Alphafetoprotein in screening for congenital hypothyroidism

This study was conducted on 500 full-term neonates and 25 older patients with congenital hypothyroidism (CH), newly or previously diagnosed. Alphafetoprotein (AFP) was elevated in two neonates. In one, persistent elevation of AFP and thyroid stimulating hormone (TSH) with low thyroxine (T4) were found (congenital hypothyroidism). In the other, AFP, TSH and T4 levels normalized (transient hypothyroidism). The mean AFP level in new CH patients was significantly higher than in previously diagnosed patients, and was higher in CH patients than in controls. Significant relationships were found between AFP and T4, AFP and TSH, and AFP and age. AFP is a sensitive indicator of thyroid status and can be used as a screening test for hypothyroidism from the first day of life and in follow-up of CH patients.

Identification and functional characterization of a member of the PUR-alpha family from Schistosoma mansoni

Schistosoma mansoni p14 gene encodes an eggshell precursor that is expressed only in vitelline cells of mature female worms in response to a male stimulus. The upstream region of the p14 gene contains several potential cis-acting regulatory sequences. We used the upstream region of the p14 gene as bait in a yeast-one-hybrid screen of a S. mansoni cDNA library to identify interacting proteins. We report the identification and characterization of a cDNA (S. mansoni PUR-alpha (SmPUR-alpha)) encoding a protein homologous to single-stranded DNA transcription activator PUR-alpha, that binds to the p14 upstream region and activates transcription of the HIS3 reporter gene in yeast. SmPUR-alpha has a predicted molecular mass of 30 kDa and shares an overall homology of 63% with mammalian PUR-alpha. The DNA binding domain of SmPUR-alpha is highly conserved. We show by gel shift assays that GST-SmPUR-alpha binds to oligonucleotides comprising the p14 upstream region. SmPUR-alpha binds preferentially to single-stranded DNA and also binds RNA. Unlike the mammalian homologue, SmPUR-alpha exhibits little specificity for the PUR element GGn, but shows strong preference for a sequence containing alternating pyrimidines. Our data support that SmPUR-alpha is a single-copy gene and through reverse transcriptase-polymerase chain reaction and in situ hybridization, we show that SmPUR-alpha is constitutively transcribed in many cell types and thus likely plays a role as a general transcription activator in schistosomes.

The Pain Catastrophizing Scale: further psychometric evaluation with adult samples

Previous studies with undergraduates have provided support for the reliability and oblique three-factor structure of a new scale, the Pain Catastrophizing Scale (PCS). We examined the reliability and validity of the PCS in adult community and pain outpatient samples. The PCS showed a high internal consistency in both groups. Using data from the community sample, confirmatory factor analyses showed that the PCS taps a single construct characterized by three related dimensions. Gender differences were obtained on the PCS total score in the community and the outpatient samples. The analyses also showed significant differences between the community and the outpatient samples on the PCS total and subscales. Overall, the results showed strong evidence of criterion-related, concurrent, and discriminant validity for the PCS in the community sample. Limitations of the present study are discussed.

Risk factors for eye complications in patients with diabetes mellitus: development and progression

A multicentre case-control study was conducted to identify and quantify risk factors that may influence the development and progression of diabetic retinopathy. A total of 200 diabetic patients with nonproliferative retinopathy were compared with 400 diabetic patients without any eye complications with regard to the development of diabetic retinopathy. They were also compared with 200 diabetic patients with major eye complications to study the progression of diabetic eye complications. Results showed that the progression of diabetic eye complications was preventable since all the variables significantly affecting the process of progression, except type of diabetes, were avoidable

Schistosoma mansoni phosphoenolpyruvate carboxykinase, a novel egg antigen: immunological properties of the recombinant protein and identification of a T-cell epitope

In schistosomiasis mansoni, hepatic granulomatous inflammation surrounding parasite eggs is mediated by CD4(+) T helper (Th) cells sensitized to schistosomal egg antigens (SEA). We previously showed that a prominent lymphoproliferative response of CD4(+) Th cells from schistosome-infected C57BL/6 (BL/6) mice was directed against a 62-kDa component of SEA. A partial amino acid sequence of the 62-kDa component was found to be identical with one present in the enzyme phosphoenolpyruvate carboxykinase (PEPCK). Based on this sequence, a cDNA clone containing the entire coding region of PEPCK was identified, and the full recombinant Schistosoma mansoni PEPCK (rSm-PEPCK) of 626 amino acids was purified from a prokaryotic expression system. rSm-PEPCK strongly stimulated a specific T-cell hybridoma, 4E6, as well as CD4(+) Th cells from SEA-immunized BL/6 mice and from infected BL/6, CBA, and BALB/c mice. In the infected mice, rSm-PEPCK elicited significant gamma interferon production as well as, to a lesser extent, production of interleukin-2 and -5. In BL/6 and BALB/c mice, the CD4(+) Th cell response to rSm-PEPCK was greater than that directed against the egg antigen Sm-p40; conversely, CBA mice responded better to Sm-p40 than to Sm-PEPCK. A 12-amino-acid region (residues 398 to 409: DKSKDPKAHPNS) was demonstrated to contain a T-cell epitope; synthetic peptides containing this epitope significantly stimulated specific hybridoma 4E6 and polyclonal CD4(+) Th cells. The identification and characterization of immunogenic egg components will contribute to the understanding and possible control of T-cell-mediated schistosomal disease.

Why young people do not kill themselves: the reasons for living inventory for adolescents

Assessed the reliability, validity, and predictive power of a new measure, the Reasons for Living Inventory for Adolescents (RFL-A; Osman et al., 1998). A group of 206 (101 boys and 105 girls) adolescent psychiatric inpatients completed the RFL-A, Minnesota Multiphasic Personality Inventory for Adolescents (Butcher et al., 1992), and a packet of self-report measures. Additional information about the patients including diagnosis and suicide status were obtained from their medical records. It was determined that the RFL-A is a valid and reliable measure of adolescent suicide risk potential. Additionally, the RFL-A possesses better predictive power than the Beck Hopelessness Scale (Beck, Weissman, Lester, & Trexler, 1974). A discussion of the clinical and research utility of the RFL-A is included along with suggestions for future research.

