Thyrotoxicosis presenting with headache

We report three cases of thyrotoxicosis who presented acutely with headache to our neurology service in a 1-year period. In two of these patients there was a pre-existing or subsequent history of migraine. With hindsight, there were other clinical features of thyrotoxicosis but this diagnosis had been missed in primary care. Severe headache can be a striking presenting feature of thyrotoxicosis, but these cases provide reassurance to the clinician that when this does occur, other clinical features of hyperthyroidism are usually present.

Heparin and EDTA as anticoagulant differentially affect cytokine mRNA level of cultured porcine blood cells

Cytokine mRNA expression profiles serve to characterize immune cell activation in different test systems. Both, diluted whole blood and isolated PBMC are widely applied for these studies. Comprehensive data regarding the suitability of different anticoagulants for profiling cytokine expression are not available for the pig. Therefore the aim of this study was to compare the effect of two commonly used anticoagulants (heparin and EDTA) on the cytokine expression pattern of porcine blood cells. IL-1alpha, IL-2, IL-4, IL-6, IL-10 and IFN-gamma mRNA levels were detected ex-vivo and upon in-vitro stimulation in diluted porcine whole blood and isolated PBMC by real-time PCR. The cells were stimulated with ConA or LPS, known to act on different target cells and implying different signalling pathways. Additionally the integrity of the isolated RNA was investigated. Ex-vivo cytokine expression pattern of fresh whole blood were not affected by the investigated anticoagulants. In contrast, stimulation of cultured diluted whole blood or PBMC resulted in significant differences depending on the applied anticoagulant. Using EDTA we found a significantly decreased capacity of whole blood to express cytokines. However, isolated PBMC from EDTA anticoagulated blood showed a higher cytokine expression capacity than PBMC from heparinized blood. Comparing diluted whole blood and PBMC we found that cultured porcine whole blood responded better to bacterial products than isolated PBMC, probably because sufficient auxiliary plasma derived factors such as LPS-binding protein, are present. However, isolated PBMC showed a higher T-cell response than diluted whole blood. In conclusion, our findings underline that each application demands a specific assay system.

Income inequality and child mortality in wealthy nations

BACKGROUND

Relationships between income inequality and various health indicators have been the subject of much study and some controversy. We investigated associations between child mortality and income inequality amongst the wealthier OECD countries as well as changes in their relative child mortality rankings over time.

METHODS

Data were drawn from the 2003-2006 'State of the World's Children' reports published by UNICEF; Gini coefficients on income inequality were also used. Pearson correlation coefficients were calculated to investigate associations. Longitudinal child mortality data was used to compare rankings.

RESULTS

We discovered very strong associations between child mortality and income inequality. In contrast to earlier results, these associations persist when the USA is excluded from the analysis. The countries with the worst child mortality figures were previously singled out in a 1993 UNICEF study on child neglect in rich nations. We also report their worsening child mortality rankings, since 1960, relative to the other OECD countries.

CONCLUSIONS

The results strengthen the existing evidence linking child mortality with income inequality in wealthy nations, and add to the evidence that sociopolitical factors are important in this regard.

Impact of consumption of different levels of Bifidobacterium lactis HN019 on the intestinal microflora of elderly human subjects

BACKGROUND

Age-related changes in the physiology and intestinal function of the elderly render them more susceptible to gut-related illnesses. Probiotic dietary supplementation has been shown to enhance the health indices in the elderly.

OBJECTIVE

To determine the effect of three different doses [5 x 109 CFU/day (high), 1.0 x 109 CFU/day (medium) and 6.5 x 107 CFU/day (low)] of Bifidobacterium lactis HN019 (DR10TM) on the intestinal flora of elderly human subjects and the dose response effect.

DESIGN

Randomised, double-blind and placebo-controlled human dietary intervention study consisting of four groups of 20 elderly (over 60 years old) volunteers. Each volunteer consumed 250 mL per day of reconstituted skim milk (RSM) which either did not contain any probiotic supplement (placebo group) or contained B. lactis HN019 at different levels (low, medium and high dose groups). The study comprised three stages: a 2-week pre-intervention (without any supplement), followed by 4 weeks of test feeding (dietary intervention) and then a 2-week washout period.

