concerns have been raised about the adequacy of allergy teaching in UK undergraduate medical curricula. Our previous work, which involved undertaking a systematic analysis of the documented curricular learning objectives relating to allergy teaching in a UK medical school, found references to allergy teaching in each of the five years of study but also identified some apparent omissions in allergy teaching. These may represent actual gaps in relation to allergy training, or alternatively may reflect dissonance between the described and delivered curricula. Objective: To compare the described and delivered undergraduate curricula on allergy and allergy-related topics in a UK medical school. Methods: We identified and e-mailed the individuals responsible for each of the 43 modules in the five-year undergraduate medical programme at the University of Edinburgh, enquiring about the delivery of allergy-related teaching within their modules. We then compared these responses with the results of the previous study mapping allergy-related teaching across the undergraduate curriculum. Results: Fifty-one individuals were identified as being responsible for leading the 43 modules in the curriculum. Forty-nine (96%) of these module organisers responded to our enquiry; these individuals represented 41 of the 43 modules (95%). Module organisers reported that allergy-related teaching and learning was delivered in 14 modules (33%), was absent in 13 (30%) modules, and may occur to varying degrees within a further 10 (23%) modules. Module organisers' responses about the delivered curriculum on allergy were consistent with the findings from documented learning objectives in 21 (49%) modules. They also reported allergy teaching and learning in modules which had not been identified by examination of the learning objectives; however, there were still important gaps in the allergy-related curriculum.

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The optimal follicular diameter associated with increased pregnancy rates in gonadotropin-stimulated IUI cycles was between 19 and 20 mm.