Risk factors for eye complications in patients with diabetes mellitus: development and progression

A multicentre case-control study was conducted to identify and quantify risk factors that may influence the development and progression of diabetic retinopathy. A total of 200 diabetic patients with nonproliferative retinopathy were compared with 400 diabetic patients without any eye complications with regard to the development of diabetic retinopathy. They were also compared with 200 diabetic patients with major eye complications to study the progression of diabetic eye complications. Results showed that the progression of diabetic eye complications was preventable since all the variables significantly affecting the process of progression, except type of diabetes, were avoidable.

Insulin resistance differentially affects the PI 3-kinase- and MAP kinase-mediated signaling in human muscle

The broad nature of insulin resistant glucose metabolism in skeletal muscle of patients with type 2 diabetes suggests a defect in the proximal part of the insulin signaling network. We sought to identify the pathways compromised in insulin resistance and to test the effect of moderate exercise on whole-body and cellular insulin action. We conducted euglycemic clamps and muscle biopsies on type 2 diabetic patients, obese nondiabetics and lean controls, with and without a single bout of exercise. Insulin stimulation of the phosphatidylinositol 3-kinase (PI 3-kinase) pathway, as measured by phosphorylation of the insulin receptor and IRS-1 and by IRS protein association with p85 and with PI 3-kinase, was dramatically reduced in obese nondiabetics and virtually absent in type 2 diabetic patients. Insulin stimulation of the MAP kinase pathway was normal in obese and diabetic subjects. Insulin stimulation of glucose-disposal correlated with association of p85 with IRS-1. Exercise 24 hours before the euglycemic clamp increased phosphorylation of insulin receptor and IRS-1 in obese and diabetic subjects but did not increase glucose uptake or PI 3-kinase association with IRS-1 upon insulin stimulation. Thus, insulin resistance differentially affects the PI 3-kinase and MAP kinase signaling pathways, and insulin-stimulated IRS-1-association with PI 3-kinase defines a key step in insulin resistance.

Mechanisms of speed-accuracy tradeoff: evidence from covert motor processes

Speed-accuracy tradeoff (SAT) refers to the inverse relation between speed and accuracy found in many tasks. The present study employed reaction times (RTs) and movement-related brain potentials arising during the RT interval (lateralized readiness potentials; LRPs) to examine the mechanisms by which people control their position along an SAT continuum. Many models of SAT postulate that changes in position across conditions (macro-tradeoffs) and trial-by-trial variations within conditions (micro-tradeoffs) are mediated, at least in part, by the same mechanisms. These include: (1) all models that postulate mixtures of guesses and accurate responses and (2) some models postulating decision criterions applied to accumulating evidence or response tendencies. Such models would seem to be rejected for conditions under which macro- and micro-tradeoffs can be shown to involve no stages of RT in common. Under the present conditions, the two types of SAT produced additive effects on RT, with the macro-tradeoff involving only that portion of the RT interval occurring after LRP onset and the micro-tradeoff involving only that portion before LRP onset. These findings imply that the two types of SAT arose during different serial stages of RT and that the macro-tradeoff involved only stages occurring after differential preparation of the two hands had begun.

Accelerated allograft degeneration after aortic valve endocarditis

Early calcification of aortic allografts is usually seen in children less than 3 years of age. We describe a case of a 22-year-old intravenous drug user who developed calcific aortic valve stenosis less than 3 years after an allograft root replacement for endocarditis.

[Seasonal migration: a case control study of malaria prevention in Sabah]

Malaria is an infectious disease that remains the main health problem in Tawau, Sabah. A case control study was carried out in the district to determine the influence of seasonal migration on malaria occurrence. Respondents consisted of 142 cases who were randomly selected from the reported cases in 1996 and they were pair-matched with 142 controls from the same villages by age and sex. The results showed that malaria occurrence was significantly associated with movement to the jungle, use of preventive measures during migration and frequency of using treated bednets (p < 0.05). The risk of individuals migrated to the jungle was 6 times as compared to those who do not (unadjusted Odd Ratio = 5.50, 95% CI 1.16-35.89) and they were more likely to get the infection if they did not use bednets (OR = 3.57, 95% CI 1.57-9.06). Health promotion campaign on the use of bednets especially during short term migration should be given priority in any malarial intervention program.

Characterization of the Ras homologue of Schistosoma mansoni

Ras is a member of a super-family of guanine-binding or G-proteins. Ras functions as a molecular switch in the transduction of signals generated by the activation of a variety of cell surface receptors and relays the signals to downstream effectors. Little is known about signal transduction in schistosomes. In order for Schistosoma mansoni to survive different immune responses triggered by the host as well as to migrate from the site of penetration at the skin to the final destination in portal circulation, they must receive signals from the host environment and respond to them in a way that allows their survival. We have isolated the schistosome Ras cDNA by using sequence information of the schistosome Ras homologue submitted to the Genbank database. Analysis of the encoded peptide revealed 81% identity and 92% similarity with K-Ras from various species. Ras is a single copy gene as determined by quantitative hybridization experiments. The cDNA was cloned into pGEX-4T and the expressed peptide was used to generate specific antibody reagents. Affinity purified antibodies identified a 23 kDa native protein that localizes to the subtegument. Ras is not associated with the tegument. Ras is expressed in all the developmental stages of the parasite. However, Ras is over-expressed in female worms compared to males. Schistosome Ras was also shown to be post-translationally modified by addition of farnesyl isoprenoid moiety to the cysteine residue in the C-terminal box. Using a schistosome extract in vitro SmRas farnesylation was inhibited by the farnesyl transferase inhibitor, FTI-277, at concentrations comparable to those required to inhibit K-Ras processing. These initial studies on signal transduction in schistosomes should provide a solid basis for improving our understanding of schistosome-host interactions.