RESULTS

After dietary intervention, statistically significant increases in bifidobacteria, lactobacilli and enterococci were observed. At the end of the 4-week feeding period the mean number of bifidobacteria recorded in the placebo group were 9.31 +/- 0.01 log CFU/g of faeces. In the high, medium and low dose groups the bifidobacteria levels were significantly (p < 0.006) higher (9.88 +/- 0.1, 9.75 +/- 0.14 and 9.74 +/- 0.11 log CFU/g of faeces, respectively), when compared to the respective pre-intervention levels. There were no significant differences (p superior 0.05) between the responses of the different dose groups, indicating that even the lowest dose tested augmented the changes in bifidobacteria. Similar trends were observed for lactobacilli and enterococci. In contrast, the counts of enterobacteria were reduced in all the probiotic dose groups.

CONCLUSION

The present study showed that dietary supplementation with B. lactis HN019 significantly increased the number of resident bifidobacteria and reduced the enterobacteria counts. In addition, enterococci and lactobacilli were also increased. Based on this study and already published clinical evidence (4, 5, 8, 9) we conclude that, B. lactis HN019 is a suitable probiotic for elderly human subjects and even the lowest dose (6.5 x 107 CFU/day) tested is able to confer desired changes in the intestinal microflora.

The influence of bovine colostrum supplementation on exercise performance in highly trained cyclists

PURPOSE

The aim of this experiment was to investigate the influence of low dose bovine colostrum supplementation on exercise performance in cyclists over a 10 week period that included 5 days of high intensity training (HIT).

METHODS

Over 7 days of preliminary testing, 29 highly trained male road cyclists completed a VO(2max) test (in which their ventilatory threshold was estimated), a time to fatigue test at 110% of ventilatory threshold, and a 40 km time trial (TT40). Cyclists were then assigned to either a supplement (n = 14, 10 g/day bovine colostrum protein concentrate (CPC)) or a placebo group (n = 15, 10 g/day whey protein) and resumed their normal training. Following 5 weeks of supplementation, the cyclists returned to the laboratory to complete a second series of performance testing (week 7). They then underwent five consecutive days of HIT (week 8) followed by a further series of performance tests (week 9).

RESULTS

The influence of bovine CPC on TT40 performance during normal training was unclear (week 7: 1+/-3.1%, week 9: 0.1+/-2.1%; mean+/-90% confidence limits). However, at the end of the HIT period, bovine CPC supplementation, compared to the placebo, elicited a 1.9+/-2.2% improvement from baseline in TT40 performance and a 2.3+/-6.0% increase in time trial intensity (% VO(2max)), and maintained TT40 heart rate (2.5+/-3.7%). In addition, bovine CPC supplementation prevented a decrease in ventilatory threshold following the HIT period (4.6+/-4.6%).

CONCLUSION

Low dose bovine CPC supplementation elicited improvements in TT40 performance during an HIT period and maintained ventilatory threshold following five consecutive days of HIT.

Gremlin gene expression in bovine retinal pericytes exposed to elevated glucose

AIM

To assess the influence of high extracellular glucose on the expression of the bone morphogenetic protein (BMP) antagonist, gremlin, in cultured bovine retinal pericytes (BRPC).

METHODS

BRPC were cultured under conditions of 5 mM and 30 mM d-glucose for 7 days and total RNA was isolated. Gremlin mRNA levels were correlated, by RT-PCR, with other genes implicated in the pathogenesis of diabetic retinopathy and the signalling pathways in high glucose induced gremlin expression were probed using physiological inhibitors. Gremlin expression was also examined in the retina of streptozotocin induced diabetic mice.

RESULTS

High glucose stimulated a striking increase in BRPC gremlin mRNA levels in parallel with increases in mRNA for the growth factors vascular endothelial growth factor (VEGF), transforming growth factor beta (TGFbeta), and connective tissue growth factor (CTGF) and changes in other genes including fibronectin and plasminogen activator inhibitor-1 (PAI-1). High glucose triggered gremlin expression was modulated by anti-TGFbeta antibody, by the uncoupler of oxidative phosphorylation, CCCP, and by inhibition of MAP-kinase (MAPK) activation. Striking gremlin expression was observed in the outer retina of diabetic mice and also at the level of the vascular wall.

CONCLUSIONS

Gremlin gene expression is induced in BRPC in response to elevated glucose and in the retina of the streptozotocin induced diabetic mouse. Its expression is modulated by hyperglycaemic induction of the MAPK, reactive oxygen species, and TGFbeta pathways, all of which are reported to have a role in diabetic fibrotic disease. This implicates a role for gremlin in the pathogenesis of diabetic retinopathy.