Cortico-spinal inhibition reflects time but not event preparation: neural mechanisms of preparation dissociated by transcranial magnetic stimulation

Changes in cortico-spinal excitability related to time and event preparation were investigated by transcranial magnetic stimulation (TMS) of the motor cortex during the foreperiod of a movement-precuing task. Subjects performed a four alternative choice reaction time (RT) task involving a button-press with the index or middle finger (FI) of the left or right hand. Advance information about the to-be-signaled response was provided by a precue, which preceded the response signal by a 1 s foreperiod. The precue either indicated the hand (right or left) or FI (index or middle) with which the response would be executed or was uninformative. TMS was delivered to the left or right cortical hand area at one of five possible times during the foreperiod: -1000, -500, -333, -166 or 0 ms prior to the response signal. Surface EMG activity from a prime mover involved in flexion of the response FIs (Flexor digitorum superficialis) was used to measure the magnitude of the motor evoked potential (MEP) elicited by TMS. Cortico-spinal excitability--as assessed by the magnitude of the MEP evoked in the target muscle contralateral to the stimulated hemisphere--progressively decreased during the foreperiod. The identity of the precued responses, however, had no effect on MEP magnitude. These results suggest that preparation to respond at a particular time inhibited excitability of the cortico-spinal tract, while advance preparation to perform specific responses affected more central structures only.

Solid state stability of ketoprofen in the presence of different excipients

Physical mixtures of ketoprofen (KT) were prepared using different excipients, namely, lactose, mannitol, sorbitol, beta-cyclodextrin, polyvinylpyrolidone (PVP) K30, polyethyleneglycol (PEG) 20,000 and urea in a ratio of 2:1 (drug/excipient). The prepared samples as well as KT alone were stored at 40, 50 and 60 degrees C in sealed glass vials for 12 weeks. The fresh and stored samples were subjected to physical examination and instrumental analysis including m.p., IR and dissolution rate. KT without additives was found to be physically stable or when mixed with either lactose, mannitol, sorbitol or beta-cyclodextrin for 12 weeks at 60 degrees C. The m.p. of the drug alone or in presence of these excipients did not change. Also IR showed no change. On the other hand, KT mixtures with PVP K30, PEG 20,000 or urea were physically unstable on storage at 40, 50 and 60 degrees C. Their m.p. were found to decrease; the IR curves were also changed. All the tested excipients enhanced the dissolution of KT from its physical mixtures and could be arranged according to the extent of dissolution as follows: Lactose = Mannitol > beta-cyclodextrin > PVP K30 = Urea > Sorbitol > PEG 20,000.

Identification of a cDNA encoding a retinoid X receptor homologue from Schistosoma mansoni. Evidence for a role in female-specific gene expression

Schistosoma mansoni, a multicelluar eukaryotic blood fluke, is a major cause of morbidity worldwide in humans. The study of female parasite growth, development, and gene regulation is important because the eggs produced are responsible for the pathogenesis observed in schistosomiasis. p14, an eggshell precursor gene expressed only in sexually mature females in response to a male stimulus, is a model for female-specific gene regulation. The upstream region of the p14 gene shares sequences present in insect genes known to be regulated in a sex-, temporal-, and tissue-specific manner by members of the steroid receptor superfamily. Herein, we report the identification and characterization of a cDNA that encodes the S. mansoni (Sm) RXR homologue. Sequence analysis predicts and Western blot analysis confirms the synthesis of a 74-kDa protein, the largest member of the RXR family reported to date. We show by electrophoretic mobility shift assay analysis that SmRXR binds to cis-elements of the p14 gene including a direct repeat that follows the "3-4-5" rule of binding elements recognized by members of the steroid receptor superfamily. Furthermore, we demonstrate that SmRXR can act as a transcription activator in the yeast one-hybrid system. Through quantitative reverse transcriptase-polymerase chain reaction, we show that the SmRXR gene is constitutively expressed and thus must play multiple roles throughout the schistosome life cycle.

The Reasons for Living Inventory for Adolescents (RFL-A): development and psychometric properties

The role of adaptive beliefs and attitudes against suicide has not been given adequate attention in the clinical or assessment literature. This article reports on the development and initial psychometric properties of a 32-item self-report inventory, the Reasons for Living Inventory for Adolescents (RFL-A). In Phase 1, we used exploratory and confirmatory factor analyses to identify five correlated factors: Future Optimism, Suicide-Related Concerns, Family Alliance, Peer Acceptance and Support, and Self-Acceptance. In Phase 2, we cross-validated the 5-factor oblique model in a different group of adolescents recruited from two high schools. In addition, we examined evidence for convergent, discriminant, and construct validities. The coefficient alpha indices for the RFL-A total and scales were satisfactory. In Phase 3, we evaluated additional evidence of reliability and validity using samples of high school and psychiatric inpatient adolescents. The results suggest that the RFL-A is a short, reliable, and valid measure that is potentially useful in the assessment of adolescent suicidal behavior.

The Suicide Probability Scale: norms and factor structure

The present study examined the factor structure of the Suicide Probability Scale with a sample of 390 undergraduates, using confirmatory factor analysis. The original oblique four-factor structure provided a poor fit to the data. Scores on the total scale correlated .63 with scores on a validated self-report measure of mood and .51 and .42 with anxiety symptoms. Additional norms for the total scale are reported.

The supplementation of levothyroxine among indigenous people in endemic goitre areas: The impact of therapy

In order to study the effect of levothyroxine in the treatment of endemic goitre, a longitudinal study was conducted among the Aborigines in Lanai Post and Sinderut Post, situated in an iodine-deficient area located in the district of Kuala Lipis, Pahang. All subjects in the treatment group (Lanai Post) were given 100 µg of levothyroxine per day and were followed for 1 1/2 years. A total of 311 subjects were examined at baseline, 323 on the first, 256 on the second, 239 on the third and 184 on the fourth visit following levothyroxine supplementation. Goitre prevalence, thyroid hormones, thyroid volume, nutritional status, urinary iodine levels, arterial blood pressure and mental performance were determined. Following the intervention, goitre prevalence was significantly reduced in the treatment group (baseline 42.8% vs final visit 13.0%, p<0.0001); however, no significant difference was noted in the control group. Total T4 levels were increased in the treatment group (p<0.0001), while a significant reduction was noted in the control group (p<0.0001). Thyroid-stimulating hormone levels increased significantly in the treatment group following 1 year of intervention, while no significant changes were observed in the control group. As for the thyroid volume, both groups showed a significant increment following the intervention (p<0.0001). With respect to the nutritional status, the treatment group showed a significant increase in body weight following the intervention (p<0.05). In addition, the mid-arm circumference and body mass index also increased after 1 year of intervention. However, the control group showed a reduction in the waist-hip ratio (p<0.0001). Although there was no statistical difference in the waist-hip ratio in the treatment group, there has been a significant reduction observed after 1 year of intervention. At 1 year, a reduction in skinfold thickness was noted in the treatment group while only the triceps and subscapular were increased in the control group. The body fat was decreased in the treatment group following 1 year of intervention (p<0.0001). No particular trend was noted in the urinary iodine excretion in the treatment group, but surprisingly, the levels were increased in the control group (p<0.0001). A significant increase in both systolic and diastolic blood pressures was observed in the treatment group following 1 year of intervention, but the controls showed a reduction in the systolic blood pressure (p<0.0001). Both groups showed a remarkable increase in mental performance, with a more pronounced effect in the treatment group (p<0.05). The correction of iodine deficiency by levothyroxine supplementation has a short-term beneficial effect in reducing the prevalence of goitre and improving the mental ability among the Aborigines in endemic areas; however, proper monitoring and close supervision are needed to maintain compliance.

The positive and negative suicide ideation inventory: development and validation

We conducted two studies to develop and validate a brief self-report measure for assessing the frequency of positive and negative thoughts related to suicidal behavior. Items on this new measure, the Positive and Negative Suicide Ideation inventory, were generated by undergraduates. In Study 1, we administered a 20-item version of the inventory to 150 male and 300 female undergraduates and conducted an exploratory principal axis factor analysis with varimax rotation. Two factors, Positive Ideation and Negative Ideation, were retained. In Study 2, we conducted a confirmatory factor analysis to validate the fit of the one-factor and the oblique two-factor models to data from another sample of 84 men and 202 women. The oblique two-factor model provided an excellent fit to the sample data. We also examined preliminary evidence of concurrent and predictive validity. Over-all, these findings suggested that the inventory is a well-developed self-report measure for assessing the frequency of positive and negative thoughts related to suicidal behavior.

TSH suppression combined with carbimazole for Graves' disease: effect on remission and relapse rates

OBJECTIVE

We studied the influence of TSH suppressive therapy combined with carbimazole (CBZ) on treatment outcome in Graves' disease.

DESIGN

Open non-randomized prospective study.

SETTING

University Hospital of Montpellier, France.

SUBJECTS

Sixty-six consecutive patients without prior treatment were included. All the patients were treated initially with 30 mg of CBZ. After 1 month of treatment, one group continued CBZ alone (n = 23), another group received a combination of CBZ plus T3 (n = 19) and a third group received CBZ and 3,5,3'-triiodothyroacetic acid (Triac, n = 24). Therapy was stopped when remission was obtained based on clinical euthyroidism, normalization of FT4 and of early radioiodine uptake. Nine patients with medical treatment failure or major side effects requiring to stop antithyroid drugs underwent surgery or radioiodine therapy. Nine patients were lost to follow-up. The remaining 48 patients were available for analysis of both remission and relapse.

RESULTS

The median duration of therapy was 18 months (range, 4-41 months). Based on clinical examination, goitre size at 4 months decreased more in the CBZ + T3 and CBZ + Triac groups than in the CBZ group (P = 0.02). The overall remission rate tended to be higher in the groups treated with CBZ + T3 and CBZ + Triac than in the group treated with CBZ alone, but the difference did not reach statistical significance (P = 0.17). No difference in the relapse rate was observed between the three groups.

CONCLUSION

TSH suppression combined with CBZ has little or no effect on remission and relapse rates in Graves' disease patients.

T and B cell reactivity to a 42-kDa protein is associated with human resistance to both schistosomiasis mansoni and haematobium

Egyptian subjects living in areas endemic for Schistosoma mansoni or Schistosoma haematobium were selected on the basis of their apparent extremes of resistance or susceptibility to schistosomiasis and examined for T and B cell responses against the major electrophoretically resolved protein species from soluble adult worm extracts. A 42-kDa band was specifically recognized by a significant majority of subjects resistant to schistosomiasis. The 42-kDa species (p-42) from S. mansoni and S. haematobium were immunologically cross-reactive and induced significant protection in mice and hamsters against infection with cercariae. Amino acid sequence analysis of S. mansoni p-42 showed that it consists predominantly of glyceraldehyde 3-P dehydrogenase (G3PDH), which has been shown to be preferentially recognized by the sera of Brazilian subjects resistant to schistosomiasis mansoni. The present data extend the previous findings and imply that S. mansoni-derived G3PDH represents a target of protective T and B cell-mediated antischistosomiasis immunity in humans.