The effect of a dietary preload on estimation of usual food portion size by photograph in female volunteers

BACKGROUND

The aim of this study was to investigate whether a subject's level of satiety influences perception of their usual portion size.

METHODS

A total of 62 school children were recruited for the pilot study. Half of the group assessed food photographs for their usual portion size before lunch, and half after lunch. For the main study, 55 female students were recruited to test within-subject variation in perception of usual portion size before and after consuming a preload.

RESULTS

Significant differences in perception of portion size were found for four of the six foods used.

CONCLUSION

Some subjects' perception of their usual portion size was influenced by their level of satiety. Further study is needed to investigate this using a wider variety of food photographs and an alternative preload.

Providing cancer services to remote and rural areas: consensus study

There is controversy about how cancer care should be provided to patients in remote and rural areas. The aim of this project was to measure consensus among health professionals who treat rural patients with cancer about priorities for cancer care. A modified Delphi process was used. Of 78 health professionals in Grampian, 62 responded (79%). Of 49 items suggested, there was agreement on 26 (53%), encompassing fast access to diagnosis, high-quality specialist treatment, and well-coordinated delivery of care with good and fast communication and effective team working between all health professionals involved. Specialist oncology nurses in local hospitals were considered a priority along with good facilities, accommodation, and transport for patients. There was no agreement on the best location for chemotherapy (local or central). The only large difference of opinion between participants based in primary and secondary care concerned chemotherapy provision at local community hospitals (primary care was in favour, hospital practitioners against, P&<0.001). In making their decisions, participants took problems of access into account, but were also concerned with quality of care and feasibility in the current health service. Our findings show that more evidence is needed regarding the balance of risks and benefits of local chemotherapy provision. Overall, however, there is agreement on many principles for cancer care that could be translated into practice.

Effectiveness of home-based food storage training: a community development approach

A community-based home hygiene training initiative, funded by Merseyside Health Action Zone, was piloted in Dingle, a deprived area of Liverpool, UK, during Spring and early Summer 2000. The project actively involved the community, and home-based domestic hygiene training was delivered by community-based facilitators to households in Dingle, Liverpool. During the project the community-based facilitators visited 904 households on two separate occasions. During the first visit, the community-based facilitators completed a questionnaire and an 'action sheet' which had been designed to measure participants' prior knowledge and behaviour, in relation to a range of important food hygiene issues, and delivered the home-based food hygiene training. Within 8 weeks of the first visit, the community-based facilitators returned to the participating households and completed a second questionnaire and action sheet. Home-based training is effective in raising awareness, and community development approach has the advantage of facilitating access to households which otherwise would have been difficult to reach.

Ecological basis for biocontrol of damping-off disease by pseudomonas fluorescens 54/96

Pseudomonas fluorescens 54/96, originally isolated from the rhizosphere of sugar beet, has been shown to be commercially effective in field trials for the suppression of a number of fungal diseases of seedlings. In vitro and microcosm-based assays revealed that both the timing and method of application of bacteria were important for effective control of Pythium ultimum, the causative agent of damping-off disease. Following transposon mutagenesis (Tn5lac), mutants deficient for the suppression of Pythium ultimum infections of peas were isolated. Three major classes of insertional mutants of Ps. fluorescens 54/96 were identified which either inhibited sporulation, reduced mycelial growth or affected the regulation of bacterial metabolic activity. Evaluation of the metabolic capability of pathogen and antagonist revealed evidence for direct competition, as both the fungus and bacterium had similar sole carbon source nutrient utilization profiles. Further comparisons of the activity of the transposon mutants indicated that although the mechanisms of disease control were multifactorial, the most significant factor was the prevention of rapid spore germination in the presence of pea seeds.

Detection of intrastrain antigenic variation of Bacteroides fragilis surface polysaccharides by monoclonal antibody labelling

Bacteroides fragilis is a constituent of the normal resident microbiota of the human intestine and is the gram-negative obligately anaerobic bacterium most frequently isolated from clinical infection. Surface polysaccharides are implicated as potential virulence determinants. We present evidence of within strain immunochemical variation of surface polysaccharides in populations that are noncapsulate by light microscopy as determined by monoclonal antibody labelling. Expression of individual epitopes can be enriched from a population of an individual strain by use of immunomagnetic beads. Also, individual colonies in which either >94% or <7% of the bacteria carry an individual epitope retain this level of expression when subcultured into broth. In broth cultures where >94% of the bacteria carry a given epitope, there is no enrichment for other epitopes recognized by different polysaccharide-specific monoclonal antibodies. This intrastrain variation has important implications for the development of potential vaccines or immunodiagnostic tests.