Post kala-azar ocular leishmaniasis

The clinical features, diagnosis and treatment of 6 patients with post kala-azar ocular leishmaniasis are described. The eye lesions were associated with past or concomitant post kala-azar dermal leishmaniasis (PKDL). Four patients had post kala-azar leishmanial conjunctivitis and blepharitis. Using the polymerase chain reaction, the causative parasite was characterized as Leishmania donovani in 2 of these 4 patients. Two patients had post kala-azar anterior uveitis. The diagnosis of uveitis was based on the clinical manifestations, temporal relation to treated visceral leishmaniasis, the association with PKDL and positive anti-Leishmania serology. All patients were treated with systemic sodium stibogluconate. Patients with anterior uveitis were also treated with steroid and atropine eyedrops. The response to treatment was good. The importance of early diagnosis and treatment of ocular leishmaniasis is stressed.

Clinical utility of the MMPI-A content scales and Harris-Lingoes subscales in the assessment of suicidal risk factors in psychiatric adolescents

This study of 143 inpatient adolescents (68 boys and 75 girls) investigated the clinical utility of the MMPI-A in assessing suicidal risk factors by examining the unique contribution of the content scales and Harris-Lingoes subscales beyond what is provided by the basic clinical scales. The results of the regression analyses indicated that for boys, the Depression, Psychopathic Deviate and Hypomania scales; Alienation and Anxiety content scales: and Subjective Depression. Self Alienation, Imperturbability, and Amorality Harris-Lingoes subscales contributed significantly to the prediction of suicide probability. For girls, the Depression, Psychopathic Deviate, and Hypomania scales; Family Problems, Conduct Problems, School Problems, Depression, and Social Discomfort content scales; and the Subjective Depression, Self Alienation, Psychomotor Acceleration, and Imperturbability Harris-Lingoes subscales contributed significantly to the prediction of suicide probability.

Effect of anticoagulation protocol on outcome in patients undergoing CABG with heparin-bonded cardiopulmonary bypass circuits

BACKGROUND

We have demonstrated that the use of heparin-bonded cardiopulmonary bypass circuits (HBCs) combined with a lower anticoagulation protocol as an adjunct to an integrated blood conservation strategy decreases the incidence and magnitude of homologous transfusion and improves clinical outcome in patients undergoing primary coronary artery bypass grafting. It is not known whether it is the lower anticoagulation protocol that influences outcome in patients treated with HBCs. Furthermore, the thrombogenic risk of using lower anticoagulation with HBCs still is debated.

METHODS

To answer these questions, a prospective randomized study was conducted in which 244 patients undergoing primary coronary artery bypass grafting were treated with HBCs and randomized to undergo either a full (activated clotting time, > 450 seconds) or a lower (activated clotting time, > 250 seconds) anticoagulation protocol. In addition to clinical outcome, levels of thrombin generation markers during and after cardiopulmonary bypass were assessed in a consecutive subset of 58 patients (full anticoagulation profile = 28, lower anticoagulation profile = 30) by measuring thrombin-antithrombin complexes and prothrombin fragment 1.2. Levels of these markers also were correlated with the activated clotting time during cardiopulmonary bypass.

RESULTS

Preoperative and intraoperative risk profiles and other characteristics were similar in both groups, with more than 60% of patients undergoing nonelective operation. Compared with the full anticoagulation protocol group, patients in the lower anticoagulation protocol group were less likely to require blood products (24.2% versus 35.8%, respectively; p = 0.047) and received substantially fewer homologous donor units (0.50 +/- 0.92 versus 1.08 +/- 2.10 U, respectively; p = 0.005). Clinical outcomes were uniformly outstanding (but similar) in both treatment groups, with a modest reduction in the length of the hospital stay in the lower anticoagulation protocol group (5.26 +/- 1.23 versus 5.63 +/- 1.73 days, respectively; p = 0.05). The use of HBCs with a lower anticoagulation protocol was not associated with any adverse clinical events. Thrombin generation increased during cardiopulmonary bypass in both treatment groups, but was unrelated to the anticoagulation protocol or the activated clotting time (r2 = 0.03). No differences between the full and lower anticoagulation protocol groups were noted in the number of microemboli detected by transcranial Doppler analyses during cardiopulmonary bypass (n = 40) or in the postoperative neurologic and neuropsychologic outcomes (n = 30).

CONCLUSIONS

This study definitively demonstrates that, when used appropriately, patients who are treated with HBCs and a lower anticoagulation protocol have a lower incidence and magnitude of homologous transfusion and are not at any added risk for clinical, hematologic (thrombin-antithrombin complex and fragment 1.2 measurements), or microscopic (transcranial Doppler analyses) thromboembolic complications or for neurologic or neuropsychologic deficits.

Teaching of basic life support in the undergraduate medical curriculum

There is now increased public awareness of the value and role of cardiopulmonary resuscitation (CPR). It is therefore not surprising that the public expects a reasonable level of expertise of medical doctors in the application of the CPR techniques during emergency situations. Newly qualified doctors often lack confidence and are usually at a loss when faced with such situations as they have never had practical training before graduation. Most doctors are gradually introduced to CPR as part and parcel of their clinical experience. Many begin to attend formal CPR workshops later in their careers. Medical schools are expected to produce well trained doctors who are competent in clinical practice which include the techniques of basic resuscitation. By virtue of their expertise in airway management and clinical resuscitation, anaesthesiologists can significantly contribute to the teaching of CPR in the undergraduate medical curriculum. This is a retrospective review of Basic Life Support programmes conducted at the Department of Anaesthesiology, Faculty of Medicine, Universiti Kebangsaan Malaysia.

[The risk of road traffic accidents among primary school children in Kuala Terengganu]

A case control study was conducted in 1996 among primary school student in Terengganu. The objective of the study is to determine the relationship between road traffic accidents and factors such as socio-economic status, distance from school, number of siblings, behavioural problems, knowledge and attitudes of pupil and their parents towards road safety and parents' educational status. A total of 140 cases was obtained from 3 urban schools and 3 from rural schools. Cases were matched with control according to age sex and locality of residence. There were significant associations between road traffic accidents and pupils' knowledge regarding road crossing (OR = 0.40, 95% CI = 0.19-0.85), parental supervision (OR = 0.43, 95% CI = 0.19, 0.64) and parents having driving licences (OR = 0.99, 95% CI = 0.856-0.999). Road safety education for pupils and parental supervision are key measures in preventing road traffic accidents among primary school children.

Factor structure, reliability, and validity of the Pain Catastrophizing Scale

The Pain Catastrophizing Scale (PCS; Sullivan et al., Psychol. Assess. 7, 524-532, 1995) has recently been developed to assess three components of catastrophizing: rumination, magnification, and helplessness. We conducted three studies to evaluate the factor structure, reliability, and validity of the PCS. In Study I, we conducted principal-components analysis with oblique rotation to replicate the three factors of the PCS. Gender differences on the original PCS subscales were also analyzed. In Study II, we conducted confirmatory factor analyses to evaluate the adequacy of fit of four alternative models. We also evaluated evidence for concurrent and discriminant validity. In Study III, we evaluated the ability of the PCS and subscales to differentiate between the responses of clinic (students seeking treatment) and nonclinic undergraduate samples. Also, in the clinic sample, we evaluated evidence of concurrent and predictive validity for the PCS. The internal consistency reliability indices for the total PCS and subscales were examined in all three studies. Limitations and future directions are discussed.

Factor structure, reliability, and validity of the Pain Catastrophizing Scale

The Pain Catastrophizing Scale (PCS; Sullivan et al., Psychol. Assess. 7, 524-532, 1995) has recently been developed to assess three components of catastrophizing: rumination, magnification, and helplessness. We conducted three studies to evaluate the factor structure, reliability, and validity of the PCS. In Study I, we conducted principal-components analysis with oblique rotation to replicate the three factors of the PCS. Gender differences on the original PCS subscales were also analyzed. In Study II, we conducted confirmatory factor analyses to evaluate the adequacy of fit of four alternative models. We also evaluated evidence for concurrent and discriminant validity. In Study III, we evaluated the ability of the PCS and subscales to differentiate between the responses of clinic (students seeking treatment) and nonclinic undergraduate samples. Also, in the clinic sample, we evaluated evidence of concurrent and predictive validity for the PCS. The internal consistency reliability indices for the total PCS and subscales were examined in all three studies. Limitations and future directions are discussed.

Heparin-bonded circuits improve clinical outcomes in emergency coronary artery bypass grafting

Compared to patients undergoing elective or urgent coronary artery bypass grafting (CABG), those undergoing emergency CABG (EM-CABG) have a higher morbidity and mortality. The use of heparin-bonded circuits (HBC) has been shown to improve clinical outcomes in nonemergent CABG patients. It is not known, however, whether the improved hemostasis and attenuation of the inflammatory response to cardiopulmonary bypass, conferred by HBC, can overcome the high incidence of comorbid risk factors in (EM-CABG) patients and improve their outcomes. A retrospective analysis of 206 consecutive patients undergoing EM-CABG over 4 years (1993-1997) at one institution was performed. Eighty-one patients were treated with conventional non-heparin-bonded circuits (NHBC) with full anticoagulation protocol (FAP, activated clotting time [ACT] > 480 sec); 125 patients were treated with HBC and a lower anticoagulation protocol (LAP, ACT > 280 seconds). Outcomes and results were collected prospectively and are presented as mean +/- SD. Preoperative risk profiles were similar in both treatment groups. Postoperatively, compared with the NHBC group, patients treated with HBC/LAP required fewer homologous donor units (4.1 +/- 10.7 vs 8.2 +/- 13.6 units, p = 0.005), were less likely to require inotropic support (18.6% vs 38.3%, p = 0.005), and had a lower incidence of perioperative myocardial infarction (MI, 3.2% vs 12.3%, p = 0.04) and pulmonary complications (4.0% vs 12.3%, p = 0.04). The use of HBC/LAP resulted in a decreased incidence of postoperative complications (12.8% vs 28.4%, p = 0.01, odds ratio 0.37 with 95% confidence interval [CI] 0.18-0.76). This resulted in a shorter duration of ventilatory support (30.5 +/- 54.0 vs 72.8 +/- 16.7 hours, p = 0.009), ICU stay (38.2 +/- 36.5 vs 91.5 +/- 68.7 hours, p = 0.009), hospital stay (8.0 +/- 7.1 vs 11.0 +/- 8.9 days, p = 0.008), and therefore cost. In conclusion, the use of HBC/LAP in EM-CABG resulted in a reduction of homologous transfusion and postoperative complications associated with decreased hospital stays and cost.

The Beck Anxiety Inventory: reexamination of factor structure and psychometric properties

Several exploratory factor-analytic studies of the Beck Anxiety Inventory (BAI; Beck, Epstein, Brown, & Steer, 1988) have reported two, four, and five factors. This study evaluated the fit of four competing models to data provided by a sample of 350 undergraduates. Results of the initial confirmatory factor analyses (CFA) provided strong support for the fit of the four-factor oblique model. Next, we respecified the four-factor model as a single second-order BAI. Results showed that the second-order model also provided adequate fit to the data. Evidence also supported the psychometric indices of reliability and convergent validity. Finally, we examined the relation of the BAI to several demographic variables. Limitations of the study are discussed.

The Beck Anxiety Inventory: reexamination of factor structure and psychometric properties

Several exploratory factor-analytic studies of the Beck Anxiety Inventory (BAI; Beck, Epstein, Brown, & Steer, 1988) have reported two, four, and five factors. This study evaluated the fit of four competing models to data provided by a sample of 350 undergraduates. Results of the initial confirmatory factor analyses (CFA) provided strong support for the fit of the four-factor oblique model. Next, we respecified the four-factor model as a single second-order BAI. Results showed that the second-order model also provided adequate fit to the data. Evidence also supported the psychometric indices of reliability and convergent validity. Finally, we examined the relation of the BAI to several demographic variables. Limitations of the study are discussed.