Creating an elder-friendly hospital

Older adults comprise the majority of people receiving hospital services in many regions of our country today. Current literature is fraught with stories of how risky hospitalization can be for an older adult. Even with the best intentions, being in hospital can set up a cascade of events for older adults and their families that result in longer lengths of stay and functional disability. In a climate of fiscal restraint, competing priorities and public pressure, meeting the challenges of hospitalization for this population is not an easy task. As the number of older adults in acute care rises and the average length of stay continues to decrease, it is necessary for acute care hospitals to rethink their views of caring for older adults; fundamental shifts are required. The purpose of this paper is to describe the "Elder Friendly Hospital" (EFH) concept and explain the strategies taken by the Capital Health Region in Victoria British Columbia.

Interactions between synthetic vanilloids and the endogenous cannabinoid system

The chemical similarity between some synthetic agonists of vanilloid receptors, such as olvanil (N-vanillyl-cis-9-octadecenoamide), and the 'endocannabinoid' anandamide (arachidonoyl-ethanolamide, AEA), suggests possible interactions between the cannabinoid and vanilloid signalling systems. Here we report that olvanil is a stable and potent inhibitor of AEA facilitated transport into rat basophilic leukemia (RBL-2H3) cells. Olvanil blocked both the uptake and the hydrolysis of [14C]AEA by intact RBL-2H3 cells (IC50 = 9 microM), while capsaicin and pseudocapsaicin (N-vanillyl-nonanamide) were much less active. Olvanil was more potent than previously reported inhibitors of AEA facilitated transport, i.e. phloretin (IC50 = 80 microM), AM404 (12.9% inhibition at 10 microM) or oleoylethanolamide (27.5% inhibition at 10 microM). Olvanil was a poor inhibitor of [14C]AEA hydrolysis by RBL-2H3 and N18TG2 cell membranes, suggesting that the inhibitory effect on [14C]AEA breakdown observed in intact cells was due to inhibition of [14C]AEA uptake. Olvanil was stable to enzymatic hydrolysis, and (i) displaced the binding of high affinity cannabinoid receptor ligands to membrane preparations from N18TG2 cells and guinea pig forebrain (Ki = 1.64-7.08 microM), but not from cells expressing the CB2 cannabinoid receptor subtype; (ii) inhibited forskolin-induced cAMP formation in intact N18TG2 cells (IC50 = 1.60 microM), this effect being reversed by the selective CB1 antagonist SR141716A. Pseudocapsaicin, but not capsaicin, also selectively bound to CB1 receptor-containing membranes. These data suggest that some of the analgesic actions of olvanil may be due to its interactions with the endogenous cannabinoid system, and may lead to the design of a novel class of cannabimimetics with potential therapeutic applications as analgesics.

Use of indomethacin for pain relief following scleral buckling surgery

BACKGROUND/AIMS

Patients undergoing scleral buckling and cryotherapy suffer from mild to moderate postoperative pain. As good pain relief facilitates post-operative ocular examination, as well as patient comfort and recovery, the authors designed a prospective randomised double masked trial to evaluate the efficacy of indomethacin as a satisfactory analgesic for such patients.

METHOD

Patients with a primary uncomplicated rhegmatogenous retinal detachment requiring scleral buckling and cryotherapy were randomly allocated to receive either indomethacin or placebo. A rectal suppository was administered 2 hours before surgery, followed by two capsules twice daily for 10 days. Pain relief was assessed with a linear graphic rating scale at the end of each day. Supplementary analgesia was allowed and recorded.

RESULTS

12 patients received indomethacin (group A) and 16 received placebo (group B). The extent of surgery was similar in both groups. One patient in group A, and two in group B withdrew after 3 days. The pain scores were converted to changes from the baseline (score on day 1), and the area under the curve calculated for each patient. The means of the areas were analysed with the Mann-Whitney test and showed that indomethacin caused a statistically significant reduction in pain score, both at 3 days (p = 0.04) and at 10 days (p = 0.014). There was no statistically significant difference in extra analgesic requirements between the two groups (p = 0.2).

CONCLUSIONS

Indomethacin is recommended for short to medium term pain relief following scleral buckling and cryotherapy.