Effects of a pH 7.4, lactate-based and a pH 7.4, bicarbonate-based peritoneal dialysis solutions on neutrophil superoxide generation

Neutrophil superoxide formation was similar when cells were incubated in self-made, non-autoclaved pH 7.4, lactate-based peritoneal dialysis solutions or in their self-made, non-autoclaved, pH 7.4, bicarbonate-based counterparts. On the other hand, commercially available, autoclaved, pH 7.4, lactate-based peritoneal dialysis solutions resulted in inhibition of superoxide production when compared to their self-made, non-autoclaved, pH 7.4, lactate-based or bicarbonate-based counterparts. The cause for this inhibition of superoxide generation is at present unknown.

The Brief Reasons for Living Inventory for Adolescents (BRFL-A)

This study modified and evaluated the psychometric properties of the Reasons for Living Inventory (RFL) in samples of adolescents. Internal consistency reliability, corrected item-total scale correlation, and exploratory factor analysis procedures were used with a mixed sample of 260 adolescents to identify 14 items for the brief version of the RFL (BRFL-A). Confirmatory factor analyses provided support for the five-factor oblique structure of the BRFL-A in a psychiatric inpatient sample with a range of suicidal behaviors. Reliabilities of the BRFL-A subscales were satisfactory. Four of the five subscales differentiated between suicidal and nonsuicidal adolescents. Significant correlations were found between three BRFL-A subscales and several suicide indices. Convergent-discriminant validity was examined by correlating the BRFL-A subscales with the Minnesota Multiphasic Personality Inventory-Adolescents (MMPI-A) Content Scales. Limitations of the study are discussed.

Effects of iodine deficiency on insulin-like growth factor-I, insulin-like growth factor-binding protein-3 levels and height attainment in malnourished children

OBJECTIVE

The expression and synthesis of IGF-I and IGFBP-3 have been shown to be regulated by hormones and nutrition. We study the effects of malnutrition and iodine deficiency on these growth factors and the height attainment of a group of children.

DESIGN

We measured serum IGF-I and IGFBP-3 levels in a group of Malaysian aborigine children from three jungle settlements; Sinderut and Pos Lanai are known for iodine deficiency and endemic goitre, and Gombak is an iodine replete area with better socioeconomic status.

PATIENTS

A total of 246 children were studied, 188 in the age group 4-10 years and 88 in the age group 11-15 years.

MEASUREMENTS

All children were assessed anthropometrically and height standard deviation score (SDS) were calculated using the CDC Anthropometric Software package. Malnutrition was confirmed clinically and according to the WHO definition of malnutrition. IGF-I and IGFBP-3 were determined by radioimmunoassay, and T4 and TSH by immunoradiometric assay.

RESULTS

Based on the height SDS, Sinderut and Pos Lanai children were significantly more malnourished and stunted than the Gombak children P = 0.0001). T4 levels were significantly lower (P = 0.0001) amongst the 4-10-years old Sinderut (81 +/- 2 nmol/l) than in Pos Lanai (101 +/- 3 nmol/l) or Gombak (123 +/- 3 nmol/l) children. Similar findings were also seen in the older children; mean T4 levels of those from Sinderut and Pos Lanai (83 +/- 3 and 88 +/- 4 nmol/l respectively), were low (P = 0.0001) compared to Gombak (118 +/- 3 nmol/l). Conversely, TSH levels in both age groups of Sinderut children were significantly elevated (P = 0.0001) (3.5 +/- 0.2 and 3.9 +/- 0.3 mU/l respectively) compared to age-matched groups from Pos Lanal (2.1 +/- 0.1 and 2.2 +/- 0.2 mU/l respectively) and Gombak (1.5 +/- 0.1 and 1.5 +/- 0.2 mU/l respectively). IGF-I and IGFBP-3 correlated significantly with the height SDS of the children, In both the 4-10 (r = 0.400, P = 0.0001 and r = 0.365, P = 0.0001 respectively) and 11-15 years age groups (r = 0.324, P = 0.002 and r = 0.533, P = 0.0001 respectively). Correlation between IGFBP-3 and T4 levels was more significant in the younger children (r = 0.412, P = 0.0001). Association between IGF-I and T4 levels was significant only in the 4-10 years age group (r = 0.237, P = 0.001).

CONCLUSIONS

Varying duration and degree of exposure to malnutrition and iodine deficiency resulted in different mean levels of T4, TSH, IGF-I and IGFBP-3 in the three areas. The strong positive associations between IGF-I and IGFBP-3 levels and height SDS suggest that these biochemical measurements are indeed useful indicators of growth and nutritional status in children. The significant correlations between T4 and IGFBP-3 and IGF-1 suggests the importance of thyroid hormones in regulating the synthesis of these growth factors. The age-related increase of these growth factors even amongst malnourished, iodine deficient children implies that age-matched reference ranges are essential for proper evaluation of laboratory results.

Levels of thyroxine, TSH, thyroid volume and mental performance among Orang Asli in selected settlements in Malaysia

A significant difference in the levels of thyroxine (T4), thyroid stimulating hormone (TSH) and thyroid volume among settlements at various selected Orang Asli locations is reported. The levels improved according to the level of socio-economic development. No significant difference was found in mental performance by location.

Peptic-tryptic digests of gliadin: contaminating trypsin but not pepsin interferes with gastrointestinal protein binding characteristics

For many years, peptic-tryptic digests of gliadin, known as Frazer's fraction III, have been used in investigations of gliadin effects. Potential contamination by the proteases pepsin and trypsin, however, was not considered. To investigate the influence of contaminating proteases on binding of gliadin peptides to rat small intestinal brush border membranes we compared binding characteristics of different gliadin digests. Binding of biotinylated probes was studied in dot blots and Western blots with an enhanced chemiluminescence system. In gliadin peptide preparations only contaminating trypsin, but not pepsin, was detectable by specific antisera. Digestion with insoluble proteases attached to cross-linked beaded agarose yielded gliadin peptides free of contaminating pepsin and trypsin. These peptides bound 30% less to brush border membranes. Using these peptides, there was no trypsin-typical binding pattern to low molecular mass membrane proteins in contrast to peptide preparations which contained contaminating trypsin. In conclusion contaminating trypsin might alter gliadin peptide binding characteristics by direct binding to brush border membranes and by interfering with interactions between gliadin peptides and brush border membranes.

Diabetic control among NIDDM patients in urban and rural areas in Malaysia

Sixty three and fifty nine non-insulin dependent diabetes mellitus (NIDDM) patients in rural (land resettlement scheme) and urban areas respectively were studied to determine factors associated with diabetic control. The anthropometric and metabolic data (HbA1 and fructosamine levels) were analysed. After adjusting for gender, age, body mass index (BMI) and food intake, the fructosamine level which correlates with short term diabetic control, was significantly lower among patients in urban areas compared to patients in rural areas (p < 0.05). However, for longer term diabetic control (HbA1 level) the difference was not statistically significant (p > 0.05). The socio-economic status, level of education, BMI and types of food did not correlate with diabetic control in either group of patients. More diabetes education is needed together with socio-economic development and changes in lifestyles to enhance compliance towards health and dietary regimens and to achieve better metabolic control.

Changing prevalence of diabetes mellitus amongst rural Malays in Kuala Selangor over a 10-year period

A cross-sectional study was carried out to determine the prevalence of diabetes mellitus and its relationship with age, physical activity, nutritional status and diet amongst rural Malays in Kuala Selangor. By simple random sampling 360 subjects were selected for the study. Besides guided questionnaires, subjects also underwent a 2 hours post prandial (2HPP) test to determine the diabetic status as recommended by WHO. The crude prevalence of diabetes mellitus was 14.6% which increases with age. The prevalence of diabetes adjusted for age was 12.2%. Physical activity status seemed to be a significant risk factor for diabetes. A greater proportion of diabetics was obese and their mean fat intake was higher than normal subjects (p < 0.05). The prevalence of diabetes mellitus in this study was significantly higher compared with data from 1984 (3.9%), representing a marked increment of 212.8 per cent over a 10-year period.

The HIV-associated risk behaviour among male drug abusers in Malaysia

To examine the risk factors of HIV type-I infection among male drug addicts in Malaysia, a case-control study was conducted on inmates, aged 20-40 years, at a drug rehabilitation centre in January, 1994. Stratified random sampling was performed. A total of 87 cases and 261 controls, chosen by frequency matching for age and ethnicity, answered self-administered questionnaires. About 59.8% of the subjects administered drugs intravenously and of these, 71.2% shared needles. Practices significantly associated with HIV infection were needle-sharing (OR = 8.53; 95% CI = 3.36-5.52), sexual relationship with prostitutes (OR = 3.70; 95% CI = 2.10-6.56), homosexuality (OR = 4.05; 95% CI = 1.49-11.11) and non-condom use while having sex with prostitutes (OR = 2.27; 95% CI = 1.05-4.97).

The pain behavior check list (PBCL): psychometric properties in a college sample

The Pain Behavior Check List (PBCL) was designed to assess the frequency of four dimensions of pain behavior: distorted ambulation, affective distress, facial/audible expressions, and seeking help. This study evaluated theoretical factor structure, internal consistency, and construct validity of the PBCL in a nonclinical college sample. Results provided support for the four-factor oblique model, compared to the one-factor and the four-factor orthogonal models. The PBCL total and subscales showed satisfactory internal consistency. Support for convergent validity was demonstrated by high correlations between the PBCL and several measures of pain behavior and with other pain indices. In addition, results of the confirmatory factor analyses suggested that self-report measures of pain can be differentiated from self-report measures of anxiety and depression.

The prevalence of goitre in remote inland versus coastal areas

The study was conducted to compare the prevalence of goitre among Malays and Aborigines in remote inland rural areas to those in coastal areas. All subjects were examined thoroughly by an experienced endocrinologist for the presence of goitre. The overall goitre prevalence in coastal areas was 6.3%; 6.0% (4/67) of Aborigines and 6.7% (4/60) of Malays were affected. However, in remote inland areas, the prevalence of goitre was almost 5 times higher compared to coastal areas. The prevalence of goitre was 30.7% in Baling; 30.2% (19/63) Aborigines and 30.8% (92/299) Malays were affected. Iodine deficiency is the most likely cause for the high prevalence of goitre in the remote inland areas.

Schistosoma mansoni: characterization of p50, an immunophilin

A 1.4-kb cDNA clone encoding a 50-kDa homologue of p59, a heat shock binding immunophilin, has been isolated from a Schistosoma mansoni cercariae cDNA library. We have designated this clone S. mansoni p50 (Smp50). From the sequence comparison, we speculate that Smp50 is similar in structural organization to other p59 proteins. As with other p59s, Smp50 also shows homology to various FK binding proteins (FKBPs). The amino acids in human FKBP12 which are proposed to be important for FK506 interaction are conserved in the schistosome protein. We have expressed and purified the recombinant protein (rSmp50) from Escherichia coli. rSmp50 demonstrated peptidyl-prolyl cis-transisomerase (PPIase) activity, typical of immunophilins. Western blot analysis of extracts from S. mansoni adult worms probed with rabbit polyclonal antisera, generated against the recombinant polypeptide, has indicated the presence of Smp50 in the parasite. The antisera did not cross-react with proteins from E. coli or HeLa cell extracts. All of the p59s characterized to date have been from vertebrate species. Therefore, our finding represents the first identification of the protein in an invertebrate system.